Auswahl der wissenschaftlichen Literatur zum Thema „Portal vein reconstruction“

Topographic and anatomical variants of vascular plastics in extended gastropancreatoduodenal resection are substantiated. The anatomical study was performed on 30 organ complexes and 5 not embalmed human corpses. Significant variability of the roots and tributaries of the v. portae and their location near the pancreas was revealed. The extended contact of the mesenteric-portal segment with the head of the pancreas promotes the involvement of the veins of the portal system in the tumor process. The magistral type of the structure of the superior mesenteric vein was revealed in 19 cases, the distributed type in 11, which determines the conditions for vascular reconstruction. In the experiment the possibility of creation the formation of the direct mesenteric-portal anastomosis after duodenectomy was established in case of shifting the mobilized root of the mesentery of the small intestine in the direction of the liver gate. If splenic vein resection is necessary, adequate blood outflow from the stomach, spleen, and pancreatic stump can be provided by forming a distal splenic-renal anastomosis or, with a sufficient length of the splenic vein, a splenic-portal anastomosis. Based on computed tomography angiographs and intraoperative data 29 patients underwent extended gastropancreatoduodenal resection followed by vascular reconstruction. Tumor invasion of the trunk of the portal vein on computed tomography angiograms was represented by offset and the contact of the tumor with portal vein for over 10 mm (in 7 cases), the displacement and deformation of the portal vein tumor (in 5 cases), tumor infiltration of more than 50% of the circumference of the portal vein (in 3 cases). Extended contact with the tumor was identified in 9 cases, confluence stenosis of the portal vein in 5 cases. The tumor invasion into the portal vein, and the vascular system was restored by the formation of a port-portal anastomosis in 15 cases. Moreover at the reconstruction of mesenteric-portal segment we formed mesenteric-portal anastomosis in 10 cases. Also in 2 cases mesenteric-portal anastomosis in the confluence area of the iliac colon and jejunum tributaries was formed, in 1 case we formed anastomosis between the ileum-colon vein and the portal vein (with 1:2 diameter difference without patency disorders). In one single case we connected iliac colon vein wall with jejunum vein wall and formed anastomosis between them and portal vein. Distal splenorenal anastomosis was formed in 10 patients from this group. Spleno-portal anastomosis was formed in 3 patients above the junction of the portal and superior mesenteric veins.

Background: Resection and reconstruction of infiltrated vessels achieve resectability of extended pancreatic tumors. The aim of the present study was to assess the feasibility of bovine pericardium as graft material for the individualised portal vein reconstruction and demonstrate a surgical technique for abdominal vein repair. Methods: We performed a MEDLINE search to review the methods for complex abdominal vein reconstruction in the course of extended pancreatectomy. Moreover, clinical data of patients receiving portal vein reconstruction using a bovine pericardial patch at our institution were retrospectively analyzed. Results: Based on the results of a review of the literature, autologous venous grafts using the internal jugular vein represent the most popular option for segmental portal vein reconstruction in case of impossible direct suture. At our center, segmental portal vein reconstruction with bovine pericardial patch in course of pancreatic surgery was performed in 4 patients. No case of vascular complications such as occlusion, segmental stenosis or thrombosis occurred. Conclusions: Our experience suggests a surgical procedure for an individual size-matched portal vein reconstruction using bovine pericardium. Although first results appear promising, prospective studies are required to objectively assess the patency of bovine pericardium compared with autologous and synthetic interposition grafts for portal vein reconstruction.

