Iliac venous conduit interposition for temporary portocaval shunt during liver transplantation

Total hepatectomy remains the most technically difficult step during liver transplantation (LT). The presence of portal hypertension, coagulopathy and the liver morphology make difficult the dissection of the native liver especially when native inferior vena cava preservation is planned. Fashioning of a temporary portocaval shunt (PCS) reduce portal hypertension, perioperative bleeding and improve hemodynamics during LT. Temporary PCS is not always easy to be performed. In obese patients and when the segment I is largely hypertrophic the access to the recipient IVC is quite narrow. Other conditions associated with difficult PCS fashioning are liver late retransplantation when portal vein could be fragile to be dissected and shortened by previous LT. In these conditions, we use a technical variation of PCS in which a venous iliac graft coming from the donor is interposed between the portal vein and the inferior vena cava. The technical details of this technique are described.