The development of techniques for liver transplantation and preservation has led to several surgical innovations for the resection of hepatic malignancies that invade the inferior vena cava (IVC) and the hepatic venous confluence. The resection of hepatic malignancies invading the IVC has become technically feasible and relatively safe since the introduction of total hepatic vascular exclusion (HVE), with or without bypass. The more aggressive approach, involving concomitant hepatic and IVC resection and subsequent replacement of the IVC using autologous or synthetic materials, has also been adopted. If a subtotal hepatectomy could not be performed, total hepatectomy with liver transplantation was a valuable option. But there is no agreement on the management of these tumors in a cirrhotic liver, so the choice of operative procedures used for these patients remains debatable. We reviewed the records of eight hepatic malignancies, including histologically proven five hepatocellular carcinomas (HCC) in cirrhotic livers, and the records of patients with metastatic carcinoma in noncirrhotic livers who underwent concomitant hepatic resection and IVC reconstruction.

https://www.journalacs.org/article/S1072-7515(98)00256-7/pdf

Concomitant major hepatectomy and inferior vena cava reconstruction.

Vascular identity is genetically determined, but can be altered during surgical procedures. We hypothesized that the environment of the procedure critically alters the identity of autologous tissue patches implanted into the arterial or venous environment. Autologous jugular vein or carotid artery was used as a patch to repair a rat aorta or inferior vena cava. In the aortic environment patches contained neointimal cells that were CD34/Ephrin-B2-dual positive but not CD34/Eph-B4-dual positive; patches expressed Ephrin-B2, notch-4 and dll-4 but not Eph-B4 and COUP-TFII. In the venous environment patches contained neointimal cells that were CD34/Eph-B4-dual positive but not CD34/Ephrin-B2-dual positive; patches expressed Eph-B4 and COUP-TFII but not Ephrin-B2, notch-4 and dll-4. These data show that autologous tissue patches heal by acquisition of the vascular identity determined by the environment into which they are implanted, suggesting some plasticity of adult vascular identity.

Autologous tissue patches acquire vascular identity depending on the environment

Composite prosthetic patches with covalently bound particles for controlled drug release, and methods of making and using thereof, have been developed The particles may encapsulate one or more therapeutic, prophylactic or diagnostic agent(s) Generally, the prosthetic patches are decellularized extracellular matrix such as bovine or porcine pericardium or synthetic polymeric materials The size of the particles ranges from between 1 nm and 1000 μm, preferably from between 10 nm and 500 nm In some embodiments, the agent is a therapeutic agent for treatment of neointimal hyperplasia In other embodiments, the agent is a therapeutic agent for suppressing or resolving inflammation In yet other embodiments, the agent is a therapeutic for mitigating scarring

Particle conjugated prosthetic patches and methods of making and using thereof

Pericardial patches are commonly used in vascular surgery to close vessels. To facilitate studies of the neointimal hyperplasia that forms on the patch, we developed a rat model of patch angioplasty that can be used in either a vein or an artery, creating a patch venoplasty or a patch arterioplasty, respectively. Technical aspects of this model are discussed. The infra-renal IVC or aorta are dissected and then clamped proximally and distally. A 3 mm venotomy or arteriotomy is performed in the infrarenal inferior vena cava or aorta of 6 to 8 week-old Wistar rats. A bovine pericardial patch (3 mm x 1.5 mm x 0.6 mm) is then used to close the site using a 10-0 nylon suture. Compared to arterial patches, venous patches show increased neointimal thickness on postoperative day 7. This novel model of pericardial patch angioplasty can be used to examine neointimal hyperplasia on vascular biomaterials, as well as to compare the differences between the arterial and venous environments.

Patch Angioplasty in the Rat Aorta or Inferior Vena Cava

Hydrogel is a nature scaffold that can degraded in animal body and can be used as a drug delivery system, we hypothesized that patch made of three layers of hydrogel with different PLGA nanoparticle drugs (bio-patch) can be used to decrease venous neointimal hyperplasia. Rat inferior vena cava (IVC) patch venoplasty model was used. Samples from rat IVC direct suture (DS), decellularized thoracic artery patch (TA) venoplasty and bovine pericardial patch (BPP) venoplasty were examined at day 14 after implantation. Sodium alginate and hyaluronic acid (SA/HA) hydrogel was used, three layers hydrogel patch (control) and three layers hydrogel patch with PLGA nanoparticle drugs (bio-patch) were used in rat IVC venoplasty. Patches were harvested at day 14 and analyzed. In rats, TA and BPP patch showed a thicker neointima and adventitia compared to the DS, there were larger numbers of CD68 and PCNA positive cells in both groups. The control hydrogel patch showed much thinner neointima and adventitia compared to TA and BPP patches. In both of the neointima and peri-patch area, bio-patch showed significantly fewer smooth muscle cells, fewer CD68, fewer PCNA positive cells, fewer collagen-1 positive cells, fewer p-smad2 positive cells, fewer TNF-α positive cells compared to control hydrogel patch. Bio-patch made of hydrogel and PLGA nanoparticle drugs showed a thinner neointimal thickness, and is biocompatible to the animal body. These results showed the potential application of hydrogel patch in vascular surgery. Absorbable three layers SA/HA vascular patch can be used to repair rat inferior vena cava. Bio-patch with inner layer mixed with PLGA nanoparticle heparin and CD34 antibody, middle layer mixed with PLGA nanoparticle rapamycin and SB431542 and outer layer mixed with PLGA nanoparticle Necrostation-1 can effectively inhibit venous neointimal hyperplasia. • Sodium alginate and hyaluronic acid (SA/HA) hydrogel can be used as vascular patch. • Bio-patch with hierarchy releasing of nanoparticle drugs can decrease neointimal hyperplasia. • Degraded hydrogel patch may have a potential clinical application. 

A three-layered hydrogel patch with hierarchy releasing of PLGA nanoparticle drugs decrease neointimal hyperplasia

BACKGROUND/AIMS Glutaraldehyde-fixed heterologous pericardium has been widely used for grafts in cardiac surgery. We applied it for inferior vena cava (IVC) patch grafting following combined resection of the liver and the IVC. METHODOLOGY IVC grafting using a glutaraldehyde-fixed horse pericardium following combined resection of the liver and the IVC was performed in 2 patients--one with hepatocellular carcinoma and the other with hepatic metastasis following rectal cancer. The retrohepatic vena cava defect was closed with a 10 x 5 cm patch in one patient and a 7 x 4 cm patch in the other. RESULTS Hepatic vascular exclusion was avoided in both patients. The IVC exclusion period was 40 min for the first patient and 25 min for the second. One patient required a veno-venous bypass with an active centrifugal pump of 153 min. There was no complication and no graft infection. The microscopic extension to the IVC was evident in one patient, and fibrous adhesive was evident in the IVC wall of the other. One patient died of hepatic failure 3 years and 6 months after surgery, and the other died of hepatic recurrence 7 months after surgery. Both grafts were patent, without calcification and stricture, until the patients' death. CONCLUSIONS Glutaraldehyde-fixed heterologous pericardium is an option for IVC grafting.

Glutaraldehyde-fixed heterologous pericardium for vena cava grafting following hepatectomy.

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Glutaraldehyde-fixed heterologous pericardium for vena cava grafting following hepatectomy.