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Marino R, Tudisco A, Ratti F, Pedica F, Aldrighetti L. Total portal vein replacement with peritoneal interposition graft during Whipple's procedure for extrahepatic cholangiocarcinoma: a technical report. World J Surg Oncol 2023; 21:117. [PMID: 36978088 PMCID: PMC10053423 DOI: 10.1186/s12957-023-02995-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 03/18/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Aggressive surgical resection in locally advanced hepatopancreatobiliary (HPB) malignancies is frequently advocated as the only potentially curative treatment. In recent years, advances in chemotherapy regimens and surgical techniques have led to improved oncologic outcomes and overall survival, by increasing the rates of radical (R0) resections. Vascular resections are increasingly reported to further increase disease clearance rates. Within this perspective, the issue of vascular reconstruction has raised growing interest, drawing particular attention to vascular substitutes and surgical techniques for reconstruction. CASE PRESENTATION A case of extrahepatic cholangiocarcinoma with high clinical suspicion of vascular infiltration of the portal trunk at preoperative assessment is reported. An autologous interposition graft, harvested from diaphragmatic peritoneum, was chosen as a vascular substitute leading to successful portal trunk reconstruction and overcoming all possible drawbacks associated with cadaveric and artificial grafts reconstructions. CONCLUSION This solution was strategic to ensure complete oncologic clearance averting the risk of positive margins (R1) at final pathology.
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Affiliation(s)
- Rebecca Marino
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, 20132, Milan, Italy
| | - Antonella Tudisco
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, 20132, Milan, Italy
| | - Francesca Ratti
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, 20132, Milan, Italy.
| | - Federica Pedica
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, 20132, Milan, Italy
| | - Luca Aldrighetti
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, 20132, Milan, Italy
- Faculty of Medicine, University Vita-Salute San Raffaele, 20132, Milan, Italy
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2
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Balzan SMP, Gava VG, Rieger A, Magalhães MA, Schwengber A, Ferreira F. Falciform ligament tubular graft for mesenteric-portal vein reconstruction during pancreaticoduodenectomy. J Surg Oncol 2021; 125:658-663. [PMID: 34862611 DOI: 10.1002/jso.26762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 11/14/2021] [Accepted: 11/22/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Portal vein resection and reconstruction in locally advanced pancreatic cancer represents a potentially curative treatment in selected patients without increasing surgical mortality. However, vascular reconstruction after segmental venous resection is challenging. The parietal peritoneum has emerged as a venous substitute but few reports include its use as a tubular graft. We report a retrospective series of portal vein reconstruction using a falciform ligament tubular graft during pancreaticoduodenectomy. MATERIAL AND METHODS Technical aspects and short-term morbidity and mortality after pancreaticoduodenectomy with falciform ligament tubular graft interposition were analyzed. RESULTS Among 21 patients who used parietal peritoneum for venous substitution between 2015 and 2019, eight underwent pancreaticoduodenectomy with venous resection and reconstruction using interposition of falciform ligament tubular graft. The mean duration of surgery and clamping time were 350 and 27 min, respectively. No perioperative blood transfusion was required. All the grafts were patent the day after surgery. No complication related to venous obstruction was detected during the hospital stay. Two patients had postoperative pancreatic fistula. No further intervention was needed. The 90-day mortality was null. CONCLUSIONS The use of interposition of falciform ligament tubular graft for portal venous reconstruction during pancreaticoduodenectomy seems to be a reliable, inexpensive, and safe procedure.
