Ann Liver Transplant.  2022 May;2(1):56-63. 10.52604/alt.22.0010.

Clinical applicability of autologous great saphenous vein for living donor liver transplantation

• Ha TY
• Hwang S
• Ahn CS
• Moon DB
• Song GW
• Jung DH
• Park GC

• KMID: 2560882
• DOI: http://doi.org/10.52604/alt.22.0010

Abstract

The great saphenous vein (GSV) is the longest vein in the human body. Because the GSV has a small diameter, the clinical use of an autologous GSV has been limited. In the field of living donor liver transplantation (LDLT), it has been used frequently because of a shortage of vessel allograft supply. In this study, we present our experience of autologous GSV used in adult LDLT. In our initial experience of LDLT using a modified right liver graft, we used the hydraulically dilated GSV conduit as an interposition graft for middle hepatic vein reconstruction, but it was no longer used. An autologous GSV has been frequently used as a patch for right hepatic vein venoplasty and for unification of inferior right hepatic-vein orifices. A GSV segment can be attached to a figure of 8-shaped graft portal vein orifice to facilitate portal vein reconstruction. A stack of two ring-shaped GSV segments can provide additional length to the recipient portal vein after excision of the damaged proximal portal vein stump. Two separate graft portal veins can be unified by means of unification patch venoplasty using GSV patches. A new Y-shaped vein graft can be made by means of a stack of multiple ring-shaped SGV segments. It is feasible to make a paneled patch or spirally wound conduit using a GSV. A GSV was also used as an interposition conduit for hepatic artery reconstruction. In conclusion, the autologous GSV is a useful vascular material for LDLT in the forms of a vein segment itself, a paneled vein patch, and a ring-shaped or spirally winded vein conduit.

Keyword

Great saphenous vein; Patch; Interposition; Autologous vein; Wound complication

Figure

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  Figure 1 Gross photographs of the harvesting process of the left great saphenous vein. (A) The proximal insertion into the femoral vein is visible. (B) A poorly developed great saphenous vein is identified.

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  Figure 2 Gross photographs for application of the hydraulically dilated graft saphenous vein conduit used as an interposition graft for middle hepatic vein reconstruction. Three (A) and two (B) middle hepatic vein branches were reconstructed.

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  Figure 3 Gross photographs for incision-and- patch venoplasty at the graft right hepatic-vein orifice. (A) The caudal wall of the right hepatic vein was incised and a graft saphenous vein segment was attached at the vein wall defect. (B) The acute angle of the wall attached at the recipient right hepatic vein orifice was also removed by application of incision and patch venoplasty.

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  Figure 4 Illustration and gross photographs for unification venoplasty using great saphenous vein patches. Two inferior hepatic veins are unified without (A) and with (B) attachment of a central patch. RHV, right hepatic vein; IRHV, inferior right hepatic vein; MRHV, middle right hepatic vein; V5, segment V hepatic vein; V8, segment VIII hepatic vein.

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  Figure 5 Gross photographs for a portal vein conduit to compensate for the figure of 8-shaped orifice. (A) The portal vein orifice appeared to be not suitable for direct anastomosis. (B–D) A graft saphenous vein segment was attached around the periphery of the portal vein stump.

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  Figure 6 Gross photographs for a portal vein conduit to compensate for the length of the recipient portal vein. (A) A stack of two ring-shaped graft saphenous vein segments was inserted. (B) This procedure provided a significant length for the recipient portal vein.

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  Figure 7 Gross photographs for unification of two graft portal veins. (A) Three small vein segments were attached. (B) Their three-dimensional suturing provided unification of two portal vein orifices.

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  Figure 8 Gross photographs for making a new Y-shaped vein graft. (A) Graft saphenous vein segments were sliced. (B, C) Multiple ring segments were made and combined to make a Y-shape. (D) This conduit was anastomosed to the recipient portal vein.

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  Figure 9 Gross photographs for making a spirally winded conduit (A) and paneled patch (B) using a graft saphenous vein.

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  Figure 10 Fig. 10 . Gross photograph for hepatic artery reconstruction using an autologous graft saphenous vein conduit (arrow).

Reference

1. Gaudino M, Taggart D, Suma H, Puskas JD, Crea F, Massetti M. 2015; The choice of conduits in coronary artery bypass surgery. J Am Coll Cardiol. 66:1729–1737. DOI: 10.1016/j.jacc.2015.08.395. PMID: 26449144.

2. Furukawa H, Yamane N, Honda T, Yamasawa T, Kanaoka Y, Tanemoto K. 2019; Angiographic appearance of patent saphenous vein graft 32 years after coronary artery bypass grafting. Circ J. 83:840. DOI: 10.1253/circj.CJ-18-0851. PMID: 30224588.

3. Queiroz RM, Ferez MA, Costa MJBD, Laguna CB, Valentin MVN. Nastri R Filho. 2017; Thrombosed aneurysm of saphenous vein coronary artery bypass grafting. Rev Assoc Med Bras (1992). 63:488–491. DOI: 10.1590/1806-9282.63.06.488. PMID: 28876423.

