PMC2892684_01
(a) Axial source image from CT angiogram (CTA) demonstrates donor hepatic artery anastomosed to the proximal aorta (arrow). Note normal arterial perfusional striations in the spleen. (b) Axial CTA source image shows the donor hepatic artery coursing to the hepatic hilum (arrow). (c) Axial CTA source image shows thin, transversely oriented intimal flap from an arterial dissection in the recipient celiac trunk (arrow). (d) Axial CTA source image depicts the initmal flap of the celiac trunk dissection extending into the splenic artery. False lumen thrombus in the partially occluded splenic artery is apparent (arrow).
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fig1
It was then discovered that the native hepatic artery was dissected (Figures 1(c) and 1(d)). The decision was made to anastomose the donor celiac artery with aortic carrel patch directly to the supraceliac aorta (Figures 1(a) and 1(b)).
(a) Thin section two-dimensional sagittal CTA reconstruction of the aorta shows the anastomosis (arrow) of the hepatic artery to the proximal abdominal aorta superior to the celiac trunk and superior mesenteric artery (SMA). (b) Colorized three-dimensional volume rendered obliquely oriented CTA reconstruction shows the course of the donor hepatic artery (arrow) from the aorta to the proper hepatic artery bifurcation.
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fig2
The arterial anastomosis was patent by CT angiogram on POD 9 (Figures 2(a) and 2(b)).