Novel use of the falciform ligament for reconstruction of the inferior vena cava and its tributary.

Janet W.C Kung,Charing C.N Chong,Kelvin K.C Ng,Kit-Fai Lee,Paul B.S Lai,John Wong

doi:10.1016/j.jvscit.2021.05.010

Abstract

Tumor invasion into the inferior vena cava (IVC) and hepatic vein (HV) is challenging in cancer surgery with curative intent. Appropriate techniques for venous reconstruction are essential. We have described in detail a novel technique of fashioning an interposition tube graft using the falciform ligament to reconstruct the IVC and HV. The falciform ligament maintains all the benefits of an autologous tissue graft, with the added advantage of its flexibility in customizing graft dimensions. Its use in IVC and HV reconstruction has rarely been reported. The short-term outcomes with this tube graft are promising.

Highlights

Tumor invasion into the inferior vena cava (IVC) and hepatic vein (HV) is challenging in cancer surgery with curative intent
The falciform ligament is readily available in most patients and can be harvested without added donor site complications during most
We have described in detail the technique of fashioning the falciform ligament into a tube graft for IVC and HV reconstruction in patients with locally advanced retroperitoneal sarcoma and hepatocellular carcinoma

Summary

Journal of Vascular Surgery Cases and Innovative Techniques

The infrarenal IVC, retrohepatic IVC, and left renal vein were temporarily clamped, and a 7-cm segment of IVC was resected with the tumor. The IVC was reconstructed using the falciform ligament interposition tube graft with retrohepatic IVC and infrarenal IVC end-to-end anastomoses using 5-0 Prolene suture in a continuous, single layer with a 1-cm “growth factor” (Fig 2, d). The left renal vein was implanted onto the tube graft using 6-0 Prolene suture in a continuous, singlelayer, end-to-side triangular manner with a 1-cm “growth factor” (Fig 2, e; Supplementary Video). The tube graft was wrapped around a 28F silicone tube, and the edges of the falciform ligament were apposed using continuous 6-0 Prolene suture (Fig 3, b). End-to-end venous anastomoses with the interposition tube graft were performed using continuous 6-0 Prolene suture with a 1-cm “growth factor” (Fig 3, c and d). A follow-up computed tomography scan at 7 weeks after surgery showed a patent reconstructed right HV (Fig 3, e)

DISCUSSION

CONCLUSIONS