PMC6515144_01
Evidence of retained CVC on predonation CT scan. White arrow pointing at retained CVC in IVC (coronal view).
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Abdominal computerized tomography (CT) scan (Figure 1) revealed an "elongated structure with metallic components in the upper portion of the IVC that extends into the right atrium."
Retained CVC in donor liver, postprocurement. Panel (a): suprahepatic IVC. White arrow pointing at retained CVC within IVC wall. Black arrow pointing at orifice of MHV and LHV. Panel (b): white arrows pointing at retained CVC within IVC wall. Black arrow pointing at orifice of MHV and LHV. Black star at infrahepatic IVC. Panel (c): retained CVC after removal.
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fig2
IVC, extending down the retrohepatic IVC (Figures 2(a) and 2(b)). It also created a calcified reaction at the junction of the suprahepatic IVC and right atrium, adjacent to the left hepatic vein (LHV) and middle hepatic vein (MHV). We removed the foreign body (Figure 2(c)) and performed a venoplasty (Figure 3) of the posterior wall of the IVC and of the common wall of the LHV and MVH, so that the outflow of the LHV and MHV was not compromised after transplant.
Method of venoplasty for removal of CVC cast in donor IVC prior to transplantation. Panel (a): anterior view of the native donor suprahepatic caval anatomy prior to venoplasty, with an area of inflammation and calcification due to foreign body reaction. Panel (b): anterior view postvenoplasty, demonstrating the areas of the IVC and MHV/LHV junction that were repaired to improve venous outflow and the overall integrity of the suprahepatic caval anastomosis.
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fig3
We removed the foreign body (Figure 2(c)) and performed a venoplasty (Figure 3) of the posterior wall of the IVC and of the common wall of the LHV and MVH, so that the outflow of the LHV and MHV was not compromised after transplant.
PMC6515144_02
Posttransplant imaging reveals no sequelae of removal of retained CVC. Panel (a): liver ultrasound with Doppler showing normal hepatic venous anastomosis waveforms and velocities. Panel (b): axial contrasted CT scan showing patent, normal appearing hepatic venous anastomosis (arrow).
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Postoperative imaging showed normal velocities and waveforms on ultrasound (Figure 4(a)) and unremarkable appearance on axial CT (Figure 4(b)) of the hepatic vein anastomosis.