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Affiliation(s)
- Silvio M P Balzan
- Postgraduate Program in Health Promotion (PPGPS), University of Santa Cruz do Sul (UNISC), Santa Cruz do Sul, Brazil.,Cancer League, Life Sciences Department, University of Santa Cruz do Sul (UNISC), Santa Cruz do Sul, Brazil.,Oncology Center Lydia Wong Ling, Moinhos de Vento Hospital, Porto Alegre, Brazil.,Surgical Department, Ana Nery Hospital, Santa Cruz do Sul, Brazil
| | - Vinicius G Gava
- Oncology Center Lydia Wong Ling, Moinhos de Vento Hospital, Porto Alegre, Brazil
| | - Alexandre Rieger
- Postgraduate Program in Health Promotion (PPGPS), University of Santa Cruz do Sul (UNISC), Santa Cruz do Sul, Brazil.,Cancer League, Life Sciences Department, University of Santa Cruz do Sul (UNISC), Santa Cruz do Sul, Brazil
| | | | - Alex Schwengber
- Surgical Department, Ana Nery Hospital, Santa Cruz do Sul, Brazil
| | - Fagner Ferreira
- Surgical Department, Ana Nery Hospital, Santa Cruz do Sul, Brazil
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3
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Parietal Peritoneum as a Novel Substitute for Middle Hepatic Vein Reconstruction During Living Donor Liver Transplantation. Transplantation 2021; 105:1291-1296. [PMID: 32568956 DOI: 10.1097/tp.0000000000003349] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Although autologous, cryopreserved, or artificial vascular grafts can be used as interpositional vascular substitutes for middle hepatic vein (MHV) reconstruction during living donor liver transplantation (LDLT), they are not always available, are limited in size and length, and are associated with risks of infection. This study aimed to evaluate the parietal peritoneum as a novel substitute for MHV reconstruction during LDLT. METHODS Prospectively collected data of 15 patients who underwent LDLT using the right liver with reconstruction of MHV using the recipients' own parietal peritoneum graft were retrospectively reviewed. RESULTS The 1-, 2-, 3-, and 5-mo patency rates were 57.1%, 57.1%, 57.1%, and 28.6%, respectively. Among the 15 cases assessed, the most recent 6 cases showed patent graft flow until discharge with 1-, 2-, 3-, and 5-mo patency rates of 80.0%, 80.0%, 80.0%, and 20.0%, respectively. All patients survived with tolerable liver function tests. There were no significant congestion-related problems, except for 1 patient who experienced MHV thrombosis requiring aspiration thrombectomy and stent insertion. There were no infection-related complications. All patients survived to the final follow-up, with a minimum follow-up duration of 8 mo. When comparing the latter 6 cases of peritoneal grafts and the recent 28 cases of conventional polytetrafluorethylene graft, the overall patency rate of the polytetrafluorethylene group was higher (P = 0.002). There were no major differences other than long-term patency rate. CONCLUSIONS Parietal peritoneum may be a novel autologous substitute for MHV reconstruction during LDLT.
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Balzan SMP, Gava VG, Magalhaes MA, Rieger A, Roman LI, Dos Santos C, Marins MP, Rabaioli B, Raupp IT, Kunzler VB. Complete and partial replacement of the inferior vena cava with autologous peritoneum in cancer surgery. J Surg Oncol 2021; 124:665-668. [PMID: 34159613 DOI: 10.1002/jso.26558] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/11/2021] [Accepted: 05/13/2021] [Indexed: 11/07/2022]
Abstract
Resection of the inferior vena cava may be required in the courses of oncological surgeries for the tumors originating from or invading it. Management of the remaining defect depends on the extension of the resection. Partial or complete replacement of the inferior vena cava, with a patch or interposition graft, may be required. Standard techniques for the reconstruction with a prosthetic material or the autologous veins can be associated with the prosthetic graft infection, high cost, long-standing anticoagulation, technical difficulties, and/or need for extra incisions. The use of the autologous peritoneum represents an easy and inexpensive alternative for the partial and complete inferior vena cava reconstructions.
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Affiliation(s)
- Silvio M P Balzan
- Postgraduate Program in Health Promotion (PPGPS) and Life Sciences Department, University of Santa Cruz do Sul (UNISC), Santa Cruz do Sul, Brazil.,Oncological Center Lydia Wong Ling, Hospital Moinhos de Vento, Porto Alegre, Brazil.,Saint Gallen Ações e Terapias em Saúde, Santa Cruz do Sul, Brazil.,Cancer League, University of Santa Cruz do Sul (UNISC), Santa Cruz do Sul, Brazil
| | - Vinicius G Gava
- Oncological Center Lydia Wong Ling, Hospital Moinhos de Vento, Porto Alegre, Brazil
| | | | - Alexandre Rieger
- Postgraduate Program in Health Promotion (PPGPS) and Life Sciences Department, University of Santa Cruz do Sul (UNISC), Santa Cruz do Sul, Brazil.,Biotechnology and Genetics Laboratory, University of Santa Cruz do Sul (UNISC), Santa Cruz do Sul, Brazil
| | - Luiz I Roman
- Cancer League, University of Santa Cruz do Sul (UNISC), Santa Cruz do Sul, Brazil
| | - Caroline Dos Santos
- Cancer League, University of Santa Cruz do Sul (UNISC), Santa Cruz do Sul, Brazil
| | - Morgana P Marins
- Cancer League, University of Santa Cruz do Sul (UNISC), Santa Cruz do Sul, Brazil
| | - Bruna Rabaioli
