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inferior veacagography reveals thrombotic portion of the IVC (arrow) before (a) and after (b) metalic stent placement (arrow).
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Percutaneous transluminal angioplasty was performed with thrombectomy and IVC stent placement by the intervention radiology team and anticoagulants treatment for hepatic vein obstruction was performed as the initial management (Fig. 1).
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Sagittal Computed tomography (CT) showing absence of flow in the hepatic veins before (a) and after (b) IVC stent placement.
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We encircled the supradiaphragmatic IVC after opening the diaphragm around the vena cava longitudinally with diathermy for hepatic vein anastomosis (Fig. 2).
Encircling the supradiaphragmatic IVC by vessel loop through a window made in the diaphragm (blue arrow). (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)
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The recipient cirrhotic liver was totally explanted with the retrohepatic IVC (Fig. 3).
Total hepatectomy together with excision of the retrohepatic IVC (blue arrow). (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)
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Then, we used the right atrium for the outflow reconstruction, the vascular clamp was applied on the right atrium through the window made in the diaphragm (Fig. 4).
Clamp applied on the RT atrium bottom to prepare it for the hepatic venous outflow reconstruction.
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Computed tomography 3 months after transplant confirmed anastomosis patency (Fig. 5).