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Domino Reconstruction of the Portal Vein Using the External Iliac Vein and an ePTFE Graft in Pancreatic Surgery

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

In the portal vein resection of long distance, an interposition by autologous vein is mandatory. External iliac vein (EIV) has been used, but harvesting the EIV is associated with severe venous congestion of the affected lower extremity. We have reconstructed the EIV using a ringed expanded polytetrafluoroethylene (ePTFE) graft.

Methods

Thirteen patients underwent this surgery. The right EIV was used for reconstructing the portal vein, and the retrieved portion of EIV was interposed by the ePTFE graft. We evaluated size and length of the graft, graft patency, girth of thigh, time for reconstruction of EIV, and graft infection.

Results

ePTFE grafts of 8 or 10 mm in diameter were used. The length of ePTFE graft used was 4.4 ± 0.5 cm. Graft patency was kept in 76.9% patients. Graft obstruction was encountered in three patients, and the girth of right thigh increased by about 10 cm. Time for reconstruction of EIV was 29.5 ± 6.8 min. Graft infection did not occur in any patients.

Conclusions

Reconstruction of the EIV using a ringed ePTFE graft seems to be a feasible option for preventing the swelling of the affected lower extremity after procurement of EIV for repairing the portal vein.

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References

  1. Tseng JF, Raut CP, Lee JE, Pisters PW, Vauthey JN, Abdalla EK, Gomez HF, Sun CC, Crane CH, Wolff RA, Evans DB. Pancreaticoduodenectomy with vascular resection: margin status and survival duration. J Gastrointest Surg 2004;8:935–949.

    Article  PubMed  Google Scholar 

  2. Jara M, Malinowski M, Bahra M, Stockmann M, Schulz A, Pratschke J, Puhl G. Bovine pericardium for portal vein reconstruction in abdominal surgery: a surgical guide and first experiences in a single center. Dig Surg 2015;32:135–141.

    Article  PubMed  Google Scholar 

  3. Carrère N, Sauvanet A, Goere D, Kianmanesh R, Vullierme MP, Couvelard A, Ruszniewski P, Belghiti J. Pancreaticoduodenectomy with mesentericoportal vein resection for adenocarcinoma of the pancreatic head. World J Surg 2006;30:1526–1535.

    Article  PubMed  Google Scholar 

  4. Bachellier P, Nakano H, Oussoultzoglou PD, Weber JC, Boudjema K, Wolf PD, Jaeck D. Is pancreaticoduodenectomy with mesentericoportal venous resection safe and worthwhile? Am J Surg 2001;182:120–129.

    Article  CAS  PubMed  Google Scholar 

  5. Müller SA, Hartel M, Mehrabi A, Welsch T, Martin DJ, Hinz U, Schmied BM, Büchler MW. Vascular resection in pancreatic cancer surgery: survival determinants. J Gastrointest Surg 2009;13:784–792.

    Article  PubMed  Google Scholar 

  6. Smoot RL, Christein JD, Famell MB. An innovative option for venous reconstruction after pancreaticoduodenectomy: the left renal vein. J Gastrointestinal Surg 2007;11:425–431.

    Article  Google Scholar 

  7. Choudry H, Avella D, Garcia L, Han D, Staveley-O’∼Carroll K, Kimchi E. Use of the left renal vein as a practical conduit in superior mesenteric vein reconstruction. J Surg Res 2008;146:117–120.

  8. Kaneoka Y, Maeda A, Isogai M. Surgical outcomes of autologous external iliac vein grafting in cases of hepato-pancreato-biliary malignancy: how I do it. J Gastrointestinal Surg 2012;16:1590–1596.

    Article  Google Scholar 

  9. Wade TP, el Ghazzawy AG, Virgo KS, Johnson FE. The Whipple resection for cancer in U.S. Department of Veterans Affairs Hospital. Ann Surg 1995;221:241–248.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Sohn TA, Yeo CJ, Cameron JL, Koniaris L, Kaushal S, Abrams RA, Sauter PK, Coleman J, Hruban RH, Lillemoe KD. Resected adenocarcinoma of the pancreas—616 patients: results, outcomes, and prognosis indicators. J Gastrointest Surg 2000;4:567–579.

    Article  CAS  PubMed  Google Scholar 

  11. Fleming JB, Barnett CC, Clagett GP. Superficial femoral vein as a conduit for portal vein reconstruction during pancreaticoduodenectomy. Arch Surg 2005;140:698–701.

    Article  PubMed  Google Scholar 

  12. Otsuka S, Kaneoka Y, Maeda A, Takayama Y, Fukami Y, Onoe S. Hepatic artery reconstruction with a continuous suture method for hepato-biliary-pancreatic surgery. World J Surg 2016;40:951–957.

