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Published in:

01-06-2007

Left Renal Vein Graft for Vascular Reconstruction in Abdominal Malignancy

Authors: Susumu Ohwada, Kunihiro Hamada, Susumu Kawate, Yutaka Sunose, Naoki Tomizawa, Tatsuya Yamada, Toshihiko Okabe, Testushi Ogawa, Yoshihiro Sato

Published in: World Journal of Surgery | Issue 6/2007

Abstract

Background

Advanced abdominal malignancies are occasionally invasive for the major blood vessels, such as the portal vein (PV), inferior vena cava (IVC), and major hepatic veins (HVs), and complete removal of the tumors is required for patients undergoing vascular resection and reconstruction. We used left renal vein (LRV) grafts for vascular reconstruction in patients with these malignancies and evaluated their clinical relevance.

Methods

A total of 113 patients underwent vascular resection including the PV (42 patients), IVC (68 patients), and HV (3 patients) for hepatobiliary-pancreatic or abdominal tumor resection. Of these, 11 patients underwent vascular reconstruction with a LRV graft of the PV, superior mesenteric vein (SMV), and HVs in 3 patients each, and the IVC in 2 patients. The HVs were resected with segmentectomy involving Couinaud’s segments VII, VIII, and IV; VII, VIII, and II; or III, IV, VIII in each patient. The PV and SMV were resected in 5 patients undergoing pancreaticoduodenectomy for pancreatic carcinoma, and in 1 patient being treated with extended right hepatectomy and pancreaticoduodenectomy for hepatic hilar carcinoma. The IVC was partially resected in 1 patient with advanced colon cancer and 1 with malignant schwannoma.

Results

The mean graft length of LRV obtained was 3.6 (3.5–4.0) cm. The graft was used as a tube in 9 patients, and as a patch in 2 patients. The mean duration of clamping time was 41.9 (35–60) min. Portal vein thrombosis was encountered in 2 patients, and anastomotic stenosis in 1 patient. Other morbidity was not related to vascular reconstruction. One patient who underwent extended right hepatectomy and pancreaticoduodenectomy died of liver failure in the hospital. The serum creatinine level after surgery did not deteriorate except in the one patient who died in the hospital. Graft patency was maintained during the follow-up period in all patients.

Conclusions

A LRV graft may enhance the possibility of vascular reconstruction without deteriorating serum creatinine level, and it provides sound graft patency.

Nakao A, Nonami T, Harada A, et al. (1990) Portal vein resection with a new antithrombogenic catheter. Surgery 108:913–918PubMed

Kaneoka Y, Yamaguchi A, Isogai M, et al. (2000) Hepatic vein reconstruction by external iliac vein graft using vascular clips. World J Surg 24:377–382PubMedCrossRef

Ohwada S, Ogawa T, Ohya T, et al. (1999) Gonadal vein graft for hepatic artery reconstruction. Hepatogastroenterology 46:1823–1826PubMed

Takayama Y, Kanamaru H, Yokoyama H, et al. (1995) Portal vein reconstruction using an internal jugular vein as a graft: report of a case. Surg Today 25:378–380PubMedCrossRef

Sakamoto Y, Yamamoto J, Saiura A, et al. (2004) Reconstruction of hepatic or portal veins by use of newly customized great saphenous vein grafts. Langenbecks Arch Surg 389:110–113PubMedCrossRef

Hemming AW, Reed AI (2005) Left trisegmentectomy with reconstruction of segment 6 hepatic venous outflow using cryopreserved vein graft. J Gastrointest Surg 9:353–356PubMedCrossRef

Sugawara Y, Makuuchi M, Tamura S, et al. (2006) Portal vein reconstruction in adult living donor liver transplantation using cryopreserved vein grafts. Liver Transpl 12:1233–1236PubMedCrossRef

Miyazaki M, Itoh H, Kaiho T, et al. (1995) Portal vein reconstruction at the hepatic hilus using a left renal vein graft. J Am Coll Surg 180:497–498PubMed

Miyazaki M, Ito H, Nakagawa K, et al. (1997) Vascular reconstruction using left renal vein graft in advanced hepatobiliary malignancy. Hepatogastroenterology 44:1619–1623PubMed

10.

