Hepatic artery anatomy in relation to reconstruction in liver transplantation: some unusual variations.

The anatomy of the hepatic artery and its variations were studied in 70 donor livers harvested for liver transplantation in the Austin Hospital. Forty three (61.5%) had a 'normal' vascular anatomy and 27 (38.5% had anomalous anatomy. The anomalies were single in 13 instances and multiple in 14 and involved the origin of the right or left hepatic arteries or the coeliac axis. The hepatic artery was reconstructed most frequently by end-to-end anastomosis of the donor to the recipient common hepatic artery (79%). A Carrel patch, an interposition aortic graft and the donor superior mesenteric artery were other techniques used for reconstruction. Two patients (3%) had a postoperative hepatic artery thrombosis, with one of those patients having a further reconstruction. When one vascular anomaly is found, there is a high probability of others being present. The authors' experience confirms that safe hepatic arterial anastomosis can be performed even in the presence of abnormalities of the vascular arterial system.