Approaches to reconstruction of inferior vena cava by ex vivo liver resection and autotransplantation in 114 patients with hepatic alveolar echinococcosis

Figure 1 Schematic diagrams of retrohepatic inferior vena cava reconstruction methods. A-C: Hepatic alveolar echinococcosis (AE) lesion invades the hepatocaval confluence; D: Retrohepatic inferior vena cava (RHIVC) is invaded by the AE lesion (yellow arrow); E: RHIVC is extensive invaded (yellow arrow); F: RHIVC completely occluded (yellow arrow), and compensation by the collateral branches (black arrow); G: Self-repairing reconstruction method, showed vascular patch repair (red arrow) and self-suture repair (yellow arrow); H: RHIVC replacement method, showed the RHIVC after replacement (red arrow); I: RHIVC resection without reconstruction method, showed IVC anastomoses with graft liver hepatic vein (yellow arrow) and adrenal vein (red arrow), the collateral circulation branches after operation (black arrow).

Figure 2 Intraoperative procedures. A: The infiltrated retrohepatic inferior vena cava (RHIVC); B: The large defect of RHIVC after radical resection; C: The RHIVC with self-suture repairing; D: The original RHIVC anastomoses with hepatic vein; E: The artificial blood vessel anastomoses with graft liver hepatic vein; F: The suprahepatic IVC anastomoses with left hepatic vein; G: The autologous RHIVC after reconstruction; H: Artificial RHIVC; I: Anastomotic stoma of suprahepatic IVC and hepatic vein.

Figure 3 Kaplan-Meier survival analysis curve.

Figure 4 Strategy for retrohepatic inferior vena cava reconstruction in exvivo liver resection and autotransplantation. CTA: Computed tomography angiography; D represents the defect of retrohepatic inferior vena cava lumen after resection; DSA: Digital subtraction angiography; RHIVC: Retrohepatic inferior vena cava.