Versatility of Right Gastroepiploic and Gastroduodenal Arteries for Arterial Reconstruction in Adult Living Donor Liver Transplantation
Versatility of Right Gastroepiploic and Gastroduodenal Arteries for Arterial Reconstruction in Adult Living Donor Liver Transplantation
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DOI：
10.1016/j.transproceed.2011.03.030
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发表时间：
2011-06-01
影响因子：
0.9
通讯作者：
Ahn, S. T.
中科院分区：
文献类型：
--
作者：
Lee, J. H.;Oh, D. Y.;Ahn, S. T.
背景如果受体肝动脉（HA）中存在严重内膜夹层，或者如果已经使用了HA，并且由于移植物排斥或动脉闭塞而需要进行额外手术，则需要替代手术。在本研究中，我们报告了在HA不可行的各种情况下使用胃网膜右动脉（RGEA）和胃十二指肠动脉（GDA）的可行性。在2002年1月至2010年7月接受初次成人间活体肝移植的463例患者中，8例受试者需要替代血管。4名受者显示与既往经动脉化疗栓塞（TACE）相关的严重内膜损伤; 2名受者因肝动脉血栓形成（HAT）需要挽救手术; 2名受者因慢性排斥反应再次移植。5例行RGEA，3例行GDA。术后多普勒超声和三维计算机断层扫描显示所有患者动脉血流通畅。然而，HAT复发的一名患者谁接受了挽救手术与RGEA;她死了2个月后。另外2例患者在3个月内因伤口感染和呼吸衰竭死亡，尽管肝动脉血流完整。4例患者在随访期间（平均= 33个月）没有进一步的并发症。尽管HA和RGEA（或GDA）的直径存在差异，但在活动和显微吻合方面没有问题。因此，我们认为，当肝动脉不可用时，这些血管可以是很好的替代品。
Background. In cases where there is severe intimal dissection in the recipient hepatic artery (HA), or if the HA has been used already and additional operations are needed due to graft rejection or arterial occlusion, an alternative is necessary. In the present study, we have reported the feasibility of using the right gastroepiploic artery (RGEA) and gastroduodenal artery (GDA) in various situations where the HA is not a feasible option.Methods. Among 463 patients who underwent primary adult-to-adult living donor liver transplantation from January 2002 to July 2010, eight subjects required alternative vessels. Four recipients displayed severe intimal injury associated with previous transarterial chemoembolization (TACE); two, required a salvage operation due to hepatic artery thrombosis (HAT); and two, retransplantations due to chronic rejection. The RGEA was used in five and the GDA in three patients.Results. Postoperative Doppler ultrasonography and three-dimensional computed tomography showed patent arterial flow in all patients. However, HAT recurred in one patient who underwent a salvage operation with the RGEA; she died 2 months later. Two other patients died due to wound infection and respiratory failure within 3 months despite intact hepatic arterial flow. Four patients had no further complications during follow-up (mean = 33 months).Conclusion. Although there was a discrepancy in the diameter of the HA and the RGEA (or GDA), there was no problem with mobilization and microanastomosis. We therefore believe that these vessels can be good alternatives when the hepatic artery is unavailable.