Isolated bowel transplant with aortic and caval vascular conduits

Background: Although bowel transplantation has been an accepted surgical procedure for several decades, there is no standard approach to establishing the arterial inflow and venous outflow. Use of the pancreas and bowel grafts from an individual donor can be challenging given that both rely on revascularization through the superior mesenteric artery (SMA) and superior mesenteric vein (SMV). In this video we present a case of an isolated bowel transplant in which the arterial inflow and venous outflow were established using donor arterial and venous interposition grafts. Results: A 22-year-old woman had a traumatic avulsion of the SMA and SMV. She was left with 30cm of jejunum, transverse colon, descending colon, and rectum. The donor intestine is separated from the pancreas so that both can be used in separate recipients. This is achieved by carefully preserving the inferior pancreaticoduodenal artery on the pancreas side and middle colic artery on the intestinal side. In the recipient operation, vascular grafts are attached to the inferior vena cava and infrarenal aorta. With vascular grafts in place, the bowel graft is easy to orient and vascular anatomosis of SMA and SMV are straightforward and fast. Conclusion: The use of jump grafts in intestinal transplantation preserves vessel length for use of both the pancreas and bowel grafts in separate recipients. Given the limited number of suitable deceased donors, this approach allows for greater utilization of a limited resource without compromising the recipient operation.