- Cancer League, University of Santa Cruz do Sul (UNISC), Santa Cruz do Sul, Brazil
| | - Isabela T Raupp
- Cancer League, University of Santa Cruz do Sul (UNISC), Santa Cruz do Sul, Brazil
| | - Vanessa B Kunzler
- Cancer League, University of Santa Cruz do Sul (UNISC), Santa Cruz do Sul, Brazil
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5
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Langella S, Menonna F, Casella M, Russolillo N, Lo Tesoriere R, Alessandro F. Vascular Resection During Hepatectomy for Liver Malignancies. Results from a Tertiary Center using Autologous Peritoneal Patch for Venous Reconstruction. World J Surg 2021; 44:3100-3107. [PMID: 32418027 DOI: 10.1007/s00268-020-05564-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND To evaluate early outcomes of venous reconstruction with peritoneal patch (PP) during resection for hepatic malignancies. METHODS Since May 2015, PP was considered as the first option for venous reconstruction in the case of lateral resection. Between May 2015 and June 2019, 579 consecutive hepatectomies for malignancies were performed at our institution. Among 27 patients requiring venous resection, PP was used in 22, who were included in the present study. Data from a prospectively collected database were analysed. RESULTS Tumour types were ten colorectal metastases (CRLM), six intrahepatic cholangiocarcinomas, four hilar cholangiocarcinomas, one hepatocellular carcinoma and one gallbladder carcinoma. Hepatectomies were major in 50% of cases. Eleven patients had hepatic vein resections, eight portal vein and three inferior vena cava. Venous reconstruction enabled resection in 12 (54.5%) patients, otherwise non-resectable. Among CRLM, the venous reconstruction allowed avoidance of major resection in eight (80%) cases. Median operative time was 456 min (range 270-960). Blood loss was a median 300 cc (range 40-1500), and blood transfusions were required in three patients (13.6%). At pathological examination, venous infiltration was confirmed in 14 (63.6%) patients. No vascular complications related to the patch were recorded. Post-operative major (Dindo III/IV) complications were observed in two (9%) patients. One patient died because of liver failure without vascular thrombosis and one due to biliary fistula complicated by arterial bleeding. Overall, post-operative mortality was 9% (2/22). CONCLUSIONS Venous reconstruction with peritoneal patch during hepatectomy for malignancies can feasibly allow resection in otherwise unresectable patients and decrease the rate of major resection in colorectal liver metastases.
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Affiliation(s)
- Serena Langella
- Department of General and Oncological Surgery, Ospedale Mauriziano "Umberto I" Hospital, Largo Turati, 62, 10128, Turin, Italy.
| | - Francesca Menonna
- Department of General and Oncological Surgery, Ospedale Mauriziano "Umberto I" Hospital, Largo Turati, 62, 10128, Turin, Italy
| | - Michele Casella
- Department of General and Oncological Surgery, Ospedale Mauriziano "Umberto I" Hospital, Largo Turati, 62, 10128, Turin, Italy
| | - Nadia Russolillo
- Department of General and Oncological Surgery, Ospedale Mauriziano "Umberto I" Hospital, Largo Turati, 62, 10128, Turin, Italy
| | - Roberto Lo Tesoriere
- Department of General and Oncological Surgery, Ospedale Mauriziano "Umberto I" Hospital, Largo Turati, 62, 10128, Turin, Italy
| | - Ferrero Alessandro
- Department of General and Oncological Surgery, Ospedale Mauriziano "Umberto I" Hospital, Largo Turati, 62, 10128, Turin, Italy
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6
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Inferior Vena Cava Repair Using Diaphragm in Animal Model. Ann Vasc Surg 2020; 67:468-473. [PMID: 32179144 DOI: 10.1016/j.avsg.2020.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 02/15/2020] [Accepted: 02/17/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Repair and reconstruction of the vena cava with an autologous vein requires multiple incisions. Prosthetic material is linked with an increased risk of infection and thrombosis. Therefore in this study, we created an animal model of vena cava repair using the diaphragm. The objective of this study is to assess the feasibility and outcomes of using diaphragm for the repair and replacement of the inferior vena cava (IVC) after resection of a part of the infrarenal IVC in an animal model, as it may be encountered in trauma patients and extensive tumors of retroperitoneum. METHODS Five healthy dogs of both sexes were prepared. After general anesthesia and laparotomy, a 1 cm width with 4 cm length defect was arranged on anterior aspect of the infrarenal IVC, subsequently, the anterior aspect of the right diaphragm with 1 cm width and 4 cm length was resected and was anastomosed to cover the defect of the IVC as a patch graft, with the pleural side of the diaphragm facing the luminal aspect and the peritoneal side on the outside. The observation period was 6 weeks. RESULTS All of the IVCs were macroscopically patent without thrombosis and stenosis. Pathologic assay revealed complete endothelialization of diaphragm. One dog died at the third night of operation without distinct reason. CONCLUSIONS The diaphragm is an accessible and safe option in the repair and reconstruction of IVC particularly when restrictions exist for the use of prosthetic material in a contaminated space of the abdomen.
