1. What happened in 133 consecutive hepatic artery reconstruction in liver transplantation in 1 year?
- Author
-
Yu-Fan Cheng, Nelamangala Ramakrishnaiah Vishnu Prasad, Pao-Jen Kuo, Shih-Ho Wang, Johnson Chia-Shen Yang, Yueh-Wei Liu, Tsan-Shiun Lin, Chao-Long Chen, Chih-Chi Wang, Chee-Chien Yong, and Yuan-Cheng Chiang
- Subjects
medicine.medical_specialty ,Encountered problems ,business.industry ,medicine.medical_treatment ,030230 surgery ,Anastomosis ,Liver transplantation ,medicine.disease ,Thrombosis ,Surgery ,Sepsis ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,medicine ,030211 gastroenterology & hepatology ,Artery reconstruction ,business ,Operating microscope ,Artery - Abstract
Background: The immediate challenges during microvascular reconstruction of hepatic artery (HAR) during liver transplantation (LT) can be many. Hence, in-order to give a cross sectional view of these problems this study over a period of 1 year, showing our routine practice, was taken up. Methods: From January 2015 to December 2015, a total of 133 LTs were performed in Kaohsiung Chang Gung Memorial Hospital, Taiwan. All hepatic artery (HA) reconstructions were performed by a microvascular surgeon under an operating microscope. Results: In the 133 patients, one artery was anastomosed in 123 (92.5%) patients, two in 9 (6.8%) patients and three in 1 (0.7%) of the patient. Eleven (8.3%) arteries were less than 2 mm in size (1–1.9 mm). There were intimal dissections (IDs) involving either the donor or the recipient arteries of mild to severe nature in 9 (6.8%) patients. Immediately following graft arterial anastomosis, either there was no flow or an intraoperative hepatic artery thrombosis (HAT) was found in nine (7.1%-8 LDLT, 4.8%-1 DDLT) patients. Immediate re-do anastomosis was done in all of these patients who did well in the follow-up. The overall post-operative success rate was 99.2%. One patient (0.8%) developed postoperative HAT due to infection during follow up and died due to sepsis. Conclusions: Small vessels or HA injury are the frequently encountered problems by a micro vascular surgeon. The other problems could be ID, need to do multiple reconstructions, immediate HAT and ability to re-do the HAR immediately.
- Published
- 2019
- Full Text
- View/download PDF