ALTERNATIVE PROCEDURE FOR FAILED RECONSTRUCTION OF A RIGHT REPLACED HEPATIC-ARTERY IN LIVER-TRANSPLANTATION

A right replaced hepatic artery (RRHA) arising from the superior mesen teric artery (SMA) is the most frequent variation of the hepatic arter ial supply requiring backtable reconstruction. There are several widel y used techniques for backtable reconstruction of the RRHA to a single conduit. If these reconstructions fail, due to technical reasons or s ize discrepancies, an alternative method of rearterialization is neede d. We describe six cases in which an RRHA was anastomosed to the donor 's gastroduodenal artery (GDA) stump utilizing a loupe magnification t echnique. In four cases the reconstruction was performed at the time o f the backtable procedure and in two after reperfusion and failure of the original RRHA to splenic artery (SA) reconstruction. In all cases, the anastomoses remained patent. All patients had Doppler sonography and two had subsequent arteriograms that verified anastomotic patency. This method of reconstruction is more demanding technically but obvia tes the awkward 90-degree twist of the hepatic artery when an RRHA is anastomosed to the SA stump.