Significance of the Splenic Vein and Its Branches in Pancreatoduodenectomy with Resection of the Portal Vein System

Background/Aims: Pancreatic head carcinoma frequently invades the superior mesenteric vein (SMV) and/or portal vein (PV). We aimed to evaluate the outcome of transection of the splenic vein (SV) and inferior mesenteric vein (IMV) in pancreatoduodenectomy (PD) with SMV and/or PV resection. Methods: We retrospectively analyzed the records of 660 patients who had undergone pancreatectomy at our institution from January 2004 to October 2013, and selected 141 consecutive patients who had undergone PD with concurrent SMV/PV resection. Postoperative hypersplenism and the presence of remnant branches were evaluated. Results: The SV had been transected in 81 patients and preserved in 60. Postoperative complications and white blood cell counts were similar between the groups. The postoperative splenic volume was not significantly associated with the status of the SV or IMV on the transected SV. The platelet count was significantly lower, and the incidence of collateral veins was higher after SV transection than after SV preservation until 6 months after surgery; these variables were similar in the long term. Conclusion: SV reconstruction might be unnecessary when SV transection is required. Preservation of the IMV on the remnant SV might not prevent sinistral portal hypertension.

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Laparoscopic pancreaticoduodenectomy with segmental resection of superior mesenteric vein-splenic vein-portal vein confluence in pancreatic head cancer: can it be a standard procedure?

Annals of Hepato-Biliary-Pancreatic Surgery ◽

10.14701/ahbps.2018.22.4.419 ◽

2018 ◽

Vol 22 (4) ◽

pp. 419 ◽

Cited By ~ 4

Author(s):

Hyejin Park ◽

Incheon Kang ◽

Chang Moo Kang

Keyword(s):

Portal Vein ◽

Superior Mesenteric Vein ◽

Standard Procedure ◽

Splenic Vein ◽

Pancreatic Head ◽

Segmental Resection ◽

Laparoscopic Pancreaticoduodenectomy ◽

Head Cancer ◽

Pancreatic Head Cancer ◽

Mesenteric Vein

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Vascular variations in abdomen, face and neck in a single cadaver

National Journal of Clinical Anatomy ◽

10.1055/s-0039-3401541 ◽

2015 ◽

Vol 04 (01) ◽

pp. 035-037

Author(s):

Dolan Champa Pal ◽

Karabi Baral ◽

Jayanta Sarkar ◽

Koushik Ray

Keyword(s):

Portal Vein ◽

Splenic Vein ◽

Facial Artery ◽

Common Trunk ◽

Inferior Mesenteric Vein ◽

Vascular Variations ◽

Mesenteric Vein ◽

Hepatic Portal Vein ◽

Hepatic Portal ◽

The Right

AbstractDuring Routine dissection at Bankura Sammilani Medical College, multiple vascular variations were detected in a cadaver of 60 years aged female. Variation in formation of hepatic portal vein was present as union of splenic vein with the common trunk formed by Superior mesenteric vein & Inferior mesenteric vein. Second variations were in unilateral facial vessels, where the right facial artery terminated as superior labial artery and the right common facial vein drained into the External jugular vein. Knowledge of variant anatomy of hepatic portal vein is essential for surgical and interventional procedures because large visceral territory drained by inferior mesenteric vein. Knowledge of Facial vessels is important for maxillofacial surgeries.

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ANATOMICAL VARIANTS OF INFERIOR MESENTERIC VEIN ACCORDING ON THE DATA OF MULTISPIRAL COMPUTED TOMOGRAPHY

MORPHOLOGICAL NEWSLETTER ◽

10.20340/mv-mn.2020.28(4):444 ◽

2021 ◽

Vol 28 (4) ◽

pp. 31-37

Author(s):

Aleksandr V. Kolsanov ◽

Maksim N. Myakotnykh ◽

Aleksey A. Mironov ◽

Renat R. Yunusov

Keyword(s):

Computed Tomography ◽

Portal Vein ◽

Superior Mesenteric Vein ◽

Splenic Vein ◽

Common Trunk ◽

Inferior Mesenteric Vein ◽

Mesenteric Vein ◽

Vein Formation ◽

Vascular Bed ◽

The Common

Knowledge of the variants of the anatomical variability of the liver vascular bed can be of critical importance in liver resection, liver transplantation, laparoscopic operations, resection of the pancreas, surgical treatment of portal hypertension The main vessels of the hepatic portal vein system are characterized by pronounced anatomical variability in the formation of the portal vein trunk, the greatest variability is characterized by inferior mesenteric vein. The aim of the investigation was to study the variant anatomy of the inferior mesenteric vein according to multispiral computed tomography. The material was 100 multispiral computed tomograms of the abdominal organs from the archive of the clinics of the Samara State Medical University for 2018-2019. For mathematical modeling and the creation of three-dimensional models based on tomograms of the vascular bed, plugins were used in the programs «Luch» and «Autoplan». Variants of the portal vein formation, the angle of inflow of the inferior mesenteric vein into the superior mesenteric and splenic veins, the distance from the point of confluence of the inferior mesenteric vein to the point of confluence with the portal vein were studied. The study revealed that the inferior mesenteric vein in 40% of cases flows into the splenic vein, in 39% - into the angle of confluence of the superior mesenteric and splenic veins, in 16% - into the superior mesenteric vein. In 5% of cases, the absence of the inferior mesenteric vein was revealed. The angle of fusion of the inferior mesenteric vein with the superior mesenteric vein was statistically significantly greater than the angle of fusion of the inferior mesenteric vein with the splenic vein. The angles were 76.36 ± 1.53 ° and 64.89 ± 3.52 °, respectively (p = 0.004). The length of the common trunk of the inferior mesenteric and splenic veins was significantly greater than the common trunk of the mesenteric veins and amounted to 16.98 ± 1.09 mm and 9.37 ± 0.65 mm (p = 0.001), respectively. Thus, the study showed a high degree of anatomical variability of the inferior mesenteric vein.

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Investigation of formation variation of portal vein with multidetector computed tomography

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20192529 ◽

2019 ◽

Vol 7 (6) ◽

pp. 2369

Author(s):

Gunes Bolatli ◽

Mahinur Ulusoy ◽

Mustafa Koplay ◽

Musa Acar ◽

Ismail Zarasiz

Keyword(s):

Portal Vein ◽

Splenic Vein ◽

Anatomical Variations ◽

Inferior Mesenteric Vein ◽

Anatomic Structure ◽

Mesenteric Vein ◽

Vein Formation ◽

Variation Rate

Background: To determine the types, frequency and clinical implications of formation of variations of portal vein with routine abdominal multi detector CT.Methods: MDCT images of 265 patients without any pathology were evaluated. Types and frequencies of formation variations of portal vein were determined.Results: Portail vein formation variations were observed in 186 (70.15%) of our study population. Normal portal vein was detected in 79 (29.8%) images. These variations were classified according to frequency. Normal anatomic structure was determined as type 1. Type 1 was observed in 79 (29.8%) images. As type 2 variation, left gastric vein flows into splenic vein instead of portal vein (60.75%). The type 3 of portal vein variation as uniting of superior mesenteric vein, inferior mesenteric vein and splenic vein at the same trunk to form portal vein was determined 9.43%.Conclusions: This study, which was performed to determine the anatomical variations of portail vein, makes the type 2 variation rate higher than the other studies. This information is different from the classical anatomy information. In addition, we are able to make the radiologists and surgeons highly capable of both recognition and functionality of the results.

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Re-interpreting mesenteric vascular anatomy on 3D virtual and/or physical models: positioning the middle colic artery bifurcation and its relevance to surgeons operating colon cancer

Surgical Endoscopy ◽

10.1007/s00464-020-08242-8 ◽

2021 ◽

Author(s):

Bjarte T. Andersen ◽

Bojan V. Stimec ◽

Bjørn Edwin ◽

Airazat M. Kazaryan ◽

Przemyslaw J. Maziarz ◽

...

Keyword(s):

Colon Cancer ◽

Splenic Vein ◽

Vascular Anatomy ◽

Middle Colic Artery ◽

Inferior Mesenteric Vein ◽

Anatomical Landmarks ◽

Colic Artery ◽

Mesenteric Vein ◽

Wide Range ◽

The Impact

Abstract Background The impact of the position of the middle colic artery (MCA) bifurcation and the trajectory of the accessory MCA (aMCA) on adequate lymphadenectomy when operating colon cancer have as of yet not been described and/or analysed in the literature. The aim of this study was to determine the MCA bifurcation position to anatomical landmarks and to assess the trajectory of aMCA. Methods The colonic vascular anatomy was manually reconstructed in 3D from high-resolution CT datasets using Osirix MD and 3-matic Medical and analysed. CT datasets were exported as STL files and supplemented with 3D printed models when required. Results Thirty-two datasets were analysed. The MCA bifurcation was left to the superior mesenteric vein (SMV) in 4 (12.1%), in front of SMV in 17 (53.1%) and right to SMV in 11 (34.4%) models. Median distances from the MCA origin to bifurcation were 3.21 (1.18–15.60) cm. A longer MCA bifurcated over or right to SMV, while a shorter bifurcated left to SMV (r = 0.457, p = 0.009). The main MCA direction was towards right in 19 (59.4%) models. When initial directions included left, the bifurcation occurred left to or anterior to SMV in all models. When the initial directions included right, the bifurcation occurred anterior or right to SMV in all models. The aMCA was found in 10 (31.3%) models, following the inferior mesenteric vein (IMV) in 5 near the lower pancreatic border. The IMV confluence was into SMV in 18 (56.3%), splenic vein in 11 (34.4%) and jejunal vein in 3 (9.4%) models. Conclusion Awareness of the wide range of MCA bifurcation positions reported is crucial for the quality of lymphadenectomy performed. The aMCA occurs in 31.3% models and its trajectory is in proximity to the lower pancreatic border in one half of models, indicating that it needs to be considered when operating splenic flexure cancer.

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Portal or superior mesenteric vein resection in pancreatoduodenectomy for pancreatic head carcinoma

British Journal of Surgery ◽

10.1002/bjs.9799 ◽

2015 ◽

Vol 102 (7) ◽

pp. 837-846 ◽

Cited By ~ 64

Author(s):

Y. Murakami ◽

S. Satoi ◽

F. Motoi ◽

M. Sho ◽

M. Kawai ◽

...

Keyword(s):

Superior Mesenteric Vein ◽

Pancreatic Head ◽

Mesenteric Vein ◽

Pancreatic Head Carcinoma ◽

Vein Resection

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Direct splenic vein reconstruction combined with resection of the portal vein/superior mesenteric vein confluence during pancreaticoduodenectomy

Langenbeck s Archives of Surgery ◽

10.1007/s00423-020-02064-x ◽

2021 ◽

Author(s):

Ryota Matsuki ◽

Hirokazu Momose ◽

Masaharu Kogure ◽

Yutaka Suzuki ◽

Toshiyuki Mori ◽

...

Keyword(s):

Portal Vein ◽

Superior Mesenteric Vein ◽

Splenic Vein ◽

Mesenteric Vein

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

HPB ◽

10.1016/j.hpb.2017.02.438 ◽

2017 ◽

Vol 19 (9) ◽

pp. 785-792 ◽

Cited By ~ 14

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

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

ASME 2009 Summer Bioengineering Conference, Parts A and B ◽

10.1115/sbc2009-206254 ◽

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.

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