Retrohepatic vena cava reconstruction with polytetrafluoroethylene graft William H . Risher, M D , R o b e r t M. Arensman, M D , J o h n L. Ochsner, M D , and L a r r y H . Hollier, MD, New Orleans, La. The case of an 18-month-old male who underwent a right hepatic lobectomy for hepatoblastoma with extensive involvement of the retrohepatic vena cava is presented. The retrohepatic vena cava was replaced with an expanded polytetrafluoroethylene graft. This graft was proved patent by ultrasonography 2 years after operation. The child has no evidence o f recurrent hepatoblastoma. The results of grafting the retrohepatic vena cava have been notoriously poor. It is widely believed that a prosthetic vena cava graft cannot be expected to remain patent. Our experience with polytetrafluoroethylene and previous reports using Dacron and polytetrafluoroethylene have shown that long-term patency of retrohepatic vena cava replacement with synthetic graft can be successful. (J VASC SURG 1990;12:36%70.)
In the course o f right hepatic lobectomy o f the liver for hepatoblastoma the retrohepatic vena cava was replaced with an expanded polytetrafluoroethylene (PTFE) graft (Gore-Tex, registered trademark o f W . L. Gore & Assoc., Elkton, Md.). The patency o f the graft was proved by ultrasonography 2 years later. There have been three previously reported successful replacements o f the retrohepatic vena cava in the literature. Starzl et al. 1 used reversed cadaver vena cava-iliac vein homograft. Iwatsuki et al. 2 used woven Dacron. Kumada et al. a used PTFE. This represents the fourth reported case o f successful retrohepatic vena caval replacement in the Englishlanguage literature. Furthermore, this is the first reported case o f successful replacement in a pediatric ~atient and the second with a P T F E graft in the English-language literature. CASE REPORT An asymptomatic 18-month-old white male during routine well-baby examination by his pediatrician was noted to have a right-sided abdominal mass. Roentgenography showed extensive calcifications in the right upper quadrant of the abdomen; the chest radiograph was norreal. An abdominal ultrasound scan showed an 8 x 9 x 5 cm right upper quadrant abdominal mass. Results of serum chemistry determinations showed carcinoembryonic antigen 1.5 ng/ml (normal < 2.5 ng/ml), beta-human From the Department of Surgery, Ochsner Clinic, and Alton Ochsner Medical Foundation. Presented at the Fourteenth Annual Meeting of the Southern Association for Vascular Surgery, Acapulco, Mexico, Jan. 2427, 1990. Reprint requests: John L. Ochsner, MD, Ochsner Clinic, 1514 Jefferson Highway, New Orelans, LA 70121. 24/6/22151
chorionic gonadotrophin
In the course o f right hepatic lobectomy o f the liver for hepatoblastoma the retrohepatic vena cava was replaced with an expanded polytetrafluoroethylene (PTFE) graft (Gore-Tex, registered trademark o f W . L. Gore & Assoc., Elkton, Md.). The patency o f the graft was proved by ultrasonography 2 years later. There have been three previously reported successful replacements o f the retrohepatic vena cava in the literature. Starzl et al. 1 used reversed cadaver vena cava-iliac vein homograft. Iwatsuki et al. 2 used woven Dacron. Kumada et al. a used PTFE. This represents the fourth reported case o f successful retrohepatic vena caval replacement in the Englishlanguage literature. Furthermore, this is the first reported case o f successful replacement in a pediatric ~atient and the second with a P T F E graft in the English-language literature. CASE REPORT An asymptomatic 18-month-old white male during routine well-baby examination by his pediatrician was noted to have a right-sided abdominal mass. Roentgenography showed extensive calcifications in the right upper quadrant of the abdomen; the chest radiograph was norreal. An abdominal ultrasound scan showed an 8 x 9 x 5 cm right upper quadrant abdominal mass. Results of serum chemistry determinations showed carcinoembryonic antigen 1.5 ng/ml (normal < 2.5 ng/ml), beta-human From the Department of Surgery, Ochsner Clinic, and Alton Ochsner Medical Foundation. Presented at the Fourteenth Annual Meeting of the Southern Association for Vascular Surgery, Acapulco, Mexico, Jan. 2427, 1990. Reprint requests: John L. Ochsner, MD, Ochsner Clinic, 1514 Jefferson Highway, New Orelans, LA 70121. 24/6/22151
chorionic gonadotrophin
