Use of endarterectomized atherosclerotic artery allograft for hepatic vein reconstruction of living donor right lobe graft

Usability of ringed polytetrafluoroethylene grafts for middle hepatic vein reconstruction during living donor liver transplantation

“…Middle hepatic vein (MHV) reconstruction with an interposition vessel graft has been established as a standard procedure for living donor liver transplantation (LDLT) with a right lobe graft when the donor's MHV trunk is preserved in the donor's remnant liver. Materials used to date for this type of venous vascular reconstruction have included various types of homologous and autologous vessel grafts 1‐5. The recent increase in the number of adult LDLT procedures and the relatively limited number of vessel allografts have led us to search for new vessel substitutes 6.…”

Cryopreserved arterial grafts as a conduit in outflow reconstruction in living donor liver transplantation

“…Cryopreserved arterial grafts have been used since the 1990s in vascular surgery for replacement of infected prosthesis and in revascularization of peripheral vessels when venous grafts are not available and the patient is at high risk of graft infection if synthetic grafts are used . In contrast few reports about their use in outflow reconstruction in LDLT are available . Limited distensibility of the CAG's in the low pressure hepatic venous flow may be responsible for the reluctance of its use.…”

“…Hepatic venous outflow, in contrast, has low pressure and only short term patency is needed to prevent hepatic congestion and graft failure. In RAS drainage, smooth thin plaque in CAGs is accepted, but for intermediate and advanced lesions, endarterectomy of atherosclerotic arterial allografts is done after cryopreservation, but this may result in damage of the graft and be discarded . In our program, arterial grafts with apparent calcification were discarded.…”

“…Moreover, the impact of atherosclerosis on their patency is not well studied. Discarding atherosclerotic arteries from cryopreservation is practiced in vascular surgery and endarterectomy of the atherosclerotic cryopreserved artery, which may result in damage of the CAG, was reported in hepatic venous outflow reconstruction . To our knowledge, no published data are available concerning the use of atherosclerotic CAGs for RAS drainage in RL LDLT.…”

Variation in the venous drainage of left lateral segment liver graft requiring reconstruction of segment III vein with donor iliac artery

“…In living donor liver transplantation, the need to reconstruct MHV tributaries has led to a variety of vessel allografts being used; these include long saphenous vein, portal, paraumbilical, intrahepatic, and cadaveric donor iliac veins, iliac artery, recipient internal jugular vein, and, rarely, synthetic vascular grafts 14…”