Portomesenteric Reconstruction During Whipple Procedures: Review and Report of a Case

Abstract

A 60-year-old man undergoing a Whipple procedure to treat a pancreatic cancer was found to have tumor adherence to the portal vein. An en block pancreaticoduodenectomy with segmental portal vein resection (PVR) was performed. A primary portal vein anastomosis was initially attempted but failed. Hemodynamic deterioration led the authors to perform a temporary prosthetic portal vein interposition graft and abdominal closure. The following morning, once stable, the patient was brought back to the operating room for autologous reconstruction with femoral vein and completion of the pancreaticoduodenectomy. The role of PVR for vein invasion or tumor adherence during a Whipple procedure is still under debate. However, there is growing evidence that the perioperative morbidity and long-term survival in patients who undergo a pancreaticoduodenectomy with PVR are similar to those of patients without vein resection. Therefore a combined resection of the pancreatic head and the portal vein has been suggested in the absence of other contraindications for resection to be able to offer a curative surgical intervention to a larger number of patients. The authors herein report the details of a patient's case and also review the currently available methods for PVR and reconstruction.

Portalvein reconstruction with a cadaveric descending thoracic aortic homograft

“…Many conduits used as interposition venous grafts have been described, including an autologous vein graft such as a spiral great saphenous vein, 13 femoral vein, 14 external iliac vein, 15 left renal vein and internal jugular vein, 16 and a synthetic graft. 8 In the present series, we used a portion of the CDTA as an allogeneic (but nonimmunogenic owing to the sterilization processes) conduit to restore PV/SMV continuity.…”

“… 6 Since its first description, this particular surgical technique has been further refined, and other conduits have been used. 7 , 8 However, no consensus has been reached regarding the best alternate conduit for portal–mesenteric vein reconstruction in the setting of pancreatic resection for pancreatic cancer.…”

Splenic Vein Turndown Repair in Superior Mesenteric Vein Trauma: A Reasonable Alternative

“…A list of potential conduits and an algorithm for the use of the splenic vein turndown method are provided in Table 1 and Figure 4. 9 The splenic vein turndown has been reported only 5 other times in the literature, with only 1 other used in blunt trauma (Table 2). [10][11][12][13] Of the combined 6 reported cases, 4 patients survived.…”

Aneurysmal Degeneration of Deep Lower Extremity Vein Conduits Used for Vascular Reconstruction

“…[1][2][3][4][5][6] The morbidity related to FPV graft procedures has been well studied; most notable complications include graft stenosis or thrombosis, 5,7 compartment syndrome, venous stasis, 8 thromboembolism, and limb loss. 9 Aneurysmal degeneration of vein grafts most commonly involves thin-walled pseudoaneurysms at anastomotic sites.…”

“…Since the first reports of the use of femoropopliteal vein (FPV) grafts for vascular reconstruction, successful outcomes have been described with their use in a variety of vascular beds. [1][2][3][4][5][6] The morbidity related to FPV graft procedures has been well studied; most notable complications include graft stenosis or thrombosis, 5,7 compartment syndrome, venous stasis, 8 thromboembolism, and limb loss. 9 Aneurysmal degeneration of vein grafts most commonly involves thin-walled pseudoaneurysms at anastomotic sites.…”