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Case Report

Ann Liver Transplant 2022; 2(2): 157-161

Published online November 30, 2022 https://doi.org/10.52604/alt.22.0026

Copyright © The Korean Liver Transplantation Society.

Asymptomatic migration of hemashield vascular graft used for middle hepatic vein reconstruction of living donor liver transplantation

Rak Kyun Oh , Chul-Soo Ahn , Deok-Bog Moon , Tae-Yong Ha , Gi-Won Song , Dong-Hwan Jung , Gil-Chun Park , Woo-Hyoung Kang , Young-In Yoon , Haesong Lee , Shin Hwang

Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

Correspondence to:Shin Hwang
Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea
E-mail: shwang@amc.seoul.kr
https://orcid.org/0000-0002-9045-2531

Received: November 2, 2022; Revised: November 11, 2022; Accepted: November 15, 2022

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/bync/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Middle hepatic vein (MHV) reconstruction with interposition vessel graft has been established as a standard procedure for living donor liver transplantation (LDLT). Unwanted migration of a synthetic vascular graft into the hollow viscus has been sporadically reported. We herein present a case of Hemashield graft migration into the duodenum following LDLT. A 64-year-old male patient presented with LDLT due to liver cirrhosis and hepatocellular carcinoma. The MHV openings in the right liver graft were reconstructed with a 10 mm-sized Hemashield graft, which was anastomosed to the common opening of the recipient middle-left hepatic vein trunk. The patient had uneventful recovery after LDLT surgery. Computed tomography (CT) scans taken at one year and two years showed no abnormal finding. However, gastroduodenoscopic examination at two years revealed accidental migration of the Hemashield graft into the duodenal bulb. The patient had no signs or symptoms and no problems with diet. The Hemashield graft migration was identified by retrospective review of 1-year and 2-year CT scans probably due to no radio-opacity of Hemashield graft. Because of the potential risk of Hemashield graft migration-associated complications, surgical removal was recommended, but the patient wished to observe more. The patient has been doing well for two years six months after LDLT. In conclusion, every synthetic vascular graft can penetrate adjacent organs and soft tissues, and its incidence is not negligibly low. Lifelong surveillance is necessary to detect unexpected rare complications in LDLT recipients who have MHV reconstruction using synthetic vascular grafts.

Keywords: Hepatic venous congestion, Liver transplantation, Hemashield graft, Middle hepatic vein, Hollow viscus

Middle hepatic vein (MHV) reconstruction with an interposition vessel graft has been established as a standard procedure for living donor liver transplantation (LDLT) using a modified right lobe graft. MHV reconstruction resulted in a new need for vascular allografts in the field of LDLT. Increasing demand for LDLT volume leads to significant shortage in vessel allografts supply. Regarding availability, synthetic vascular grafts have a definite merit of unlimited supply, and their patency rates were acceptably high [1-3]. However, unwanted migration of the synthetic vascular graft into the hollow viscus has been sporadically reported worldwide [3-10]. We previously used ringed expanded polytetrafluoroethylene (PTFE) grafts for a long period, but that were replaced with collagen-impregnated woven double-velour polyester grafts (Hemashield Platinum, Maquet; Rastatt, Germany; Hemashield grafts) because of its limited supply and accidental PTFE graft migration [11]. Even after conversion to use Hemashield grafts, we encountered recurrence of incidental graft migration in a LDLT recipient. Thus, we present a case of Hemashield graft migration into the duodenum following LDLT.

This patient was a 64-year-old man with hepatitis B virus–associated liver cirrhosis and hepatocellular carcinoma, with an end-stage liver disease score of 25. This patient had undergone transarterial chemoembolization nine times before transplantation. Because of deterioration of liver function and altered mentality (Fig. 1A, B), we decided to perform LDLT. The donor was his 35-year-old daughter. An LDLT operation using a modified right lobe graft was performed. The V and VIII vein openings in the right hepatic graft were reconstructed with a 10 mm-sized Hemashield graft, which was anastomosed to the common opening of the recipient’s middle-left hepatic vein trunk (Fig. 1C, D). The patient recovered uneventfully after LDLT operation and was discharged 13 days after transplantation.

