title: 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.
abstract: 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.
authors.affiliation: Department of General Surgery, Cleveland Clinic, Cleveland, OH 44195, USA. quintic@ccf.org
authors.forename: Cristiano
authors.initials: C
authors.lastname: Quintini
authors.forename: Charles M
authors.initials: CM
authors.lastname: Miller
authors.forename: Koji
authors.initials: K
authors.lastname: Hashimoto
authors.forename: Ding
authors.initials: D
authors.lastname: Philip
authors.forename: Teresa Diago
authors.initials: TD
authors.lastname: Uso
authors.forename: Federico
authors.initials: F
authors.lastname: Aucejo
authors.forename: Dympna
authors.initials: D
authors.lastname: Kelly
authors.forename: Charles
authors.initials: C
authors.lastname: Winans
authors.forename: Bijan
authors.initials: B
authors.lastname: Eghtesad
authors.forename: David
authors.initials: D
authors.lastname: Vogt
authors.forename: John
authors.initials: J
authors.lastname: Fung
mesh_terms: 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*