Vascular resection (portal vein, superior mesenteric vein, and hepatic artery) in HPB surgery

2005 ◽  
Vol 9 (4) ◽  
pp. 559-559
Author(s):  
E VICENTE ◽  
Y QUIJANO ◽  
C LOINAZ ◽  
C MONROY ◽  
I PRIETO ◽  
...  
Keyword(s):  
Portal Vein ◽  
Hepatic Artery ◽  
Superior Mesenteric Vein ◽  
Vascular Resection ◽  
Mesenteric Vein

scholarly journals Pancreaticoduodenectomy for ductal adenocarcinoma of the pancreatic head with venous resection

2016 ◽  
Vol 50 (3) ◽  
pp. 321-328 ◽  
Author(s):  
Vojko Flis ◽  
Stojan Potrc ◽  
Nina Kobilica ◽  
Arpad Ivanecz
Keyword(s):  
Portal Vein ◽  
Superior Mesenteric Vein ◽  
Splenic Vein ◽  
Vascular Resection ◽  
Synthetic Graft ◽  
En Bloc ◽  
Venous Reconstruction ◽  
Interposition Graft ◽  
Mesenteric Vein ◽  
Vein Resection

Abstract Background Recent reports have shown that patients with vascular tumour invasion who undergo concurrent vascular resection can achieve long-term survival rates equivalent to those without vascular involvement requiring pancreaticoduodenectomy alone. There is no consensus about which patients benefit from the portal-superior mesenteric vein resection and there is no consensus about the best surgical technique of vessel reconstruction (resection with or without graft reconstruction). As published series are small the aim of this study was to evaluate our experience in pancreatectomies with en bloc vascular resection and reconstruction of vessels. Methods Review of database at University Clinical Centre Maribor identified 133 patients (average age 65.4 ± 8.6 years, 69 female patients) who underwent pancreatoduodenectomy between January 2006 and August 2014. Clinical data, operative results, pathological findings and postoperative outcomes were collected prospectively and analyzed. Current literature and our experience in pancreatectomies with en bloc vascular resection and reconstruction of portal vein are reviewed. Results Twenty-two patients out of 133 (16.5%) had portal vein-superior mesenteric vein resection and portal vein reconstruction (PVR) during pancreaticoduodenectomy. In fourteen patients portal vein was reconstructed without the use of synthetic vascular graft. In these series two types of venous reconstruction were performed. When tumour involvement was limited to the superior mesenteric vein (SPV) or portal vein (PV) such that the splenic vein could be preserved, and vessels could be approximated without tension a primary end-to-end anastomosis was performed. When tumour involved the SMV-splenic vein confluence, splenic vein ligation was necessary. In the remaining eight procedures interposition graft was needed. Dacron grafts with 10 mm diameter were used. There was no infection after dacron grafting. One patient had portal vein thrombosis after surgery: it was thrombosis after primary reconstruction. There were no thromboses in patients with synthetic graft interposition. There were no significant differences in postoperative morbidity, mortality or grades of complication between groups of patients with or without a PVR. Median survival time in months was in a group with vein resection 16.13 months and in a group without vein resection 15.17 months. Five year survival in the group without vein resection was 19.5%. Comparison of survival curves showed equal hazard rates with log-rank p = 0.090. Conclusions Survival of patients with pancreatic cancer who undergo an R0 resection with reconstruction was comparable to those who have a standard pancreaticoduodenectomy with no added mortality or morbidity. Synthetic graft appeared to be an effective and safe option as an interposition graft for portomesenteric venous reconstruction after pancreaticoduodenectomy.

scholarly journals 5-HT causes splanchnic venodilation

2017 ◽  
Vol 313 (3) ◽  
pp. H676-H686 ◽  
Author(s):  
Bridget M. Seitz ◽  
Hakan S. Orer ◽  
Teresa Krieger-Burke ◽  
Emma S. Darios ◽  
Janice M. Thompson ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Inferior Vena Cava ◽  
Portal Vein ◽  
Superior Mesenteric Vein ◽  
Inferior Vena ◽  
Vena Cava ◽  
Receptor Protein ◽  
Mesenteric Vein

