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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

(a) Dacron prosthesis with a wide elliptical incision. (b) Lateral view of the transplanted liver with a wide side-to-side anastomosis between Dacron interposition graft (DG) and the inferior vena cava  of the donor liver graft (IVCg) (*portal vein stump).
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fig3: (a) Dacron prosthesis with a wide elliptical incision. (b) Lateral view of the transplanted liver with a wide side-to-side anastomosis between Dacron interposition graft (DG) and the inferior vena cava of the donor liver graft (IVCg) (*portal vein stump).

Mentions: The porto-caval shunt was disconnected by endovascular stapler. Removal of the Dacron graft was considered but the donor liver was harvested with a caval segment shorter than the Dacron graft. The iliac venous graft harvested from the donor was unsuitable as an extension caval graft. The Dacron prosthesis was then maintained in situ and occluded by two vascular clamps. The suprahepatic and infrahepatic vena cava orifices of the donor liver allograft were sutured by endovascular stapler. A wide side-to-side cavo-caval anastomosis was performed between retrohepatic vena cava of the liver and the Dacron interposition graft (Figure 3). The portal vein anastomosis was completed. Clamps removal resulted in a prompt and homogeneous revascularization of the graft. Total anhepatic phase endured 16 hours. Continuity of the arterial and biliary system was re-established.


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)

(a) Dacron prosthesis with a wide elliptical incision. (b) Lateral view of the transplanted liver with a wide side-to-side anastomosis between Dacron interposition graft (DG) and the inferior vena cava  of the donor liver graft (IVCg) (*portal vein stump).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

fig3: (a) Dacron prosthesis with a wide elliptical incision. (b) Lateral view of the transplanted liver with a wide side-to-side anastomosis between Dacron interposition graft (DG) and the inferior vena cava of the donor liver graft (IVCg) (*portal vein stump).
Mentions: The porto-caval shunt was disconnected by endovascular stapler. Removal of the Dacron graft was considered but the donor liver was harvested with a caval segment shorter than the Dacron graft. The iliac venous graft harvested from the donor was unsuitable as an extension caval graft. The Dacron prosthesis was then maintained in situ and occluded by two vascular clamps. The suprahepatic and infrahepatic vena cava orifices of the donor liver allograft were sutured by endovascular stapler. A wide side-to-side cavo-caval anastomosis was performed between retrohepatic vena cava of the liver and the Dacron interposition graft (Figure 3). The portal vein anastomosis was completed. Clamps removal resulted in a prompt and homogeneous revascularization of the graft. Total anhepatic phase endured 16 hours. Continuity of the arterial and biliary system was re-established.

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