PMC4258371_01
CT view of preoperative liver with (a) large mass filling almost all liver and IVC is nonvisible. (b) Invasion and compression of IVC by EA are seen. (c) Compression to surrounding tissues and organs by EA. (d) Compression and invasion of IVC extending up to renal vein level.
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fig1
A large mass in the liver was compressing and invading the inferior vena cava and completely obstructing retrohepatic IVC (Figure 1).
Large native liver filling the entire abdomen is seen.
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fig2
Large liver with alveolar disease extended to pelvis and had strong adhesions with the surrounding tissues, anterior abdominal wall, right hemidiaphragm, colon and small intestine, and the retrohepatic part of inferior vena cava up to the right atrium that made recipient hepatectomy more difficult than other cirrhotic livers (Figure 2).
The view after diaphragm resection and the anastomosis between right atrium and first part of cadaveric aortic graft is seen.
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fig3
In particular, strong invasion to the diaphragm and inferior vena cava extending in cephalic destination forces us to perform caval vein resection until right atrium and resection a left suprahepatic part of diaphragm (Figure 3). Replacement of inferior vena cava was done from the suprarenal part of IVC up to the right atrium by cryopreserved cadaveric aortic graft with end-to-end anastomosis (Figures 3 and 4).
Incised pericardium and total replacement of retrohepatic part of vena cava (from renal vein to right atrium) are seen.
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fig4
Replacement of inferior vena cava was done from the suprarenal part of IVC up to the right atrium by cryopreserved cadaveric aortic graft with end-to-end anastomosis (Figures 3 and 4).
Final view after implantation. Diaphragm plication with mesh is seen.
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fig5
Defect in diaphragm was repaired with using mesh (Figures 5 and 6). For resolving this problem we used retrohepatic part of diaphragm plication with mesh (Figures 5 and 6).
CT view after living donor liver transplantation. Diaphragmatic plication and new IVC are seen.
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fig6
Defect in diaphragm was repaired with using mesh (Figures 5 and 6). For resolving this problem we used retrohepatic part of diaphragm plication with mesh (Figures 5 and 6).