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7
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Castillo JM, Flores-Plascencia A, Perez-Montiel MD, Garcia S, Vergara N, Perez-Blanco A, Sanchez-Valdivieso EA. PARIETAL PERITONEUM GRAFT FOR DUODENUM INJURIES IN AN ANIMAL MODEL. ACTA ACUST UNITED AC 2019; 32:e1418. [PMID: 30758466 PMCID: PMC6368166 DOI: 10.1590/0102-672020180001e1418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 09/25/2018] [Indexed: 11/30/2022]
Abstract
Background: Duodenal injuries and their surgical procedure cause a high morbidity and
mortality. Aim: To assess the overall effectiveness of the auto-graft of peritoneum in the
treatment of the perforation of the duodenum, aiming to reduce surgery time,
costs, complexity and mortality. Methods: Twelve New Zealand rabbits, ages 4-6 months, both sexes, underwent designed
surgical grade III duodenal injuries that were repaired 18 h after. Rabbits
were surgically treated with the proposed auto-graft of peritoneum. Results: No postoperative deaths were observed; the animals presented corporal weight
increase and were euthanized six months later. There was no significant
difference between both groups relating to the postoperative evolution or in
the histological changes. Conclusion: Auto-graft of the peritoneum and posterior fascia is a useful option for
duodenal repair and that is worth of evaluation for humans.
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Affiliation(s)
- Joana M Castillo
- Department of Surgery, Hospital de Alta Especialidad, Veracruz City, Mexico
| | | | | | - Salma Garcia
- Department of Research, Cristobal Colon University School of Medicine
| | - Neydel Vergara
- Department of Research, Cristobal Colon University School of Medicine
| | - Aida Perez-Blanco
- Department of Research, Cristobal Colon University School of Medicine
| | - Enrique Alejandro Sanchez-Valdivieso
- Department of Surgery, Hospital de Alta Especialidad, Veracruz City, Mexico.,Department of Research, Cristobal Colon University School of Medicine
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8
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Coubeau L, Rico Juri JM, Ciccarelli O, Jabbour N, Lerut J. The Use of Autologous Peritoneum for Complete Caval Replacement Following Resection of Major Intra-abdominal Malignancies. World J Surg 2017; 41:1005-1011. [PMID: 27826769 DOI: 10.1007/s00268-016-3804-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Assessment of a simple layer peritoneal tube used as an autogenous inferior vena cava replacement. BACKGROUND Extensive en-bloc multivisceral resection including major vessels is effective in selected abdominal malignancies, but the need for vascular reconstruction represents a surgical challenge. We describe the use of autologous peritoneum for caval replacement. METHODS Autogenous parietal peritoneum without fascial backing was harvested and tubularized to replace the inferior vena cava (IVC) in four patients with complex abdominal tumors. Surgical morbidity was evaluated using the Clavien-Dindo classification, and graft patency was systematically evaluated with ultrasound. RESULTS All four patients had multiorgan resections for malignancies involving the retro-hepatic IVC, and they all required the replacement of infrarenal and suprarenal IVC segments. Additionally, all four required a right nephrectomy, two had a combined major hepatectomy, and one patient needed a veno-venous bypass. All had an R0 resection. A clinical follow-up took place between 5 and 11 months after surgery for each patient. Four-month graft patency was confirmed by ultra-sound and TDM with no sign of disease recurrence. CONCLUSIONS Autologous peritoneum without fascial backing is a good and safe option for circumferential replacement of IVC after extensive en-bloc tumor resection with IVC involvement.
