Reconstruction of hepatic or portal veins by use of newly customized great saphenous vein grafts.
OBJECTIVE
Segmental resection of major hepatic veins or the portal vein is sometimes required if one is to secure adequate surgical margins from hepatic or pancreatic malignancies. An external iliac vein is widely sacrificed as a vein graft to replace the defect, but this is associated with postoperative edema of the lower leg. We developed a new method for constructing the great saphenous vein to interpose the hepatic or portal veins.


METHODS
The great saphenous vein was divided transversely into three sections, which were aligned side-to-side. The three pieces were anastomosed to make a sheet 3 x 2 cm, which was rolled up into a cylindrical form of approximately 1 cm in diameter and 2 cm in length. We applied the finished vein grafts to interpose the major hepatic veins in three patients with metastatic liver tumors and the portal vein in two patients with pancreatic malignancies in cylindrical form and to reconstruct the portal vein in one patient with a pancreas cancer, using a three-row sheet as a patch graft.


RESULTS
No patient developed venous thrombosis of the graft or edema of the lower leg.


CONCLUSIONS
The newly customized vein graft was safe and useful for the reconstruction of the major hepatic or portal veins.
Sakamoto
Yoshihiro
Y
Department of Gastrointestinal Surgery, Cancer Institute Hospital, 1-37-1 Kami-Ikebukuro, Toshima-ku, 170-8455 Tokyo, Japan.
Yamamoto
Junji
J
Saiura
Akio
A
Koga
Rintaro
R
Kokudo
Norihiro
N
Kosuge
Tomoo
T
Yamaguchi
Toshiharu
T
Muto
Tetsuichiro
T
Makuuchi
Masatoshi
M
D000368:Aged; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D005260:Female; D006503:Hepatic Veins / Q000473:pathology / Q000601:surgery; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000601:surgery*; D011169:Portal Vein / Q000473:pathology / Q000601:surgery; D012501:Saphenous Vein / Q000601:surgery / Q000637:transplantation*; D019043:Vascular Neoplasms / Q000473:pathology / Q000556:secondary*