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Hepatic Artery Reconstruction (hepatic + artery_reconstruction)

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Medical Sciences	100%

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Hepatic artery reconstruction in pediatric living donor liver transplantation under 10 kg, without microscope use

PEDIATRIC TRANSPLANTATION, Issue 1 2010
Marcelo Enne
Enne M, Pacheco-Moreira L, Balbi E, Cerqueira A, Alves J, Valladares MA, Santalucia G, Martinho J-M. Hepatic artery reconstruction in pediatric living donor liver transplantation under 10 kg, without microscope use. Pediatr Transplantation 2010: 14: 48,51. © 2009 John Wiley & Sons A/S. Abstract:, Arterial reconstructions are pivotal, particularly in pediatric LDLT. We describe microsurgical reconstruction technique with 6× loupes and the clinical course of the first 23 less than 10 kg recipients in an initial LDLT program at a developing country. From March 2002 to October 2008, 286 liver transplantation were performed in 279 patients at our unit. There were 73 children and 206 adults. Among the children, 23 weighing less than 10 kg were recipients from living donors. Arterial reconstructions were with end-to-end interrupted suture using a 6× magnification loupe, according to the untied suture technique. All patients were prospectively followed by color Doppler ultrasound protocol. In our initial experience there were no arterial complications. With mean 24 months of follow-up, 19 patients (82%) are alive with good graft function. Hepatic artery in LDLT can be safely reconstructed with microsurgical techniques without microscope using, with 6× loupe magnification, and can achieve good results in patients under 10 kg. [source]

Color Doppler sonography of hepatic artery reconstruction in liver transplantation

JOURNAL OF CLINICAL ULTRASOUND, Issue 1 2002
Alessandro De Candia MD
Abstract Purpose The purpose of this study was to evaluate the Doppler spectral waveforms in the hepatic artery after liver transplantation and hepatic artery reconstruction by end-to-end anastomosis or aortohepatic bypass. The peak systolic velocities (PSVs), end-diastolic velocities (EDVs), and resistance indices (RIs) between the 2 reconstruction groups were compared to establish normal post-transplantation values. Methods We retrospectively reviewed the Doppler sonograms and the sonographic reports from 48 patients who had undergone liver transplantation, 30 with end-to-end arterial anastomoses and 18 with aortohepatic bypasses. All aortohepatic bypasses had been performed using the infrarenal technique. All sonographic examinations had been performed 3,6 months after transplantation in patients with no clinical sign of transplant failure and whose liver function test results more normal. We compared the mean hepatic artery PSVs, EDVs, and RIs of the 2 groups. Results Doppler spectral analysis allowed the detection of 2 types of arterial flow, a low-resistance pattern in the end-to-end anastomosis group and a high-resistance pattern with low diastolic flow in the infrarenal bypass group. The mean PSV ± standard deviation (SD) was 57 ± 16 seconds in the end-to-end anastomosis group and 62 ± 16 cm/second in the infrarenal bypass group. The mean EDV ± SD was 25 ± 14 cm/second in the end-to-end anastomosis group and 12 ± 4 cm/second in the infrarenal bypass group. The RIs ranged from 0.33 to 0.71 (mean ± SD, 0.58 ± 0.13) in the patients with end-to-end anastomoses and from 0.70 to 0.87 (mean ± SD, 0.77 ± 0.06) in those with infrarenal bypasses. The difference in the mean RIs between the 2 groups was statistically significant (p < 0.05). Conclusions Spectral waveform and RI are associated with the length and caliber of the type of hepatic artery anastomosis used. End-to-end anastomoses are short and have a uniform small caliber; aortohepatic bypasses are longer and have a progressively by smaller caliber. We must be cognizant of the method of anastomosis used when examining patients for complications after liver transplantation because the method used affects the resulting spectral waveform and RI. © 2002 John Wiley & Sons, Inc. J Clin Ultrasound 30:12,17, 2002. [source]