Side-to-side cavocavostomy with an endovascular stapler: Rescue technique for severe hepatic vein and/or inferior vena cava outflow obstruction after liver transplantation using the piggyback technique
✍ Scribed by Cristiano Quintini; Charles M. Miller; Koji Hashimoto; Ding Philip; Teresa Diago Uso; Federico Aucejo; Dympna Kelly; Charles Winans; Bijan Eghtesad; David Vogt; John Fung
- Publisher
- John Wiley and Sons
- Year
- 2009
- Tongue
- English
- Weight
- 247 KB
- Volume
- 15
- Category
- Article
- ISSN
- 1527-6465
- DOI
- 10.1002/lt.21667
No coin nor oath required. For personal study only.
✦ Synopsis
Venous outflow obstruction is a rare but potentially lethal complication after orthotopic liver transplantation (OLT) with the "piggyback" technique. Therapeutic options include angioplasty with or without stent placement, surgical reconstruction of the venous anastomosis, and retransplantation. Surgical options are technically very challenging and the outcomes discouraging. We describe here two cases of venous outflow obstruction in recipients of piggyback liver grafts, one involving both the vena cava and hepatic veins and the other affecting only hepatic vein outflow. Both patients were treated successfully with side-to-side cavo-cavostomy using an endovascular (endo-GIA) stapler. This novel technique is fast and effective in resolving the outflow obstruction.