Puia-Negulescu, Serban <br/><br/>
Vascular reconstructions in transplantation and liver surgery: Essential elements for specialists in hepato-gastroenterology 

 -  2026.<br/>							 
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<br/><br/> Hepatic vascular reconstructions constitute the cornerstone of liver transplantation and, more exceptionally, of hepatic oncological surgery. In transplantation, they systematically involve the three vascular axes: inferior vena cava, portal vein, and hepatic artery. Each vessel follows specific reconstruction principles, with technical mastery of anastomoses directly determining vascular patency and graft survival. Technical complexity varies according to the type of graft used: whole liver versus partial liver (split or living donor), being more difficult for a partial graft compared to a whole liver. The arterial anastomosis remains the most challenging, particularly due to its small caliber, frequent anatomical variations, and the risk of arterial dissection. Recipient pathological conditions (portal thrombosis, biliary atresia, portal hypertension) require adapted reconstructive strategies, sometimes including a temporary shunt or bypass techniques. In hepatic oncological surgery, the evolution of vascular reconstruction techniques developed in transplantation has revolutionized the management of tumors with vascular invasion, transforming former contraindications into operative indications. Although their use remains limited (&lt; 1% of hepatic resections), they now enable complex oncological resections for hepatocellular carcinomas, cholangiocarcinomas, and hepatic metastases, with an acceptable complication rate. These interventions require rigorous preoperative planning and meticulous patient selection.