Arterial reconstruction with donor iliac vessels during pancreas transplantation: an intraoperative approach to arterial injury or inadequate flow.
BACKGROUND
Outcome of pancreas transplantation (PTX) has improved because of use of novel immunosuppression and advances in surgical technique. It is not uncommon for severe atherosclerosis in patients with type 1 insulin-dependent diabetes mellitus or the presence of a previously transplanted organ to limit the options for vascular anastomosis. Herein we report the novel application of donor iliac arterial interposition grafts for arterial reconstruction in patients with severe iliac artery arteriosclerosis, and/or previous transplant who develop an arterial injury or stenosis during surgery.


METHODS
In five patients undergoing PTX, the external iliac artery was severely atherosclerotic and/or occupied by a previous vascular anastomosis. In four of the five patients, an arterial intimal dissection became apparent. The external iliac artery was excised and reconstructed with donor iliac artery interposition graft (end-to-end anastomosis). Pancreas or kidney was engrafted onto this arterial interposition graft (end-to-side anastomosis).


RESULTS
There was no operative morbidity related to this surgical approach. All grafts functioned well after transplantation. Distal lower extremities have no evidence of vascular insufficiency with mean follow-up of 26 months (7-45 months).


CONCLUSIONS
This surgical technique is an acceptable option during PTX for the patient with severe iliac artery arteriosclerosis with intraoperative intimal dissection or stenosis, or perhaps those with challenging arterial access.
Moon
Jang Il
JI
Division of Transplantation, Department of Surgery, University of Miami School of Medicine, Miami, FL, USA. jmoon@med.miami.edu
Ciancio
Gaetano
G
Burke
George W
GW
D000328:Adult; D000714:Anastomosis, Surgical / Q000379:methods*; D000784:Aortic Dissection / Q000601:surgery; D001161:Arteriosclerosis / Q000601:surgery; D003251:Constriction, Pathologic / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007083:Iliac Artery / Q000473:pathology / Q000601:surgery / Q000637:transplantation*; D007431:Intraoperative Complications / Q000601:surgery; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D016035:Pancreas Transplantation / Q000502:physiology; D019651:Plastic Surgery Procedures / Q000379:methods*; D012039:Regional Blood Flow / Q000502:physiology; D017539:Tunica Intima / Q000473:pathology; D014654:Vascular Patency / Q000502:physiology