Figure 1.Computerized tomography (CT) findings before and after liver transplantation. Pretransplant CT images showed over liver cirrhosis (A, B). CT scan taken 1 week after transplantation showed no abnormal findings with good patency of the Hemashield graft conduit (C, D) (arrows).

This patient underwent dynamic computerized tomography (CT) at each follow-up (Fig. 2). CT scans taken at one year (Fig. 2D), and two years (Fig. 3A, B), revealed no abnormal abdomen findings. However, a gastroduodenoscopic examination at two years revealed accidental migration of the Hemashield graft into the duodenal bulb (Fig. 4). The patient had no signs or symptoms and no problem with diet. The Hemashield graft migration was identified by retrospective review of the 1-year CT (Fig. 2D) and 2-year CT scan (Fig. 3A, B).

Figure 2.Follow-up computerized tomography (CT) scans. The Hemashield conduit showed good patency at the 1-month CT (A), partial occlusion at the 2-month CT (B), and near-complete occlusion at the 3-month CT (C). One-year CT scan showed complete luminal occlusion of the Hemashield graft conduit, but its location within the duodenum was not identified (D). Arrows indicate the location of a Hemashield graft conduit.

Figure 3.Follow-up computerized tomography (CT) scans with overt findings of Hemashield graft migration (arrows). A Hemashield graft was located within the duodenum in the 2-year CT scan, but this finding was missed due to lack of radio-opacity (A, B). Follow-up CT scan taken after two years and six months showed no significant change in the location of the migrated Hemashield graft and its surrounding tissue reaction (C, D). Arrows indicate the location of the Hemashield graft.

Figure 4.The gastroduodenal endoscopic finding of Hemashield graft migration taken years after transplantation. The distal stump of the Hemashield graft is located within the duodenum (A). The Hemashield graft penetrates the duodenal wall without severe inflammation at the duodenal wall (B).

Because of the potential risk of Hemashield graft migration-associated complications, surgical removal was recommended, but the patient wished to observe more with taking CT scans more frequently. A follow-up CT scan taken at two years and six months showed no significant changes compared with the 2-year CT scan (Fig. 3C, D). The patient is doing well two years and six months after LDLT.

MHV reconstruction with vascular graft interposition is widely accepted as an essential procedure for LDLT using a modified right liver graft. The increased frequency of LDLTs has led to relative lake of vessel allograft supply. Cryopreserved iliac vein allografts have traditionally been considered the most suitable conduit for MHV reconstruction, but its supply shortage has been a critical problem. Synthetic vascular grafts have a definite advantage of unlimited supply regarding availability as well as high patency rates [1-5].

However, we experienced accidental displacement of a PTFE graft into the hollow viscus [3,5]. Migration of such foreign material into the stomach or duodenum can trigger life-threatening complications, necessitating removal. Hsu et al. [4] reported that 1.5% of the patients developed complications related to the PTFE graft. One patient developed fulminant thrombosis with sepsis at 24 months and died of multiple-organ failure; the other three patients experienced graft migration to the second portion of the duodenum, which required surgical removal.

The physical features of Hemashield grafts are similar to PTFE grafts, but the former has some merits. Hemashield grafts have the circular pleats (Concentricrimp, Maquet) and a thin-walled flexible structure formed using a woven double velour polyester material, making it easier to handle and sew. Its longitudinal colored lines (Guideline Strip, Maquet) are also helpful in correcting the alignment during anastomosis. In addition, its bovine collagen-impregnated and the woven double velour structure facilitates prevention of early luminal thrombus formation and tissue reaction at the anastomosis sites [11]. However, Hemashield grafts are not radio-opaque, unlike our expectations.

Because of these physical features of Hemashield grafts, we expected the risk of accidental graft migration to be lower than that associated with PTFE. We did not experience accidental migration in the first two years after using Hemashield grafts [11]. However, we encountered an accidental Hemashield graft during 5-year experience with more than 600 cases of LDLT using Hemashield graft.

