Intimal dissection of the hepatic artery following transarterial embolization for hepatocellular carcinoma: an intraoperative problem in adult living donor liver transplantation.
The objective of this study was to describe the relationship between intimal dissection (ID) in the recipient hepatic artery (HA) and transarterial embolization (TAE) and highlight the reconstructive methods for the different types of ID encountered in living donor liver transplantation (LDLT). Fifty-four patients with hepatocellular carcinoma underwent LDLT. ID was classified as mild, moderate, or severe, and this classification was based on the extent of intimal injury. Mild, moderate, or severe ID were defined as ID that was less than one-quarter of the circumference of the HA, had reached one-half of the circumference of the HA, or was more than one-half of the circumference of the HA or involved the entire vessel wall, respectively. The reconstructive methods were based on the severity of ID encountered. Forty patients underwent TAE before LDLT, and 23 of these patients (57.5%) had ID. Nine patients had mild ID, 6 had moderate ID, and 8 had severe ID. In the 14 patients who did not undergo TAE, 4 had ID (28.6%; 3 mild and 1 severe). The other 10 patients (71.4%) had normal HA. In mild and moderate ID, the native HA was used after trimming of the HA until a healthy segment was encountered. In severe ID, the HA was reconstructed with alternative vessels. Two HA thromboses occurred postoperatively. TAE increased the risk of developing ID 2-fold. There was no graft loss or mortality in this series due to HA complications. In conclusion, ID of the HA is associated with pretransplant TAE among hepatocellular carcinoma patients undergoing LDLT. Intraoperative recognition of this complication and trimming until good vessel quality is encountered or using alternative vessels are important.
Lin
Tsan-Shiun
TS
Liver Transplantation Program, Department of Surgery, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Chiang
Yuan-Cheng
YC
Chen
Chao-Long
CL
Concejero
Allan M
AM
Cheng
Yu-Fan
YF
Wang
Chih-Chi
CC
Wang
Shih-Ho
SH
Liu
Yueh-Wei
YW
Yang
Chin-Hsiang
CH
Yong
Chee-Chien
CC
D000328:Adult; D000784:Aortic Dissection / Q000453:epidemiology* / Q000209:etiology; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology / Q000601:surgery* / Q000628:therapy; D003131:Combined Modality Therapy; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000706:statistics & numerical data*; D005260:Female; D006499:Hepatic Artery; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology*; D008113:Liver Neoplasms / Q000453:epidemiology / Q000601:surgery* / Q000628:therapy; D016031:Liver Transplantation / Q000706:statistics & numerical data*; D019520:Living Donors; D008297:Male; D019651:Plastic Surgery Procedures / Q000379:methods / Q000706:statistics & numerical data; D012307:Risk Factors; D012720:Severity of Illness Index; D017539:Tunica Intima