Autologous vein graft for vascular reconstruction in pancreatic surgery: strategy to reduce complication and portal vein clamp time

Abstract

Aim: Feasibility of autologous vein graft (AVG) for vascular reconstruction is widely accepted in pancreatic surgery. However, portal vein (PV) reconstruction using AVG had brought longer PV clamp time and larger blood loss (EBL). We here report our series of PV reconstruction using AVG and our strategy for reducing PV clamp time and EBL. Patients: 298 patients underwent pancreatic surgery since Jan. 2013 to Nov. 2017 in our facility. 70 patients had PV reconstruction. AVG was applied for PV reconstruction in 17 patients (AVG), 53 patients were directly anastomosed (DA). Operative time (OR time), EBL and PV clamp time were retrospectively reviewed. Results: 12 left renal vein, 3 right iliac vein, 1 splenic vein and 1 superficial femoral vein (SFV) were utilized as AVG. Mean OR time and EBL were not different between AVG and DA. PV clamp time was significantly longer in AVG. PV obstruction was observed in 14 out of 53 patient from DA, whereas 3 out of 17 patients from AVG. Temporary renal insufficiency was observed in 2 out of 12 patients who procured left renal vein. AVG anastomosis to distal SMV before dissecting PV collateral flow to prepare porto-caval shunt was devised to reduce intestinal congestion. Conclusion: PV reconstruction using AVG was acceptable in terms of vascular patency. However, appropriate graft selection should be considered to avoid complications. AVG anastomosis to distal SMV prior to collateral vein dissection may be acceptable strategy to reduce PV clamp time and EBL.