Trenches in Transplant Surgery

Hepatic Artery Variants in Liver Transplantation


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Reconstruction of variant hepatic artery anatomy during liver transplantation is a critical component of graft revascularization, given that up to 50% of donors exhibit anatomical variations such as replaced or accessory right or left hepatic arteries. Techniques include back-table reconstructions using Carrel or branch patches, end-to-end anastomoses, or grafting variant arteries to donor gastroduodenal or splenic artery stumps. When recipient arterial inflow is inadequate, alternatives like aortohepatic conduits or splenic artery inflow are employed, though with increased risk. In pediatric cases, microsurgical techniques are essential due to small-caliber vessels. While these reconstructions carry a slightly higher risk of hepatic artery thrombosis, meticulous planning, appropriate use of classification systems (Michels and Hiatt), and technical precision can yield outcomes comparable to grafts with normal anatomy.

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Trenches in Transplant SurgeryBy Sabin Subedi