title: Living donor liver transplantation for the patients with portal vein thrombosis: use of an interpositional venous graft passed posteriorly to the pancreatic parenchyma without using jump graft.
abstract: BACKGROUND
  It is difficult to reconstruct the portal vein (PV) using a long interpositional venous graft in living donor liver transplant (LDLT) patients with portal vein thrombosis (PVT), which involves the confluence of the superior mesenteric vein (SMV) and splenic vein (SV). We successfully performed LDLT for three patients with PVT using an interpositional vascular conduit passing posterior to the pancreas without a jump graft.
  
  
  METHODS
  Three of 130 patients who underwent LDLT in our hospital between March 2002 and June 2011 required this technique. After indentifying the location of the SMV, SV and gastrocolic trunk, we ligated and cut the posterior superior pancreaticoduodenal vein and other short branches from the PV. The PV was drawn inferiorly to the pancreas and transected at the confluence of SMV and SV. The external iliac vein or internal jugular vein was sacrificed as a graft for anastomosis to the cut end of the SMV using 6-0 polypropylene running sutures. Then the venous graft was drawn superiorly to the pancreas by passing it posterior to the pancreas parenchyma for anastomosis to the liver graft PV. The interpositional vein was placed posterior to the pancreas where the PV used to be.
  
  
  RESULTS
  All three patients displayed favorable postoperative courses with the Doppler ultrasound demonstrating good portal flow perioperatively. The postoperative portogram demonstrated patency of the vascular graft.
  
  
  CONCLUSIONS
  This method is easy and helpful to treat portal vein thrombosis, by providing the shortest route between the PV of the donor and the SMV of the recipient.
authors.affiliation: Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University School of Medicine, Tsu, Mie, Japan. mizunos@clin.medic.mie-u.ac.jp
authors.forename: S
authors.initials: S
authors.lastname: Mizuno
authors.forename: Y
authors.initials: Y
authors.lastname: Murata
authors.forename: N
authors.initials: N
authors.lastname: Kuriyama
authors.forename: I
authors.initials: I
authors.lastname: Ohsawa
authors.forename: M
authors.initials: M
authors.lastname: Kishiwada
authors.forename: T
authors.initials: T
authors.lastname: Hamada
authors.forename: M
authors.initials: M
authors.lastname: Usui
authors.forename: H
authors.initials: H
authors.lastname: Sakurai
authors.forename: M
authors.initials: M
authors.lastname: Tabata
authors.forename: S
authors.initials: S
authors.lastname: Isaji
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical; D005260:Female; D006801:Humans; D007084:Iliac Vein / Q000637:transplantation*; D007564:Japan; D007601:Jugular Veins / Q000637:transplantation*; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D008875:Middle Aged; D011169:Portal Vein / Q000000981:diagnostic imaging / Q000601:surgery*; D011172:Portography; D013536:Suture Techniques; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D058017:Vascular Grafting; D014654:Vascular Patency; D020246:Venous Thrombosis / Q000175:diagnosis / Q000601:surgery*