肝静脉-下腔静脉汇流处的静脉阻塞在需要进行相关肝切除的情况下可能特别具有挑战性。在这种情况下，可以使用全血管排斥（TVE）与静脉-静脉旁路（VVB）和低温原位灌注（HP）来进行治疗。方法：患者为58岁，患有侵袭肾脏、右肝和肝静脉汇合处有血管内血栓延伸的大体积肾上腺癌。计划进行右肝切除，切除范围延伸到分段1、右肾和肝上腔下腔静脉。在TVE、VVB和左侧肝低温灌注的条件下进行肝实质切割，以减少术中失血和术后肝功能衰竭的风险。利用环形 Gore-Tex 假体与左侧肾静脉重新植入实现下腔静脉重建。静脉-静脉旁路和肝血管排斥的总持续时间分别为2小时40分钟和2小时10分钟。患者在术后第17天出院。全血管排斥与静脉-静脉旁路和原位肝低温灌注增加了需要复杂血管重建的重大肝切除术的安全性。我们的机构在以下情况下使用VVB和未来肝脏残留物的HP进行TVE：（1）TVE持续时间超过30分钟；（2）需要血管重建；（3）存在静脉阻塞；（4）存在受损的肝组织；（5）存在心血管合并症。© 2023. 外科肿瘤学会。

Venous obstruction at the hepatic veins-inferior vena cava confluence can be particularly challenging to manage if an associated liver resection is needed. Total vascular exclusion (TVE) with veno-venous bypass (VVB) and hypothermic in situ perfusion (HP) of the future liver remnant can be used in these conditions.1,2 METHODS: The patient was a 58-year-old with a voluminous adrenal cancer invading the kidney, the right liver and the retrohepatic inferior vena cava with intraluminal thrombus extending up to the hepatic veins confluence. A right hepatectomy, extended to segment 1, the right kidney, and the retrohepatic inferior vena cava was planned.The parenchymal liver transection was performed under a TVE, VVB, and HP of the left liver to decrease blood losses and risk of postoperative liver failure. Vena cava reconstruction was achieved by a ringed Gore-Tex prosthesis with reimplantation of the left renal vein. Total duration of veno-venous bypass and liver vascular exclusion were 2 h 40 min and 2 h 10 min, respectively. The patient was discharged on postoperative day 17.Total vascular exclusion with veno-venous bypass and in-situ liver hypothermic perfusion increases the safety of major liver resection requiring complex vascular reconstruction.1,2 TVE under VVB and HP of the future liver remnant is used at our institution when: (1) TVE will last more than 30 min; (2) vascular reconstruction is needed; (3) in the presence of venous obstruction; (4) in the presence of injured liver parenchyma; and (5) in the presence of cardiovascular comorbidities.© 2023. Society of Surgical Oncology.