Abstract
Background and aims
Segmental resection of major hepatic veins or the portal vein is sometimes required if one is to secure adequate surgical margins from hepatic or pancreatic malignancies. An external iliac vein is widely sacrificed as a vein graft to replace the defect, but this is associated with postoperative edema of the lower leg. We developed a new method for constructing the great saphenous vein to interpose the hepatic or portal veins.
Patients and methods
The great saphenous vein was divided transversely into three sections, which were aligned side-to-side. The three pieces were anastomosed to make a sheet 3 × 2 cm, which was rolled up into a cylindrical form of approximately 1 cm in diameter and 2 cm in length. We applied the finished vein grafts to interpose the major hepatic veins in three patients with metastatic liver tumors and the portal vein in two patients with pancreatic malignancies in cylindrical form and to reconstruct the portal vein in one patient with a pancreas cancer, using a three-row sheet as a patch graft.
Results
No patient developed venous thrombosis of the graft or edema of the lower leg.
Conclusions
The newly customized vein graft was safe and useful for the reconstruction of the major hepatic or portal veins.
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References
Nakamura S, Sakiguchi S, Kitazawa T, Suzuki S, Koyano K, Muro H (1990) Hepatic vein reconstruction for preserving remnant liver function. Arch Surg 125:1455–1459
Nakamura S, Sakaguchi S, Hachiya T, Suzuki S, Nishiyama R, Konnno H, Muro H, Baba S (1993) Significance of hepatic vein reconstruction in hepatectomy. Surgery 114:59–64
Urayama H, Katada S, Matsumoto I, Ishida F, Ohmura K, Watanabe Y, Muroki T (1993) Reconstruction of jugular and portal blood flows using remodeled great saphenous vein grafts. Surg Today 23:936–938
Doty DB, Baker WH (1976) Bypass of superior vena cava with spiral vein graft. Ann Thorac Surg 22:490–493
Kaneoka Y, Yamaguchi A, Isogai M, Hori A (2000) Hepatic vein reconstruction by external iliac vein graft using vascular clips. World J Surg 24:377–382
Kubota K, Makuuchi M, Sugawara Y, Midorikawa Y, Sakamoto Y, Takayama T, Harihara Y (1998) Reconstruction of the hepatic and portal veins using a patch graft from the right ovarian vein. Am J Surg 176:295–297
Miyazaki M, Itoh H, Kaiho T, Ambiru S, Togawa A, Sasada K, Shiobara M, Shimizu Y, Yoshioka S, Yoshitome H, Nakajima N (1995) Portal vein reconstruction at the hepatic hilus using a left renal vein graft. J Am Coll Surg 180:497–498
McCullough DL, Gitles RF (1975) Ligation of the renal vein in the solitary kidney. J Urol 113:295–298
Shinohara H, Morisawa S, Toshima M, Mizukami S (1990) Distribution of valves in the great saphenous vein; its clinical implications. Okajimas Folia Anat Jpn 67:219–222
Makuuchi M, Hasegawa H, Yamazaki S, Takayasu K (1987) Four new hepatectomy procedures for resection of the right hepatic vein and preservation of the inferior right hepatic vein. Surg Gynecol Obstet 164:69–72
Takayama T, Nakatsuka T, Yamamoto J, Shimada K, Kosuge T, Yamasaki S, Kakazu T, Makuuchi M (1996) Re-reconstruction of a single remnant hepatic vein. Br J Surg 83:762–763
Kakazu T, Makuuchi M, Kawasaki S, Miyagawa S, Nakazawa Y, Kubota T, Takayama T, Kusuge T (1995) Reconstruction of the middle hepatic vein tributary during right anterior segmentectomy. Surgery 117:238–240
Lasinski W, Zientarski B (1976) The anastomotic system of sub-hepatic veins in man. Bull Assoc Anat 60:559–560
Murata S, Itai Y, Asato M, Kobayashi H, Nakajima K, Eguchi N, Saida Y, Kuramoto K, Tohno E (1995) Effect of temporary occlusion of the hepatic vein on dual blood supply in the liver: evaluation with spiral CT. Radiology 197:351–356
Sano K, Makuuchi M, Miki K, Maema A, Sugawara Y, Imamura H, Matsunami H, Takayama T (2002) Evaluation of hepatic venous congestion: proposed indication criteria for hepatic vein reconstruction. Ann Surg 236:241–247
Yamamoto J, Kosuge T, Shimada K, Yamasaki S, Moriya Y, Sugihara K (1999) Repeat liver resection for recurrent colorectal liver metastases. Am J Surg 178:275–281
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Sakamoto, Y., Yamamoto, J., Saiura, A. et al. Reconstruction of hepatic or portal veins by use of newly customized great saphenous vein grafts. Langenbecks Arch Surg 389, 110–113 (2004). https://doi.org/10.1007/s00423-003-0452-9
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DOI: https://doi.org/10.1007/s00423-003-0452-9