Until now, accidental migration of synthetic vascular grafts into the hollow viscus could be easily detected on CT images because PTFE graft is radio-opaque, thus suggesting contrast-enhanced CT as the best early detection of synthetic vascular graft-associated complications [3,10]. However, two sessions of contrast-enhanced CT scan missed Hemashield migration in the present case, which was retrospectively identifies after the performance of endoscopic gastroduodenoscopy. This experience makes two points. First, the Hemashield graft is not radio-opaque, thus special care should be paid to identify its location. We strongly recommend adding radio-opaque markers to Hemashield grafts during manufacturing. Second, Hemashield grafts also have a penetrative force comparable to that of PTFE grafts. Final closure of synthetic vascular grafts with a sizeable surgical polymer clip (Hem-o-lok Weck; Teleflex, Wayne, PA, USA) may increase the risk of graft migration, as this clip may be associated with strong tissue reaction and adhesion. Thus, we recommend sewing the graft end manually rather than end clipping.

So far, we have treated surgically displaced synthetic vascular grafts through surgical removal after laparotomy [3,5]. However, to date, there is no definite consensus on the treatment of such graft migration into the hollow viscus. Most patients underwent definitive treatment including surgical removal, but some remained asymptomatic and under close observation at the time of writing [3-10].

In conclusion, every synthetic vascular graft can penetrate into the adjacent organs and soft tissues and its incidence may not be negligibly low. Thus, lifelong surveillance is necessary to detect unexpected rare complications in LDLT recipients who had MHV reconstruction using synthetic vascular grafts.

All authors have no conflicts of interest to declare.

Conceptualization: RKO, SH. Data curation: RKO, CSA, DBM, GWS, DHJ, GCP, WHK, SH. Formal analysis: CSA, DBM, TYH, GWS, DHJ, GCP, WHK, YIY, HL, SH. Funding acquisition: TYH. Investigation: RKO, CSA, TYH, GWS, DHJ, GCP, WHK, YIY, HL, SH. Methodology: All. Supervision: SH. Visualization: SH. Writing – original draft: All. Writing – review & editing: RKO, SH.

  1. Hwang S, Jung DH, Ha TY, Ahn CS, Moon DB, Kim KH, et al. Usability of ringed polytetrafluoroethylene grafts for middle hepatic vein reconstruction during living donor liver transplantation. Liver Transpl 2012;18:955-965.
    Pubmed CrossRef
  2. Yi NJ, Suh KS, Lee HW, Cho EH, Shin WY, Cho JY, et al. An artificial vascular graft is a useful interpositional material for drainage of the right anterior section in living donor liver transplantation. Liver Transpl 2007;13:1159-1167.
    Pubmed CrossRef
  3. Ha TY, Hwang S, Jung DH, Ahn CS, Kim KH, Moon DB, et al. Complications analysis of polytetrafluoroethylene grafts used for middle hepatic vein reconstruction in living-donor liver transplantation. Transplant Proc 2014;46:845-849.
    Pubmed CrossRef
  4. Hsu SC, Thorat A, Yang HR, Poon KS, Li PC, Yeh CC, et al. Assessing the safety of expanded polytetrafluoroethylene synthetic grafts in living donor liver transplantation: graft migration into hollow viscous organs - diagnosis and treatment options. Med Sci Monit 2017;23:3284-3292.
    Pubmed KoreaMed CrossRef
  5. Jung IJ, Hwang S, Ha TY, Song GW, Jung DH, Ahn CS, et al. Long-term patency and complications of ringed polytetrafluoroethylene grafts used for middle hepatic vein reconstruction in living-donor liver transplantation. Korean J Transplant 2020;34:31-37.
    Pubmed KoreaMed CrossRef
  6. Kim MJ, Kim HB, Han JK, Suh KS, Kim SH, Baek JH, et al. Injuries of adjacent organs by the expanded polytetrafluoroethylene grafts in the venoplasty of middle hepatic veins in living-donor liver transplantation: computed tomographic findings and possible risk factors. J Comput Assist Tomogr 2011; 35:544-548.
    Pubmed CrossRef
  7. Sultan AM, Shehta A, Salah T, Elshoubary M, Wahab MA. Spontaneous migration of thrombosed synthetic vascular graft to the duodenum after living-donor liver transplantation: a case-report. Int J Surg Case Rep 2018;45:42-44.
    Pubmed KoreaMed CrossRef
  8. Sevmiş M, Zarbaliyev E, Yıldız H, Alkara U, Aktaş S, Sevmiş Ş. Asymptomatic synthetic vascular graft migration to duodenum after living donor liver transplantation: report of two cases. Acta Chir Belg 2021. https://doi.org/10.1080/00015458.2021.1966185 [Epub ahead of print]
    Pubmed CrossRef
  9. Koc C, Akbulut S, Bilgic Y, Otan E, Sarici B, Isik B, et al. Artificial vascular graft migration into hollow viscus organs in patients who underwent right lobe living donor liver transplantation. Acta Chir Belg 2020;120:404-412.
    Pubmed CrossRef
  10. Woo HY, Hong SK, Cho JH, Lee JM, Choi Y, Yi NJ, et al. Complications of polytetrafluoroethylene graft use in middle hepatic vein reconstruction in living donor liver transplantation: a retrospective, single-centre, long-term, real-world experience. Transpl Int 2021;34:455-464.
    Pubmed CrossRef
  11. Park GC, Hwang S, Ha TY, Song GW, Jung DH, Ahn CS, et al. Hemashield vascular graft is a preferable prosthetic graft for middle hepatic vein reconstruction in living donor liver transplantation. Ann Transplant 2019;24:639-646.
    Pubmed KoreaMed CrossRef

