title: Vascular reconstruction for intraoperative major vascular injuries.
abstract: BACKGROUND
  The purpose of this study was to find an effective and precise surgical procedure to cope with the major vascular injuries that might be encountered during hepato-biliary and pancreatic surgery.
  
  
  METHODS
  Among the 220 cases of hepato-biliary and pancreatic surgery from 1991 to 1995 in our department, 8 patients who sustained 13 different instances of vascular injury were reviewed retrospectively.
  
  
  RESULTS
  Five injuries occurred in the portal vein (PV), 4 in the hepatic artery (HA), and 2 in the inferior vena cava (IVC). The repair procedures consisted of 2 direct closures, 2 resections of the injured sites followed by the end to end anastomosis, 2 autologous venous grafts and 1 artificial vascular graft implantation, and 2 diversions of the arterial bloodflow of the middle colic artery and the gastroepiploic artery to the injured HA. The reconstructed vessels showed postoperative obstructions in 2 cases, in which artificial vascular graft implantation and direct closure were used for the reconstruction.
  
  
  CONCLUSIONS
  Based on the above findings, the use of an artificial graft and a direct closure all contributed to the early postoperative obstruction of the reconstructed vessels. However, a diversion of the arterial bloodflow to the injured hepatic arteries was found to maintain a good postoperative patency in these cases.
authors.affiliation: First Department of Surgery, University of Ryukyu, School of Medicine, Okinawa, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Shiraishi
authors.forename: S
authors.initials: S
authors.lastname: Hiroyasu
authors.forename: T
authors.initials: T
authors.lastname: Kusano
authors.forename: Y
authors.initials: Y
authors.lastname: Muto
mesh_terms: D000328:Adult; D000368:Aged; D001662:Biliary Tract Surgical Procedures; D005260:Female; D006499:Hepatic Artery / Q000293:injuries* / Q000601:surgery*; D006801:Humans; D007431:Intraoperative Complications; D008099:Liver / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000601:surgery; D011169:Portal Vein / Q000293:injuries* / Q000601:surgery*; D011183:Postoperative Complications; D012189:Retrospective Studies; D014656:Vascular Surgical Procedures; D014682:Vena Cava, Inferior / Q000293:injuries* / Q000601:surgery*