Introduction : To report intraoperative common hepatic artery dissection associated with median arcuate ligament syndrome during liver transplantation

Methods : Case report: A 54-years old male patient underwent living donor liver transplantation due to hepatitis B liver cirrhosis with intractable ascites. His MELD score was 9. Preparing hepatic artery anastomosis, there was suspicious intimal dissection on the recipient’s proper hepatic artery. Because initial hepatic artery flow was not bad, the operator tried primary anastomosis. But the hepatic artery occlusion occurred immediately due to the tamponade effect of increased peri-intimal hematoma in the whole length of common hepatic artery. Using the right gastroepiploic artery as inflow, hepatic artery anastomosis was successfully finished. When we reviewed the preoperative CT scan, there was a stenotic area around celiac trunk, compatible with median arcuate ligament syndrome (MALS). The patient uneventfully recovered after surgery and the color doppler showed adequate flow in the hepatic artery. The postoperative CT, checked at the postoperative day 7, showed a long segment thrombosis in the peri-intimal space of the common hepatic artery causing luminal narrowing of the artery and the graft arterial supply from right gastroepiploic artery was intact.

Results : Median arcuate ligament syndrome can cause hepatic artery complications in the liver transplantation patient

Conclusions : If there is a stenotic lesion in the celiac root, suggesting MALS, a surgeon should be aware of the potential risk of the hepatic arterial inflow disturbance.