Hepatic Artery Reconstruction Prior to Orthotopic Liver Transplantation P. Hevelke, M. Grodzicki, P. Nyckowski, K. Zieniewicz, W. Patkowski, A. Alsharabi, L. Pa ˛ czek, and M. Krawczyk ABSTRACT Background: This study examines the types of arterial reconstruction for grafts prepared for orthotopic transplantation procedures. Methods: Between 1993 and February 2003, 200 organs were harvested for orthotopic liver transplantation. Arterial variations were found in 28 cases (14%), among which 16 cases (8%) required vascular reconstruction with 4 cases due to accidentally damaged during liver harvesting. Results: Among the 200 organs harvested for liver transplantation, arterial variations requiring reconstruction were found in 12 cases (6%); these included: replacing an accessory left hepatic artery from the left gastric artery (9/1 reconstruction); replacing an accessory left hepatic artery from the upper mesenteric artery (2/1 reconstruction), and replacing an accessory right hepatic artery from the upper mesenteric artery (10/10 reconstructions). The splenic artery was typically used for anastomosis (seven cases, 58.3%) as well as the gastroduodenal artery (two cases, 16.7%) or the right gastric artery (one case, 8.3%). In the remaining two cases, a more complex technique was required. Conclusions: Reconstruction of graft vessels before an orthotopic liver transplantation procedure does not increase the risk of vascular complications. C ONSIDERABLE differences in the arterial blood sup- ply to the liver have already been reported. According to one study, 1 two groups of arterial variations can be distinguished: (1) variations in the origin of celiac trunk arteries; and (2) different combinations of accessory hepatic arteries. Variations applying to the beginning of celiac trunk arteries include: hepatogastrosplenic trunk (86%); hepatosplenic trunk (8%); hepatosplenomesenteric trunk (1%); celiac-mesenteric trunk (1.5%); hepatomesenteric trunk (0.5%); and gastromesenteric trunk (3%). Those involving accessory hepatic arteries include: accessory right upper hepatic artery (2%); accessory right lower hepatic artery (12%); accessory left hepatic artery from left gastric artery (18%); and arterial hepatogastric circle. The classification just presented does not exhaust the existing variations that may be encountered during the operation. The detection of accessory hepatic arteries is an important issue during liver harvesting procedures. The most frequent is the presence of an accessory artery sup- plying the left hepatic lobe from the left gastric artery. This variation is not by itself an indication for vascular recon- struction. What is important is the detection of an addi- tional vessel supplying the right liver lobe from the upper mesenteric artery. Most typically, this artery runs backward from the head of the pancreas to the rear portion of the hepatoduodenal ligament. This topographic pattern may often be difficult to diagnose; it is frequently responsible for inadvertent damage to the arterial system during the har- vesting procedure. There are isolated reports on the pres- ence of an accessory artery running to the left lobe from the upper mesenteric artery; we observed two cases of this type in our studies (1%). The aim of this investigation is to present the types of arterial reconstruction necessary for orthotopic transplant grafts. From the Departments of General, Transplantation, and Liver Surgery (P.H., M.G., P.N., K.Z., W.P., A.A., M.K.) and Immunol- ogy, Transplant Medicine, and Internal Diseases (L.P.), Medical University of Warsaw, Warsaw, Poland. Address reprint requests to P. Hevelke, Medical University of Warsaw, Department of General, Transplantation and Liver Sur- gery, Nowogrodzka 59 Str., Warsaw P202-006, Poland. © 2003 by Elsevier Inc. All rights reserved. 0041-1345/03/$–see front matter 360 Park Avenue South, New York, NY 10010-1710 doi:10.1016/S0041-1345(03)00796-6 Transplantation Proceedings, 35, 2253–2255 (2003) 2253