Serotonin [5-hydroxytryptamine (5-HT)] causes relaxation of the isolated superior mesenteric vein, a splanchnic blood vessel, through activation of the 5-HT7 receptor. As part of studies designed to identify the mechanism(s) through which chronic (≥24 h) infusion of 5-HT lowers blood pressure, we tested the hypothesis that 5-HT causes in vitro and in vivo splanchnic venodilation that is 5-HT7 receptor dependent. In tissue baths for measurement of isometric contraction, the portal vein and abdominal inferior vena cava relaxed to 5-HT and the 5-HT1/7 receptor agonist 5-carboxamidotryptamine; relaxation was abolished by the 5-HT7 receptor antagonist SB-269970. Western blot analyses showed that the abdominal inferior vena cava and portal vein express 5-HT7 receptor protein. In contrast, the thoracic vena cava, outside the splanchnic circulation, did not relax to serotonergic agonists and exhibited minimal expression of the 5-HT7 receptor. Male Sprague-Dawley rats with chronically implanted radiotelemetry transmitters underwent repeated ultrasound imaging of abdominal vessels. After baseline imaging, minipumps containing vehicle (saline) or 5-HT (25 μg·kg−1·min−1) were implanted. Twenty-four hours later, venous diameters were increased in rats with 5-HT-infusion (percent increase from baseline: superior mesenteric vein, 17.5 ± 1.9; portal vein, 17.7 ± 1.8; and abdominal inferior vena cava, 46.9 ± 8.0) while arterial pressure was decreased (~13 mmHg). Measures returned to baseline after infusion termination. In a separate group of animals, treatment with SB-269970 (3 mg/kg iv) prevented the splanchnic venodilation and fall in blood pressure during 24 h of 5-HT infusion. Thus, 5-HT causes 5-HT7 receptor-dependent splanchnic venous dilation associated with a fall in blood pressure. NEW & NOTEWORTHY This research is noteworthy because it combines and links, through the 5-HT7 receptor, an in vitro observation (venorelaxation) with in vivo events (venodilation and fall in blood pressure). This supports the idea that splanchnic venodilation plays a role in blood pressure regulation.

scholarly journals Splenic vein reconstruction is unnecessary in pancreatoduodenectomy combined with resection of the superior mesenteric vein–portal vein confluence according to short-term outcomes

HPB ◽  
2017 ◽  
Vol 19 (9) ◽  
pp. 785-792 ◽  
Author(s):  
Haruyoshi Tanaka ◽  
Akimasa Nakao ◽  
Kenji Oshima ◽  
Kiyotsugu Iede ◽  
Yukiko Oshima ◽  
...  
Keyword(s):  
Portal Vein ◽  
Superior Mesenteric Vein ◽  
Splenic Vein ◽  
Short Term ◽  
Mesenteric Vein

Portal Vein Thrombosis after Laparoscopic Colectomy: Thrombolytic Therapy via the Superior Mesenteric Vein

2005 ◽  
Vol 71 (10) ◽  
pp. 856-860 ◽  
Author(s):  
George A. Poultsides ◽  
W. Cannon Lewis ◽  
Robert Feld ◽  
David L. Walters ◽  
David A. Cherry ◽  
...  
Keyword(s):  
Portal Vein ◽  
Thrombolytic Therapy ◽  
Venous Thrombosis ◽  
Portal Vein Thrombosis ◽  
Superior Mesenteric Vein ◽  
Right Hemicolectomy ◽  
Published Data ◽  
Mesenteric Vein ◽  
Vein Thrombosis ◽  
Laparoscopic Assisted

Portal vein thrombosis is a rare but well-reported complication after laparoscopic surgery. We present a case of portomesenteric venous thrombosis that occurred 8 days after a laparoscopic-assisted right hemicolectomy. Systemic anticoagulation failed to improve symptoms. The early postoperative state precluded the use of transarterial thrombolytic therapy. Transjugular intra-hepatic catheter-directed infusion of urokinase into the superior mesenteric vein resulted in clearance of thrombus and resolution of symptoms. The published data on laparoscopy-induced splanchnic venous thrombosis and transjugular intrahepatic intramesenteric thrombolysis are discussed.

Contribution of Superior Mesenteric Vein Flow to the Right and Left Lobes of the Liver Using CFD

2009 ◽  
Author(s):  
Stephanie M. George ◽  
Diego R. Martin ◽  
Don P. Giddens
Keyword(s):  
Portal Vein ◽  
Superior Mesenteric Vein ◽  
Splenic Vein ◽  
Normal Subjects ◽  
Diagnostic Techniques ◽  
Mesenteric Vein ◽  
Right Lobe ◽  
Computational Fluid Dynamics Cfd ◽  
The Right ◽  
End Stage

