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. 2025 May 1;281(5):843-851.
doi: 10.1097/SLA.0000000000006188. Epub 2023 Dec 25.

Validation of the Back-table Graft Arterial Anastomosis Between the Splenic Artery and Superior Mesenteric Artery: Arterial Complications After a 21-year Single-center Experience of Pancreas Transplantation

Joana Ferrer-Fàbrega  1   2   3   4 , Gabriel Cárdenas  1 , Víctor Sapena  2   5   6 , Ángeles García-Criado  2   3   4   7 , Marta Barrufet  2   7 , Carles Pérez  2   7 , Rocío García-Pérez  1   2 , Ramón Rull  1   2 , Miguel Ángel López-Boado  1   2 , Emma Folch-Puy  4   8 , Alba Torroella  1 , Pedro Ventura-Aguiar  2   3   4   9 , Frederic Cofan  2   4   9 , Enric Esmatjes  2   4   10 , Antonio Amor  2   4   10 , Fritz Diekmann  2   3   4   9 , Laureano Fernández-Cruz  1   2 , Juan Carlos García-Valdecasas  1   2   3   4 , Josep Fuster  1   2   3   4
Affiliations

Validation of the Back-table Graft Arterial Anastomosis Between the Splenic Artery and Superior Mesenteric Artery: Arterial Complications After a 21-year Single-center Experience of Pancreas Transplantation

Joana Ferrer-Fàbrega et al. Ann Surg. .

Abstract

Objective: To determine the role of the arterial splenomesenteric anastomosis (ASMA) vascular reconstruction technique in terms of arterial vascular complications in pancreas transplantation (PT) recipients.

Background: The ASMA technique was first described in 1992 by the Hospital Clínic Barcelona group. Regardless that the iliac Y-graft technique is the most frequently used worldwide, evidence of arterial complications and implications of using a different back-table reconstruction is conspicuously absent in the literature.

Methods: Descriptive review of 407 PTs performed at a single center (1999-2019) by analyzing the type of arterial reconstruction technique, focusing on ASMA. The end points were the management of arterial complications and long-term patient and graft survival.

Results: ASMA was performed in 376 cases (92.4%) and a Y-graft in 31 cases (7.6%). A total of 34 arterial complications (8.3%) were diagnosed. In the ASMA group (n=30, 7.9%), they comprised 15 acute thrombosis, 4 stenosis, 1 pseudoaneurysm, and 10 diverse chronic arterial complications, whereas in the Y-graft group (n=4, 12.9%), 3 acute thrombosis and 1 chronic artery-duodenal fistula occurred. Graft salvage was achieved in 16 patients (53.3%) from the ASMA group and in 2 (50%) from the Y-graft. After a median follow-up of 129.2 (IQR 25-75%, 77.2-182) months, the overall graft and patient survival for the whole cohort at 1, 5, and 10 years were 86.7%, 79.5%, and 70.5%, and 98.5%, 95.3%, and 92.5%, respectively.

Conclusions: The ASMA proves to be a safe and more easily reproducible technique and could therefore be considered a safe alternative vascular reconstruction procedure to the Y-graft in the PT population.

Keywords: arterial complications; back-table vascular reconstruction; graft survival; pancreas transplantation; postoperative outcomes.

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Conflict of interest statement

J.F.-F.: Lecture fees from Bayer and AstraZeneca. Consultancy fees from AstraZeneca. J.F. received grant support from Instituto de Salud Carlos III (PI18/00161). V.S.: travel grants from Bayer. Consultancy fees from LEO Pharma. J.F.: received grant support from the “Llavaneres contra el càncer” Association (grant IP004500). The remaining authors report no conflicts of interest.

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