Using the Vessel Ligature Clip to Make the Mismatched Hepatic Artery Microsurgical Anastomosis Easier and Effective

Clinical Image

Using the Vessel Ligature Clip to Make the Mismatched Hepatic Artery Microsurgical Anastomosis Easier and Effective

Levent Yalçin^*
Departemnt of Orthopaedics and Traumatology, Selcuk University, Konya, Turkey

^*Corresponding author: Levent Yalçin, Departemnt of Orthopaedics and Traumatology, Selcuk University, Konya, Sakayik sokak No: 58/1 Nisantasi, İstanbul, Turkey

Published: 05 Oct, 2017
Cite this article as: Yalçin L. Using the Vessel Ligature Clip to Make the Mismatched Hepatic Artery Microsurgical Anastomosis Easier and Effective. Clin Surg. 2017; 2: 1651.

Clinical Image

There are some specific challenges in microsurgical anastomosis of mismatched Hepatic Arteries in Living Donor Liver Transplantation. Hepatic Artery anastomosis is an important part of the Liver Transplantation from living donor [1,2]. Mismatching of arterial diameter is not unusual. Most of the arteries could be anastomosed end to end after stretching the artery which has a narrow diameter. Also sometimes doing a very shallow fish mouth incision on the artery which has narrow diameter is very helpful for anastomosing with the other artery. But if mismatching between arterial diameters are more than 30% to 50% these techniques are not enough. Cone-shaping is a wellknown technique to make narrow the wide diameter artery to adopt the other one. Classic technique is performed by cutting and suturing the end wall of the artery by creating a semi-cone. Especially if there is a big discrepancy like 3 or 4 times more between arterial diameters old cone-shaping technique is not very practical and also time consuming.
In such circumstances I like to make the larger diameter artery cone-shaped using the vessel ligature clips. I apply the clip to the artery end wall from outside with approximately 30 degree angle to its longitudinal axis (Figure 1-3). This angle is important to create less jet stream in the anastomosis side. In some cases, applying a one middle size clip is suitable. Also in some cases I use a double small size clip (Figure 4). Applying the safety sutures to prevent unexpected movement of the clip could also be recommended. There is not any knowledge about this technique in the literature. The advantages of this technique are that it consumes less time and also less arterial ischemia for transplanted liver.

Figure 1-3

Figure 1-3
Apply the clip to the artery end wall from outside with approximately 30 degree angle to its longitudinal axis.

Figure 4

Figure 4
Double small size clip.

Clinical Image