Innominate Artery Interposition Graft Simplifies the Portal Venous Drainage Method of Pancreas Transplantation

Abstract

Pancreas transplantation utilizing portal venous and enteric exocrine drainage has potential benefits over the standard systemic venous and bladder exocrine drainage method. Unfortunately, technical difficulties are often experienced with the arterial anastomosis after the portal venous anastomosis is completed. We have found that the addition of an innominate artery interposition graft has greatly simplified the procedure.

Extended Donor Iliac Arterial Patch for Vascular Reconstruction During Pancreas Transplantation

“…During portal‐drained pancreatic transplantation, achieving adequate exposure to join the Y‐graft and right common iliac arteries can produce substantial anastomotic tension. Bigam et al greatly simplified the procedure by first joining a segment of brachiocephalic artery end‐to‐side to the recipient iliac artery, then subsequently performing a Y‐graft‐to‐brachiocephalic anastomosis in a much easier position out of the pelvis (Figure 2D) (7); this technique might also be useful when the arterial anastomosis must be distally or deeply positioned on the iliac arterial system secondary to proximal vessel disease.…”

Methods of arterial reconstruction for pancreatic graft

“…В таких случаях Bigam предложил формировать дополнительный анастомоз между донорским плечеголовным стволом и участком подвздошной артерии реципиента, после чего восстанавливать кровоснабжение трансплантата с помощью соединения плечеголовного ствола и Y-graft по типу «конец в конец» (рис. 5) [18]. Во время мультиорганного изъятия хирурги пересекали общую печеночную артерию после разделения чревного ствола, что позволяло им оставлять селезеночную и верхнюю брыжеечную артерии с чревным стволом на одной площадке с участком аорты (рис.…”

Pancreatic transplantation: Beta cell replacement

“…The pancreas is anastomosed to the recipient's right common iliac artery for inflow and superior mesenteric vein for outflow. The donor duodenum, which is kept enbloc with the pancreas, is anastomosed to a loop of jejunum [19]. Complications Potential complications of pancreas alone transplantation include surgical site infections or pancreatitis necessitating second look laparotomy and lavage in about 20% of cases, anastomotic leak from the duodenojejunostomy site (rare), cytomegalovirus related graft pancreatitis, portal vein thrombosis or thrombosis of the arterial jump graft, and abdominal dehiscence (a recognized complication in obese pancreas transplant recipients -increased risk with the use of either high dose steroid or sirolimus therapy).…”

“…2). The donor duodenum , kept enbloc with the pancreas, is anastomosed to a loop of jejunum [19]. The kidney is placed in retroperitoneal position in the left iliac fossa with arterial inflow from the external iliac artery and venous outflow to the external iliac vein.…”