Miyazaki M, Ito H, Kimura F, et al. (2004) Hepatic vein reconstruction using autologous vein graft for resection of advanced hepatobiliary malignancy. Hepatogastroenterology 51:1581–1585PubMed

11.

Ohwada S, Takeyoshi I, Ogawa T, et al. (1998) Hepatic vein reconstruction at inferior vena cava confluence using left renal vein graft. Hepatogastroenterology 45:1833–1836PubMed

12.

Nakamura S, Sakaguchi S, Kitazawa T, et al. (1990) Hepatic vein reconstruction for preserving remnant liver function. Arch Surg 125:1455–1459PubMed

13.

Suzuki T, Yoshidome H, Kimura F, et al. (2006) Renal function is well maintained after use of left renal vein graft for vascular reconstruction in hepatobiliary-pancreatic surgery. J Am Coll Surg 202:87–92PubMedCrossRef

14.

Cancarini GC, Pola A, Pezzotti G, et al. (2002) Recovery of renal function after right nephrectomy, cavectomy and left renal vein ligation. J Nephrol 15:186–190PubMed

15.

Machado MA, Herman P, Makdissi FF, et al. (2006) Feasibility of bisegmentectomy 7–8 is independent of the presence of a large inferior right hepatic vein. J Surg Oncol 93:338–342PubMedCrossRef

16.

Cho KJ, Geisinger KR, Shields JJ, et al. (1982) Collateral channels and histopathology in hepatic vein occlusion. AJR Am J Roentgenol 139:703–709PubMed

17.

Sano K, Makuuchi M, Miki K, et al. (2002) Evaluation of hepatic venous congestion: proposed indication criteria for hepatic vein reconstruction. Ann Surg 236:241–247PubMedCrossRef

18.

Hemming AW, Reed AI, Langham MR, et al. (2002) Hepatic vein reconstruction for resection of hepatic tumors. Ann Surg 235:850–858PubMedCrossRef

19.

Nakamura S, Sakaguchi S, Hachiya T, et al. (1993) Significance of hepatic vein reconstruction in hepatectomy. Surgery 114:59–64PubMed

20.

Murata S, Itai Y, Asato M, et al. (1995) Effect of temporary occlusion of the hepatic vein on dual blood in the liver: evaluation with spiral CT. Radiology 197:351–356PubMed

21.

Kasahara M, Takada Y, Fujimoto Y, et al. (2005) Impact of right lobe with middle hepatic vein graft in living-donor liver transplantation. Am J Transplant 5:1339–1346PubMedCrossRef

22.

Radtke A, Sotiropoulos GC, Molmenti EP, et al. (2006) The influence of accessory right inferior hepatic veins on the venous drainage in right graft living donor liver transplantation. Hepatogastroenterology 53:479–483PubMed

23.

Ohwada S, Kawashima Y, Ogawa T, et al. (1999) Extended hepatectomy with ePTFE graft vena caval replacement and hepatic vein reconstruction: a case report. Hepatogastroenterology 46:1151–1155PubMed

24.

Ohwada S, Ogawa T, Kawashima Y, et al. (1999) Concomitant major hepatectomy and inferior vena cava reconstruction. J Am Coll Surg 188:63–71PubMedCrossRef

Title: Left Renal Vein Graft for Vascular Reconstruction in Abdominal Malignancy
Authors: Susumu Ohwada
Kunihiro Hamada
Susumu Kawate
Yutaka Sunose
Naoki Tomizawa
Tatsuya Yamada
Toshihiko Okabe
Testushi Ogawa
Yoshihiro Sato
Publication date: 01-06-2007
Publisher: Springer-Verlag
Published in: World Journal of Surgery / Issue 6/2007
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-007-9015-5

At a glance: The STEP trials

Springer Medicine

Left Renal Vein Graft for Vascular Reconstruction in Abdominal Malignancy

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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