Story of Dying Inferior Vana Cava and Saviour Azygous- Inferior Vana Cava Thrombosis and Azygous Continuity in Deceased Donor Liver Transplant

Abstract

Liver transplantation is the only solution or treatment of decompensated chronic liver disease and it becomes more difficult when there is shortage of organ donor leading to mortality. Here an unusual case of a 62 year old male patient of decompensated chronic liver disease with Hepatocellular Carcinoma (HCC) is reported who underwent a Deceased Donor Liver Transplant (DDLT). Intraoperatively patient was found to have a new onset Inferior Vana Cava (IVC) thrombosis, which posed technical difficulty in caval anastomosis and risk of thrombus propagation with standard techniques. Patient also had azygous continuity, where azygous vein was tortuous and was draining entire abdominal, pelvic and lower limb venous return into systemic circulation. Hence, piggyback reconstruction was used; the native vena cava was ligated infra hepatically and allowed azygous to remain sole drainage. This reduced risk of future thrombus propagation into IVC, also eliminated risk of unhealthy vascular anastomosis. There are very few case reports regarding azygous continuity in liver transplant surgery. As per the literature search this is the first case such reconstruction in setting of DDLT from India.

Keywords

• azygous vein
• hepatocellular carcinoma
• piggyback reconstruction