(A) Overview Hepatic artery thrombosis usually occurs within 4 weeks after surgery, with an incidence of 5%, and in children with liver transplantation the incidence can be as high as 26%. （The risk factors for hepatic artery thrombosis include surgical and non-surgical factors. Surgical factors include the size of the hepatic artery caliber, the type of hepatic artery anastomosis and the number of intraoperative hepatic artery anastomoses; non-surgical factors include the use of fresh frozen plasma intraoperatively, the absence of postoperative anticoagulants and a hematocrit greater than 0.45. (iii) Clinical manifestations Hepatic artery complications are the most common and most aggressive, and those occurring early postoperatively are often due to differences in donor and recipient artery caliber and abnormal intimal morphology also may be related to hepatic arterioplasty reconstruction due to anatomical variants. For this reason, we emphasize the skill of donor liver pruning, and any larger vessel originating from the abdominal aorta above the renal artery and its branches & should be followed up and dissected to see the direction so as not to damage the variant hepatic artery, while taking care to protect the intima. Hepatic artery thrombosis, which can manifest as acute hepatic necrosis, sepsis, elevated transaminases, transplantation liver failure and interruption of bile secretion, but most patients have latent episodes that manifest as recurrent fever and progressive elevation of transaminases. Since the common bile duct does not have portal blood supply, it is completely supplied by the hepatic artery, therefore, hepatic artery thrombosis must lead to ischemic necrosis of the common bile duct, so chronic hepatic artery thrombosis mainly manifests as bile leak, bile duct stenosis, intrahepatic bile duct necrosis and liver abscess. (iv) Auxiliary examination The diagnosis of vascular complications should first emphasize color Doppler ultrasound dynamic examination. Color Doppler ultrasound examination is an effective non-invasive examination method, which should be routinely performed on the first and seventh postoperative days, and can detect the caliber, direction, signs of embolism H distortion and stenosis of hepatic artery, portal vein, inferior vena cava and other vessels, as well as blood flow velocity, resistance index, pulsatility index and other Hemodynamic indexes. Intraoperative and postoperative ultrasound examination can understand the patency of blood vessels, and timely detection and management of vascular complications. (E) Early detection of clues Once hepatic artery thrombosis is suspected, Doppler ultrasonography should be performed immediately. If the pulsating blood flow in the liver can be seen, it means the hepatic artery is open. If no intrahepatic pulsatile hepatic artery flow is detected, but there is clearly good intraoperative arterial flow and satisfactory hepatic artery anastomosis, it can be re-examined within 24h. If there is still no intrahepatic pulsatile artery, abdominal arteriography is required. (vi) Early diagnosis Daily Doppler ultrasound is required within 1 week after surgery, and CTA is performed on the 7th postoperative day. Further abdominal arteriography can be performed for early diagnosis in suspicious cases, striving to perform thrombectomy before irreversible liver damage occurs, thus avoiding retransplantation. (vii) Differential diagnosis Poor hepatic artery blood supply is one of the most important causes of non-anastomotic stenosis of the biliary tract. Once abnormal hepatic artery blood flow is detected early after liver transplantation, the possibility of combined biliary stenosis should be considered and necessary countermeasures should be taken. (viii) Prevention and treatment In order to reduce the incidence of hepatic artery thrombosis, it is not necessary to correct coagulation if no significant bleeding exists and the prothrombin time is within 25s. If the prothrombin time is less than 18s without the presence of significant bleeding, intravenous low-molecular dextrose (0.5 ml/kg/h) or subcutaneous heparin (50 U/kg/8h) should be administered. In the absence of significant hypoxia, the hematocrit should preferably be kept below 0.30. If the diagnosis is clear at an early stage of hepatic artery thrombosis, an emergency hepatic artery reconstruction should be performed, which may yet save the liver and usually requires an end-to-end anastomosis of the donor hepatic artery and the recipient abdominal aorta. However, in most cases, a repeat liver transplantation is required. Because the formation of hepatic artery thrombosis is related to the diameter of the donor hepatic artery, the hepatic artery flow pressure, the thicker diameter of the adult hepatic artery, the removal of the right liver, which is more prone to thrombosis, during volume reduction, and the higher hepatic artery flow pressure provided by the anastomosis between the donor hepatic artery and the recipient abdominal aorta, the incidence of hepatic artery thrombosis is higher in adult liver transplants than in similarly sized children. The incidence of hepatic artery thrombosis is significantly lower in children with liver transplants of similar size for whole liver transplantation.