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Rocco G, Siniscalchi A, Serenari M, Fallani G, Germinario G, Maroni L, Prosperi E, Del Gaudio M, Odaldi F, Cescon M, Ravaioli M. Complex Liver Transplantation Using Venovenous Bypass With an Atypical Placement of the Portal Vein Cannula. Liver Transpl 2021; 27:231-235. [PMID: 37160012 DOI: 10.1002/lt.25878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 06/06/2020] [Accepted: 07/01/2020] [Indexed: 01/13/2023]
Abstract
In liver transplantation (LT) medical literature, venovenous bypass (VVB) with the interposition of a venous graft attached to the inferior mesenteric vein (IMV) or to the splenic vein (SV) has not been reported previously. Here, we report the decompression of the portomesenteric compartment in 2 patients with complex cases of orthotopic LT. A femoroaxillary percutaneous VVB was installed prior to abdominal opening to decompress massive collateral veins in the abdominal wall. In the first patient, the IMV was connected to a donor vein graft with a lateroterminal anastomosis, and the distal part of the vein graft was cannulated and connected to the VVB. In the second patient, because of the excessive size of the spleen, it was necessary to perform a splenectomy to gain sufficient space in the abdomen to implant the new liver. The SV was connected to a donor vein graft with a terminoterminal anastomosis, and the distal part of the vein graft was cannulated and connected to the VVB. In both patients, the decompression of the portomesenteric compartment was crucial to reduce portal hypertension and to access the hepatic hilum, where the dissection was very complex due to previous major surgeries. In conclusion, VVB with the interposition of a venous graft attached to the IMV or to the SV during LT is a safe and simple technique, and it may be useful for patients needing VVB with no standard access to the portal compartment, particularly in the case of severe portal hypertension and re-LTs.
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Affiliation(s)
- Giuseppe Rocco
- Department of General Surgery and Transplantation, Azienda Ospedaliero-Universitaria di Bologna, Alma Mater, Bologna, Italy
| | - Antonio Siniscalchi
- Department of General Surgery and Transplantation, Azienda Ospedaliero-Universitaria di Bologna, Alma Mater, Bologna, Italy
| | - Matteo Serenari
- Department of General Surgery and Transplantation, Azienda Ospedaliero-Universitaria di Bologna, Alma Mater, Bologna, Italy
| | - Guido Fallani
- Department of General Surgery and Transplantation, Azienda Ospedaliero-Universitaria di Bologna, Alma Mater, Bologna, Italy
| | - Giuliana Germinario
- Department of General Surgery and Transplantation, Azienda Ospedaliero-Universitaria di Bologna, Alma Mater, Bologna, Italy
| | - Lorenzo Maroni
- Department of General Surgery and Transplantation, Azienda Ospedaliero-Universitaria di Bologna, Alma Mater, Bologna, Italy
| | - Enrico Prosperi
- Department of General Surgery and Transplantation, Azienda Ospedaliero-Universitaria di Bologna, Alma Mater, Bologna, Italy
| | - Massimo Del Gaudio
- Department of General Surgery and Transplantation, Azienda Ospedaliero-Universitaria di Bologna, Alma Mater, Bologna, Italy
| | - Federica Odaldi
- Department of General Surgery and Transplantation, Azienda Ospedaliero-Universitaria di Bologna, Alma Mater, Bologna, Italy
| | - Matteo Cescon
- Department of General Surgery and Transplantation, Azienda Ospedaliero-Universitaria di Bologna, Alma Mater, Bologna, Italy
| | - Matteo Ravaioli
- Department of General Surgery and Transplantation, Azienda Ospedaliero-Universitaria di Bologna, Alma Mater, Bologna, Italy
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