scholarly journals Two-Stage Liver Transplantation with Temporary Porto-Middle Hepatic Vein Shunt

2010 ◽  
Vol 2010 ◽  
pp. 1-3 ◽  
Author(s):  
Giovanni Varotti ◽  
Enzo Andorno ◽  
Marco Casaccia ◽  
Stefano Di Domenico ◽  
Giuliano Bottino ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Hepatic Vein ◽  
Inferior Vena ◽  
Vena Cava ◽  
Middle Hepatic Vein ◽  
Liver Graft ◽  
Two Stage ◽  
Second Stage ◽  
End To End ◽  
The Creation

Two-stage liver transplantation (LT) has been reported for cases of fulminant liver failure that can lead to toxic hepatic syndrome, or massive hemorrhages resulting in uncontrollable bleeding. Technically, the first stage of the procedure consists of a total hepatectomy with preservation of the recipient's inferior vena cava (IVC), followed by the creation of a temporary end-to-side porto-caval shunt (TPCS). The second stage consists of removing the TPCS and implanting a liver graft when one becomes available. We report a case of a two-stage total hepatectomy and LT in which a temporary end-to-end anastomosis between the portal vein and the middle hepatic vein (TPMHV) was performed as an alternative to the classic end-to-end TPCS. The creation of a TPMHV proved technically feasible and showed some advantages compared to the standard TPCS. In cases in which a two-stage LT with side-to-side caval reconstruction is utilized, TPMHV can be considered as a safe and effective alternative to standard TPCS.

scholarly journals Partial Hepatectomy with Middle Hepatic Vein Reconstruction Using a Left Inferior Vena Cava Graft

2017 ◽  
Vol 11 (2) ◽  
pp. 320-328 ◽  
Author(s):  
Yusuke Kawamoto ◽  
Yusuke Ome ◽  
Kazuyuki Kawamoto
Keyword(s):  
Inferior Vena Cava ◽  
Partial Hepatectomy ◽  
Hepatic Vein ◽  
Inferior Vena ◽  
Vena Cava ◽  
Future Liver Remnant ◽  
Middle Hepatic Vein ◽  
Venous Graft ◽  
Liver Remnant ◽  
Hepatic Vein Reconstruction

Duplicated inferior vena cava (IVC) is a rare congenital anomaly. We describe the utility of a new graft from the left IVC in a patient with duplicated IVC for reconstructing the middle hepatic vein (MHV) after partial hepatectomy with MHV resection. A 67-year-old woman with hepatitis C was found to have a liver tumor. Magnetic resonance imaging confirmed that the tumor, which was attached to the MHV, was hepatocellular carcinoma. Central bisectionectomy (S4, S5, and S8 resection) could not be tolerated because of poor liver function and a low future liver remnant volume. Therefore, partial hepatectomy with MHV resection was performed. The left IVC was harvested as a venous graft and was substituted for the resected MHV. She recovered uneventfully and was discharged on postoperative day 12. To the best of our knowledge, this is the first report of using the left IVC as a venous graft. The left IVC is a good candidate graft for the MHV or for portal vein reconstruction because of its length, diameter, and easy harvesting (it did not require an extra incision) in a patient with duplicated IVC.

scholarly journals A CASE OF EXTENDED LEFT LOBECTOMY WITH RESECTION OF THE INFERIOR VENA CAVA USING MIDDLE HEPATIC VEIN AS PATCH GRAFT

2004 ◽  
Vol 65 (1) ◽  
pp. 172-174
Author(s):  
Kazuyoshi YAMAMOTO ◽  
Junzo SHIMIZU ◽  
Seizo MASUTANI ◽  
Masayuki TATSUTA ◽  
Hideyuki ISHIDA ◽  
...  
Keyword(s):  
Inferior Vena Cava ◽  
Hepatic Vein ◽  
Inferior Vena ◽  
Vena Cava ◽  
Middle Hepatic Vein ◽  
Left Lobectomy ◽  
Patch Graft

scholarly journals Hepatic vein variations in 500 patients: surgical and radiological significance