The incidence of cirrhosis, the end stage for many liver diseases, is rising and with it the need for better understanding of the progression of the disease and diagnostic techniques. The authors have noted that liver disease occurs preferentially in the right side of the liver which is the largest lobe. One hypothesis is that this is due to the composition of the blood that supplies the right lobe. The liver is fed by both the hepatic artery and the portal vein with the portal vein contributing about 80% of the blood supply. The portal vein (PV) is supplied by the superior mesenteric vein (SMV), which drains blood from the digestive track, and the splenic vein (SV), which drains blood from the spleen. Since the blood in the SMV is coming from the digestive track, it carries toxins and items absorbed during digestion. Toxins such as alcohol are known to damage the liver. Thus, our hypothesis is that the majority of the SMV flow feeds into the right portal vein and ultimately the right lobe of the liver. This study seeks to assess the validity of our hypothesis in four subjects by creating subject specific models in two normal subjects and two patients and using computational fluid dynamics (CFD) to calculate the SMV contribution to the right portal vein.

scholarly journals A Case of Superior Mesenteric Vein and Portal Vein Thrombosis Associated with Normal Delivery Presented by Acute Pancreatitis

2008 ◽  
Vol 31 (1) ◽  
pp. 41
Author(s):  
Youn Ju Na ◽  
Min Jung Kang ◽  
Ji Min Jung ◽  
Chang Yoon Ha ◽  
Hae Sun Jung ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
Superior Mesenteric Vein ◽  
Normal Delivery ◽  
Mesenteric Vein ◽  
Vein Thrombosis

scholarly journals Major hepatectomy with concomitant vascular resection (portal vein and/or hepatic artery) for perihilar cholangiocarcinoma

HPB ◽  
2019 ◽  
Vol 21 ◽  
pp. S1014
Author(s):  
T. Noji ◽  
K. Okamura ◽  
K. Tanaka ◽  
Y. Nakanishi ◽  
T. Asano ◽  
...  
Keyword(s):  
Portal Vein ◽  
Hepatic Artery ◽  
Major Hepatectomy ◽  
Perihilar Cholangiocarcinoma ◽  
Vascular Resection

The use of an interposed graft during portal vein and/or superior mesenteric vein reconstruction in pancreatic resection for pancreatic cancer.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 482-482 ◽  
Author(s):  
Hiroki Yamaue ◽  
Seiko Hirono ◽  
Manabu Kawai ◽  
Ken-Ichi Okada ◽  
Motoki Miyazawa ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Portal Vein ◽  
Superior Mesenteric Vein ◽  
Iliac Vein ◽  
Mesenteric Vein ◽  
Venous Grafts ◽  
Periampullary Tumors ◽  
Mean Size ◽  
Short And Long Term

482 Background: Combined portal vein and/or superior mesenteric vein (PV/SMV) resection with pancreatectomy sometimes leads to prolonged survival for patients with periampullary tumors. In this study, we evaluated outcomes of patients with PV/SMV reconstruction, and we considered indications for the use of a graft during this procedure. Methods: We performed PV/SMV resection with pancreatectomy in 128 patients with periampullary tumors, including 14 using grafts. Short and long-term outcomes associated with PV/SMV reconstruction and harvesting venous grafts and reconstructed PV/SMV patency during follow-up were assessed. Results: Of the 128 patients with periampullary tumors, 5 underwent total pancreatectomy, 99 pancreaticoduodenectomy, and 24 distal pancreatectomy. In the 14 patients who underwent PV/SMV reconstruction with grafts, the grafts were harvested from external iliac vein in 10 patients and internal jugular vein in the other 4. Five patients (3.9%) had intraoperative or postoperative acute thrombus or stenosis of reconstructed PV/SMV after direct end-to-end anastomosis. However, PV/SMV patency was excellent after reconstruction using grafts. Among 228 patients with common pancreatic cancer, there were no significant differences in overall survival (OS) between the patients with PV/SMV resection (n=99) and without PV/SMV resection (n=206) (P=0.354), although the lymph node metastasis rates in the patients with PV/SMV resection were higher than those without PV/SMV resection (78.8 vs. 64.6%, P=0.012). Furthermore, the tumor size in the patients with the use of a graft was larger than that without a graft (Mean size; 40.5 vs. 29.3 mm, P=0.047), and the R0 rates and OS were not different between the patients with and without a graft (R0 rates; 50 vs. 73%, P=0.129 and OS; 23.4 vs. 16.6 months, P=0.323). Conclusions: Depending on the length and/or position of the removed PV/SMV segment, an interposed graft may be required for reconstruction in some patients.

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