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Life-saving super-urgent liver transplantation with replacement of retrohepatic vena cava by dacron graft.

Aseni P, Lauterio A, Slim AO, Giacomoni A, Lamperti L, De Carlis L - HPB Surg (2010)

Bottom Line: A liver graft from a deceased donor was available 16 hours later.Due to the shortness of the vena cava of the donor liver graft, the removal of the Dacron graft was impossible and a modified side-to-side cavo-cavostomy between the Dacron interposition graft and the vena cava of the donor liver was than performed.Liver transplantation was uneventful and the patient is doing well 25 months after the surgical procedure.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Liver Transplantation Unit, Niguarda "Cà Granda" Hospital, Piazza Ospedale Maggiore 3, 20162 Milan, Italy.

ABSTRACT
We describe a modified technique of side-to-side cavo-cavostomy by Dacron interposition prosthesis during a super urgent liver transplantation. A liver graft from a deceased donor was immediately requested on a top priority basis as a consequence of massive bleeding during extended left hepatectomy for a huge hepatic haemangioma arising from the caudate lobe. Veno-venous bypass was employed during anhepatic phase but it was disconnected due to severe fibrinolysis and hypothermia. A porto-caval shunt was performed and the inferior vena cava outflow was restored by a Dacron interposition prosthesis. A liver graft from a deceased donor was available 16 hours later. Due to the shortness of the vena cava of the donor liver graft, the removal of the Dacron graft was impossible and a modified side-to-side cavo-cavostomy between the Dacron interposition graft and the vena cava of the donor liver was than performed. Liver transplantation was uneventful and the patient is doing well 25 months after the surgical procedure. Although the use of synthetic vascular prosthesis should usually be discouraged during organ transplantation, its exceptional use during liver transplantation is possible with long-term good results.

No MeSH data available.


Related in: MedlinePlus

Pre-operative CT scan showing  the huge hepatic mass arising from the caudate lobe with a right sided dislocation of the inferior vena cava (arrow).
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fig2: Pre-operative CT scan showing the huge hepatic mass arising from the caudate lobe with a right sided dislocation of the inferior vena cava (arrow).

Mentions: A 46-year-old male patient with compression and dislocation of the inferior vena cava (IVC) by a giant hepatic haemangioma was referred to our surgical department after two episodes of pulmonary thromboembolism. The second episode occurred while the patient was on oral anticoagulant therapy. Based on abdominal and thoracic CT scan, the patient was diagnosed to have a giant cavernous hepatic haemangioma, arising from the caudate lobe. The tumour was surrounding the inferior vena cava (IVC) and occupying segment I, III, IV, V, and in part segment VIII. A CT scan showed compression of the retrohepatic IVC (Figure 1) with thrombosis of the left and middle suprahepatic veins. On the basis of CT-scan imaging, hepatic malignancy such as haemangiosarcoma could not be ruled out (Figure 2) [5].


Life-saving super-urgent liver transplantation with replacement of retrohepatic vena cava by dacron graft.

Aseni P, Lauterio A, Slim AO, Giacomoni A, Lamperti L, De Carlis L - HPB Surg (2010)

Pre-operative CT scan showing  the huge hepatic mass arising from the caudate lobe with a right sided dislocation of the inferior vena cava (arrow).
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2926580&req=5

fig2: Pre-operative CT scan showing the huge hepatic mass arising from the caudate lobe with a right sided dislocation of the inferior vena cava (arrow).
Mentions: A 46-year-old male patient with compression and dislocation of the inferior vena cava (IVC) by a giant hepatic haemangioma was referred to our surgical department after two episodes of pulmonary thromboembolism. The second episode occurred while the patient was on oral anticoagulant therapy. Based on abdominal and thoracic CT scan, the patient was diagnosed to have a giant cavernous hepatic haemangioma, arising from the caudate lobe. The tumour was surrounding the inferior vena cava (IVC) and occupying segment I, III, IV, V, and in part segment VIII. A CT scan showed compression of the retrohepatic IVC (Figure 1) with thrombosis of the left and middle suprahepatic veins. On the basis of CT-scan imaging, hepatic malignancy such as haemangiosarcoma could not be ruled out (Figure 2) [5].

Bottom Line: A liver graft from a deceased donor was available 16 hours later.Due to the shortness of the vena cava of the donor liver graft, the removal of the Dacron graft was impossible and a modified side-to-side cavo-cavostomy between the Dacron interposition graft and the vena cava of the donor liver was than performed.Liver transplantation was uneventful and the patient is doing well 25 months after the surgical procedure.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Liver Transplantation Unit, Niguarda "Cà Granda" Hospital, Piazza Ospedale Maggiore 3, 20162 Milan, Italy.

ABSTRACT
We describe a modified technique of side-to-side cavo-cavostomy by Dacron interposition prosthesis during a super urgent liver transplantation. A liver graft from a deceased donor was immediately requested on a top priority basis as a consequence of massive bleeding during extended left hepatectomy for a huge hepatic haemangioma arising from the caudate lobe. Veno-venous bypass was employed during anhepatic phase but it was disconnected due to severe fibrinolysis and hypothermia. A porto-caval shunt was performed and the inferior vena cava outflow was restored by a Dacron interposition prosthesis. A liver graft from a deceased donor was available 16 hours later. Due to the shortness of the vena cava of the donor liver graft, the removal of the Dacron graft was impossible and a modified side-to-side cavo-cavostomy between the Dacron interposition graft and the vena cava of the donor liver was than performed. Liver transplantation was uneventful and the patient is doing well 25 months after the surgical procedure. Although the use of synthetic vascular prosthesis should usually be discouraged during organ transplantation, its exceptional use during liver transplantation is possible with long-term good results.

No MeSH data available.


Related in: MedlinePlus