Inferior Vena Cava Reconstruction with a Flap of Parietal Peritoneum: An Animal Study

Background: The development of reconstructive venous surgery has been hampered by the lack of suitable grafts. Patency rates with grafts in the venous system are commonly less satisfactory than in arterial system, mainly due to nonpulsatile flow velocity and the low pressure in veins. Grafting of the inferior vena cava may be necessary in cases of trauma and major tumor surgery involving the vein. Several types of grafts have been evaluated. Reconstruction of the vena cava with autologous vein is so time-consuming and requires extra incisions. Prosthetic material is associated with a higher risk of infection and thrombosis. We, therefore, created an animal model of inferior vena cava reconstruction using a flap of parietal peritoneum. Methods: A tube, 5 cm in length and 1cm in diameter, was constructed from the parietal peritoneum of the anterior abdominal wall of ten dogs. It was anastomosed end-to-end as an interposition graft to the inferior vena cava. The observation period was two months. Results: Eight of ten grafts were macroscopically and venographically patent, while the other two were occluded. Eight out of ten specimens (for pathologic examination) which revealed patent lumens were completely endothelialized. No infection or other problems were noted. Conclusion: The peritoneum is an accessible and safe substitute for reconstruction of the inferior vena cava.