title: Experiences of 120 microsurgical reconstructions of hepatic artery in living related liver transplantation.
abstract: BACKGROUND
  We reviewed 120 microsurgical reconstructions of a hepatic artery in living related liver transplantation and discussed the problems encountered.
  
  
  METHODS
  From January 1991 to July 1994 we performed a series of 105 living related liver transplantations on children with end-stage liver disease. Arterial reconstruction was performed under the optical field of a continuous zoom magnification of approximately 10 times with an operating microscope.
  
  
  RESULTS
  Twenty-six percent of the graft arteries were less than 2 mm in diameter. The time required for an arterial reconstruction was 49.5 +/- 1.8 minutes. In 15 of the 31 cases in which there were two graft arteries, two arterial reconstructions were required. The caliber differences between the graft artery and the recipient artery in 30 instances was dealt with by cutting an undersized artery obliquely (17 instances), by fish-mouth method (10 instances), by end-to-side anastomosis (1 instance), or by funnelization method (2 instances). In one case we performed an intimal dissection of a recipient hepatic artery and substituted a splenic artery. Consequently, hepatic arterial thrombosis occurred in only two cases (1.7%).
  
  
  CONCLUSIONS
  Microsurgical technique has overcome the high risk of hepatic arterial thrombosis in cases of fine graft arteries, enabled the reconstruction of arteries with caliber difference, and decreased arterial complications with its delicate manipulation.
authors.affiliation: Second Department of Surgery, Faculty of Medicine, Kyoto University, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Inomoto
authors.forename: F
authors.initials: F
authors.lastname: Nishizawa
authors.forename: H
authors.initials: H
authors.lastname: Sasaki
authors.forename: H
authors.initials: H
authors.lastname: Terajima
authors.forename: Y
authors.initials: Y
authors.lastname: Shirakata
authors.forename: S
authors.initials: S
authors.lastname: Miyamoto
authors.forename: I
authors.initials: I
authors.lastname: Nagata
authors.forename: M
authors.initials: M
authors.lastname: Fujimoto
authors.forename: F
authors.initials: F
authors.lastname: Moriyasu
authors.forename: K
authors.initials: K
authors.lastname: Tanaka
authors.forename: Y
authors.initials: Y
authors.lastname: Yamaoka
mesh_terms: D000293:Adolescent; D000714:Anastomosis, Surgical / Q000379:methods; D002648:Child; D002675:Child, Preschool; D005260:Female; D006499:Hepatic Artery / Q000033:anatomy & histology / Q000601:surgery*; D006801:Humans; D007223:Infant; D016031:Liver Transplantation; D008297:Male; D008866:Microsurgery