Inferior vena caval resection with autogenous peritoneo-fascial patch graft caval repair: a new technique.

Abstract

In the course of oncological surgery, resection of the inferior vena cava (IVC) may be required to obtain an adequate resection margin and to offer the best opportunity of cure. The remaining defect in the IVC may be managed by: (i) primary repair which may lead to subsequent narrowing of the lumen, possibly leading to turbulent flow and thrombus formation; (ii) patch grafting of the defect, which may prevent narrowing. Several synthetic and biosynthetic materials are available as patch grafts and autologous pericardium has also been used. The harvesting and use of the autogenous peritoneo-fascial (APF) graft as an alternative caval patch graft material in the management of defects in the caval wall is proposed. Autogenous peritoneo-fascial caval patch graft repair in six patients was undertaken. One patient with leiomyosarcoma secondaries in the liver eventually succumbed to the disease. The other five patients are clinically well with no evidence of IVC obstruction or venous aneurysms. Preliminary results show that this new technique of utilizing an APF patch graft for caval repair is clinically a suitable alternative to current biosynthetic and synthetic materials and may in fact be superior in many aspects.