A New Percutaneous Technique for Establishing Venous Bypass Access in Orthotopic Liver Transplantation

Oken, Andrew; Frank, Steven M.; Merritt, William T.; Klein, Anja; Burdick, J. Steven; Fair, Jeffrey H.; Beattie, Charles

doi:10.1097/00000542-199209001-00130

Cited by 6 publications

(9 citation statements)

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“…Venous access to the left femoral vein for a VVB drainage cannula was separately analyzed in this study, which had a complication rate of 0.58% (seven cases). As the percutaneous method of VVB cannulation was introduced , a few studies have examined the complication rate related to these procedures; Budd et al. found a rate of 1.28% and we found a rate of 2.2% in our previous study .…”

Section: Discussionsupporting

confidence: 52%

“…The invasive monitoring devices usually include arterial catheters, central venous catheters, a pulmonary artery catheter, and transesophageal echocardiography (TEE). Although the clinical utility and potential risks of arterial cannulation have been well described in the literature , studies assessing the rate and the severity of complications that are directly related to hemodynamic monitoring devices such as central venous cannulae, a pulmonary arterial catheter, veno‐venous bypass (VVB) cannulae , and TEE have been limited, especially in LT patients.…”

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confidence: 99%

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Complications related to invasive hemodynamic monitors during adult liver transplantation

Matsusaki

Abuelkasem

et al. 2013

Clinical Transplantation

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The rate of complications directly related to invasive monitors during liver transplantation (LT) was reviewed in 1206 consecutive adult LTs performed over 8.6 yr (1/1/2004-7/31/2012). The designated anesthesiologists placed intra-operative monitors, including two arterial catheters (via the radial and the right femoral arteries), central venous catheters (a 9 Fr. catheter and an 18 Fr. veno-venous bypass [VVB] return cannula in an internal jugular vein), a pulmonary artery catheter, and a transesophageal echocardiography (TEE) probe. A 17 Fr. VVB drainage cannula was placed via the left femoral vein. No Clavien-Dindo Grade V (death) or Grade IV (organ dysfunction) complication was identified. Nine Grade III complications (requiring surgical intervention) and 15 Grade II complications (conservative treatment) were noted. Seven (0.58% in 1206 cases) were related to a femoral arterial line with Grade III of four; seven (0.58%) were due to VVB return cannula in the femoral vein with Grade III of one; four (0.33%) were related to central venous catheters with Grade III of two; four (0.33%) were due to a TEE probe with Grade III of two; and two minor complications (0.17%) that were related to a radial arterial line. No complication was observed with a pulmonary arterial catheter. Current invasive monitors placed during LT have an acceptable risk.

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Section: Discussionsupporting

confidence: 52%

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confidence: 99%

Complications related to invasive hemodynamic monitors during adult liver transplantation

Matsusaki

Abuelkasem

et al. 2013

Clinical Transplantation

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“…None of the previously published series of percutaneous cannulation reported major complications, although they report on smaller series. [1][2][3][7][8][9][10] However, a study that reviewed the safety of percutaneous insertion of large-bore cannulae for extracorporeal life support in 94 patients reported 1 death that was the direct result of perforation of the SCV by the cannula. 11 NOTE.…”

Section: Discussionmentioning

confidence: 99%

“…Methods of cannulae placement for VVBP vary among institutes, but percutaneous placement is common and has been reported to be rapid, simple, and safe. [1][2][3] We report the serious morbidity and mortality associated with a series of 312 OLTs performed using VVBP with percutaneous placement of large-bore (18 to 20 F) bypass cannulae over 8 years. …”

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confidence: 99%

Morbidity and mortality associated with large-bore percutaneous venovenous bypass cannulation for 312 orthotopic liver transplantations

et al. 2001

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The aim of this study is to establish the incidence of serious morbidity and mortality associated with the placement of large-bore (18 to 20 F) percutaneous bypass cannulae for venovenous bypass (VVBP) during orthotopic liver transplantation (OLT). This technique has been reported to be rapid, simple, and safe. We reviewed the case notes of 312 patients who underwent OLT in our center using this technique. We describe 4 cases of serious morbidity (incidence, 1.28%) and 1 death (incidence, 0.32%) related directly to percutaneous placement of the bypass cannula. We conclude that percutaneous cannula placement for VVBP during OLT has the potential for lifethreatening complications, and this must be considered when electing to use this technique. When percutaneous cannulae are to be used, we recommend the use of the right internal jugular vein for return cannulation and the use of ultrasound guidance, particularly in those patients in whom cannulation is predictably difficult. S urgical approaches to adult orthotopic liver transplantation (OLT) vary among institutes and individual surgeons around the world. Approaches to maintain venous return if the inferior vena cava is clamped and divided during the conventional surgical technique vary among institutes. Some centers perform venovenous bypass (VVBP) only in high-risk patients, whereas others use VVBP whenever the conventional surgical technique is used. Methods of cannulae placement for VVBP vary among institutes, but percutaneous placement is common and has been reported to be rapid, simple, and safe. [1][2][3] We report the serious morbidity and mortality associated with a series of 312 OLTs performed using VVBP with percutaneous placement of large-bore (18 to 20 F) bypass cannulae over 8 years. MethodsIn this institute, percutaneous catheters for VVBP have been used with increasing frequency since the early 1990s. It is now our practice in those patients undergoing OLT with the use of VVBP to insert two 18 F, polyurethane, 15-cm long, wirereinforced, thin-walled cannulae (Fem-Flex II femoral arterial cannula with internal dilator; Research Medical Inc, Midvale, UT) percutaneously after induction of anesthesia. One cannula is inserted into either the internal jugular (IJV) or subclavian vein (SCV) and the other into a femoral vein using the Seldinger technique and serial dilation. The cannulae are flushed with heparin, 1 IU/mL (maximum, 50 mL), and clamped pending connection to the bypass circuit. In the operating room after mobilization of the portal vein, all cannulae are connected in circuit to the centrifugal pump (Medtronics Inc, Minneapolis, MN).We reviewed the case notes of 312 patients for whom this method of cannulation was used to establish the safety of this technique.

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“…(3) Evaluation of the hemodynamic and splanchnic tolerance by clamping the portal pedicle and the inferior vena cava followed in some cases (patients who do not tolerate the clamping) by installation of extracorporal veno-venous bypass. Otherwise, for patients with symptomatic cardiac disease and pace makers, the extracorporal veno-venous bypass is installed systematically (25,26). (4) Completion of the total hepatectomy safely and rapidly.…”

Section: Hepatectomy In the Fap Liver Donormentioning

confidence: 99%

Operative Risks of Domino Liver Transplantation for the Familial Amyloid Polyneuropathy Liver Donor and Recipient: A Double Analysis

Tincani

Hoti

Andreani

et al. 2011

American Journal of Transplantation

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A New Percutaneous Technique for Establishing Venous Bypass Access in Orthotopic Liver Transplantation

Cited by 6 publications

References 0 publications

Complications related to invasive hemodynamic monitors during adult liver transplantation

Complications related to invasive hemodynamic monitors during adult liver transplantation

Morbidity and mortality associated with large-bore percutaneous venovenous bypass cannulation for 312 orthotopic liver transplantations

Operative Risks of Domino Liver Transplantation for the Familial Amyloid Polyneuropathy Liver Donor and Recipient: A Double Analysis

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