Article

Case Report

Ann Liver Transplant 2022; 2(2): 157-161

Published online November 30, 2022 https://doi.org/10.52604/alt.22.0026

Copyright © The Korean Liver Transplantation Society.

Asymptomatic migration of hemashield vascular graft used for middle hepatic vein reconstruction of living donor liver transplantation

Rak Kyun Oh , Chul-Soo Ahn , Deok-Bog Moon , Tae-Yong Ha , Gi-Won Song , Dong-Hwan Jung , Gil-Chun Park , Woo-Hyoung Kang , Young-In Yoon , Haesong Lee , Shin Hwang

Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

Correspondence to:Shin Hwang
Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea
E-mail: shwang@amc.seoul.kr
https://orcid.org/0000-0002-9045-2531

Received: November 2, 2022; Revised: November 11, 2022; Accepted: November 15, 2022

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/bync/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Middle hepatic vein (MHV) reconstruction with interposition vessel graft has been established as a standard procedure for living donor liver transplantation (LDLT). Unwanted migration of a synthetic vascular graft into the hollow viscus has been sporadically reported. We herein present a case of Hemashield graft migration into the duodenum following LDLT. A 64-year-old male patient presented with LDLT due to liver cirrhosis and hepatocellular carcinoma. The MHV openings in the right liver graft were reconstructed with a 10 mm-sized Hemashield graft, which was anastomosed to the common opening of the recipient middle-left hepatic vein trunk. The patient had uneventful recovery after LDLT surgery. Computed tomography (CT) scans taken at one year and two years showed no abnormal finding. However, gastroduodenoscopic examination at two years revealed accidental migration of the Hemashield graft into the duodenal bulb. The patient had no signs or symptoms and no problems with diet. The Hemashield graft migration was identified by retrospective review of 1-year and 2-year CT scans probably due to no radio-opacity of Hemashield graft. Because of the potential risk of Hemashield graft migration-associated complications, surgical removal was recommended, but the patient wished to observe more. The patient has been doing well for two years six months after LDLT. In conclusion, every synthetic vascular graft can penetrate adjacent organs and soft tissues, and its incidence is not negligibly low. Lifelong surveillance is necessary to detect unexpected rare complications in LDLT recipients who have MHV reconstruction using synthetic vascular grafts.

Keywords: Hepatic venous congestion, Liver transplantation, Hemashield graft, Middle hepatic vein, Hollow viscus

INTRODUCTION

Middle hepatic vein (MHV) reconstruction with an interposition vessel graft has been established as a standard procedure for living donor liver transplantation (LDLT) using a modified right lobe graft. MHV reconstruction resulted in a new need for vascular allografts in the field of LDLT. Increasing demand for LDLT volume leads to significant shortage in vessel allografts supply. Regarding availability, synthetic vascular grafts have a definite merit of unlimited supply, and their patency rates were acceptably high [1-3]. However, unwanted migration of the synthetic vascular graft into the hollow viscus has been sporadically reported worldwide [3-10]. We previously used ringed expanded polytetrafluoroethylene (PTFE) grafts for a long period, but that were replaced with collagen-impregnated woven double-velour polyester grafts (Hemashield Platinum, Maquet; Rastatt, Germany; Hemashield grafts) because of its limited supply and accidental PTFE graft migration [11]. Even after conversion to use Hemashield grafts, we encountered recurrence of incidental graft migration in a LDLT recipient. Thus, we present a case of Hemashield graft migration into the duodenum following LDLT.

