Portal/Superior Mesenteric Vein Reconstruction during Pancreatic Resection Using a Cryopreserved Arterial Homograft

Abstract

Background: Portal-superior mesenteric vein (PV/SMV) resection during pancreatic resection has been widely applied in clinical practice. Methods: From a prospective data base of pancreatic resections, patients undergoing PV/SMV resection and reconstruction with a cryopreserved arterial homograft were extracted with the aim of evaluating the safety, feasibility and reproducibility of the procedure. Data regarding patient demographics, preoperative staging, surgery, histopathology and postoperative outcomes were analyzed. Results: Five patients were extracted in the last year. Indications for this technique were type IV-V degree of vein involvement and a 3.5 cm median length of vein infiltration. Median operative and clamping times were satisfactory (385 and 27 min, respectively), postoperative outcomes were good and there was no graft infection, thrombosis or stenosis occurred postoperatively and during the follow-up period. Conclusion: The use of a cryopreserved arterial homograft for PV/SMV reconstruction after pancreatic resection seems to be a feasible, safe and easily reproducible surgical technique in high-volume specialized centers and can be added to the pool of surgical solutions in selected patients.

Pancreatoduodenectomy combined with portal-superior mesenteric vein resection and reconstruction with interposition grafts for cancer: a meta-analysis

“…Of these, 51 studies were excluded due to insufficient data of key outcomes. Additionally, 5 studies lacked a control group [ 20 , 25 – 29 ]. In 2 studies, data were extracted from the same institution [ 21 , 28 ].…”

“…However, when primary end-to-end anastomosis has a risk of stenosis or over-tension of the PV-SMV reconstruction, an interposed graft is necessary [ 5 ]. Autologous veins [ 17 , 18 ], prosthetic veins [ 11 , 19 ], and allograft veins [ 20 , 21 ] have been used in PV-SMV reconstruction, and the most appropriate interposed grafts for PV-SMV reconstruction after PD remains controversial. Because of the risk of developing a postoperative or long-term PV-SMV thrombus leading to bowel ischemia, sepsis, or death [ 22 – 24 ], it also remains controversial which patients are indicated for use of an interposed graft for PV-SMV reconstruction when undergoing PD with venous resection to promote postoperative and long-term PV-SMV thrombus.…”

Portal vein reconstruction with interposition of cryopreserved aortic graft: A case report and literature review

“…In order to minimize the risks of perioperative complications, multiple types of reconstructions have been proposed including: autologous vein, cadaveric arterial or venous grafts, bovine pericardial or synthetic grafts such as Gore-Tex, polytetrafluoroethylene or Dacron prostheses (18). Whenever a venous graft of a synthetic prosthesis is used, there is a significant risk of graft thrombosis which might reach 17% of cases, depending on the extent of resection, timing and graft harvesting and type of reconstruction (19)(20)(21)(22).…”

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

“…Cases presenting a low degree of venous invasion primary end to end anastomosis or even venorrhaphy have shown good results, while cases presenting more extended venous resections require grafts (4,5,(14)(15)(16). 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).…”