Abstract
Background
When the mesenterico-portal vein is stenosed due to tumor related compression, venous collaterals develop and flow occurs antegrade towards the portal vein through the collateral tributaries. Undertaking pancreatoduodenectomy for pancreatic cancer in this setting may result in significant blood loss during the process of ligation of these tributaries.
Description of technique
We describe the technique of endovascular stenting of the mesenterico-portal vein to reduce flow within these collateral tributaries and hence blood loss, to facilitate extended pancreatoduodenectomy and vein resection.
Conclusion
Percutaneous transhepatic placement of endovascular stent into a stenotic mesentero-portal vein facilitates pancreatoduodenectomy by reducing operative time, which would otherwise be required in dealing with the extensive venous collaterals and hence also reducing blood loss.
Similar content being viewed by others
References
Jemal A, Siegel R, Xu J, Ward E (2010) Cancer statistics. CA Cancer J Clin 60(5):277–300
Riall TS, Cameron JL, Lillemoe KD, Winter JM, Campbell KA, Hruban RH et al (2006) Resected periampullary adenocarcinoma: 5-year survivors and their 6- to 10-year follow-up. Surgery 140(5):764–772
Alvarado-Bachmann R, Choi J, Gananadha S, Hugh TJ, Samra JS (2010) The infracolic approach to pancreatoduodenectomy for large pancreatic head tumours invading the colon. Eur J Surg Oncol 36(12):1220–1224
Wang F, Arianayagam R, Gill A, Puttaswamy V, Neale M, Gananadha S et al (2012) Grafts for mesenterico-portal vein resections can be avoided during pancreatoduodenectomy. J Am Coll Surg 215(4):569–579
Bockhorn M, Uzunoglu FG, Adham M, Imrie C, Milicevic M, Sandberg AA et al (2014) Borderline resectable pancreatic cancer: a consensus statement by the International Study Group of Pancreatic Surgery (ISGPS). Surgery 155(6):977–988
Izbicki JR, Yekebas EF, Strate T, Eisenberger CF, Hosch SB, Steffani K et al (2002) Extrahepatic portal hypertension in chronic pancreatitis: an old problem revisited. Ann Surg 236(1):82–89
Grootjans J, Lenaerts K, Derikx JP, Matthijsen RA, de Bruïne AP, van Bijnen AA et al (2010) Human intestinal ischemia-reperfusion-induced inflammation characterized: experiences from a new translational model. Am J Pathol 176(5):2283–2291
Nakao A, Kanzaki A, Fujii T, Kodera Y, Yamada S, Sugimoto H et al (2012) Correlation between radiographic classification and pathological grade of portal vein wall invasion in pancreatic head cancer. Ann Surg 255(1):103–108
Lu DSRH, Krasny RM, Kadell BM, Sayre J (1997) Local staging of pancreatic cancer: criteria for unresectability of major vessels as revealed by pancreatic-phase, thin-section helical CT. AJR Am J Roentgenol 168(6):1439–1443
Yamakado K, Nakatsuka A, Tanaka N, Fujii A, Terada N, Takeda K (2001) Malignant portal venous obstructions treated by stent placement: significant factors affecting patency. J Vasc Interv Radiol 12:1407–1415
Zhou ZQ, Lee JH, Song KB, Hwang JW, Kim SC, Lee YJ et al (2014) Clinical usefulness of portal venous stent in hepatobiliary pancreatic cancers. ANZ J Surg 84(5):346–352
Nakao A, Takagi H (1993) Isolated pancreatectomy for pancreatic head carcinoma using catheter bypass of the portal vein. Hepatogastroenterology 40(5):426–429
Siriwardana HP, Siriwardena AK (2006) Systematic review of outcome of synchronous portal-superior mesenteric vein resection during pancreatectomy for cancer. Br J Surg 93:662–673
Conflicts of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Chua, T.C., Wang, F., Maher, R. et al. Endovascular stenting of mesenterico-portal vein stenosis to reduce blood flow through venous collaterals prior to pancreatoduodenectomy. Langenbecks Arch Surg 400, 629–631 (2015). https://doi.org/10.1007/s00423-015-1307-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00423-015-1307-x