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Satisfactory blood flow after hepatic arterial anastomosis in liver transplantation is a critical point of the operation. Problems with this anastomosis can result in hepatic artery thrombosis with resultant graft failure and patient morbidity and mortality. Causes of hepatic artery thrombosis include problematic technique, hep-atic artery dissection, extal compression (e.g. from hematoma), hypercoagulable state, splenic arterial steal and rarer causes such as median arcuate ligament compression (MALC). A careful review of preoperative radiology and imaging will reveal these rare in-stances and enable a proper intraoperative plan.