Vascular Complications and Long-Term Outcomes in Pancreas Transplantation Using Backtable Arterial Splenomesenteric Anastomosis

Abstract

Introduction: To determine the role of the arterial spleno-mesenteric anastomosis reconstruction technique compared to other types of backtable arterial anastomosis, in terms of vascular complications and long-term patient and graft survival in a single institution. Methods: Retrospective analysis including all pancreas transplants performed over 21 years (1999-2019). For the bench reconstruction:(1) the distal superior mesenteric artery (SMA) was distally dissected and sewn to the splenic artery (SA), or (2) arterial reconstruction with iliac arterial “Y” graft. Results:At the bench procedure SMA/SA anastomosis was performed in 376 of patients and arterial iliac “Y” graft in 31 of patients. A total of 85 patients presented vascular complications within the 30 days following transplant. Regarding acute arterial events:for the SMA/SA anastomosis group, a total of 23 patients presented with thrombosis (n=16), stenosis (n=5), pseudoaneurysm (n=2);for the iliac “Y” graft group, there were 3 patients with thrombosis. Focusing on chronic arterial events:for the SMA/SA anastomosis group, a total of 2 patients presented with chronic thrombosis, 2 with pseudoaneurysm, 2 with arterioenteral fistula and one with arteriovenous fistula;for the iliac “Y” graft group, and one patient with arterioenteral fistula. After a median follow-up of 129.2 [77.2-182] months, no statically differences were found between groups in terms of patient and graft survival. Conclusions: The back table procedure used in our institution (SMA/SA) is an easy, effective and safe surgical technique that can be used as the first option for arterial reconstruction or as a good alternative for surgeons to the widely used arterial “Y” graft.