Fig. 1. Illustration of portal vein (PV) conduit reconstruction. (A) Conventional technique for PV conduit reconstruction. ⓐ Longitudinal incision of the native PV with an inverted-Y shaped extension to the superior mesenteric vein-splenic vein confluence. ⓑ Creation of a small longitudinal slit at the vein conduit. ⓒ Anastomosis of the opened native PV stump and a vein conduit with continuous running sutures. (B) Virtual simulation of the process of vein conduit degeneration. ⓐ Conventional technique with insertion of a triangular native PV wall showing marked shrinkage at the mid-portion of the conduit. ⓑ Modified technique, showing that the inserted rectangular native PV wall works as a buttress to prevent excessive shrinkage at the mid-portion of the PV conduit. (C) Simulation of the procedures for modified patch-conduit venoplasty. ⓐ Full-length longitudinal incision of the native PV to the superior mesenteric vein-splenic vein confluence. ⓑ Complete longitudinal incision of the vein conduit portion to make a rectangular patch. ⓒ Anastomosis of the opened native PV stump and opened vein conduit with continuous running sutures. The native PV wall was inserted into the incised vein conduit like a longitudinal patch. (D) Comparison of the reconstructed PV diameter according to the size of vein patch. ⓐ A narrow patch can enlarge the PV diameter only by 50% or less. ⓑ A patch greater than 1 cm can enlarge the PV diameter two-fold.