CASE PRESENTATION

This patient was a 64-year-old man with hepatitis B virus–associated liver cirrhosis and hepatocellular carcinoma, with an end-stage liver disease score of 25. This patient had undergone transarterial chemoembolization nine times before transplantation. Because of deterioration of liver function and altered mentality (Fig. 1A, B), we decided to perform LDLT. The donor was his 35-year-old daughter. An LDLT operation using a modified right lobe graft was performed. The V and VIII vein openings in the right hepatic graft were reconstructed with a 10 mm-sized Hemashield graft, which was anastomosed to the common opening of the recipient’s middle-left hepatic vein trunk (Fig. 1C, D). The patient recovered uneventfully after LDLT operation and was discharged 13 days after transplantation.

Figure 1. Computerized tomography (CT) findings before and after liver transplantation. Pretransplant CT images showed over liver cirrhosis (A, B). CT scan taken 1 week after transplantation showed no abnormal findings with good patency of the Hemashield graft conduit (C, D) (arrows).

This patient underwent dynamic computerized tomography (CT) at each follow-up (Fig. 2). CT scans taken at one year (Fig. 2D), and two years (Fig. 3A, B), revealed no abnormal abdomen findings. However, a gastroduodenoscopic examination at two years revealed accidental migration of the Hemashield graft into the duodenal bulb (Fig. 4). The patient had no signs or symptoms and no problem with diet. The Hemashield graft migration was identified by retrospective review of the 1-year CT (Fig. 2D) and 2-year CT scan (Fig. 3A, B).

Figure 2. Follow-up computerized tomography (CT) scans. The Hemashield conduit showed good patency at the 1-month CT (A), partial occlusion at the 2-month CT (B), and near-complete occlusion at the 3-month CT (C). One-year CT scan showed complete luminal occlusion of the Hemashield graft conduit, but its location within the duodenum was not identified (D). Arrows indicate the location of a Hemashield graft conduit.

Figure 3. Follow-up computerized tomography (CT) scans with overt findings of Hemashield graft migration (arrows). A Hemashield graft was located within the duodenum in the 2-year CT scan, but this finding was missed due to lack of radio-opacity (A, B). Follow-up CT scan taken after two years and six months showed no significant change in the location of the migrated Hemashield graft and its surrounding tissue reaction (C, D). Arrows indicate the location of the Hemashield graft.

Figure 4. The gastroduodenal endoscopic finding of Hemashield graft migration taken years after transplantation. The distal stump of the Hemashield graft is located within the duodenum (A). The Hemashield graft penetrates the duodenal wall without severe inflammation at the duodenal wall (B).

Because of the potential risk of Hemashield graft migration-associated complications, surgical removal was recommended, but the patient wished to observe more with taking CT scans more frequently. A follow-up CT scan taken at two years and six months showed no significant changes compared with the 2-year CT scan (Fig. 3C, D). The patient is doing well two years and six months after LDLT.

DISCUSSION

MHV reconstruction with vascular graft interposition is widely accepted as an essential procedure for LDLT using a modified right liver graft. The increased frequency of LDLTs has led to relative lake of vessel allograft supply. Cryopreserved iliac vein allografts have traditionally been considered the most suitable conduit for MHV reconstruction, but its supply shortage has been a critical problem. Synthetic vascular grafts have a definite advantage of unlimited supply regarding availability as well as high patency rates [1-5].

However, we experienced accidental displacement of a PTFE graft into the hollow viscus [3,5]. Migration of such foreign material into the stomach or duodenum can trigger life-threatening complications, necessitating removal. Hsu et al. [4] reported that 1.5% of the patients developed complications related to the PTFE graft. One patient developed fulminant thrombosis with sepsis at 24 months and died of multiple-organ failure; the other three patients experienced graft migration to the second portion of the duodenum, which required surgical removal.