4. Dubois CL, Vandervoort PM. 2001; Aneurysms and pseudoaneurysms of coronary arteries and saphenous vein coronary artery bypass grafts: a case report and literature review. Acta Cardiol. 56:263–267. DOI: 10.2143/AC.56.4.2005656. PMID: 11573835.

5. Lee S, Park K, Hwang S, Kim K, Ahn C, Moon D, et al. 2003; Anterior segment congestion of a right liver lobe graft in living-donor liver transplantation and strategy to prevent congestion. J Hepatobiliary Pancreat Surg. 10:16–25. DOI: 10.1007/s10534-002-0789-5. PMID: 12918453.

6. Cadwallader RA, Walsh SR, Cooper DG, Tang TY, Sadat U, Boyle JR. 2009; Great saphenous vein harvesting: a systematic review and meta-analysis of open versus endoscopic techniques. Vasc Endovascular Surg. 43:561–566. DOI: 10.1177/1538574409334133. PMID: 19640918.

7. Imai H, Yoshida S, Mese T, Roh S, Koshima I. 2021; Supermicrosurgical lymphatic venous anastomosis for intractable lymphocele after great saphenous vein harvesting graft. J Vasc Surg Cases Innov Tech. 8:45–47. DOI: 10.1016/j.jvscit.2021.11.003. PMID: 35097247. PMCID: PMC8783068.

8. Hwang S, Lee SG, Ahn CS, Moon DB, Kim KH, Sung KB, et al. 2010; Morphometric and simulation analyses of right hepatic vein reconstruction in adult living donor liver transplantation using right lobe grafts. Liver Transpl. 16:639–648. DOI: 10.1002/lt.22045. PMID: 20440773.

9. Hwang S, Ha TY, Ahn CS, Moon DB, Kim KH, Song GW, et al. 2016; Standardized surgical techniques for adult living donor liver transplantation using a modified right lobe graft: a video presentation from bench to reperfusion. Korean J Hepatobiliary Pancreat Surg. 20:97–101. DOI: 10.14701/kjhbps.2016.20.3.97. PMID: 27621745. PMCID: PMC5018955.

10. Hwang S, Ahn CS, Kim KH, Moon DB, Ha TY, Song GW, et al. 2012; Standardization of modified right lobe grafts to minimize vascular outflow complications for adult living donor liver transplantation. Transplant Proc. 44:457–459. DOI: 10.1016/j.transproceed.2012.01.072. PMID: 22410043.

11. Hwang S, Ha TY, Ahn CS, Moon DB, Kim KH, Song GW, et al. 2012; Reconstruction of inferior right hepatic veins in living donor liver transplantation using right liver grafts. Liver Transpl. 18:238–247. DOI: 10.1002/lt.22465. PMID: 22140053.

12. Hwang S, Lee SG, Park KM, Kim KH, Ahn CS, Moon DB, et al. 2005; Quilt venoplasty using recipient saphenous vein graft for reconstruction of multiple short hepatic veins in right liver grafts. Liver Transpl. 11:104–107. DOI: 10.1002/lt.20314. PMID: 15690544.

13. Hwang S, Lee SG, Ahn CS, Moon DB, Kim KH, Ha TY, et al. 2006; Outflow vein reconstruction of extended right lobe graft using quilt venoplasty technique. Liver Transpl. 12:156–158. DOI: 10.1002/lt.20574. PMID: 16382469.

14. Chiu KM, Chu SH, Chen JS, Li SJ, Chan CY, Chen KS. 2007; Spiral saphenous vein graft for portal vein reconstruction in pancreatic cancer surgery. Vasc Endovascular Surg. 41:149–152. DOI: 10.1177/1538574406297259. PMID: 17463208.

15. Moon DB, Hwang S, Jung DH, Ahn CS, Park GC, Ha TY, et al. 2021; Hepatic artery reconstruction using interposition of autologous saphenous vein conduit for living donor liver transplantation: a case report. Korean J Transplant. 35:183–188. DOI: 10.4285/kjt.20.0059.

16. Kan CD, Luo CY, Yang YJ. 1999; Endoscopic saphenous vein harvest decreases leg wound complication in coronary artery bypass grafting patients. J Card Surg. 14:157–162. DOI: 10.1111/j.1540-8191.1999.tb00969.x. PMID: 10789700.

17. Felisky CD, Paull DL, Hill ME, Hall RA, Ditkoff M, Campbell WG, et al. 2002; Endoscopic greater saphenous vein harvesting reduces the morbidity of coronary artery bypass surgery. Am J Surg. 183:576–579. DOI: 10.1016/S0002-9610(02)00835-8.

18. Bhatti ABH, Dar FS, Qureshi AI, Haider S, Khan NA. 2019; Saphenous vein conduits for hepatic arterial reconstruction in living donor liver transplantation. Langenbecks Arch Surg. 404:293–300. DOI: 10.1007/s00423-019-01774-1. PMID: 30859361.

19. Bitondo JM, Daggett WM, Torchiana DF, Akins CW, Hilgenberg AD, Vlahakes GJ, et al. 2002; Endoscopic versus open saphenous vein harvest: a comparison of postoperative wound complications. Ann Thorac Surg. 73:523–528. DOI: 10.1016/S0003-4975(01)03334-3.