title: Arterial reconstruction in a case of subintimal dissection of celiac arterial tributaries in living donor liver transplantation: a case report.
abstract: BACKGROUND
  Hepatic arterial reconstruction is one of the critical issues in living donor liver transplantation (LDLT). Herein we have reported an LDLT case whose celiac arterial trunk tributaries were insufficient as host arteries because of extensive subintimal dissection proceeding to all tributaries of the celiac arterial trunk.
  
  
  METHODS
  A 45-year-old woman with fulminant hepatic failure underwent LDLT. After reperfusion of the hepatic and portal veins, subintimal dissection of the recipient right and left hepatic arteries was found to extend to all tributaries of the celiac arterial trunk, preventing an anastomosis using the more proximal part of these arteries. Therefore, a jejunal arterial arcade of Roux-en-Y limb mobilized for biliary reconstruction was anastomosed to the donor left hepatic artery in end-to-end fashion.
  
  
  RESULTS
  Arterial blood flow to the grafted liver was established successfully, and the patient's postoperative recovery was excellent. Postoperative computed tomography demonstrated sufficient hepatic arterial blood flow. The patient is doing well 4 years after transplantation.
  
  
  CONCLUSIONS
  The method of hepatic graft arterialization described herein is an important option for LDLT recipients when tributaries of the celiac arterial trunk are insufficient as host arteries.
authors.affiliation: Department of Surgery, Shinshu University, School of Medicine, Matsumoto, Nagano, Japan. tikegami@hsp.md.shinshu-u.ac.jp
authors.forename: T
authors.initials: T
authors.lastname: Ikegami
authors.forename: Y
authors.initials: Y
authors.lastname: Masuda
authors.forename: Y
authors.initials: Y
authors.lastname: Ohno
authors.forename: K
authors.initials: K
authors.lastname: Urata
authors.forename: Y
authors.initials: Y
authors.lastname: Nakazawa
authors.forename: S
authors.initials: S
authors.lastname: Miwa
authors.forename: Y
authors.initials: Y
authors.lastname: Hashikura
authors.forename: S
authors.initials: S
authors.lastname: Miyagawa
mesh_terms: D000784:Aortic Dissection / Q000601:surgery*; D001160:Arterioles / Q000601:surgery; D001783:Blood Flow Velocity; D002445:Celiac Artery / Q000601:surgery*; D005260:Female; D006499:Hepatic Artery / Q000601:surgery*; D006801:Humans; D017114:Liver Failure, Acute / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects* / Q000379:methods; D019520:Living Donors; D008875:Middle Aged; D019651:Plastic Surgery Procedures; D016896:Treatment Outcome