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Techniques and results of portal vein/superior mesenteric vein reconstruction using femoral and saphenous vein during pancreaticoduodenectomy.
J Vasc Surg. 2010 Mar; 51(3):662-6.JV

Abstract

BACKGROUND

Patients with pancreatic tumors may have portal vein (PV) and/or superior mesenteric vein (SMV) invasion. In such cases, lower extremity veins can provide an autogenous conduit for PV/SMV reconstruction. Little data exist, however, describing the technique of PV/SMV reconstruction, patency of such reconstructions, and the morbidity of using lower extremity veins for PV/SMV reconstruction during pancreaticoduodenectomy.

METHODS

Thirty-four patients underwent PV/SMV reconstruction during pancreaticoduodenectomy using lower extremity vein. The saphenous vein was preferred for patching and femoral vein for replacement. We analyzed preoperative imaging, reconstruction patency, vein harvest morbidity, and late mortality.

RESULTS

The mean age was 62.6 years. All 34 patients had preoperative computed tomography (CT) imaging and/or endoscopic ultrasound (EUS) scan. Fourteen of the 34 patients had evidence of PV/SMV invasion on CT or EUS scans, 14 did not, and six studies were indeterminate. Twenty-five patients had follow-up imaging, and 22 (88%) had patent reconstructions. Fifteen patients had PV/SMV replacement using femoral vein. Seven of these 15 had minor postoperative lower extremity edema that resolved over time, five had wound complications from the femoral vein harvest site, three of which required minor operative procedures for treatment. Fifteen patients had PV/SMV patching with the great saphenous vein, none had postoperative wound problems, and one had minimal postoperative lower extremity edema. Four patients had PV/SMV patching using femoral vein, none had postoperative wound problems, and one had minimal postoperative lower extremity edema. Compared with patients undergoing pancreaticoduodenectomy without PV/SMV reconstruction, by Kaplan-Meier analysis, there was no difference in late mortality.

CONCLUSION

Preoperative imaging may fail to detect PV/SMV involvement in patients undergoing pancreaticoduodenectomy. The PV/SMV reconstruction with leg vein provides good patency with minimal postoperative lower extremity complications and no increase in late mortality. The lower extremities should be routinely included in the operative field of patients undergoing pancreaticoduodenectomy.

Authors+Show Affiliations

Division of Vascular Surgery, Department of Surgery, Oregon Health & Science University, Portland, OR 97201-3098, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

20080375

Citation

Lee, Dae Y., et al. "Techniques and Results of Portal Vein/superior Mesenteric Vein Reconstruction Using Femoral and Saphenous Vein During Pancreaticoduodenectomy." Journal of Vascular Surgery, vol. 51, no. 3, 2010, pp. 662-6.
Lee DY, Mitchell EL, Jones MA, et al. Techniques and results of portal vein/superior mesenteric vein reconstruction using femoral and saphenous vein during pancreaticoduodenectomy. J Vasc Surg. 2010;51(3):662-6.
Lee, D. Y., Mitchell, E. L., Jones, M. A., Landry, G. J., Liem, T. K., Sheppard, B. C., Billingsley, K. G., & Moneta, G. L. (2010). Techniques and results of portal vein/superior mesenteric vein reconstruction using femoral and saphenous vein during pancreaticoduodenectomy. Journal of Vascular Surgery, 51(3), 662-6. https://doi.org/10.1016/j.jvs.2009.09.025
Lee DY, et al. Techniques and Results of Portal Vein/superior Mesenteric Vein Reconstruction Using Femoral and Saphenous Vein During Pancreaticoduodenectomy. J Vasc Surg. 2010;51(3):662-6. PubMed PMID: 20080375.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Techniques and results of portal vein/superior mesenteric vein reconstruction using femoral and saphenous vein during pancreaticoduodenectomy. AU - Lee,Dae Y, AU - Mitchell,Erica L, AU - Jones,Mark A, AU - Landry,Gregory J, AU - Liem,Timothy K, AU - Sheppard,Brett C, AU - Billingsley,Kevin G, AU - Moneta,Gregory L, Y1 - 2010/01/18/ PY - 2009/07/30/received PY - 2009/09/09/revised PY - 2009/09/12/accepted PY - 2010/1/19/entrez PY - 2010/1/19/pubmed PY - 2010/4/14/medline SP - 662 EP - 6 JF - Journal of vascular surgery JO - J. Vasc. Surg. VL - 51 IS - 3 N2 - BACKGROUND: Patients with pancreatic tumors may have portal vein (PV) and/or superior mesenteric vein (SMV) invasion. In such cases, lower extremity veins can provide an autogenous conduit for PV/SMV reconstruction. Little data exist, however, describing the technique of PV/SMV reconstruction, patency of such reconstructions, and the morbidity of using lower extremity veins for PV/SMV reconstruction during pancreaticoduodenectomy. METHODS: Thirty-four patients underwent PV/SMV reconstruction during pancreaticoduodenectomy using lower extremity vein. The saphenous vein was preferred for patching and femoral vein for replacement. We analyzed preoperative imaging, reconstruction patency, vein harvest morbidity, and late mortality. RESULTS: The mean age was 62.6 years. All 34 patients had preoperative computed tomography (CT) imaging and/or endoscopic ultrasound (EUS) scan. Fourteen of the 34 patients had evidence of PV/SMV invasion on CT or EUS scans, 14 did not, and six studies were indeterminate. Twenty-five patients had follow-up imaging, and 22 (88%) had patent reconstructions. Fifteen patients had PV/SMV replacement using femoral vein. Seven of these 15 had minor postoperative lower extremity edema that resolved over time, five had wound complications from the femoral vein harvest site, three of which required minor operative procedures for treatment. Fifteen patients had PV/SMV patching with the great saphenous vein, none had postoperative wound problems, and one had minimal postoperative lower extremity edema. Four patients had PV/SMV patching using femoral vein, none had postoperative wound problems, and one had minimal postoperative lower extremity edema. Compared with patients undergoing pancreaticoduodenectomy without PV/SMV reconstruction, by Kaplan-Meier analysis, there was no difference in late mortality. CONCLUSION: Preoperative imaging may fail to detect PV/SMV involvement in patients undergoing pancreaticoduodenectomy. The PV/SMV reconstruction with leg vein provides good patency with minimal postoperative lower extremity complications and no increase in late mortality. The lower extremities should be routinely included in the operative field of patients undergoing pancreaticoduodenectomy. SN - 1097-6809 UR - https://www.unboundmedicine.com/medline/citation/20080375/Techniques_and_results_of_portal_vein/superior_mesenteric_vein_reconstruction_using_femoral_and_saphenous_vein_during_pancreaticoduodenectomy_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0741-5214(09)01911-9 DB - PRIME DP - Unbound Medicine ER -