Cholangiocarcinoma (CCA) is an aggressive malignancy of the biliary tract. To date, surgical treatment remains the only hope for definitive cure of CCA patients. Involvement of major vascular structures was traditionally considered a contraindication for resection. Nowadays, selected cases of CCA with vascular involvement can be successfully approached. Intrahepatic CCA often involves the major hepatic veins or the inferior vena cava and might necessitate complete vascular exclusion, in situ hypothermic perfusion, ex situ surgery and reconstruction with autologous, heterologous or synthetic grafts. Hilar CCA more frequently involves the portal vein and hepatic artery. Resection and reconstruction of the portal vein is now considered a relatively safe and beneficial technique, and it is accepted as a standard option either with direct anastomosis or jump grafts. However, hepatic artery resection remains controversial; despite accumulating positive reports, the procedure remains technically challenging with increased rates of morbidity. When arterial reconstruction is not possible, arterio-portal shunting may offer salvage, while sometimes an efficient collateral system could bypass the need for arterial reconstructions. Keys to achieve success are represented by accurate selection of patients in high-volume referral centres, adequate technical skills and eclectic knowledge of the various possibilities for vascular reconstruction.

Portal vein thrombosis is observed in up to 10% of liver transplant candidates, hindering execution of the procedure. A dilated gastric vein is an alternative to portal vein reconstruction and decompression of splanchnic bed. We present two cases of patients with portal cavernoma and dilated left gastric vein draining splanchnic bed who underwent liver transplantation. The vein was dissected and sectioned near the cardia; the proximal segment was ligated with suture and the distal segment was anastomosed to the donor portal vein. Gastroportal anastomosis is an excellent option for portal reconstruction in the presence of thrombosis or hypoplasia. It allows an adequate splanchnic drainage and direction of hepatotrophic factors to the graft.

Abstract Background Recent reports have shown that patients with vascular tumour invasion who undergo concurrent vascular resection can achieve long-term survival rates equivalent to those without vascular involvement requiring pancreaticoduodenectomy alone. There is no consensus about which patients benefit from the portal-superior mesenteric vein resection and there is no consensus about the best surgical technique of vessel reconstruction (resection with or without graft reconstruction). As published series are small the aim of this study was to evaluate our experience in pancreatectomies with en bloc vascular resection and reconstruction of vessels. Methods Review of database at University Clinical Centre Maribor identified 133 patients (average age 65.4 ± 8.6 years, 69 female patients) who underwent pancreatoduodenectomy between January 2006 and August 2014. Clinical data, operative results, pathological findings and postoperative outcomes were collected prospectively and analyzed. Current literature and our experience in pancreatectomies with en bloc vascular resection and reconstruction of portal vein are reviewed. Results Twenty-two patients out of 133 (16.5%) had portal vein-superior mesenteric vein resection and portal vein reconstruction (PVR) during pancreaticoduodenectomy. In fourteen patients portal vein was reconstructed without the use of synthetic vascular graft. In these series two types of venous reconstruction were performed. When tumour involvement was limited to the superior mesenteric vein (SPV) or portal vein (PV) such that the splenic vein could be preserved, and vessels could be approximated without tension a primary end-to-end anastomosis was performed. When tumour involved the SMV-splenic vein confluence, splenic vein ligation was necessary. In the remaining eight procedures interposition graft was needed. Dacron grafts with 10 mm diameter were used. There was no infection after dacron grafting. One patient had portal vein thrombosis after surgery: it was thrombosis after primary reconstruction. There were no thromboses in patients with synthetic graft interposition. There were no significant differences in postoperative morbidity, mortality or grades of complication between groups of patients with or without a PVR. Median survival time in months was in a group with vein resection 16.13 months and in a group without vein resection 15.17 months. Five year survival in the group without vein resection was 19.5%. Comparison of survival curves showed equal hazard rates with log-rank p = 0.090. Conclusions Survival of patients with pancreatic cancer who undergo an R0 resection with reconstruction was comparable to those who have a standard pancreaticoduodenectomy with no added mortality or morbidity. Synthetic graft appeared to be an effective and safe option as an interposition graft for portomesenteric venous reconstruction after pancreaticoduodenectomy.

Resection of the confluence of the superior mesenteric and portal veins has been performed most frequently in the treatment of adenocarcinoma of the pancreas, in view of the reported positive results, but it can also be used in cases of benign pancreatic neolpasias when they are strongly adhered to the mesenteric-portal trunk. Nevertheless, there is no study on the best type of venous grafts for reconstruction of the mesenteric-portal trunk when required. The choice of graft depends on the preference of the surgeon or the institution. This technical note critically discusses the use of the splenic vein as an option for mesenteric-portal trunk reconstruction after gastroduodenopancreatectomy.

