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Refined surgical techniques to improve the patency of cryopreserved iliac artery homografts for middle hepatic vein reconstruction during living donor liver transplantation

PURPOSE: A cryopreserved iliac artery homograft (IAH) has not been considered suitable for middle hepatic vein (MHV) reconstruction during living donor liver transplantation (LDLT), primarily due to the low patency from its small diameter. We revised our surgical techniques for MHV reconstruction us...

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Autores principales: Park, Gil-Chun, Hwang, Shin, Jung, Dong-Hwan, Ha, Tae-Yong, Song, Gi-Won, Ahn, Chul-Soo, Moon, Deok-Bog, Kim, Ki-Hun, Yoon, Young-In, Cho, Hwui-Dong, Choi, Jin-Uk, Lee, Sung-Gyu
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The Korean Surgical Society 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7606128/
https://www.ncbi.nlm.nih.gov/pubmed/33163459
http://dx.doi.org/10.4174/astr.2020.99.5.294
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author Park, Gil-Chun
Hwang, Shin
Jung, Dong-Hwan
Ha, Tae-Yong
Song, Gi-Won
Ahn, Chul-Soo
Moon, Deok-Bog
Kim, Ki-Hun
Yoon, Young-In
Cho, Hwui-Dong
Choi, Jin-Uk
Lee, Sung-Gyu
author_facet Park, Gil-Chun
Hwang, Shin
Jung, Dong-Hwan
Ha, Tae-Yong
Song, Gi-Won
Ahn, Chul-Soo
Moon, Deok-Bog
Kim, Ki-Hun
Yoon, Young-In
Cho, Hwui-Dong
Choi, Jin-Uk
Lee, Sung-Gyu
author_sort Park, Gil-Chun
collection PubMed
description PURPOSE: A cryopreserved iliac artery homograft (IAH) has not been considered suitable for middle hepatic vein (MHV) reconstruction during living donor liver transplantation (LDLT), primarily due to the low patency from its small diameter. We revised our surgical techniques for MHV reconstruction using an IAH to improve its patency. METHODS: This study analyzed the causes of early conduit occlusion and developed revised techniques to address this that had clinical application. RESULTS: The potential risk factors for early conduit occlusion were the small IAH size, small graft in the segment V vein (V5) and segment VIII vein (V8) opening, and small recipient MHV-left hepatic vein stump. These factors were reflected to our revised surgical methods which included endarterectomy of the atherosclerotic plaque, unification of the internal and external iliac artery branches for large V5, and branch-patch arterioplasty for large V8. IAH endarterectomy, branch unification technique, and branch-patch arterioplasty were applied to 8, 5, and 5 patients, respectively and resulted in 1-month occlusion rates of 37.5%, 20.0%, and 40.0%, respectively. The overall patency rates of the IAH-MHV conduits in our 18 patients were 66.7% at 1 month, 38.9% at 3 months, and 33.3% at 1 year. CONCLUSION: Our refined MHV reconstruction using an IAH improved short-term MHV conduit patency, but did not effectively prevent early conduit occlusion, particularly with a small- or medium-sized IAH. Individualized reconstruction designs during LDLT operation are needed when an IAH is used for a modified right liver graft.
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spelling pubmed-76061282020-11-05 Refined surgical techniques to improve the patency of cryopreserved iliac artery homografts for middle hepatic vein reconstruction during living donor liver transplantation Park, Gil-Chun Hwang, Shin Jung, Dong-Hwan Ha, Tae-Yong Song, Gi-Won Ahn, Chul-Soo Moon, Deok-Bog Kim, Ki-Hun Yoon, Young-In Cho, Hwui-Dong Choi, Jin-Uk Lee, Sung-Gyu Ann Surg Treat Res Original Article PURPOSE: A cryopreserved iliac artery homograft (IAH) has not been considered suitable for middle hepatic vein (MHV) reconstruction during living donor liver transplantation (LDLT), primarily due to the low patency from its small diameter. We revised our surgical techniques for MHV reconstruction using an IAH to improve its patency. METHODS: This study analyzed the causes of early conduit occlusion and developed revised techniques to address this that had clinical application. RESULTS: The potential risk factors for early conduit occlusion were the small IAH size, small graft in the segment V vein (V5) and segment VIII vein (V8) opening, and small recipient MHV-left hepatic vein stump. These factors were reflected to our revised surgical methods which included endarterectomy of the atherosclerotic plaque, unification of the internal and external iliac artery branches for large V5, and branch-patch arterioplasty for large V8. IAH endarterectomy, branch unification technique, and branch-patch arterioplasty were applied to 8, 5, and 5 patients, respectively and resulted in 1-month occlusion rates of 37.5%, 20.0%, and 40.0%, respectively. The overall patency rates of the IAH-MHV conduits in our 18 patients were 66.7% at 1 month, 38.9% at 3 months, and 33.3% at 1 year. CONCLUSION: Our refined MHV reconstruction using an IAH improved short-term MHV conduit patency, but did not effectively prevent early conduit occlusion, particularly with a small- or medium-sized IAH. Individualized reconstruction designs during LDLT operation are needed when an IAH is used for a modified right liver graft. The Korean Surgical Society 2020-11 2020-10-28 /pmc/articles/PMC7606128/ /pubmed/33163459 http://dx.doi.org/10.4174/astr.2020.99.5.294 Text en Copyright © 2020, the Korean Surgical Society http://creativecommons.org/licenses/by-nc/4.0/ Annals of Surgical Treatment and Research is an Open Access Journal. All articles are distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Park, Gil-Chun
Hwang, Shin
Jung, Dong-Hwan
Ha, Tae-Yong
Song, Gi-Won
Ahn, Chul-Soo
Moon, Deok-Bog
Kim, Ki-Hun
Yoon, Young-In
Cho, Hwui-Dong
Choi, Jin-Uk
Lee, Sung-Gyu
Refined surgical techniques to improve the patency of cryopreserved iliac artery homografts for middle hepatic vein reconstruction during living donor liver transplantation
title Refined surgical techniques to improve the patency of cryopreserved iliac artery homografts for middle hepatic vein reconstruction during living donor liver transplantation
title_full Refined surgical techniques to improve the patency of cryopreserved iliac artery homografts for middle hepatic vein reconstruction during living donor liver transplantation
title_fullStr Refined surgical techniques to improve the patency of cryopreserved iliac artery homografts for middle hepatic vein reconstruction during living donor liver transplantation
title_full_unstemmed Refined surgical techniques to improve the patency of cryopreserved iliac artery homografts for middle hepatic vein reconstruction during living donor liver transplantation
title_short Refined surgical techniques to improve the patency of cryopreserved iliac artery homografts for middle hepatic vein reconstruction during living donor liver transplantation
title_sort refined surgical techniques to improve the patency of cryopreserved iliac artery homografts for middle hepatic vein reconstruction during living donor liver transplantation
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7606128/
https://www.ncbi.nlm.nih.gov/pubmed/33163459
http://dx.doi.org/10.4174/astr.2020.99.5.294
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