Use of autologous radial artery for revascularization of hepatic artery thrombosis after orthotopic liver transplantation: Case report and review of indications and options for urgent hepatic artery reconstruction

Hepatic artery thrombosis (HAT) is the most common vascular complication af ter orthotopic liver transplantation (OLT) and has traditionally been manag ed with re-OLT. However, several reports have shown that urgent revasculari zation is frequently an effective means of graft salvage. This most often i nvolves hepatic artery (HA) thrombectomy and thrombolysis, with reestablish ment of arterial inflow through a donor iliac artery conduit based on the s upraceliac or infrarenal aorta. We report a 46-year-old man who developed H AT 13 days after OLT after angiographic splenic artery embolization to redu ce splenic artery steal. A suitable donor iliac artery was not available fo r arterial reconstruction and could not be obtained from neighboring transp lant centers. The patient underwent urgent HA thrombectomy, intrahepatic ar terial thrombolysis, and revascularization using an autologous; radial arte ry (RA) conduit based on the supraceliac aorta. The patient is alive more t han 1 year after revascularization, with normal liver function and document ed flow in the arterial conduit by Doppler ultrasound and arteriography. He has not developed late biliary complications or adverse sequelae of RA har vest. Autologous RA can be safety and successfully used as an aortic-based arterial conduit in urgent revascularization of HAT after OLT. RA should be considered for use in RA revascularization if an adequate donor iliac arte ry is not available and other potential conduits are not usable or desirabl e. The availability of autologous RA expands the armamentarium of vascular conduits that can be used in HA revascularization and may help minimize re- OLT for otherwise potentially salvageable liver allografts.