{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T00:36:59Z","timestamp":1793407019691,"version":"4.5.0"},"reference-count":11,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"11","license":[{"start":{"date-parts":[[2020,10,1]],"date-time":"2020-10-01T00:00:00Z","timestamp":1601510400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2020,10,1]],"date-time":"2020-10-01T00:00:00Z","timestamp":1601510400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Liver Transpl."],"published-print":{"date-parts":[[2020,11]]},"abstract":"<jats:p>Recipient hepatic artery intimal dissection (HAD) followed by hepatic artery thrombosis (HAT) is a serious complication of liver transplantation. Once this is recognized intraoperatively, the accepted approach is to use an alternative arterial inflow, which may not be possible in all patients. We describe a new classification and technique for the management of HAD during living donor liver transplantation. On the basis of the longitudinal extent of intimal dissection, HAD was classified into 4 types. Management was based on the type of dissection, availability of an adequate length of hepatic artery (HA), and an alternate source of inflow. The dissected HA itself was used for arterial anastomosis in patients with preserved pulsatile flow in the dissected artery and a lack of an alternative source of arterial inflow. The technique of using the dissected artery was based on close approximation of the tunica intima to the media with the first 2 sutures of the arterial anastomosis. Of 47 (2.4%) patients who developed HAD, 22 (46.8%) had a type 2 dissection for whom the other (right or the left) undissected HA was used for the anastomosis, and 20 (42.6%) had major (type 3 or 4) dissection. The dissected artery was used for the anastomosis in 9 (45%) of these patients. Postoperative HAT developed in only 1 of 9 patients. Pre\u2010existing portal vein thrombosis and prior transarterial embolization were found to be major risk factors for the development of HAD. Using the technique described, the dissected artery can be successfully used for a satisfactory HA anastomosis with low thrombosis rates.<\/jats:p>","DOI":"10.1002\/lt.25857","type":"journal-article","created":{"date-parts":[[2020,8,1]],"date-time":"2020-08-01T06:04:37Z","timestamp":1596261877000},"page":"1422-1429","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Managing Recipient Hepatic Artery Intimal Dissection During Living Donor Liver Transplantation"],"prefix":"10.1097","volume":"26","author":[{"given":"Shaleen","family":"Agarwal","sequence":"first","affiliation":[{"name":"Centre for Liver and Biliary Sciences,Max Super Speciality Hospital,New Delhi,India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajesh","family":"Dey","sequence":"additional","affiliation":[{"name":"Centre for Liver and Biliary Sciences,Max Super Speciality Hospital,New Delhi,India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8864-9968","authenticated-orcid":false,"given":"Yuktansh","family":"Pandey","sequence":"additional","affiliation":[{"name":"Centre for Liver and Biliary Sciences,Max Super Speciality Hospital,New Delhi,India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sapana","family":"Verma","sequence":"additional","affiliation":[{"name":"Centre for Liver and Biliary Sciences,Max Super Speciality Hospital,New Delhi,India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Subash","family":"Gupta","sequence":"additional","affiliation":[{"name":"Centre for Liver and Biliary Sciences,Max Super Speciality Hospital,New Delhi,India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2020,10,1]]},"reference":[{"key":"lt25857-bib-0001-20240115","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1007\/s005340050114","article-title":"Technical advances in living\u2010related liver transplantation","volume":"6","year":"1999","journal-title":"J Hepatobiliary Pancreat Surg"},{"key":"lt25857-bib-0002-20240115","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1016\/S0039-6060(96)80208-X","article-title":"Experiences of 120 microsurgical reconstructions of hepatic artery in living related liver transplantation","volume":"119","year":"1996","journal-title":"Surgery"},{"key":"lt25857-bib-0003-20240115","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1016\/j.clinimag.2015.06.007","article-title":"The computed tomographic angiography finding of hepatic artery dissection after living donor liver transplantation; what is the clinical significance?","volume":"40","year":"2016","journal-title":"Clin Imaging"},{"key":"lt25857-bib-0004-20240115","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1097\/00007890-199708270-00020","article-title":"Results of using the recipient\u2019s splenic artery for arterial reconstruction in liver transplantation in 23 patients","volume":"64","year":"1997","journal-title":"Transplantation"},{"key":"lt25857-bib-0005-20240115","doi-asserted-by":"crossref","first-page":"1553","DOI":"10.1002\/lt.21888","article-title":"Intimal dissection of the hepatic artery following transarterial embolization for hepatocellular carcinoma: an intraoperative problem in adult living donor liver transplantation","volume":"15","year":"2009","journal-title":"Liver Transpl"},{"key":"lt25857-bib-0006-20240115","doi-asserted-by":"crossref","first-page":"686","DOI":"10.1016\/j.surg.2007.11.018","article-title":"Arterial reconstruction in hepatic artery occlusions in adult living donor liver transplantation using gastric vessels","volume":"143","year":"2008","journal-title":"Surgery"},{"key":"lt25857-bib-0007-20240115","doi-asserted-by":"crossref","first-page":"1720","DOI":"10.1016\/j.transproceed.2011.03.051","article-title":"Long\u2010term outcome of hepatic artery reconstruction during living\u2010donor liver transplantation","volume":"43","year":"2011","journal-title":"Transplant Proc"},{"key":"lt25857-bib-0008-20240115","doi-asserted-by":"crossref","first-page":"639","DOI":"10.1111\/j.1432-2277.2004.tb00399.x","article-title":"Rescue for rare complications of the hepatic artery in living donor liver transplantation using grafts of autologous inferior mesenteric artery","volume":"17","year":"2004","journal-title":"Transpl Int"},{"key":"lt25857-bib-0009-20240115","doi-asserted-by":"crossref","first-page":"195","DOI":"10.12659\/AJCR.883331","article-title":"Hepatic artery reconstruction with gonodal vein interposition: first case in patients receiving liver from the living donor","volume":"13","year":"2012","journal-title":"Am J Case Rep"},{"issue":"2","key":"lt25857-bib-0010-20240115","first-page":"21","article-title":"Does preoperative transarterial chemoembolization for hepatocellular carcinoma increase the incidence of hepatic artery thrombosis after living donor liver transplant?","volume":"15","year":"2017","journal-title":"Exp Clin Transplant"},{"key":"lt25857-bib-0011-20240115","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1111\/j.1399-0012.2005.00339.x","article-title":"Arterial reconstruction with donor iliac vessels during pancreas transplantation: an intraoperative approach to arterial injury or inadequate flow","volume":"19","year":"2005","journal-title":"Clin Transplant"}],"container-title":["Liver Transplantation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/lt.25857","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/lt.25857","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.lww.com\/10.1002\/lt.25857","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,1,15]],"date-time":"2024-01-15T02:11:08Z","timestamp":1705284668000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/10.1002\/lt.25857"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,10,1]]},"references-count":11,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2020]]}},"URL":"https:\/\/doi.org\/10.1002\/lt.25857","relation":{},"ISSN":["1527-6465","1527-6473"],"issn-type":[{"value":"1527-6465","type":"print"},{"value":"1527-6473","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,10,1]]},"assertion":[{"value":"2020-04-03","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-07-07","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-10-01","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}