*Purpose: Living donor hepatic artery intimal dissection is a rare but devastating complication often resulting in inability to utilize the graft. We detail the salvage of a dissected living donor right hepatic artery utilizing the recipient hepatic artery

*Methods: After removal of the right lobe, the donor artery was found to have an intimal dissection extending up to multiple branches. The liver transplant surgeons requested the assistance of their plastic microsurgeon colleague to assist with the reconstruction using the native recipient hepatic artery branches. The donor artery was trimmed until four healthy undissected branches were visible. The recipient hepatic artery was then mobilized from the PHA/GDA junction up onto the right, left, middle, and cystic branches and then excised. Microvascular reconstruction was done on the back table using the recipient hepatic artery branches (right, left, middle, and cystic) as graft to the four donor artery branches. These anastomoses were performed in an around-the-world fashion using 8-0 interrupted nylon sutures and patency was confirmed on the back table using heparinized saline with methylene blue before transplanting the liver into the recipient.

*Results: Each graft’s flow was assessed with intraoperative doppler and found to be patent with acceptable flow characteristics. The patient did well post-operatively with post-operative ultrasounds demonstrating patency of the graft. The patient presented 4 months after transplantation with two polymicrobial abscesses that were drained and eventually resolved with normalization of liver function tests and patient is doing well.

*Conclusions: This case highlights the importance of collaboration with microvascular surgeons for salvage of complex vascular issues related to arterial dissections.

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