Nine-year patency of a vascular prosthesis used for portal vein reconstruction during pancreatoduodenectomy

Abstract

We report a patient in whom a polytetrafluoroethylene (PTFE) graft used for reconstruction of the portal vein was confirmed to be patent 9 years after pancreatoduodenectomy (which was performed when he was aged 51 years). The patient had advanced cancer of the head of the pancreas. Pancreatoduodenectomy was performed, and 6cm of the portal vein was resected. The portal vein was reconstructed with a PTFE graft (internal diameter 9ram; length about 6cm). The graft was demonstrated to be patent on angiography 3 years after the operation. A computed tomographic (CT) scan performed 9 years after the operation showed that the portal graft was still patent. About 2 years after the operation, the patient had been able to resume physical labor, similar to the work he performed before the operation.

“Mesopancreas-first” radical resection of pancreatic head cancer following the Cattell–Braasch–Valdoni maneuver: Appreciating the legacy of pioneers in visceral surgery

“…Special attention is warranted to the usefulness of the Cattell-Braasch-Valdoni maneuver in the case of radical excision of borderline resectable pancreatic cancer that necessitates venous resection and reconstruction. Especially in cases that require more than 5 cm of venous segment resection, the available reconstruction options (autologous, heterologous, or polytetrafluethylene graft) have significant specific drawbacks, making their use problematic [40,47,48]. Contrary to these methods, the Cattell-Braasch-Valdoni maneuver can be easily performed, allowing a safe and tension-free direct end-to-end venous anastomosis, regardless of the length of the resected venous segment [49] since the distal SMV stump can easily be shifted cranially because the root of the small bowel mesentery is completely mobilized [50].…”

Cattell‐Braasch maneuver in pancreatic surgery. No need of venous graft for vascular resection

“…In the case of an autologous graft, notably the left renal vein or jugular vein, the procurement may lead to a functional impairment and postoperative morbidity. 9 In the case of heterologous (cadaveric) graft use, availability is usually restricted to centers that perform transplantation as well; in addition, results are uncertain because in current literature only small singlecenter series have been published. Finally, if a synthetic PTFE vascular graft is preferred, a higher rate of graft infections and thrombosis has been reported.…”

“…Finally, if a synthetic PTFE vascular graft is preferred, a higher rate of graft infections and thrombosis has been reported. 9,10 In any case the use of a graft prolongs the operative time and vascular clamping for the need of a double anastomosis and some anastomotic geometrical problems (ie, kinking). 6 The use of the Cattell-Braasch maneuver is easy to perform, it is not associated with morbidity and allows a safe and tension free direct venous anastomosis independently of the length of the segment to be resected.…”

“…When the length of the venous segment to be resected is more than 5 cm, an autologous, heterologous, or PTFE graft is often used, but these options have some specific drawbacks. In the case of an autologous graft, notably the left renal vein or jugular vein, the procurement may lead to a functional impairment and postoperative morbidity 9 . In the case of heterologous (cadaveric) graft use, availability is usually restricted to centers that perform transplantation as well; in addition, results are uncertain because in current literature only small single‐center series have been published.…”

“…In the case of heterologous (cadaveric) graft use, availability is usually restricted to centers that perform transplantation as well; in addition, results are uncertain because in current literature only small single‐center series have been published. Finally, if a synthetic PTFE vascular graft is preferred, a higher rate of graft infections and thrombosis has been reported 9,10 . In any case the use of a graft prolongs the operative time and vascular clamping for the need of a double anastomosis and some anastomotic geometrical problems (ie, kinking) 6 .…”