Case Report Right Gastroepiploic Artery as an Alternative for Arterial Reconstruction in Living Donor Liver Transplantation Klaus Steinbrück, 1 Reinaldo Fernandes, 1,2 Marcelo Enne, 3 Rafael Vasconcelos, 2 Giuliano Bento, 1,2 Gustavo Stoduto, 1,2 Thomas Auel, 1 and Lúcio Filgueiras Pacheco-Moreira 2 1 Hepatobiliary Surgery Unit, Servic ¸o de Cirurgia Hepato-Biliar, Bonsucesso Federal Hospital-Health Ministry, Avenida Londres 616, Predio 3/2 ∘ Andar, 21041-030 Rio de Janeiro, RJ, Brazil 2 Transplantation Unit, S˜ ao Francisco Hospital-Rio de Janeiro State Health Secretary, Rua Conde de Bonfm 1033, 20530-190 Rio de Janeiro, RJ, Brazil 3 General Surgery Department, Ipanema Federal Hospital-Health Ministry, Rua Antˆ onio Parreiras 67/69, 22411-020 Rio de Janeiro, RJ, Brazil Correspondence should be addressed to Klaus Steinbr¨ uck; drsteinbruck@yahoo.com.br Received 19 August 2014; Accepted 28 October 2014; Published 16 November 2014 Academic Editor: Melanie Deutsch Copyright © 2014 Klaus Steinbr¨ uck et al. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. An adequate blood fow is directly related to graf survival in living donor liver transplantation. However, in some cases, unfavorable conditions prevent the use of the hepatic artery for arterial reconstruction. Herein, we report a case in which the recipient right gastroepiploic artery was used as an option for arterial reconstruction in adult-to-adult living donor liver transplantation. Case Report. A 62-year-old woman, with cirrhosis due to hepatitis B associated with hepatocellular carcinoma, was submitted to living donor liver transplantation. During surgery, thrombosis of the hepatic artery with intimal dissection until the celiac trunk was observed, which precluded its use in arterial reconstruction. We decided to use the right gastroepiploic artery for arterial revascularization of the liver graf. Despite the discrepancy in size between donor hepatic artery and recipient right gastroepiploic artery, anastomosis was performed successfully. Conclusions. Te use of the right gastroepiploic artery as an alternative for arterial revascularization of the liver graf in living donor liver transplantation should always be considered when the hepatic artery of the recipient cannot be used. For performing this type of procedure, familiarity with microsurgical techniques by the surgical team is necessary. 1. Introduction An adequate blood fow is directly related to graf survival and prevention of postoperative complications in living donor liver transplantation (LDLT). However, in some cases, unfavorable conditions prevent the use of the recipient hepatic artery for arterial reconstruction. In these cases, an alternative source for arterial infow is necessary. Herein, we report a case in which the right gastroepiploic artery (RGEA) was used as an option for arterial reconstruction in adult-to- adult LDLT. 2. Case Report A 62-year-old woman, with cirrhosis due to hepatitis B associated with hepatocellular carcinoma, was submitted to adult-to-adult LDLT, using a right liver graf. Recipient, donor, and graf weight were 51 Kg, 72 Kg, and 774 g, respec- tively. Graf to recipient weight ratio was 1.52%. During recipient’s hepatectomy, thrombosis of the hepatic artery with extensive subintimal dissection until celiac trunk was observed. Te use of hepatic artery for graf revasculariza- tion was judged impossible. We decided to use the RGEA Hindawi Publishing Corporation Case Reports in Hepatology Volume 2014, Article ID 616251, 3 pages http://dx.doi.org/10.1155/2014/616251