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Surgical anterior cavoplasty for managing a case of early acute outflow obstruction after liver transplantation
Author(s) -
Ibáñez Vicente,
Montalvá Eva,
Vila Juan J.,
LópezAndújar Rafael
Publication year - 2016
Publication title -
pediatric transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.457
H-Index - 69
eISSN - 1399-3046
pISSN - 1397-3142
DOI - 10.1111/petr.12629
Subject(s) - medicine , anastomosis , surgery , liver transplantation , transplantation , thrombosis , stenosis , inferior vena cava , venae cavae , venous thrombosis , radiology
HVOO following liver transplantation is rarely treated surgically because it tends to debut subacutely. However, acute HVOO is a surgical emergency that compromises the viability of the graft. We report a case of HVOO diagnosed intra‐operatively during surgical revision for a suspected arterial thrombosis in a 10‐month‐old male recipient of a second graft (segments II – III ) for familial intrahepatic cholestasis. HVOO was related to a stenosis at the first transplant hepato‐caval anastomosis, left in place to obtain longer venous cuffs for retransplantation. An anterior cavoplasty was necessary to resolve the issue. The new anastomosis was created under total vascular exclusion after gaining control of the supradiaphragmatic vena cava, because the inferior vena cava was unsuitable for further surgery. This approach (normally used as a means to avoid sternotomy in patients with hepatic or renal tumours associated with venous thrombosis) allows adequate vascular control and, in selected cases, offers a surgical alternative for treating HVOO .