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Abstract

This study was conducted to assess the efficacy of portal vein reconstruction with an expanded polytetrafluoroethylene (e-PTFE) graft.

Five patients underwent interposition of the portal vein with e-PTFE graft following en bloc resection of the entire pancreas and the portal vein for advanced pancreatic cancer. The length of the excised vein ranged from 5 to 7 cm and that of the implanted graft (8 or 10 mm in diameter), 3 to 7.5 cm. In 4 of the 5 cases, the graft was patent at five to eighteen months following implantation. One patient died of respiratory failure two months after operation, and partial occlusion of the graft was noted at autopsy. Four patients died of recurrence of the original disease five to eighteen months after operation. The implanted graft taken at autopsy eighteen months after operation was covered uniformly with thin neointima on the internal surface. Microscopic examination showed endothelial cells covering the surface of the neointima, and capillary vessels had developed in the neointimal layer.

Experimentally, five grafts, 0.8 cm in diameter and 2.5 cm in length with external ring support, were interposed in the portal vein in pigs. All grafts were patent during a four-month follow-up period.

The authors conclude that the e-PTFE graft is a suitable prosthesis for replacement of the portal vein following its resection.

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References

1. Tanaka K , Furukawa T , Nishi S , et al: Four cases of portal replacement of polytetrafluoroethylene for carcinoma of the pancreas. J Biliary Tract Pancreas 12:103-106, 1991.

2. Cancer of the pancreas task force : Staging of cancer of the pancreas. Cancer 47:1631-1637, 1981.

3. Fortner JG : Regional resection of cancer of the pancreas: A new surgical approach. Surgery 73:307-320, 1973.

4. Ogata Y , Takahashi N : Extended radical pancreatectomy with combined resection of vessels for cancer of the head of the pancreas. J Biliary Tract Pancreas 7:961-970, 1986.

5. Uchino R , Hiraoka T , Saitoh N , et al: Surgical evaluation of resection of the portal vein in pancreas cancer. Jpn J Gastroenterol Surg 22:1098-1101, 1989.

6. Mimura H , Mori M , Hamasaki K , et al: Isolated pancreatectomy for ductal carcinoma of the head of the pancreas. J Biliary Tract Pancreas 12:293-298, 1991.

7. Konishi K , Tsuji M , Yamamoto S , et al: A clinicopathological study of pancreatoduodenectomy with combined resection of portal vein in pancreatic head cancer. Jpn J Gastroenterol Surg 27:1786-1790, 1994.

8. Sigel B , Bassett JG , Cooper DR , et al: Resection of the superior mesenteric vein and replacement with a venous autograft during pancreaticoduodenectomy. Ann Surg 162:941-945, 1965.

9. Asada S , Itaya H , Nakamura K , et al: Radical pancreatoduodenectomy and portal vein resection. Arch Surg 87:609-613, 1963.

10.

10. Miyata M , Nakao K , Hirose H , et al: Reconstruction of portal vein with an autograft of splenic vein. J Cardiovasc Surg 28:18-21, 1987.

11.

11. Norton L , Eiseman B : Replacement of portal vein during pancreatectomy for carcinoma. Surgery 77:280-284, 1975.

12.

12. Soyer T , Lempinen M , Cooper P , et al: A new venous prosthesis. Surgery 72:864-872, 1972.

13.

13. Gloviczki P , Pairolero PC , Cherry KJ , et al: Reconstruction of the vena cava and of its primary tributaries: A preliminary report. J Vasc Surg 11:373-381, 1990.

14.

14. Moore WM , Hollier LH , Pickett TK : Superior vena cava and central venous reconstruction. Surgery 110:35-41, 1991.

15.

15. Dale WA , Harris J , Terry RB : Polytetrafluoroethylene reconstruction of the inferior vena cava. Surgery 95:625-630, 1984.

16.

16. Takada T , Hanyu F , Nakamura M , et al: Extended surgery for carcinoma of the pancreas. J Jpn Surg Soc 83:122-131, 1982.

17.

17. Sugiura Y , Shibata H , Inoue K , et al: Pancreatectomy preceding resection and reconstruction of portal vein. Operation 46:2033-2037, 1992.

18.

18. Ohkuma T : Replacement of portal vein with E-PTFE vascular graft: Experimental study on the process of the endothelialization. J Jpn Surg Soc 85:1558-1569, 1984.

Portal Vein Replacement with Expanded Polytetrafluoroethylene (e-PTFE) Graft

Abstract

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