The Use of the "Flange Joint" Anastomotic Technique for Hepatic Artery Reconstruction in Liver Transplantation

A successful liver transplantation requires hepatic artery inflow reconstitution. In living donor liver transplantation, there are additional challenges in the form of a short and small-caliber donor vessel stump, exacerbating the challenges of microsurgery. Meanwhile, in deceased donor liver transplantation, vessel diameter mismatch remains a potential challenge since the liver graft is procured with a long segment of the celiac axis with branches of differing calibers. Other challenges include the poor condition of the recipient vessels due to previous trans-arterial chemoembolization or radiofrequency ablation. We present an illustrated report of our anastomosis technique utilizing a "flange-joint" to increase the luminal diameter of the recipient vessel while minimizing the risk of vessel wall separation.

Ten patients had hepatic reconstruction with our "flange-joint" anastomosis technique. The indications for this technique were poor vessel quality with fibrosis and/or previous trans-arterial chemoembolization (n = 5) and vessel size mismatch (n = 5).

All patients had successful reconstitution of hepatic arterial inflow. The average post-operative resistive index was 0.66 [0.52-0.79]. The average follow-up was 11.7 months [1-27] with no biliary complications.

We propose that the distal tied-off branches of the recipient artery be splayed open to provide an expanded vessel end. This allows for increased flexibility in tailoring the vessel end to match the caliber of the donor artery, thereby overcoming vessel caliber mismatch.