Quilt venoplasty using recipient saphenous vein graft for reconstruction of multiple short hepatic veins in right liver grafts

Major short hepatic veins (SHV) are indicated for vascular reconstruction to prevent excessive hepatic venous congestion of right liver grafts. As separate anastomoses of multiple small SHVs are vulnerable to stenosis or regeneration-related torsion, a conjoined large opening of SHVs may be better than multiple separate anastomoses. We devised an innovative method to reconstruct SHVs through a patchwork quilt using autologous greater saphenous vein (GSV). We applied this method to 3 different configurations of multiple SHVs. For double SHVs in alignment, 2 GSV fragments were stitched longitudinally to wrap 2 SHVs, forming the cuff shape of an ovoid bowl. For double SHVs not in alignment, a central patch of GSV was placed between 2 SHVs to offset the alignment gap, and the outer fence of a long GSV fragment was anastomosed to make a common cuff. For complex anatomy of quadruple SHVs, the central patch was designed to contact with 4 SHVs altogether and the outer fence was similarly created. Although this method was applied to only 4 right liver grafts, there was no disturbance of SHV drainage during 4 months of follow-up. In conclusion, we think that this quilt venoplasty technique using autologous GSV may be applicable for reconstruction of multiple or variant SHVs.