There are several options for the arterial anastomosis. In most cases, an end-to-end anastomosis is made between the common hepatic artery or celiac trunk of the donor and the common hepatic artery or the bifurcation of the left and right hepatic arteries of the recipient, using running or interrupted polypropylene 6-0 or 7-0 (A-1). Depending on the length and diameter of the vessels, alternative sites for anastomosis are possible. The recipient artery should be adequately flushed to remove clots, before completing the anastomosis.
Accessory or aberrant donor arteries should be revascularized by either making a direct anastomosis to the recipient artery or by anastomosing it to the stump of the gastroduodenal artery or splenic artery of the graft (A-2.1, A-2.2, A-2.3).
When the recipient artery is not suitable for grafting (i. e., hepatic artery thrombosis or severe stenosis of the celiac trunk), a segment of iliac artery from the donor should be used as a conduit to make a direct anastomosis with the supratruncal or infrarenal abdominal aorta. In some cases, the donor artery is long enough to make a direct anastomosis between the donor celiac trunk and recipient supratruncal aorta (A-3). When an iliac conduit is used, it can either be anastomosed in an end-to-side fashion to the supratruncal aorta after removal of the native liver (A-4), or to the infrarenal aorta, when the anastomosis is delayed until after reperfusion of the liver via the portal vein (A-5). In the latter situation, clamping of the aorta during construction of the anastomosis will not interfere with the portal perfusion of the graft.
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