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Cavoportal Hemitransposition in Liver Transplantation: Toward a More Safe and Efficient Technique
Author(s) -
Lerut Jan P.,
Lai Quirino,
Ville de Goyet Jean
Publication year - 2020
Publication title -
liver transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.814
H-Index - 150
eISSN - 1527-6473
pISSN - 1527-6465
DOI - 10.1002/lt.25635
Subject(s) - medicine , liver transplantation , splanchnic , anastomosis , inferior vena cava , surgery , transplantation , venous thrombosis , thrombosis , blood flow , radiology
Extended splanchnic venous thrombosis represents a challenge for the liver transplantation (LT) surgeon. In the absence of large venous tributaries, the cavoportal hemitransposition (CPHTr) and the combined liver‐intestinal or multivisceral transplantation are the only technical solutions. Because of the reported high morbidity and mortality rates due to infrequent use and a lack of standardization, the former technique has been almost abandoned by the transplant community. A newly designed technique of CPHTr is presented that is based on the combination of an inferior vena cava (IVC)–sparing hepatectomy and large laterolateral cavocaval and end‐to‐side cavoportal anastomoses separated only by a double vascular stapler line. This technique allows the splanchnic blood to be completely diverted toward the allograft and to eliminate low‐flow IVC areas, which possibly lead to complications. The modified CPHTr technique proposed here offers a valuable alternative to much more complex and invasive intestinal transplantation procedures.