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Affiliation(s)
- Laurent Coubeau
- Department of Abdominal Surgery and Transplantation, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, 10 Avenue Hippocrate, 1200, Brussels, Belgium.
| | - Juan-Manuel Rico Juri
- Department of Abdominal Surgery and Transplantation, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, 10 Avenue Hippocrate, 1200, Brussels, Belgium
| | - Olga Ciccarelli
- Department of Abdominal Surgery and Transplantation, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, 10 Avenue Hippocrate, 1200, Brussels, Belgium
| | - Nicolas Jabbour
- Department of Abdominal Surgery and Transplantation, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, 10 Avenue Hippocrate, 1200, Brussels, Belgium
| | - Jan Lerut
- Department of Abdominal Surgery and Transplantation, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, 10 Avenue Hippocrate, 1200, Brussels, Belgium
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9
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Zhiying Y, Haidong T, Xiaolei L, Yongliang S, Shuang S, Liguo L, Li X, Atyah M. The falciform ligament as a graft for portal-superior mesenteric vein reconstruction in pancreatectomy. J Surg Res 2017; 218:226-231. [PMID: 28985853 DOI: 10.1016/j.jss.2017.05.090] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 04/30/2017] [Accepted: 05/24/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Tumor invasion or adherence to the portal vein-superior mesenteric vein (PV/SMV) may be encountered during pancreatic surgery. In such cases, venous resection and reconstruction might be required for complete resection of the tumor. We report an innovative technique in which the graft for PV/SMV reconstruction was made with the falciform ligament. METHODS Between May 2011 and July 2016, PV/SMV reconstruction with a falciform ligament graft was performed in 10 cases during pancreatectomy. Among these cases, including six cases with a patch graft and four cases with a conduit graft. Retrospective reviews of medical records and radiologic studies were performed. RESULTS Ten patients with pancreatobiliary cancer underwent en bloc tumor resection with concurrent PV/SMV resection and reconstruction with a falciform ligament graft. There were six males and four females, and the mean age was 65.3 ± 9.4 (48-80) y. Using Doppler ultrasound examination, all 10 grafts were shown to be patent at postoperative 2 wk. However, occlusion was found in one case with conduit graft and stenosis in the other three cases with conduit graft using enhanced computed tomography at postoperative 2 mo. Complete patency was shown in three of six cases with patch graft and stenosis in the other three cases at 2 mo after the operation. Although occlusion or stenosis of the grafts was observed, no severe adverse events occurred, and normal liver function was discovered in all 10 cases at postoperative 2 mo. CONCLUSIONS Falciform ligament grafts might be considered for reconstruction of PV/SMV in the absence of appropriate vascular grafts.
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Affiliation(s)
- Yang Zhiying
- Department of Hepatobiliary Surgery, China-Japan Friendship Hospital, Beijing, China.
| | - Tan Haidong
- Department of Hepatobiliary Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Liu Xiaolei
- Department of Hepatobiliary Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Sun Yongliang
- Department of Hepatobiliary Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Si Shuang
- Department of Hepatobiliary Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Liu Liguo
- Department of Hepatobiliary Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Xu Li
- Department of Hepatobiliary Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Manar Atyah
- Department of Hepatobiliary Surgery, China-Japan Friendship Hospital, Beijing, China
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10
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Parietal Peritoneum as an Autologous Substitute for Venous Reconstruction in Hepatopancreatobiliary Surgery. Ann Surg 2015; 262:366-71. [PMID: 25243564 DOI: 10.1097/sla.0000000000000959] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To evaluate the parietal peritoneum (PP) as an autologous substitute for venous reconstruction during hepatopancreatobiliary (HPB) surgery. BACKGROUND Venous resection during liver or pancreatic resection may require a rapidly available substitute especially when the need for venous resection is unforeseen. METHODS The PP was used as an autologous substitute during complex liver and pancreatic resections. Postoperative anticoagulation was standard and venous patency was assessed by routine computed tomographic scans. RESULTS Thirty patients underwent vascular resection during pancreatic (n = 18) or liver (n = 12) resection, mainly for malignant tumors (n = 29). Venous resection was an emergency procedure in 4 patients due to prolonged vascular occlusion. The PP, with a mean length of 22 mm (15-70), was quickly harvested and used as a lateral (n = 28) or a tubular (n = 2) substitute for reconstruction of the mesentericoportal vein (n = 24), vena cava (n = 3), or hepatic vein (n = 3). Severe morbidity included Clavien grade-III complications in 4 (13%) patients but there was no PP-related or hemorrhagic complications. Histological vascular invasion was present in 18 (62%) patients, and all had an R0 resection (100%). After a mean follow-up of 14 (7-33) months, all venous reconstructions were patent except for 1 tubular graft (97%). CONCLUSIONS A PP can be safely used as a lateral patch for venous reconstruction during HPB surgery; this could help reduce reluctance to perform vascular resection when oncologically required. Clinical trials identification: NCT02121886.
