title: Versatility of right gastroepiploic and gastroduodenal arteries for arterial reconstruction in adult living donor liver transplantation.
abstract: BACKGROUND
  In cases where there is severe intimal dissection in the recipient hepatic artery (HA), or if the HA has been used already and additional operations are needed due to graft rejection or arterial occlusion, an alternative is necessary. In the present study, we have reported the feasibility of using the right gastroepiploic artery (RGEA) and gastroduodenal artery (GDA) in various situations where the HA is not a feasible option.
  
  
  METHODS
  Among 463 patients who underwent primary adult-to-adult living donor liver transplantation from January 2002 to July 2010, eight subjects required alternative vessels. Four recipients displayed severe intimal injury associated with previous transarterial chemoembolization (TACE); two, required a salvage operation due to hepatic artery thrombosis (HAT); and two, retransplantations due to chronic rejection. The RGEA was used in five and the GDA in three patients.
  
  
  RESULTS
  Postoperative Doppler ultrasonography and three-dimensional computed tomography showed patent arterial flow in all patients. However, HAT recurred in one patient who underwent a salvage operation with the RGEA; she died 2 months later. Two other patients died due to wound infection and respiratory failure within 3 months despite intact hepatic arterial flow. Four patients had no further complications during follow-up (mean = 33 months).
  
  
  CONCLUSIONS
  Although there was a discrepancy in the diameter of the HA and the RGEA (or GDA), there was no problem with mobilization and microanastomosis. We therefore believe that these vessels can be good alternatives when the hepatic artery is unavailable.
authors.affiliation: Department of Plastic and Reconstructive Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: J H
authors.initials: JH
authors.lastname: Lee
authors.forename: D Y
authors.initials: DY
authors.lastname: Oh
authors.forename: J W
authors.initials: JW
authors.lastname: Seo
authors.forename: S H
authors.initials: SH
authors.lastname: Moon
authors.forename: J W
authors.initials: JW
authors.lastname: Rhie
authors.forename: S T
authors.initials: ST
authors.lastname: Ahn
mesh_terms: D000328:Adult; D001158:Arteries / Q000601:surgery*; D005260:Female; D006801:Humans; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed; D014656:Vascular Surgical Procedures