The physical features of Hemashield grafts are similar to PTFE grafts, but the former has some merits. Hemashield grafts have the circular pleats (Concentricrimp, Maquet) and a thin-walled flexible structure formed using a woven double velour polyester material, making it easier to handle and sew. Its longitudinal colored lines (Guideline Strip, Maquet) are also helpful in correcting the alignment during anastomosis. In addition, its bovine collagen-impregnated and the woven double velour structure facilitates prevention of early luminal thrombus formation and tissue reaction at the anastomosis sites [11]. However, Hemashield grafts are not radio-opaque, unlike our expectations.

Because of these physical features of Hemashield grafts, we expected the risk of accidental graft migration to be lower than that associated with PTFE. We did not experience accidental migration in the first two years after using Hemashield grafts [11]. However, we encountered an accidental Hemashield graft during 5-year experience with more than 600 cases of LDLT using Hemashield graft.

Until now, accidental migration of synthetic vascular grafts into the hollow viscus could be easily detected on CT images because PTFE graft is radio-opaque, thus suggesting contrast-enhanced CT as the best early detection of synthetic vascular graft-associated complications [3,10]. However, two sessions of contrast-enhanced CT scan missed Hemashield migration in the present case, which was retrospectively identifies after the performance of endoscopic gastroduodenoscopy. This experience makes two points. First, the Hemashield graft is not radio-opaque, thus special care should be paid to identify its location. We strongly recommend adding radio-opaque markers to Hemashield grafts during manufacturing. Second, Hemashield grafts also have a penetrative force comparable to that of PTFE grafts. Final closure of synthetic vascular grafts with a sizeable surgical polymer clip (Hem-o-lok Weck; Teleflex, Wayne, PA, USA) may increase the risk of graft migration, as this clip may be associated with strong tissue reaction and adhesion. Thus, we recommend sewing the graft end manually rather than end clipping.

So far, we have treated surgically displaced synthetic vascular grafts through surgical removal after laparotomy [3,5]. However, to date, there is no definite consensus on the treatment of such graft migration into the hollow viscus. Most patients underwent definitive treatment including surgical removal, but some remained asymptomatic and under close observation at the time of writing [3-10].

In conclusion, every synthetic vascular graft can penetrate into the adjacent organs and soft tissues and its incidence may not be negligibly low. Thus, lifelong surveillance is necessary to detect unexpected rare complications in LDLT recipients who had MHV reconstruction using synthetic vascular grafts.

FUNDING

There was no funding related to this study.

CONFLICT OF INTEREST

All authors have no conflicts of interest to declare.

AUTHORS’ CONTRIBUTIONS

Conceptualization: RKO, SH. Data curation: RKO, CSA, DBM, GWS, DHJ, GCP, WHK, SH. Formal analysis: CSA, DBM, TYH, GWS, DHJ, GCP, WHK, YIY, HL, SH. Funding acquisition: TYH. Investigation: RKO, CSA, TYH, GWS, DHJ, GCP, WHK, YIY, HL, SH. Methodology: All. Supervision: SH. Visualization: SH. Writing – original draft: All. Writing – review & editing: RKO, SH.

Fig 1.

Figure 1.Computerized tomography (CT) findings before and after liver transplantation. Pretransplant CT images showed over liver cirrhosis (A, B). CT scan taken 1 week after transplantation showed no abnormal findings with good patency of the Hemashield graft conduit (C, D) (arrows).
Annals of Liver Transplantation 2022; 2: 157-161https://doi.org/10.52604/alt.22.0026

Fig 2.

Figure 2.Follow-up computerized tomography (CT) scans. The Hemashield conduit showed good patency at the 1-month CT (A), partial occlusion at the 2-month CT (B), and near-complete occlusion at the 3-month CT (C). One-year CT scan showed complete luminal occlusion of the Hemashield graft conduit, but its location within the duodenum was not identified (D). Arrows indicate the location of a Hemashield graft conduit.
Annals of Liver Transplantation 2022; 2: 157-161https://doi.org/10.52604/alt.22.0026

Fig 3.

Figure 3.Follow-up computerized tomography (CT) scans with overt findings of Hemashield graft migration (arrows). A Hemashield graft was located within the duodenum in the 2-year CT scan, but this finding was missed due to lack of radio-opacity (A, B). Follow-up CT scan taken after two years and six months showed no significant change in the location of the migrated Hemashield graft and its surrounding tissue reaction (C, D). Arrows indicate the location of the Hemashield graft.
Annals of Liver Transplantation 2022; 2: 157-161https://doi.org/10.52604/alt.22.0026

Fig 4.

