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Reconstruction of Inferior Vena Cava by Autologous Great Saphenous Vein Grafts in Liver Surgery

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Abstract

Background

To secure surgical margin for hepatic lesion with involvement of the inferior vena cava (IVC), combined radical liver resection and IVC replacement are required. A novel method of replacing IVC by newly customized autologous great saphenous vein (GSV) grafts was introduced by this study. This study aimed at reporting the feasibility and outcome of this novel technique.

Methods

From January 2014 to January 2021, all consecutive patients who underwent concomitant hepatectomy and IVC replacement by autogenous GSV graft were enrolled in this study. Technical insights, intraoperative details, demographic data, postoperative complication, graft patency and survival data were collected and analyzed.

Results

Concomitant hepatectomy/autotransplantation (ERAT) with IVC replacement by autogenous GSV graft was successful in 47 patients and there was no 30-day mortality. There were 8 out of the 47 patients whose retrohepatic venae cavae were completely invaded by the lesion and their reconstructed IVCs were totally made from GSV grafts. The other 39 patients whose IVCs were partially invaded had their IVCs reconstructed by both the unaffected part of the IVC wall and newly customized GSV graft. Postoperative complications classified as Clavien-Dindo grade II, III A and III B were observed in 10, 7 and 3 patients, respectively. The median follow-up months were 35 months (29–80 months). No patient developed thrombosis of the graft and 100% patency of the IVC was observed throughout the study.

Conclusion

In selected patients, hepatectomy/ERAT with IVC replacement by autogenous GSV graft is safe and feasible. The newly customized autologous GVS graft was ideal for reconstruction of the IVC in liver surgery.

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Acknowledgements

This research was founded by the National Natural Science Foundation of China (No. 81770566) and New Medical Technology Foundation of West China Hospital of Sichuan University (No.2016-036) and was supported by Sichuan Science and Technology Program (No. 2019YFS0029).

Funding

This research was founded by the National Natural Science Foundation of China (No. 81770566) and New Medical Technology Foundation of West China Hospital of Sichuan University (No.2016-036) and was supported by Sichuan Science and Technology Program (No. 2019YFS0029), 1.3.5 project for disciplines of excellence, West China Hospital, Sichuan University, The New Medical Technology Foundation of West China Hospital of Sichuan University (XJS2016004) and the Department of Science and Technology of Sichuan Province (No. 2016FZ0076).

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Author notes

  1. Xi Feng and Kan Wu have contributed equally to this work.

Authors and Affiliations

  1. Department of Liver Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China

    Xi Feng, XianWei Yang, HaiZhou Qiu, YongGang Wei, Bo Li & Wentao Wang

  2. Department of Vascular Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China

    Bin Huang

  3. Department of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China

    Kan Wu

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  1. Xi Feng
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Contributions

Authorship in this study has been complied with international guidelines and contributions of all authors listed below. WW and BH conceived the study and critically revised the manuscript. XF and KW drafted and edited the manuscript. Surgical procedures were performed by WW, XF, BH, BL and YGW. The procedures were assisted by KW and XWY.

Corresponding author

Correspondence to Bin Huang.

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Feng, X., Wu, K., Yang, X. et al. Reconstruction of Inferior Vena Cava by Autologous Great Saphenous Vein Grafts in Liver Surgery. World J Surg 47, 2221–2229 (2023). https://doi.org/10.1007/s00268-023-07003-7

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