Hepatic venous outflow reconstruction using an external iliac vein graft for hepatic malignancies (with video)

Abstract

Hepatic venous outflow reconstruction after major hepatectomy for advanced hepatic malignancies is often difficult even for experienced surgeons because of difficulties in application of anastomotic techniques and selection of the appropriate graft. We present our approach to hepatic venous reconstruction using an external iliac vein (EIV) graft for patients with hepatic malignancies. The EIV graft was preoperatively assessed using three-dimensional abdominal multidetector computed tomography (MDCT). The EIV graft (3.5-4.5cm) was harvested extraperitoneally through an upper groin incision. First, the inferior vena cava and the EIV graft were sutured at two separate sites by using 6/0 propolypropylene as a traction suture with an operating loupe (×2.5) under hemi-hepatic portal inflow occlusion. The distal end of the right hepatic vein (HV) was then reconstructed using the same technique. Graft patency was confirmed by intraoperative color Doppler ultrasonography (Aloca SSD2000, Japan). The mean reconstruction time was 34±6min. There were no complications related to the HV reconstruction and no mortality. Follow-up MDCT showed patency of the graft in all cases without noticeable caliber change. The EIV graft for hepatic venous outflow reconstruction during hepatic resection is a simple technique with long-term graft patency for major HV reconstruction.