PORTAL VEIN GRAFTS IN HEPATIC TRANSPLANTATION

摘要: Confirmation of patency the portal vein by either ultrasound or angiography is a routine part evaluation patients being considered for hepatic transplantation (1). Complete thrombosis usually has been viewed as precluding successful orthotopic replacement In addition, some pediatric present with extremely small (less than 4 to 5 millimeters in diameter) veins which, although patent, have proved be thick walled and sclerotic. Our recent experience shown that, both these situations, complete revascularization allografts quite feasible. Two patients, ages 47 21 years, presented vein. four ranging age from one five patent but measured less diameter (Fig. 1). Furthermore, when vessels were transected, their luminal caliber was found further reduced sclerosis. Another instance involved seven year old boy who had recanalization. Fig. 1 Wedged venogram showing 2.5 millimeter vein. In all instances, restoration adequate venous flow allograft achieved dissecting out area confluence between splenic superior mesenteric order obtain vessel caliber. More importantly, grafts required span distance more proximal recipient 2). On other hand, three instances involving on length obviate use graft. Fig. 2 Vessel graft reconstruction. The obtained liver procurement procedure our practice number years (2). To this end, following removal abdominal organs, terminal aorta inferior vena cava continuity entire complex iliac are excised, placed tissue culture medium transported ice along liver. The usefulness arterial described previously (3). In first patient, an used, second fourth distal end better size match. third donor pulmonary artery used because unsatisfactory. All made uneventful recoveries except patient died acute rejection tenth postoperative day at autopsy graft. six surviving now observed 24 months. Repeat angiograms studied, fours weeks after transplantation, showed 3). Fig. 3 Angiograms graft. In course operation replacement, early recognition thrombosed otherwise inadequate vein, combined aggressive approach obtaining control veins, resulted several whom later date rejection. dissection required, behind neck pancreas under duodenum, not any injury organs additonal hemorrhage.