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Hospital Federal de Bonsucesso, Serviço de Cirurgia Hepato-Biliar
O objetivo deste estudo foi avaliar as complicações associadas às reconstruções vasculares nos receptores de Transplante Hepático Intervivos operados no Hospital Federal de Bonsucesso, no período de dezembro de 2001 e fevereiro de 2011. Foram levantados dados referentes aos receptores, seus respectivos doadores e relacionados ao procedimento cirúrgico, visando identificar possíveis fatores de risco ao desenvolvimento das complicações vasculares. Cento e quarenta e quatro transplantes foram realizados em 141 receptores, 76 adultos e 65 crianças. Foram identificadas sete complicações (4,9% do total) da artéria hepática, cinco complicações (3,5%) da veia porta e uma complicação (0,7%) da veia hepática. Devido ao pequeno número de complicações, não foi possível realizar análise estatística de fatores de risco. A sobrevida em um ano dos pacientes com e sem complicação vascular foi de 26% e 82%, respectivamente. A sobrevida em um ano dos enxertos utilizados em pacientes com e sem complicação vascular foi de 15% e 82%, respectivamente. Houve diferença estatística (p < 0,001) na sobrevida de pacientes e enxertos, que foi menor no grupo que apresentou complicações vasculares. Concluiu-se que as técnicas de reconstrução vascular utilizadas no Hospital Federal de Bonsucesso apresentam resultados comparáveis aos grandes centros internacionais. A presença de complicação na reconstrução vascular diminui a sobrevida do receptor e do enxerto
The objective of this study was to evaluate the complications associated with vascular reconstruction in recipients of living donor liver transplantation at Bonsucesso Federal Hospital, between December 2001 and February 2011. Data associated to recipients, their donors and surgical procedure were collected to identify possible risk factors for vascular complications development. One hundred and forty-four transplants were performed in 141 recipients, 76 adults and 65 children. We identified seven hepatic artery complications (4.9% of total), five complications (3.5%) of portal vein and one complication (0.7%) of hepatic vein. Due to the small number of complications, statistical analysis of risk factors could not be performed. The 1-year survival of patients with and without vascular complications was 26% and 82%, respectively. The 1-year survival of grafts in patients with and without vascular complications was 15% and 82%, respectively. There was statistical difference (p <0.001) on survival of patients and grafts, which was lower in the group with vascular complications. It was concluded that techniques used in vascular reconstruction at Bonsucesso Federal Hospital showed results comparable to major international centers. The presence of vascular complications in the reconstruction decreases survival of recipients and grafts

Possibilities of Portal Vein Reconstruction during Surgical Treatment of Pancreatic Cancer - Experiment on a Large Animal Introduction: Pancreatic cancer is a fatal malignancy that is known as one of the leading causes of cancer mortality worldwide. The only potentially curative treatment is radical surgical resection. Because of the lack of early symptoms, the diagnosis is usually made in advanced stages of the disease. In the majority of patients, the tumor is already locally advanced or it has distant metastases at the time of diagnosis. Pancreatic cancer tends to infiltrate the portal vein (PV) or the superior mesenteric vein (SMV). Nowadays, resection of infiltrated parts of PV/SMV is recommended in specialized centers. There are several established techniques of PV/SMV reconstruction. The use of allogeneic venous grafts seems to be a method with minimal risk of adverse effects but there is only limited experience with these grafts. The optimal anatomical origin of allogeneic venous grafts for PV/SMV reconstruction remains unknown. Aims: The aim of this experiment was to compare two types of allogeneic venous grafts used for PV reconstruction in a large animal model of pancreatico- duodenectomy. These grafts were harvested from the systemic venous system (inferior caval vein grafts - IVC grafts) and...