Usability of Cryopreserved Aortic Allografts for Middle Hepatic Vein Reconstruction During Living-Donor Liver Transplantation
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- 作者：Seok-Hwan Kim ; Shin Hwang ; Tae-Yong Ha ; Gi-Won Song…
- 刊名：Journal of Gastrointestinal Surgery
- 出版年：2016
- 出版时间：May 2016
- 年：2016
- 卷：20
- 期：5
- 页码：1049-1055
- 全文大小：651 KB
- 刊物主题：Surgery; Gastroenterology;
- 出版者：Springer US
- ISSN：1873-4626
- 卷排序：20
文摘
Iliac vein allografts are suitable for middle hepatic vein (MHV) reconstruction during living-donor liver transplantation (LDLT), but their supply is often limited. Polytetrafluoroethylene (PTFE) grafts are easily available but have drawbacks of accidental gastric penetration and non-degradable foreign body. To replace the use of PTFE grafts, we started using cryopreserved aorta allografts (CAAs). This study presents the technical details and patency outcomes of using CAAs in MHV reconstruction. We reviewed the surgical techniques of CAA interposition and analyzed the patency rates in 74 patients who underwent LDLT during the 6-year study period. The two control groups received either cryopreserved iliac veins (n = 122) or PTFE grafts (n = 84). The surgical techniques for MHV reconstruction used to implant the CAA and PTFE grafts are very similar because the techniques developed for PTFE grafts were also applied to CAAs. We inserted an arterial patch at the liver cut surface because the CAA wall is too thick to perform direct anastomosis. Two patients (2.7 %) underwent MHV stenting during the first month. The 1-year patency rate was 69.7 % in the CAA group vs. 39.2 % in iliac vein group vs. 57.2 % in PTFE group (p = 0.000). The overall graft and patient survival rates did not differ depending on the MHV interposition vessel materials (p > 0.1). CAAs combined with small-artery patches demonstrated high patency rates that surpass other vessel grafts, and thus, we suggest that CAA can be reliably used for MHV reconstruction when CAA is available.KeywordsPolytetrafluoroethyleneProsthetic graftIliac vein graftHepatic venous congestionPatency