A simplified technique for revascularization of homografts of the liver with a variant right hepatic artery from the superior mesenteric artery

Abstract

A simplified technique for conversion of a complex hepatic arterial supply into a common channel is described. This technique permits single vessel anastomosis in the recipient of a liver transplant.

Fig. 1. Split arterial supply to the liver originating from the left gastric, celiac and superior mesenteric arteries. L.H.A., Left hepatic artery; c.d., Common duct; h.a., Hepatic artery; L.G.A., Left gastric artery; s.m.v., Superior mesenteric vein; s.m.a., Superior mesenteric artery; s.a., Splenic artery; L.R.A., Left renal artery; p.v., Portal vein. Fig. 2. A patch of anterior aorta including the origins of the celiac axis and superior mesenteric artery is removed. The renal artery orifices are protected. c.a., Celiac axis; R.R.A., Right renal artery; L.R.A., Left renal artery; s.m.a., Superior mesenteric artery. Fig. 3. Folding of the aortic patch permits safe anastomosis of the celiac axis to the superior mesenteric artery. Fig. 4. The superior mesenteric artery distal to the right hepatic artery is used for anastomosis to the recipient artery. recip. ha., Recipient hepatic artery; s.m.a., Superior mesenteric artery; R.H.A., Right hepatic artery; s.a., Splenic artery; h.a., Hepatic artery; L.H.A., Left hepatic artery; P.V., Portal vein; c.a., Celiac axis. Fig. 5. The reconstructed arterial supply of the graft may be rotated to match the orientation of the host vessel. L.H.A., Left hepatic artery; P. V., Portal vein; h.a., Hepatic artery; R.H.A., Right hepatic artery; s.m.a., Superior mesenteric artery; recip. h.a., Recipient hepatic artery.