Sideways arterial reconstructions in liver transplantation: lateral infrarenal aorta and common right iliac artery for extra-anatomic rescue revascularization.

When the native hepatic artery is unsuitable for use in liver transplantation (LT), an extra-anatomical reconstruction became mandatory. Commonly, this unsuitability is due to the consequences of repeated intra-arterial procedures (such as chemoembolization or radioembolization), congenital arterial hypoplasia, intraoperative arterial dissection, or postoperative arterial thrombosis or rupture. In such conditions, a possible technical solution is extra-anatomical reconstruction directly on the infrarenal aorta or the right common iliac artery. Both of these extra-anatomical reconstructions can benefit from a lateral (sideways) implantation of an interposition arterial graft, which produces an angle that reduces the risk of thrombosis. In this technical article, we describe these two sideways approaches to rescue extra-anatomical arterial reconstruction in LT.