    Article  PubMed  Google Scholar 

  13. Kaneoka Y, Maeda A, Sugimoto M, Isogai M, Ishibashi H. Quality of life and the venous function of the lower limb after harvest of autologous external iliac vein grafts: a clinical follow-up study. Surg Today 2013;43:1254–1260.

    Article  PubMed  Google Scholar 

  14. Hirono S, Kawai M, Tani M, Okada K, Miyazawa M, Shimizu A, Kitahata Y, Yamaue H. Indication for the use of an interposed graft during portal vein and/or superior mesenteric vein reconstruction in pancreatic resection based on perioperative outcomes. Langenbecks Arch Surg 2014;399:461–471.

    Article  PubMed  Google Scholar 

  15. Chiu KM, Chu SH, Chen JS, Li SJ, Chan CY, Chen KS. Spiral saphenous vein graft for portal vein reconstruction in pancreatic cancer surgery. Vasc Endovascular Surg 2007;41:149–152.

    Article  PubMed  Google Scholar 

  16. Tran TB, Mell MW, Poultsides GA. An updated resource: left renal vein interposition graft for portal vein reconstruction during pancreaticoduodenectomy. Dig Dis Sci 2016 DOI: 10.1007/s10620-016-4050-4

    Google Scholar 

  17. Stauffer JA, Dougherty MK, Kim GP, Nguyen JH. Interposition graft with polytetrafluoroethylene for mesenteric and portal vein reconstruction after pancreaticoduodenectomy. Br J Surg 2009;96:247–252.

    Article  CAS  PubMed  Google Scholar 

  18. Liao K, Wang H, Chen Q, Wu Z, Zhang L. Prosthetic graft for superior mesenteric-portal vein reconstruction in pancreaticoduodenectomy: a retrospective, multicenter study. J Gastrointest Surg. 2014;18:1452–1461.

    Article  PubMed  Google Scholar 

  19. Chu CK, Farnell MB, Nguyen JH, Stauffer JA, Kooby DA, Sclabas GM, Sarmiento JM. Prosthetic graft reconstruction after portal vein resection in pancreaticoduodenectomy: a multicenter analysis. J Am Coll Surg 2010;211:316–324.

    Article  PubMed  Google Scholar 

  20. Nishibe T, Manase H, Miyazaki K, Ohkashiwa H, Satoh Y, Watanabe S, Takahashi T, Katoh H, Okuda Y, Tanabe T. Portal vein reconstruction with conventional polytetrafluoroethylene grafts: an experimental study in dogs. Surg Today 1988;28:391–395.

    Article  Google Scholar 

  21. Lindholt JS, Gottschalksen B, Johannesen N, Dueholm D, Ravn H, Christensen ED, Viddal B, Flørenes T, Pedersen G, Rasmussen M, Carstensen M, Grøndal N, Fasting H. The Scandinavian Propaten (®) trial - 1-year patency of PTFE vascular prostheses with heparin-bonded luminal surfaces compared to ordinary pure PTFE vascular prostheses - a randomised clinical controlled multi-centre trial. Eur J Vasc Endovasc Surg 2011;41:668–673.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Gastroenterological Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan

    Masato Yoshioka, Hiroshi Uchinami, Go Watanabe, Masatake Iida, Yasuhiko Nakagawa, Hideaki Miyazawa & Yuzo Yamamoto

  2. Department of Cellular and Organ Pathology, Akita University Graduate School of Medicine, Akita, Japan

    Makoto Yoshida

Authors
  1. Masato Yoshioka
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  2. Hiroshi Uchinami
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  3. Go Watanabe
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  4. Masatake Iida
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  5. Yasuhiko Nakagawa
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  6. Hideaki Miyazawa
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  7. Makoto Yoshida
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  8. Yuzo Yamamoto
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Contributions

Conceived and designed the study: Masato Yoshioka and Yuzo Yamamoto. Collection of data: Masato Yoshioka, Hiroshi Uchinami, Go Watanabe, Masatake Iida, and Makoto Yoshida. Analysis of data: All authors. Manuscript writing: Masato Yoshioka and Yuzo Yamamoto. Critical revision of the manuscript: Hiroshi Uchinami, Go Watanabe, Masatake Iida, Yasuhiko Nakagawa, Hideaki Miyazawa, and Makoto Yoshida.

All authors approved the final manuscript submitted.

Corresponding author

Correspondence to Masato Yoshioka.

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Additional information

Meeting presentation: Presented, in part, at the 51th Congress of the European Society for Surgical Research, Prague, Czech Republic, May 2016.

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Yoshioka, M., Uchinami, H., Watanabe, G. et al. Domino Reconstruction of the Portal Vein Using the External Iliac Vein and an ePTFE Graft in Pancreatic Surgery. J Gastrointest Surg 21, 1278–1286 (2017). https://doi.org/10.1007/s11605-017-3413-2

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  • DOI: https://doi.org/10.1007/s11605-017-3413-2

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