2019 ◽  
Vol 92 (1102) ◽  
pp. 20190487
Author(s):  
Binit Sureka ◽  
Neelmani Sharma ◽  
Pushpinder Singh Khera ◽  
Pawan Kumar Garg ◽  
Taruna Yadav
Keyword(s):  
Hepatic Vein ◽  
Inferior Vena ◽  
Multidetector Ct ◽  
Vena Cava ◽  
Middle Hepatic Vein ◽  
Hepatic Veins ◽  
Common Trunk ◽  
Biliary Anatomy ◽  
Iatrogenic Complications ◽  
Anatomy Knowledge

Objectives: The purpose of the study was to assess the incidence of hepatic vein variations on multidetector CT (MDCT) for abdominal examinations. Methods: A retrospective analysis of 534 MDCT scans was performed in patients sent for various abdominal pathologies between January 2017 and April 2019. After excluding 34 patients, finally total of 500 patients (N = 500) were included in the study. For simplification, we classified the hepatic vein variations as classified by Soyer et al, Fang et al and Cheng et al. Results: Single right hepatic vein was seen in 458 (91.6%) out of 500 patients in our study. Two right hepatic veins were seen in 36 patients out of which 27 had common trunk and nine had independent drainage into the inferior vena cava (IVC). Common trunk of middle hepatic vein (MHV) and left hepatic vein (LHV) was seen in 405 (81%) and independent drainage of MHV and LHV into the IVC was seen in 95 (19%) of patients in our study. Amongst the segmental hepatic vein variations, most common drainage of segment IV vein was into LHV (333,66.6%) followed by MHV (148,29.6%) and IVC (19,3.8%). Conclusion: Hepatic vein variations are commonly seen similar to variations in hepatic artery, portal vein and biliary anatomy. Knowledge of these variations is extremely important for transplant surgeons and intervention radiologists. Advances in knowledge: Awareness of the hepatic vein variations is essential for intervention radiologists and surgeons to reduce iatrogenic complications.

scholarly journals Segmental Liver Transplantation From Living Donors Report of the Technique and Preliminary Results in Dogs

HPB Surgery ◽  
1990 ◽  
Vol 2 (3) ◽  
pp. 189-204 ◽  
Author(s):  
Daniel Cherqui ◽  
Jean C. Emond ◽  
Andrea Pietrabissa ◽  
Mireille Michel ◽  
Manuela Roncella ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Bile Duct ◽  
Inferior Vena Cava ◽  
Hepatic Vein ◽  
Inferior Vena ◽  
Vena Cava ◽  
Living Donors ◽  
Left Lobe ◽  
The Other ◽  
Left Hepatic Vein

A technique of orthotopic liver transplantation using a segmental graft from living donors was developed in the dog. Male mongrel dogs weighing 25–30 kg were used as donors and 10–15 kg as recipients. The donor operation consists of harvesting the left lobe of the liver (left medial and left lateral segments) with the left branches of the portal vein, hepatic artery and bile duct, and the left hepatic vein. The grafts are perfused in situ through the left portal branch to prevent warm ischemia. The recipient operation consists of two phases: 1total hepatectomy with preservation of the inferior vena cava using total vascular exclusion of the liver and veno-venous bypass, 2implantation of the graft in the orthotopic position with anastomosis of the left hepatic vein to the inferior vena cava and portal, arterial and biliary reconstruction. Preliminary experiments consisted of four autologous left lobe transplants and nine non survival allogenic left lobe transplants. Ten survival experiments were conducted. There were no intraoperative deaths in the donors and none required transfusions. One donor died of sepsis, but all the other donor dogs survived without complication. Among the 10 grafts harvested, one was not used because of insufficient bile duct and artery. Two recipients died intraoperatively of air embolus and cardiac arrest at the time of reperfusion. Three dogs survived, two for 24 hours and one for 48 hours. They were awake and alert a few hours after surgery, but eventually died of pulmonary edema in 2 cases and of an unknown reason in the other. Four dogs died 2–12 hours postoperatively as a result of hemorrhage for the graft's transected surface. An outflow block after reperfusion was deemed to be the cause of hemorrhage in these cases. On histologic examination of the grafts, there were no signs of ischemic necrosis or preservation damage.This study demonstrates the technical feasibility of living hepatic allograft donation. It shows that it is possible, in the dog, to safely harvest non ischemic segmental grafts with adequate pedicles without altering the vascularization and the biliary drainage of the remaining liver. We propose that this technique is applicable to human anatomy.

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