Side-to-side cavocavostomy with an endovascular stapler: Rescue technique for severe hepatic vein and/or inferior vena cava outflow obstruction after liver transplantation using the piggyback technique.
Venous outflow obstruction is a rare but potentially lethal complication after orthotopic liver transplantation (OLT) with the "piggyback" technique. Therapeutic options include angioplasty with or without stent placement, surgical reconstruction of the venous anastomosis, and retransplantation. Surgical options are technically very challenging and the outcomes discouraging. We describe here two cases of venous outflow obstruction in recipients of piggyback liver grafts, one involving both the vena cava and hepatic veins and the other affecting only hepatic vein outflow. Both patients were treated successfully with side-to-side cavo-cavostomy using an endovascular (endo-GIA) stapler. This novel technique is fast and effective in resolving the outflow obstruction.
Quintini
Cristiano
C
Department of General Surgery, Cleveland Clinic, Cleveland, OH 44195, USA. quintic@ccf.org
Miller
Charles M
CM
Hashimoto
Koji
K
Philip
Ding
D
Uso
Teresa Diago
TD
Aucejo
Federico
F
Kelly
Dympna
D
Winans
Charles
C
Eghtesad
Bijan
B
Vogt
David
D
Fung
John
J
D000328:Adult; D000368:Aged; D005260:Female; D006503:Hepatic Veins / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D007511:Ischemia / Q000473:pathology; D008099:Liver / Q000473:pathology; D016031:Liver Transplantation / Q000295:instrumentation* / Q000379:methods*; D008297:Male; D008875:Middle Aged; D008953:Models, Anatomic; D011167:Portacaval Shunt, Surgical / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods; D018608:Ultrasonography, Doppler; D014682:Vena Cava, Inferior / Q000473:pathology*