All-in-one sleeve patch graft venoplasty for multiple hepatic vein reconstruction in living donor liver transplantation
| Autor: | Allan M. Concejero, Chun-Yi Liu, Anthony Q. Yap, Chao-Long Chen |
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| Rok vydání: | 2012 |
| Předmět: |
Adult
Liver Cirrhosis Umbilical Veins medicine.medical_specialty venoplasty medicine.medical_treatment Hepatic Veins Iliac Vein Anastomosis Liver transplantation Technical Report right lobe graft Living Donors medicine Humans Vein Vein reconstruction living donor liver transplantation multiple hepatic veins Cryopreservation Hepatology business.industry Anastomosis Surgical Suture Techniques Gastroenterology Ultrasonography Doppler Hepatitis C Middle Aged Plastic Surgery Procedures outflow reconstruction medicine.disease Liver Transplantation Surgery Treatment Outcome surgical procedures operative medicine.anatomical_structure Female Vascular Grafting Radiology Ultrasonography business Patch graft Living donor liver transplantation |
| Zdroj: | HPB. 14:274-278 |
| ISSN: | 1365-182X |
| DOI: | 10.1111/j.1477-2574.2012.00442.x |
| Popis: | ObjectivesThis paper presents an innovative technique to address complex multiple hepatic vein (HV) reconstruction in right lobe graft living donor liver transplantation (RL-LDLT).MethodsA patient with hepatitis C virus-related cirrhosis underwent RL-LDLT. The graft had seven HVs, including: the right HV (17mm); one segment VII HV (11mm); two segment VI HVs (6mm and 16mm), and three segment V HVs. The graft weighed 663g (53% of standard liver volume; ratio of graft weight to recipient body weight: 0.96). Each HV had significant drainage territory requiring reconstruction. A cryopreserved iliac vein graft was used to create a sleeve patch to incorporate the HV openings. The holes were anastomosed to their corresponding HV tributaries using continuous 6–0 polydioxanone (PDS) sutures. Two of the three segment V HVs were combined using a smaller iliac vein patch, which was anastomosed in an end-to-side fashion to a previously harvested recipient umbilical vein interposition graft. The other end of the umbilical vein graft was anastomosed to the larger iliac vein sleeve patch.ResultsOverall, six HV openings were incorporated in one sleeve patch to allow a single wide anastomosis with the recipient inferior vena cava. Doppler ultrasound after reconstruction showed adequate flow patterns in all the HVs.ConclusionsAll-in-one sleeve patch graft venoplasty simplifies the reconstruction of multiple HVs and reduces warm ischaemia time in RL-LDLT with excellent outcomes. |
| Databáze: | OpenAIRE |
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