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11
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Csébi P, Jakab C, Patonai A, Arany-Tóth A, Kóbori L, Németh T. Morphological evaluation of experimental autologous rectus fascia sheath vascular grafts used for arterial replacement in a dog model. Acta Vet Hung 2014; 62:429-38. [PMID: 25410385 DOI: 10.1556/avet.2014.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Although experimental autologous patch or tubular conduit vascular grafts made from the internal rectus fascia sheath (IRFS) have been reported in the literature, thorough morphological evaluation and verification of the histological arterialisation of such grafts are lacking. Four purpose-bred Beagle dogs were utilised to create eight arterial internal rectus fascia sheath (ARFS) grafts implanted between bisected ends of the external iliac arteries. Four out of the eight ARFS grafts were patent after three months. Haematoxylin-eosin and Azan staining verified that the grafts gained a vessel-like layered structure with the presence of large amounts of collagen fibres. Although the inner surface of the intact IRFS was originally covered with claudin-5-negative and pancytokeratin-positive mesothelial cells in control samples, the internal cells of the ARFS grafts became claudin-5 positive and pancytokeratin negative like in intact arteries. Spindle-shaped cells of the wall of ARFS grafts were α-smooth muscle actin (α-SMA) positive just like the smooth muscle cells of intact arteries, but α-SMA immunoreactivity was negative in the intact IRFS. According to these findings, the fibroblast cells of the ARFS graft have changed into myofibroblast cells. The study has proved that ARFS grafts may be used as an alternative in arterial replacement, since the graft becomes morphologically and functionally similar to the host vessel via arterialisation.
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Affiliation(s)
- Péter Csébi
- 1 Szent István University Department and Clinic of Surgery and Ophthalmology István utca 2 H-1078 Budapest Hungary
| | - Csaba Jakab
- 2 Szent István University Department of Pathology and Forensic Veterinary Medicine, Faculty of Veterinary Science István utca 2 H-1078 Budapest Hungary
| | - Attila Patonai
- 3 Semmelweis University Transplantation and Surgical Clinic Budapest Hungary
| | - Attila Arany-Tóth
- 1 Szent István University Department and Clinic of Surgery and Ophthalmology István utca 2 H-1078 Budapest Hungary
| | - László Kóbori
- 3 Semmelweis University Transplantation and Surgical Clinic Budapest Hungary
| | - Tibor Németh
- 1 Szent István University Department and Clinic of Surgery and Ophthalmology István utca 2 H-1078 Budapest Hungary
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12
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Hodjati H, Salehipour M, Safai A, Boveiri K, Hekmati P, Hadian P, Tanideh N. Use of autologous renal capsule grafts for venous repair. Urology 2013; 81:696.e9-12. [PMID: 23312894 DOI: 10.1016/j.urology.2012.10.048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Revised: 10/22/2012] [Accepted: 10/30/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To evaluate the efficacy of the renal capsule for reconstruction of the inferior vena cava in a canine model. MATERIALS AND METHODS The present study was conducted on 10 dogs; an oval window (2-8 cm long, mean 6.5 cm) was made in the inferior vena cava and then repaired using the autologous renal capsule patch. The patency and functionality of the graft were assessed macroscopically and microscopically 3 months postoperatively. RESULTS All the dogs were killed at 3 months, showing excellent patency of the vena cava macroscopically and in the venography. In the microscopic examination, all the patches were completely endothelialized. No evidence of infection or thrombosis was noted. CONCLUSION A renal capsule patch can be used for reconstruction of the inferior vena cava. Patency appears to be good, and the risk of infection is low. Moreover, this is an accessible material.
