title: Hepatic artery kinking during liver transplantation: survey and prospective intraoperative flow measurement.
abstract: BACKGROUND
  Hepatic artery thrombosis (HAT) represents the most common vascular complication occurring after liver transplantation (LT). Herein, we report the results of a prospective study of hepatic artery flow (HAF) measurement during abdominal wall closure after LT along with the results of an international survey of procedures adopted, in order to avoid the arterial kinking (AK) in case of long artery.
  
  
  METHODS
  Sixty-four surgeons were asked regarding the different procedures used to avoid AK in the presence of long artery. We prospectively assessed the HAF during three phases of LT in 26 consecutive LT performed in patients with a long HA: after completion of the biliary anastomosis (M0), and partial abdominal wall closure with (M1w) or without (M1w/o) hepatic artery anti-kinking method (HAAK).
  
  
  RESULTS
  Sixty (93.7 %) surgeons replied to the survey: 44 (73.3 %) surgeons cut the artery as short as possible, of whom 38 (86.3 %) interposed an oxidized polymer or the omentum, and six (13.7 %) used other systems. Fourteen (23.3 %) surgeons did not use any interposition methods. The remaining two (3.3 %) surgeons left a long artery without HAAK. In our cohort we obtained the following HAF measures: M0 152 mL/min (89-205), M1 without HAAK 114 (66-168) and M1 with HAAK procedure 158 (91-219) (p = 0.002).
  
  
  CONCLUSIONS
  Our survey confirms that no consensus is currently available regarding the most effective method for avoiding AK. Kinking occurs most probably when the liver is released in its final position. The utilization of an interposition method could ensure the maintenance of a correct HAF.
authors.affiliation: Department of General and Liver Transplant Surgery, University of Montpellier Hôpital Saint Eloi, 80 Avenue Augustin Fliche, 34295 Montpellier, Cedex 5, France. f-panaro@chu-montpellier.fr
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Panaro
authors.forename: Hassan
authors.initials: H
authors.lastname: Bouyabrine
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Carabalona
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Marchand
authors.forename: Samir
authors.initials: S
authors.lastname: Jaber
authors.forename: Francis
authors.initials: F
authors.lastname: Navarro
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006085:Graft Survival; D019538:Health Care Surveys; D006499:Hepatic Artery / Q000033:anatomy & histology / Q000473:pathology / Q000502:physiology / Q000601:surgery; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control*; D053208:Kaplan-Meier Estimate; D016031:Liver Transplantation / Q000379:methods* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D011183:Postoperative Complications / Q000517:prevention & control*; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D012039:Regional Blood Flow; D013927:Thrombosis / Q000209:etiology / Q000517:prevention & control*; D055815:Young Adult