0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Operative Techniques |

Superficial Femoral Vein as a Conduit for Portal Vein Reconstruction During Pancreaticoduodenectomy

Jason B. Fleming, MD; Carlton C. Barnett, MD; G. Patrick Clagett, MD
Arch Surg. 2005;140(7):698-701. doi:10.1001/archsurg.140.7.698.
Text Size: A A A
Published online

Extract

The management of pancreatic tumor adherence to the lateral wall of the superior mesenteric and portal veins (SMPV) represents the most challenging technical aspect of pancreaticoduodenectomy (PD). Prior studies have demonstrated that partial or segmental venous resection and reconstruction is an ideal means of managing tumor adherence to the SMPV. Options for conduit during SMPV reconstruction include synthetic or autogenous vein grafts; however, the infectious risks of PD make autogenous tissue preferable. Our institution has extensive experience with use of the superficial femoral vein (SFV) for aortic and venous reconstruction. We describe herein the use of the SFV in the reconstruction of the SMPV in patients undergoing PD and vein resection for periampullary tumors. Our early experience with this specific technique has generated several observations. First, our experience has confirmed that safe performance of SMPV resection and graft placement requires complete dissection of the specimen and SMPV away from the superior mesenteric artery and retroperitoneal attachments. Second, we have found that harvesting of a short segment of SFV is easily achieved and safe in these patients if one adheres to the technique of SFV harvest as described by Clagett et al.1 Lastly, the SFV vein is an excellent size match for the SMPV, and its superior handling properties and durability make it our preferred conduit for SMPV reconstruction at the time of PD for cancer.

Figures in this Article

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

First Page Preview

View Large
/>
First page PDF preview

Figures

Place holder to copy figure label and caption
Figure 1.

The operative view after transsection of the stomach and pancreas exposes a pancreatic head tumor with lateral involvement of the superior mesenteric vein confluence (SMV).

Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.

Reflection of the specimen medially (arrow) allows dissection of the retroperitoneal attachments from the superior mesenteric artery (SMA) to mobilize the specimen and attached superior mesenteric veins (SMV).

Graphic Jump Location
Place holder to copy figure label and caption
Figure 3.

The medial-to-lateral view of the tumor and attached veins after dissection from surrounding structures. Note the divided pancreas (P) and superior mesenteric artery (SMA). SMV indicates superior mesenteric vein; PV, portal vein; and SV, splenic vein.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 4.

The lateral-to-medial view of the tumor and attached superior mesenteric vein (SMV) and portal vein (PV) after dissection from surrounding structures and the superior mesenteric artery (SMA).

Graphic Jump Location
Place holder to copy figure label and caption
Figure 5.

These figures provide an anatomic basis for the surgical approach for superficial femoral vein harvest. A, The skin incision and soft-tissue dissection is performed over the lateral border of the middle third of the sartorious muscle. B, The vein lies within the Hunter canal along with the superficial femoral artery and saphenous nerve.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 6.

The superficial femoral popliteal vein (SFV) ready for harvest from the right leg. Multiple side branches have been divided from the SFV so that it is now separate from the superficial femoral artery (SFA) and saphenous nerve (SN) that have been reflected medially with the sartorious muscle.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 7.

Placement of the graft in the superior mesenteric portal vein (SMV) confluence. A, The proximal portion of the graft (closest to the heart) is used to reconstruct the portal vein (PV)–splenic vein confluence and preserve splenic flow. Note the Rumel tourniquet at the mesenteric root. P indicates pancreas; SMA, superior mesenteric artery. B, The SMV anastomosis is nearly complete in this photo; note the excellent size match of the SFV with the SMV. PV indicates portal vein; SV, splenic vein; and SFV, superficial femoral vein.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 8.

A typical superior mesenteric vein (SMV) and portal vein graft in place prior to reconstruction of the gastrointestinal tract.

Graphic Jump Location

Tables

References

Correspondence

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Topics
Jobs
brightcove.createExperiences();