In situ Graft-Trimming Method Using Polyester Vascular Prosthesis for Inferior Vena Cava Reconstruction after Hepatectomy

Abstract

Hepatectomy for secondary liver cancer that has invaded the inferior vena cava (IVC) can be the only way to achieve long-term survival. We describe a method for hepatectomy combined with partial IVC resection without venous bypass circulation and an in situ graft-trimming method to avoid graft size mismatch after reconstruction. We carried out left hepatectomy extended to segment 1 with partial IVC resection first. During resection and reconstruction of the IVC, it was clamped below the right hepatic vein and above the inferior right hepatic vein to maintain systemic circulation. The graft was trimmed in situ, after a half running suture of the graft was finished to ensure the correct size. Preservation of both inferior right hepatic vein and right hepatic vein helps to maintain systemic circulation during reconstruction of the IVC. The in situ graft-trimming method is an easy and safe method to ensure the correct graft size after IVC reconstruction.

Polyester vascular patches acquire arterial or venous identity depending on their environment

“…Polyester patches are used clinically, especially in carotid artery reconstruction, despite some studies reporting increased stenosis in polyester patches compared to vein patches . However, while the application of polyester in the arterial system is very common, polyester is infrequently used in the venous system, primarily attributed to the lower blood flow and higher chance of thrombosis . In the venous system, since there is also a high incidence of anastomotic neointimal hyperplasia and stenosis, a distal arteriovenous fistula (AVF) is typically created to maintain the patency of the polyester graft, both in human and animal models …”

“…[10][11][12] However, while the application of polyester in the arterial system is very common, polyester is infrequently used in the venous system, primarily attributed to the lower blood flow and higher chance of thrombosis. [13][14][15][16][17] In the venous system, since there is also a high incidence of anastomotic neointimal hyperplasia and stenosis, a distal arteriovenous fistula (AVF) is typically created to maintain the patency of the polyester graft, both in human and animal models. [18][19][20] The importance of vascular identity to healing of vascular devices and interventions is beginning to be understood.…”