Beneficial use of the round ligament as a patch graft for vena cava reconstruction

Background/Purpose: The availability of an appropriate vascular graft is a significant concern in an extensive hepatic resection with part of the vena cava. Methods/Results: The patient had multinodular hepatocellular carcinoma, occupying the whole posterior segment with a tumor thrombus bulging inside the vena cava. At laparotomy, a segment of the round ligament was procured for use as a patch graft. After the mobilization of the right-side liver without taking down the short hepatic veins, parenchymal resection was completed with the use of a hanging maneuver. The hepatic vena cava was semitotally side-clamped, followed by resection of the caval wall with the tumor thrombus, resulting in an en-bloc resection. The procured round ligament was opened, trimmed, and sutured to the vena cava as a patch graft, followed by smooth reperfusion. Conclusions: The use of an opened round ligament as a venous patch graft is an easy and feasible technique in patch reconstruction of the vena cava.