Peritoneal tabularization for inferior vena cava (ivc) replacement in animal model study (dog)

The aim of the present study was to evaluate the flap of parietal peritoneum for replacement of the inferior vena cava as interposition graft in dogs during an observation period of two months. Background: The development of reconstructive venous surgery has been hampered by the lack of suitable graft. Patency rates with grafts in the venous system are commonly less satisfactory than in the arterial system, mainly due to non-pulsatile flow velocity and the low pressure in veins. Grafting in the inferior vena cava may be necessary in the cases of trauma and major tumour surgery involving the vena cava. Several types of grafts have been evaluated. Reconstruction of vena cava with autologous vein is so time consuming and requires extra incisions. Prosthetic material is associated with an increased risk of infection and thrombosis. We, therefore, created an animal model of the Inferior Vena Cava reconstruction using the flap of parietal peritoneum. Methods: A tube was constructed from parietal peritoneum of the antero-lateral part of abdominal wall of 10 dogs with a length of 5cm and 1 cm in diameter. It was anastomosed end-to-end as an interposition graft in the inferior vena cava. The observation period was 2 months. Results: Seven out of ten grafts were macroscopically and venographically patent, but three of ten were occluded. Eight out of ten yielded suitable specimens for pathologic examination; and five of them revealed patent lumens, which were completely deendothelialized. No infection or other problems were noted. Conclusions: The Peritoneum is an accessible and safe substitute for reconstruction of Inferior Vena Cava at least in animal model.