RESUMO
Variations in donor and recipient arterial anatomy frequently present challenges for surgeons when attempting to establish proper arterial inflow during liver transplantation. We reviewed our data on 233 adult primary liver transplants, conducted from January 1996 through December 2001, to determine the impact of these variations on the outcomes after liver transplantation. Twenty-four (10.3%) arterial complications were encountered at a mean of 2.27 months after transplant. Carrel patches for the anastomoses were not used in 33 patients (14%), which had no relation to arterial complications (P = 0.7). Sixty-one donors (26.2%) had at least one aberrant artery, which had no relation to arterial complications. However, use of donor celiac artery for anastomosis was significantly associated with higher arterial complications (16% versus other choices, P = 0.03). Furthermore, use of common hepatic recipient artery was associated with higher arterial complications (16%, P = 0.03). There were 58 total biliary complications (24.8%). Biliary complications were associated with the presence of arterial complications (P = 0.01). In conclusion, aberrant donor arterial anatomy was not associated with an increased rate of arterial complications; however, choice of location of arterial anastomosis may be a significant factor. Biliary complications were associated with arterial complications.
Assuntos
Artéria Hepática/anormalidades , Transplante de Fígado/métodos , Complicações Pós-Operatórias/prevenção & controle , Procedimentos Cirúrgicos Vasculares/métodos , Adulto , Anastomose Cirúrgica , Estudos de Coortes , Feminino , Seguimentos , Rejeição de Enxerto , Sobrevivência de Enxerto , Artéria Hepática/cirurgia , Humanos , Circulação Hepática/fisiologia , Cirrose Hepática/diagnóstico , Cirrose Hepática/cirurgia , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/cirurgia , Transplante de Fígado/efeitos adversos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Medição de Risco , Doadores de Tecidos , Resultado do TratamentoAssuntos
Síndrome de Budd-Chiari/diagnóstico , Hemangioma Cavernoso/diagnóstico , Neoplasias Hepáticas/diagnóstico , Síndrome de Budd-Chiari/complicações , Diagnóstico Diferencial , Feminino , Seguimentos , Hemangioma Cavernoso/complicações , Hemangioma Cavernoso/cirurgia , Hepatectomia , Humanos , Neoplasias Hepáticas/complicações , Neoplasias Hepáticas/cirurgia , Imageamento por Ressonância Magnética , Pessoa de Meia-IdadeRESUMO
Significant aortic invasion by metastatic nonseminomatous germ cell tumors can present difficult problems intraoperatively in attempted curative retroperitoneal lymph node dissection. Aortic replacement with Dacron graft has been a successful method of dealing with this predicament. We describe a new approach of intraoperative floppy aortic graft reconstruction in a young patient with testicular germ cell cancer in whom a 14 cm pseudoaneurysm involving the infrarenal aorta developed after four courses of preoperative chemotherapy. This technique prevents significant lower extremity and pelvic ischemia during resection of the aorta and retroperitoneal tumor while providing the urologic surgeon with excellent exposure and minimal interference from the aortic graft.
