Depending on the center, a venovenous bypass will be used systematically, occasionally, or never. When venovenous bypass is used during the anhepatic stage, this usually includes drainage of (a) the portal vein and (b) the lower part of the body via the left greater saphenous vein into the left axilliary, brachial or internal jugular vein. An alternative for direct cannulation of the portal vein stump is cannulation of the inferior mesenteric vein. The centripetal Biopump with heparin-coated, armed cannulas is the most widely used one. Before use, the cannulas are primed with normal saline or an equivalent solution.
A 6-cm longitudinal incision is made in the left groin, just below Poupart's ligament, and the proximal end of the greater saphenous vein is isolated and encircled with sutures. After ligation of the distal side, the cannula of the venovenous bypass is inserted via a small venotomy in the proximal side of the greater saphenous vein and advanced into the femoral vein. The portal vein can be cannulated either directly by inserting and securing the cannula into the stump of the recipient portal vein or by cannulation of the inferior mesenteric vein. The axillary vein is cannulated following an identical procedure as for the saphenous vein, via a small longitudinal incision in the left axilla. It is also possible to insert a large bore catheter transcutaneously into the internal jugular vein.
Some centers perform a temporary portosystemic shunt, which will not be covered in this chapter.
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This ebook provides an introductory explanation of the workings of the human body, with an effort to draw connections between the body systems and explain their interdependencies. A framework for the book is homeostasis and how the body maintains balance within each system. This is intended as a first introduction to physiology for a college-level course.