Ann Liver Transplant.  2022 May;2(1):48-55. 10.52604/alt.22.0009.

Usability of cryopreserved homologous great saphenous vein for hepatobiliarypancreatic surgery and living donor liver transplantation

• Jung DH
• Hwang S
• Bae JH
• Kim IO

• KMID: 2560881
• DOI: http://doi.org/10.52604/alt.22.0009

Abstract

The great saphenous vein (GSV) is the longest vein in the human body. Because of the small diameter of the GSV, the clinical use of homologous GSV allografts has yet not been reported worldwide. In the present study, we present our early experience with the employment of cryopreserved homologous GSV allografts in hepatobiliary-pancreatic surgery and liver transplantation. Recently, the Korea Public Tissue Bank (KPTB) initiated harvesting of GSV allografts from deceased donors, thereby making cryopreserved GSVs available for clinical practice. The cryopreserved GSVs can be used in three forms. First, it can be enlarged through parallel paneling, in which the paneled GSV patch can be used for patch venoplasty of portal vein reconstruction during hepatobiliary-pancreatic surgery. Second, spiral winding or the GSV can make a large-caliber conduit, which can be used for interposition venoplasty of portal vein reconstruction during hepatobiliary-pancreatic surgery. The third is the use of a short GSV segment per se for hepatic vein venoplasty during living donor liver transplantation. To the best of our knowledge, this study is the first report on the clinical use of cryopreserved homologous GSV allografts in the field of hepatobiliary-pancreatic surgery and liver transplantation. In conclusion, cryopreserved GSV allografts are proposed as useful vascular materials that can be employed for hepatobiliary-pancreatic surgery and living donor liver transplantation in the forms of GSV segment itself, paneled vein patch, and spirally winded vein conduit.

Keyword

Great saphenous vein; Cryopreservation; Interposition; Homologous vein; Patency

Figure

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  Figure 1 Gross photographs of the paneling procedure with a thawed great saphenous vein. (A) The side branches were already tie-ligated at the time of harvest. (B) The vein wall was incised longitudinally with removal of the internal semilunar valves. A small vein segment was resected and anastomosed with the remaining part. (C, D) A third segment was attached with parallel paneling sutures.

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  Figure 2 Gross photographs for application of a paneled patch in a patient who underwent extended bile duct resection for proximal bile duct cancer. (A) The main portal vein was invaded by the tumor (arrow). (B) The tumor-invaded portal vein wall was resected. (C) The wall defect at the portal vein was repaired with a paneled great saphenous vein patch with one continuous running suture. (D) The patch portion was expanded without stenosis.

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  Figure 3 Gross photographs of the spiral winding procedure with a thawed great saphenous vein. (A, B) A vein segment was wrapped around a 10 mL plastic disposable syringe. (C) A continuous running suture was applied until the first turn, and then the suture material was transfixed (arrow) to prevent the purse-string effect. (D) The same suture material was used for next-turn suturing, and transfixation suture was repeated.

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  Figure 4 Gross photographs of the application of a spirally winded conduit in a patient who underwent left hepatectomy, caudate lobectomy, and bile duct resection for perihilar bile duct cancer. (A) The main portal vein was invaded by the tumor (arrow). The longitudinal axis of the portal vein was marked for keeping the axial orientation. (B) The size of the main portal vein and the vein conduit were compared. (C) The tumor-invaded portal vein wall was segmentally resected with interposition of a vein conduit. (D) The interposed conduit portion (arrow) was expanded without stenosis.

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  Figure 5 Gross photographs of the application of a spirally winded conduit in a patient who underwent pylorus-preserving pancreaticoduodenectomy for distal bile duct cancer. (A) The tumor had invaded the main portal vein. (B) A spirally winded vein conduit was prepared. (C) The tumor-invaded segment was resected and interposed with the vein conduit. (D) The interposed conduit portion was expanded with mild anastomotic stenosis at the splenic vein confluence portion.

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  Figure 6 Gross photographs of the application of incision-and-patch venoplasty at the graft right hepatic vein orifice. (A) The caudal wall of the right hepatic vein was incised. (B) A cryopreserved great saphenous vein segment was attached at the vein wall defect to make the orifice larger.

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