Tubularized Bovine Pericardium Graft for Inferior Vena Cava Reconstruction in Abdominal Malignant Tumor

Abdominal malignant tumors sometimes involve the inferior vena cava (IVC).^1-4 In such cases, radical resection, including IVC resection and reconstruction, is a critical component of curative treatment.^3,4 Although patch repair or synthetic tube grafts are used for IVC reconstruction, synthetic grafts may carry risks of infection and thrombosis.^5-7 Although tubularized bovine pericardium grafts have shown favorable outcomes, the technical details are not well documented.^1,8-11 CASE PRESENTATION: IVC patch reconstruction using bovine pericardial grafts was performed in three cases. In one, the patch extended over more than two-thirds of the circumference, and the reconstruction was carried out in an irregular shape to preserve the branch of the left renal vein. By using a tubularized bovine pericardium graft, a smooth shape enabled easier reconstruction of the branches. A 33-year-old woman presented with an initially unresectable large leiomyosarcoma invading the IVC and hepatic veins. After chemotherapy shrank the tumor, surgical resection, including right nephrectomy, partial hepatectomy, and IVC resection, was performed. A 14 cm tube graft was created in the operating room using bovine pericardium, and this was anastomosed to the IVC. Elevated left renal vein pressure indicated side-to-end anastomosis. Postoperative computed tomography confirmed graft patency, and the patient was discharged uneventfully on postoperative day 10.

We present the technical details of IVC resection and reconstruction using a tubularized bovine pericardium graft, along with left renal vein reconstruction.