Re-appropriation of a right anterior thoracotomy approach to portal-systemic bypass for liver transplantation in a patient with complete superior vena cava occlusion

Justin A. Steggerda, Andre Y. Son, Marcos E. Pozo, Amit Pawale, Aaron S. Reynolds, Kush Desai, Daniel Galvez-Lima, Josh Herborn, Andre DeWolf, Daniela Ladner, Juan Carlos Caicedo, Nitin Katariya, Daniel Borja-Cacho

Research output: Contribution to journalArticlepeer-review

Abstract

The utilization of venovenous bypass in liver transplantation (LT) has become less frequent and more center dependent over time. Unfortunately, this has left many transplant surgeons, particularly younger trainees, unfamiliar with the techniques and indications for its utilization. We present a case of LT in a patient with complete superior vena cava (SVC) occlusion prohibiting direct vascular access. A multi-disciplinary approach involving interventional radiology, anesthesiology, cardiac surgery, and transplant surgery, was used to diagnose, evaluate, and develop an operative plan for successful LT. In doing so, a novel approach to portosystemic bypass was utilized involving a right mini-thoracotomy with direct cannulation of the right atrium to gain central venous access and optimize venous return during LT. As a center that does not routinely use venovenous bypass, this multidisciplinary approach was crucial identifying the need for a rarely used technique for vascular access and performance of a successful LT.

Original languageEnglish
Article number100086
JournalTransplantation Reports
Volume6
Issue number4
DOIs
StatePublished - Dec 2021
Externally publishedYes

Keywords

  • Superior vena cava occlusion
  • Thoracotomy
  • Venovenous bypass

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