PMC9081796_01
Schematic representation of an MRB creation. (A) Meso-Rex post-LT with whole liver grafts. (B) Meso-Rex post-LT with partial grafts (LLS). IJV, internal jugular vein; IMV, inferior mesenteric vein; IVC, inferior vena cava; LHV, left hepatic vein; LPV, left portal vein; MHV, middle hepatic vein; RHV, right hepatic vein; RPV, right portal vein; SMV, superior mesenteric vein; SV, splenic vein.
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F1
Due to her risk of GI bleeding due to continued portal hypertension, a decision was made to proceed with MRB creation (Figure 1B).
Important steps during an MRB creation. (A) Identification of the hilar structures. (B) Exposure of the left IJV. (C) Anastomosis of the left portal vein and proximal end of the left IJV.
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F2
The patient was taken to the operating room for MRB creation (Figure 2). The hilar structures were identified (Figure 2A), and a very small bridge of liver parenchyma connecting segment 3 and the small portion of segment 4 was found. The vein was taken as proximal as possible, down to its takeoff from the subclavian vein (Figure 2B). Prolene (Figure 2C). Portal venography was performed and confirmed good flow into the liver from the bypass graft (Figure 3).
Portal venography via the anastomosed graft with evidence of good flow into the liver.
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F3
Prolene (Figure 2C). Portal venography was performed and confirmed good flow into the liver from the bypass graft (Figure 3).