PMC9731753_01
In case 1, the right lobe liver graft has a dual arterial blood supply with a single common orifice for implantation after back-table procedure angioplasty (a). Spatulating the recipient's LGA creates a size-matched inflow for anastomosis with the graft artery. LGA mobilization from the lesser curve proximally to its celiac artery trunk takeoff superficializes the vessel with a natural rightward curve for tension-free anastomosis.
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fig1
After spatulating both lumens, a running 8-0 Prolene suture (Figure 1(a)) was used to create the single common orifice for anastomosis in the recipient. The LGA is spatulated to size-match the graft artery common orifice (Figure 1(b)). The general principle of our strategy for graft artery reconstruction is shown in Figure 1(c).
Case 1 baseline Doppler ultrasound with appropriate posttransplant waveforms at the recipient left gastric to graft artery anastomosis (a). Dampened "parvus tardus" waveforms concerning for arterial stenosis at the anastomosis on postoperative day 37 prior to intervention. Appropriate arterial waveforms three-year posttransplant after successful primary balloon angioplasty (c).
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fig2
On postoperative day (POD) 1, the baseline Doppler ultrasound (US) confirms vascular patency and graft arterial inflow with typical waveforms (Figure 2(a)). However, on POD 37, a repeat US has abnormal "parvus tardus" waveforms at the anastomosis concerning for arterial stenosis (Figure 2(b)). Three-year postangioplasty US findings (Figure 2(c)) show typical waveforms.
Case 1 celiac angiogram on postoperative day 38. The arrow points to the long segment arterial stenosis preangioplasty (a) and after successful balloon angioplasty (b).
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Diagnostic celiac angiography revealed a long segment stenosis at the anastomosis and this was simultaneously treated with balloon angioplasty (Figure 3(a)). The completion angiogram confirms successful initial intervention (Figure 3(b)).
PMC9731753_02
Case 2 Doppler ultrasound (US) imaging on postoperative day 1 with appropriate waveforms at the alternatively reconstructed anastomosis with inflow from the left gastric artery (a). Repeat US nine-month posttransplant with stable findings (b).
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On POD 1, the baseline Doppler US confirms vascular patency and appropriate waveforms (Figure 4(a)). A repeat US at nine-month posttransplantation is with stable and appropriate findings (Figure 4(b)).