Cold-stored cadaveric venous allograft for superior mesenteric/portal vein reconstruction during pancreatic surgery

Abstract

Cold-stored cadaveric venous AG for SMV/PV reconstruction during pancreatic surgery is safe and associated with acceptable long-term patency.

Superior Mesenteric and Portal Vein Reconstruction With Cadaveric Allograft During Pancreatoduodenectomy – A Case Report and Literature Review

“…Concerning the type of grafts, these range from autologous grafts consisting of i) saphenous, ii) superficial femoral, iii) iliac, iv) internal jugular vein or v) even gonadal veins to synthetic grafts, such as polytetrafluoroethylene grafts or arterial cryopreserved allografts (4,5,(20)(21)(22). The use of venous cadaveric allografts is, on the other hand, rarely reported (23)(24)(25). The maximum length of the resected segment required to establish the contiguity by direct anastomosis and not by graft interposition has been strongly debated.…”

“…One of the largest studies which were focused on the subject of cadaveric venous allografts used for mesentericoportal reconstruction after pancreatoduodenectomy was published by the Norwegian team led by Kleive in 2016 (25). The study included 45 patients submitted to venous reconstruction of portal and superior mesenteric vein continuity by using cadaveric venous allografts; among these cases there were 16 patients who developed severe postoperative complications, reoperation being needed in four cases while intraoperative mortality was further reported in two cases (25).…”

Use of Biosurgicals in Hepatobiliary Surgery

“…This practice is currently recommended by most major surgical societies and are a part of the National Comprehensive Cancer Network (NCCN) guidelines [41,42]. The ideal method of reconstruction is still not yet known but several options can be considered depending on the clinical situation and anatomy including primary end-to-end anastomosis, autologous interposition grafts (from internal jugular, saphenous, superficial femoral, gonadal, or external iliac veins), synthetic grafts (such as PTFE or bovine pericardium), or cadaveric allograft [43,44]. As with any other vascular anastomosis, bleeding from suture lines can put the anastomosis at risk as well as prolong operative time.…”

Surgical strategies and novel therapies for locally advanced pancreatic cancer

“…These include, in addition to primary repair, the use of a patch of bovine pericardium, a peritoneal Dokmak patch, left renal vein, internal jugular, external iliac or saphenous vein grafts, or synthetic PTFE grafts . The use of cold‐stored cadaveric venous allografts, though described, is not commonly used due to institutional restrictions on the use of such materials in non‐transplant patients. If needed, the splenic vein can be ligated as patterns of venous collateralization after extended PD with ligation of the splenic vein do not appear to result in sinistral hypertension, especially if collateral flow can be ensured through the coronary vein or the inferior mesenteric vein …”

“…These include, in addition to primary repair, 12 the use of a patch of bovine pericardium, a peritoneal Dokmak patch, 13,14 left renal vein, internal jugular, external iliac or saphenous vein grafts, 15 or synthetic PTFE grafts. 16 The use of cold-stored cadaveric venous allografts, 17 or the inferior mesenteric vein. 18,19 Meta-analyzed estimates from two randomized trials comparing VR at PD with palliative bypasses and chemotherpay support the conclusion that this approach increases long term survival, despite the cost of perioperative morbidity and mortality: while no patients treated with palliative bypass and chemotherapy are alive at 2 years, almost 40% of patients treated with VR at PD were alive at 3 years.…”