Figure 4.The gastroduodenal endoscopic finding of Hemashield graft migration taken years after transplantation. The distal stump of the Hemashield graft is located within the duodenum (A). The Hemashield graft penetrates the duodenal wall without severe inflammation at the duodenal wall (B).
Annals of Liver Transplantation 2022; 2: 157-161https://doi.org/10.52604/alt.22.0026

References

  1. Hwang S, Jung DH, Ha TY, Ahn CS, Moon DB, Kim KH, et al. Usability of ringed polytetrafluoroethylene grafts for middle hepatic vein reconstruction during living donor liver transplantation. Liver Transpl 2012;18:955-965.
    Pubmed CrossRef
  2. Yi NJ, Suh KS, Lee HW, Cho EH, Shin WY, Cho JY, et al. An artificial vascular graft is a useful interpositional material for drainage of the right anterior section in living donor liver transplantation. Liver Transpl 2007;13:1159-1167.
    Pubmed CrossRef
  3. Ha TY, Hwang S, Jung DH, Ahn CS, Kim KH, Moon DB, et al. Complications analysis of polytetrafluoroethylene grafts used for middle hepatic vein reconstruction in living-donor liver transplantation. Transplant Proc 2014;46:845-849.
    Pubmed CrossRef
  4. Hsu SC, Thorat A, Yang HR, Poon KS, Li PC, Yeh CC, et al. Assessing the safety of expanded polytetrafluoroethylene synthetic grafts in living donor liver transplantation: graft migration into hollow viscous organs - diagnosis and treatment options. Med Sci Monit 2017;23:3284-3292.
    Pubmed KoreaMed CrossRef
  5. Jung IJ, Hwang S, Ha TY, Song GW, Jung DH, Ahn CS, et al. Long-term patency and complications of ringed polytetrafluoroethylene grafts used for middle hepatic vein reconstruction in living-donor liver transplantation. Korean J Transplant 2020;34:31-37.
    Pubmed KoreaMed CrossRef
  6. Kim MJ, Kim HB, Han JK, Suh KS, Kim SH, Baek JH, et al. Injuries of adjacent organs by the expanded polytetrafluoroethylene grafts in the venoplasty of middle hepatic veins in living-donor liver transplantation: computed tomographic findings and possible risk factors. J Comput Assist Tomogr 2011; 35:544-548.
    Pubmed CrossRef
  7. Sultan AM, Shehta A, Salah T, Elshoubary M, Wahab MA. Spontaneous migration of thrombosed synthetic vascular graft to the duodenum after living-donor liver transplantation: a case-report. Int J Surg Case Rep 2018;45:42-44.
    Pubmed KoreaMed CrossRef
  8. Sevmiş M, Zarbaliyev E, Yıldız H, Alkara U, Aktaş S, Sevmiş Ş. Asymptomatic synthetic vascular graft migration to duodenum after living donor liver transplantation: report of two cases. Acta Chir Belg 2021. https://doi.org/10.1080/00015458.2021.1966185 [Epub ahead of print]
    Pubmed CrossRef
  9. Koc C, Akbulut S, Bilgic Y, Otan E, Sarici B, Isik B, et al. Artificial vascular graft migration into hollow viscus organs in patients who underwent right lobe living donor liver transplantation. Acta Chir Belg 2020;120:404-412.
    Pubmed CrossRef
  10. Woo HY, Hong SK, Cho JH, Lee JM, Choi Y, Yi NJ, et al. Complications of polytetrafluoroethylene graft use in middle hepatic vein reconstruction in living donor liver transplantation: a retrospective, single-centre, long-term, real-world experience. Transpl Int 2021;34:455-464.
    Pubmed CrossRef
  11. Park GC, Hwang S, Ha TY, Song GW, Jung DH, Ahn CS, et al. Hemashield vascular graft is a preferable prosthetic graft for middle hepatic vein reconstruction in living donor liver transplantation. Ann Transplant 2019;24:639-646.
    Pubmed KoreaMed CrossRef
The Korean Liver Transplantation Society

Vol.3 No.2
November 2023

pISSN 2765-5121
eISSN 2765-6098

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