title: Hepatic artery reconstruction with the jejunal artery of the Roux-en-Y limb in pediatric living donor liver re-transplantation.
abstract: When re-anastomosis and re-transplantation becomes necessary after LDLT, arterial reconstruction can be extremely difficult because of severe inflammation and lack of an adequate artery for reconstruction. Frequently, the recipient's HA is not in good condition, necessitating an alternative to the HA. In such cases, the recipient's splenic artery, right gastroepiploic artery or another vessel can be safely used for arterial reconstruction. There have, however, been few reports on using the jejunal artery. Herein, we report our experience with arterial reconstruction using the jejunal artery of the Roux-en-Y limb as an alternative to the HA. A three-yr-old girl who had developed graft failure due to early HA thrombosis after LDLT required re-transplantation. At re-transplantation, an adequate artery for reconstruction was lacking. We reconstructed the artery by using the jejunal artery of the Roux-en-Y limb, as we judged it to be the most appropriate alternative. After surgery, stent was deployed because hepatic blood flow had reduced due to kinking of the anastomosed site, and a favorable outcome was obtained. In conclusion, when an alternative to the HA is required, using the jejunal artery is a feasible alternative.
authors.affiliation: Department of Transplant Surgery, Jichi Medical University, Tochigi, Japan. wakiya@jichi.ac.jp
authors.forename: T
authors.initials: T
authors.lastname: Wakiya
authors.forename: Y
authors.initials: Y
authors.lastname: Sanada
authors.forename: K
authors.initials: K
authors.lastname: Mizuta
authors.forename: M
authors.initials: M
authors.lastname: Umehara
authors.forename: T
authors.initials: T
authors.lastname: Urahashi
authors.forename: S
authors.initials: S
authors.lastname: Egami
authors.forename: S
authors.initials: S
authors.lastname: Hishikawa
authors.forename: M
authors.initials: M
authors.lastname: Nakata
authors.forename: K
authors.initials: K
authors.lastname: Hakamada
authors.forename: Y
authors.initials: Y
authors.lastname: Yasuda
authors.forename: H
authors.initials: H
authors.lastname: Kawarasaki
mesh_terms: D000713:Anastomosis, Roux-en-Y / Q000379:methods*; D000792:Angiography / Q000379:methods; D001158:Arteries / Q000601:surgery; D002675:Child, Preschool; D005260:Female; D006499:Hepatic Artery / Q000601:surgery*; D006801:Humans; D007583:Jejunum / Q000098:blood supply* / Q000601:surgery*; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D008953:Models, Anatomic; D019651:Plastic Surgery Procedures; D012086:Reoperation; D015607:Stents; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures