Feasibility of bile duct as venous graft for venous reconstruction in pancreatic surgery: An animal experimental study

Objective Pancreatic cancer is a kind of high malignant tumor with a poor prognosis. The aim is to determine whether the dilated bile duct can be used to reconstruct the vessels. Methods An animal model of jugular vein and portal vein reconstruction was established using the bile duct. A total of 20 landrace pigs were selected to undergo jugular vein reconstruction or portal vein reconstruction using the bile duct as a patch or bridge. The patency was evaluated by color Doppler, the reconstructed segments were removed and examined macroscopically and histologically at specified intervals, and the results were compared with synthetic vessels (IMPRA straight, 10s03-19). Results The lumen was patent, although a low level thrombosis was observed when jugular or portal vein patching was used. For bridging, stenosis of the lumen was observed, and necrosis appeared when the bile duct was used for bridging, indicating that it is feasible to reconstruct the jugular vein and portal vein with a bile duct patch. However, the bridge was not feasible possibly due to loss of blood supply, and consequent necrosis and fibrosis. Conclusion The bile duct is technically feasible, but the outcomes are unsatisfactory.

Download Full-text

Superior mesenteric-portal vein reconstruction in pancreatic surgery – comparing reconstruction with cold-stored cadaveric vein allograft versus reconstruction without graft

HPB ◽

10.1016/j.hpb.2016.02.198 ◽

2016 ◽

Vol 18 ◽

pp. e85

Author(s):

D. Kleive ◽

A. Elnæs Berstad ◽

I. Prydz Gladhaug ◽

C. Verbeke ◽

S.-P. Haugvik ◽

...

Keyword(s):

Portal Vein ◽

Pancreatic Surgery ◽

Portal Vein Reconstruction ◽

Vein Allograft

Download Full-text

Domino compensation of the external iliac vein using an ePTFE graft after its procurement for portal vein reconstruction in pancreatic surgery

HPB ◽

10.1016/j.hpb.2019.10.532 ◽

2019 ◽

Vol 21 ◽

pp. S688-S689

Author(s):

Y. Yamamoto ◽

M. Yoshioka ◽

H. Uchinami ◽

G. Watanabe ◽

M. Iida ◽

...

Keyword(s):

Portal Vein ◽

Pancreatic Surgery ◽

Iliac Vein ◽

Eptfe Graft ◽

External Iliac Vein ◽

Portal Vein Reconstruction

Download Full-text

The Falciform Ligament for Mesenteric and Portal Vein Reconstruction in Local Advanced Pancreatic Tumor: A Surgical Guide and Single-Center Experience

HPB Surgery ◽

10.1155/2018/2943879 ◽

2018 ◽

Vol 2018 ◽

pp. 1-8 ◽

Cited By ~ 4

Author(s):

T. Malinka ◽

F. Klein ◽

T. Denecke ◽

U. Pelzer ◽

J. Pratschke ◽

...

Keyword(s):

Blood Flow ◽

Portal Vein ◽

Pancreatic Tumor ◽

Falciform Ligament ◽

Optimal Size ◽

Venous Blood Flow ◽

Single Center ◽

Venous Reconstruction ◽

Portal Vein Reconstruction ◽

Local Advanced

Background. Since local tumor infiltration to the mesenteric-portal axis might represent a challenging assignment for curative intended resectability during pancreatic surgery, appropriate techniques for venous reconstruction are essential. In this study, we acknowledge the falciform ligament as a feasible and convenient substitute for mesenteric and portal vein reconstruction with high reliability and patency for local advanced pancreatic tumor. Methods. A retrospective single-center analysis. Between June 2017 and January 2018, a total of eleven consecutive patients underwent pancreatic resections with venous reconstruction using falciform ligament. Among them, venous resection was performed in nine cases by wedge and in two cases by full segment. Patency rates and perioperative details were reviewed. Results. Mean clamping time of the mesenteric-portal blood flow was 34 min, while perioperative mortality rate was 0%. By means of Duplex ultrasonography, nine patients were shown to be patent on the day of discharge, while two cases revealed an entire occlusion of the mesenteric-portal axis. Orthograde flow demonstrated a mean value of 34 cm/s. All patent grafts on discharge revealed persistent patency within various follow-up assessments. Conclusion. The falciform ligament appears to be a feasible and reliable autologous tissue for venous blood flow reconstruction with high postoperative patency. Especially the possibility of customizing graft dimensions to the individual needs based on local findings allows an optimal size matching of the conduit. The risk of stenosis and/or segmental occlusion may thus be further reduced.

Download Full-text