Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Jul 1;237(1):58-67.
doi: 10.1097/XCS.0000000000000744. Epub 2023 Jun 15.

Technical Outcomes of Porto-Mesenteric Venous Reconstruction in Pancreatic Resection Using Autologous Left Renal Vein Graft as Conduit

Alessandro Fogliati  1 , Guido Fiorentini, Roberto Alva-Ruiz, Amro M Abdelrahman, Andrea Zironda, Isaac T Lynch, Rory L Smoot, Patrick P Starlinger, Sean P Cleary, Michael L Kendrick, Mark J Truty
Affiliations

Technical Outcomes of Porto-Mesenteric Venous Reconstruction in Pancreatic Resection Using Autologous Left Renal Vein Graft as Conduit

Alessandro Fogliati et al. J Am Coll Surg. .

Abstract

Background: Portal or superior mesenteric vein (PV-SMV) resection and reconstruction is sometimes required during pancreatic tumor resection. In patients requiring segmental venous resection with interposition grafting, the left renal vein (LRV) is an accessible autologous solution. However, long-term patency outcomes of the LRV as an interposition conduit in this setting have not been analyzed.

Study design: We conducted a retrospective analysis of patients undergoing pancreatic resection with PV-SMV reconstruction using LRV between 2002 and 2022. The primary outcome was PV-SMV patency at last follow-up, assessed with postoperative CT scans and analyzed using Kaplan-Meier survival methods that account for variation in follow-up duration. Development of any postoperative acute kidney injury within 7 days of surgery and morbidity were secondary outcomes.

Results: The study cohort includes 65 patients who underwent LRV harvest; 60 (92%) ultimately underwent successful reconstruction with harvested LRV graft. Kaplan-Meier 2-year estimated patency rate of the LRV graft was 88%, with no cases of complete occlusion. Six (10%) patients experienced graft stenosis. Nine of 61 (15%) patients experienced grade II or III acute kidney injury, 6 of 9 returning to normal renal function before discharge. No difference in median serum creatinine was observed at baseline, 6 and 12 months from surgery. LRV remnant thrombosis was seen in 7 of 65 (11%) patients. Only 3 of 61 (5%) patients had persistent acute kidney injury caused by complications unrelated to LRV harvesting.

Conclusions: Autologous LRV graft was a reliable conduit for segmental PV-SMV reconstruction, resulting in a high patency rate and marginal impact on renal function. LRV harvest is a safe and potentially ideal surgical option for PV-SMV reconstruction in pancreatic surgery.

PubMed Disclaimer

References

    1. Giovinazzo F, Turri G, Katz MH, et al. Meta-analysis of benefits of portal-superior mesenteric vein resection in pancreatic resection for ductal adenocarcinoma. Br J Surg 2016;103:179–191.
    1. Groen JV, van Manen L, van Roessel S, et al. Resection of the portal-superior mesenteric vein in pancreatic cancer: pathological assessment and recurrence patterns. Pancreas 2021;50:1218–1229.
    1. Zwart ES, Yilmaz BS, Halimi A, et al. Venous resection for pancreatic cancer, a safe and feasible option? A systematic review and meta-analysis. Pancreatology 2022;22:803–809.
    1. Labori KJ, Kleive D, Khan A, et al. Graft type for superior mesenteric and portal vein reconstruction in pancreatic surgery - A systematic review. HPB (Oxford) 2021;23:483–494.
    1. Chang CK, Scali ST, Feezor RJ, et al. Defining utility and predicting outcome of cadaveric lower extremity bypass grafts in patients with critical limb ischemia. J Vasc Surg 2014;60:1554–1564.

LinkOut - more resources