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Affiliation(s)
- Hossein Hodjati
- Department of Surgery, Shiraz University of Medical Sciences, Shiraz, Iran
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13
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Csébi P, Németh T, Jakab C, Patonai A, Garamvölgyi R, Manczur F, Spitzner Á, Arany-Tóth A, Kóbori L. Experimental results of using autologous rectus fascia sheath for venous patch grafts in dogs. Acta Vet Hung 2011; 59:373-84. [PMID: 21727069 DOI: 10.1556/avet.2011.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Autologous vascular patch grafts developed from the internal rectus sheath were implanted onto the bilateral common iliac vein and jugular vein of 4 experimental beagle dogs. During the development and implanting of the grafts no technical difficulties or perioperative complications were encountered. The follow-up lasted 6 months and 3 months in the case of the common iliac vein grafts and the jugular grafts, respectively. In the postoperative period, the morphological and functional characteristics of the implanted venous sections were examined by Doppler ultrasonography and CT angiography. Normal patency was detected, and none of these check-ups showed obturation or stenosis. The histological survey showed no mesothelial cell layer, but the insides of the grafts showed total restructuring and were covered by a normal endothelial layer. No difference could be detected between samples harvested 3 and 6 months after implanting. The immunohistochemical examinations using anti-claudin-5 and anti-CD31 antibodies confirmed the preliminary results of the histological examinations that the luminal surfaces of the implanted grafts developed a differentiated monolayer endothelium which was free of degenerative and inflammatory signs. The control examinations show the suitability of the internal rectus sheath as a venous wall donor.
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Affiliation(s)
- Péter Csébi
- 1 Szent István University Department and Clinic of Surgery and Ophthalmology István u. 2 H-1078 Budapest Hungary
| | - Tibor Németh
- 1 Szent István University Department and Clinic of Surgery and Ophthalmology István u. 2 H-1078 Budapest Hungary
| | - Csaba Jakab
- 2 Szent István University Department of Pathology and Forensic Veterinary Medicine István u. 2 H-1078 Budapest Hungary
| | - Attila Patonai
- 5 Semmelweis University Medical School 2nd Department of Pathology Budapest Hungary
| | - Rita Garamvölgyi
- 4 University of Kaposvár Institute of Diagnostic Imaging and Radiation Oncology Kaposvár Hungary
| | - Ferenc Manczur
- 3 Szent István University Department and Clinic of Internal Medicine, Faculty of Veterinary Science István u. 2 H-1078 Budapest Hungary
| | - Ádám Spitzner
- 1 Szent István University Department and Clinic of Surgery and Ophthalmology István u. 2 H-1078 Budapest Hungary
| | - Attila Arany-Tóth
- 1 Szent István University Department and Clinic of Surgery and Ophthalmology István u. 2 H-1078 Budapest Hungary
| | - László Kóbori
- 6 Semmelweis University Medical School Transplantation and Surgical Department Budapest Hungary
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14
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Sarac TP, Carnevale K, Smedira N, Tanquilut E, Augustinos P, Patel A, Naska T, Clair D, Ouriel K. In vivo and mechanical properties of peritoneum/fascia as a novel arterial substitute. J Vasc Surg 2005; 41:490-7. [PMID: 15838485 DOI: 10.1016/j.jvs.2004.11.033] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE This study evaluates the efficacy of bovine peritoneum/fascia as an arterial substitute. METHODS AND OUTCOME MEASURES Twelve dogs underwent bilateral femoral artery patch angioplasty with a glutaraldehyde-fixed bovine peritoneal/fascial patch (PFA patch) on one side and polyester patch on the contralateral side. Arteriograms were performed just before vessel harvest at 1 and 6 months, and vessels were evaluated for aneurysms and inflammation. Histologic analysis included intima area, media thickness, and lumen area. Immunofluorescence for CD 34 and Factor VIII was done to evaluate endothelialization and alpha-actin for smooth muscle cell growth. Mechanical strength testing was evaluated in separate PFA patches and compared independently to a commercially available bovine pericardial patch and polyester patch. RESULTS All vessels examined at both 1 and 6 months were patent with no arteriographic evidence of stenosis. There was no evidence of aneurysm formation in any vessel and no difference between groups in inflammatory reaction. One polyester patch at 1 month developed an infection. Microscopic evaluation of experimental vessels revealed no difference between groups in intima area at 1 month (2.1 +/- 1.2 vs 2.2 +/- 1.2 mm 2 ; P = .5) and at 6 months (1.81 +/- 1.2 vs 1.9 +/- 1.2 mm 2 ; P = .5). There was no difference in media thickness, but the PFA patch group had a greater lumen area at 1 month (8.8 +/- 2.9 vs 9.8 +/- 3.0 mm 2 ; P = .02) and 6 months (10.5 +/- 4.2 vs 11.7 +/- 5.6 mm 2 ; P = .02). Immunofluorescence for CD34 and Factor VIII demonstrated complete re-endothelialization of all patches. The polyester patch had a chronic inflammatory response, but not the PFA patch. Mechanical strength testing demonstrated that compared to pericardium, the PFA patch had superior ( P < .05) failure tension, stiffness, and suture pull-out strength, whereas extensibility, fatigue tension, relax slope, and creep tests were not different. Polyester demonstrated superior suture pull-out, stiffness, relax slope, and failure strain ( P < .05), but it was not different in failure tension and extensibility than the PFA patch. However, the PFA patch had significantly less creep (0.25 +/- 0.25 vs 4.92 +/- 0.84; P < .01). CONCLUSIONS The PFA patch has similar clot-resistant properties to polyester and is superior to the pericardial patch in mechanical strength. It is a promising endothelial alternative for not only arterial patches but other vascular products. CLINICAL RELEVANCE The search for an artificial, thromboresistant, and intimal hyperplasia resistant interface between blood and native blood vessels still continues. This study demonstrates the feasibility and proof of concept of the peritoneum's clot-resistant properties. When adding the underlying fascia, it serves as an ideal arterial patch. Other studies are underway evaluating its feasibility as a bypass graft and a "drug coated"-like stent lining.
