Successful Use of the Recanalized Remnant Umbilical Vein as a Patch Graft for Venous Reconstruction in Abdominal Surgery

Abstract

Various approaches have been described for the reconstruction of the portal vein (PV), superior mesenteric vein (SMV), and the inferior vena cava (IVC). We present the use of the recanalized remnant umbilical vein in various settings including transplantation, major liver resection, and pancreatic surgery. We retrospectively analyzed four cases, in which a recanalized remnant umbilical vein was used for vascular reconstruction. The graft harvesting, size of the graft, technique of application, and short-term results of vascular patency were studied. A recanalized umbilical vein was successfully harvested from the ligamentum teres hepatis in all patients with 5 cm (median, range 3-7 cm) in length and 1.3 cm (median, range 1.0-1.8 cm) in width. The preparation of the vein was technically feasible and took no more than 5 min in each patient. All grafts were used as a patch for venous reconstruction. In three cases, the graft was used for the reconstruction of the PV or SMV. In one patient, the graft was used to repair a large defect of the IVC. All vascular reconstructions were considered as successful as no bleeding or thrombosis was observed postoperatively. The remnant umbilical vein is a reliable native autologous graft. We found that it is feasible to use this graft as a patch for the reconstruction of the IVC, PV, and SMV.

Keywords: IVC resection; PV resection; Patch patency; Umbilical vein patch; Venous reconstruction.