IVC angioplasty using an autologous vascular graft for IVC stenosis due to metallic stent in a pediatric liver transplant

Abstract

A 12‐year‐old girl underwent LDLT using a left lobe graft for hepatic dysfunction associated with citrin deficiency. A continuous anastomosis suture technique was performed between the recipient's IVC and the donor's left hepatic vein. At age 14, the patient developed intractable ascites. Venography of the IVC and hepatic vein showed twisted‐shape stenosis of the hepatic vein‐IVC anastomosis with intravascular pressure gradient, probably due to the enlarged transplanted liver, for which a metallic stent was placed. The ascites disappeared, and the patient was making satisfactory progress eight months after surgery. However, nine months after surgery, the ascites appeared again with edema in the lower extremities. Since the stent that had been inserted was suspected of hampering the outflow of the graft liver and IVC, it was decided to conduct stent removal and IVC angioplasty. After intravascular exploration, the stent was removed. Angioplasty was performed. An autologous vascular graft patch was designed to be wedge‐shaped to fit the incised part of the IVC, and it was sutured with 5‐0 non‐absorbable surgical sutures using a continuous suture technique. No postoperative complications or perioperative graft dysfunction were observed. The ascites decreased markedly, and the edema in the lower extremities disappeared. Thus, we were able to successfully perform IVC angioplasty using an autologous vascular graft patch in a patient who developed IVC stenosis after stenting. This procedure is one of the most effective treatment options, especially for pediatric patients requiring long‐term vascular patency.

Absorbable sutures for cardiopulmonary bypass purse strings in pediatric heart surgery

“…The main issue when introducing new materials in surgery is to verify safety. Absorbable long-lasting sutures, commonly used in general surgery, 1 have typically only been utilized in cardiovascular surgery for sternal closure after pediatric and adult cardiac surgery procedures, [2][3][4][5] for vascular surgery procedures, [6][7][8][9][10] for diaphragmatic or superficial cutaneous sutures related to cardiovascular procedures, 11,12 and for experimental research surgery in animals. 13 Despite being regularly used in hospitals in Europe as purse strings for arterial and venous cannulation for cardiopulmonary bypass in pediatric heart surgery, to the best of our knowledge, their use in this specific utilization has not been reported.…”

Transcatheter stent implantation in a child with severe stenosis of the inferior caval vein secondary to injury

“…He underwent multiple procedures including placement of an extra ventricular drain and intracranial pressure monitor, reconstructive facial surgery, upper and lower extremity Over the course of his postoperative hospitalisation, he developed extensive lymphatic drainage with chylothorax, chyloperitoneum, and severe abdominal ascites [7][8][9] (Fig 1 Chest X-ray). He was initiated on a chylous effusion protocol including pausing all enteral intake, diuretics, and treatment with octreotide and required placement of bilateral chest tubes and an abdominal drain considering his persistent high volume output.…”

“…11 Noninvasive imaging including abdominal ultrasonography was initially unremarkable however a follow-up chest computed tomography angiogram demonstrated severe stenosis of his inferior caval vein at the right atrial junction (Fig 2). 8,9 The aetiology of the stenosis was thought to be the initial severe abdominal trauma. Considering this finding he was taken to the cardiac catheterisation laboratory.…”