title: Left renal vein graft for vascular reconstruction in abdominal malignancy.
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.
authors: Department of Surgery, Gunma University, Graduate School of Medicine, Maebashi, Japan. go.go.ohwada@gmail.com
authors: Susumu
authors: S
authors: Ohwada
authors: Kunihiro
authors: K
authors: Hamada
authors: Susumu
authors: S
authors: Kawate
authors: Yutaka
authors: Y
authors: Sunose
authors: Naoki
authors: N
authors: Tomizawa
authors: Tatsuya
authors: T
authors: Yamada
authors: Toshihiko
authors: T
authors: Okabe
authors: Testushi
authors: T
authors: Ogawa
authors: Yoshihiro
authors: Y
authors: Sato
mesh_terms: D000008:Abdominal Neoplasms / Q000098:blood supply / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery; D001653:Bile Ducts, Intrahepatic / Q000473:pathology / Q000601:surgery; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000601:surgery; D002292:Carcinoma, Renal Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery; D018281:Cholangiocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy; D017052:Hospital Mortality; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000556:secondary / Q000601:surgery; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery; D016577:Pancreaticoduodenectomy; D011169:Portal Vein / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications / Q000401:mortality; D014057:Tomography, X-Ray Computed; D014654:Vascular Patency / Q000502:physiology; D014680:Veins / Q000637:transplantation*; D014682:Vena Cava, Inferior / Q000473:pathology / Q000601:surgery*