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Affiliation(s)
- Timur P Sarac
- Department of Vascular Surgery, Cleveland Clinic Lerner College of Medicine, 9500 Euclid Avenue Desk S40, Cleveland, OH 44195, USA.
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15
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Cekirdekci A, Bayar MK, Yilmaz S, Cihangiroglu M, Ayan E, Duran M, Bakalim T, Kaya D, Gokce O. Reconstruction of the Vena Cava with the Peritoneum: The Effect of Temporary Distal Arteriovenous Fistula on Patency (An Experimental Study). Eur J Vasc Endovasc Surg 2004; 27:84-8. [PMID: 14652843 DOI: 10.1016/j.ejvs.2003.10.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To determine the effect of increasing inferior vena cava blood flow by means of distal arteriovenous fistula on the patency of a peritoneal tube graft. MATERIALS AND METHODS In 16 mongrel dogs, a 3-4 cm long circular defect was created at the infrarenal inferior vena cava. The defect was interposed with peritoneal tube graft. A temporary distal femoro-femoral arteriovenous fistula was also constructed in 8 dogs just after the caval interposition. Graft patency was evaluated by Doppler ultrasonography and angiography. Histological evaluation was also performed. RESULTS Seven dogs in each group survived. All control grafts occluded within the first week, compared to no occlusions in fistula group (Fisher's exact test, p<0.005). However one 'fistula' dog with a still patent graft was sacrificed on the 18th day due to ultrasonographically occluded arteriovenous fistula. CONCLUSION In dogs, the peritoneum may be used as graft material for reconstruction of the inferior vena cava, provided a distal arteriovenous fistula is constructed.
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Affiliation(s)
- A Cekirdekci
- Department of Cardiovascular Surgery, Faculty of Medicine, Afyon Kocatepe University, Afyon, Turkey
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16
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Yoshioka M, Onda M, Tajiri T, Akimaru K, Mineta S, Hirakata A, Takubo K. Reconstruction of the portal vein using a peritoneal patch-graft. Am J Surg 2001; 181:247-50. [PMID: 11376580 DOI: 10.1016/s0002-9610(01)00552-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Reconstruction of the portal vein with autologous veins requires extra incisions. Prosthetic material is associated with an increased risk of infection. We therefore created an animal model of portal vein reconstruction using the peritoneum. METHODS A 2.5 x 2.5 cm piece of the peritoneum was resected from Landrace pigs weighing 30 to 40 kg and was dipped in 100% alcohol for 10 minutes. The anterior wall of the portal vein measuring 1.2 x 0.6 cm was resected. The peritoneal patch-graft fitting the defect of the portal vein was used to repair it. RESULTS All 7 pigs survived the surgery, and were killed at 2, 7, 7, 14, 21, 35 and 49 days, respectively, after surgery. There was no evidence of thrombosis or obstruction of the reconstructed portal vein or any other complications. Complete endothelialization of the patches were noted at day 14. CONCLUSIONS Our patch-graft technique using the peritoneum is considered to be a good and safe alternative for reconstruction after partial resection of the portal vein in clinical surgery.
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Affiliation(s)
- M Yoshioka
- First Department of Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, 113-8603, Tokyo, Japan.
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