title: Operative interventions for extrahepatic portomesenteric venous aneurysms and long-term outcomes.
abstract: BACKGROUND
  Extrahepatic portal venous aneurysms (PVAs) are rare, and the pathogenesis is not fully understood. The optimum management of these patients is unknown.
  
  
  METHODS
  Consecutive patients with PVA were identified over an 18-year period (1992-2010). A retrospective review was conducted. Clinical presentation, modality of diagnosis, surgical treatment, 30-day morbidity and mortality, and follow-up are reported.
  
  
  RESULTS
  Four patients were identified who underwent surgical management of an extrahepatic PVA. Operative technique using left renal vein, femoral vein panel graft, polytetrafluoroethylene (ePTFE) graft, and segmental aneurysm wall resected with aneurysmorrhaphy is described. Early complications occurred in 1 patient with an ePTFE graft. The patient returned to the operating room for bleeding. In addition, the same patient had a late graft thrombosis 6 years postoperatively when the anticoagulation was discontinued for pregnancy. The remainder of the patients recovered without complication, and their repairs are still patent with a mean follow-up of 78 months (17-144 months). There were no mortalities in the series.
  
  
  CONCLUSIONS
  Operative intervention for portomesenteric venous aneurysm can be done safely in select patients and should be considered in those with symptoms, rapid growth, mural thrombus, or aneurysms ≥4 cm in diameter. Repair with an autogenous interposition graft affords good long-term patency. Aneurysmorrhaphy may be performed if the remaining venous wall is of good quality.
authors.affiliation: Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN. Electronic address: fleming.mark@mayo.edu.
authors.forename: Mark D
authors.initials: MD
authors.lastname: Fleming
authors.affiliation: Department of Vascular Surgery, Western New York VA Healthcare System, Buffalo, NY.
authors.forename: Purandath
authors.initials: P
authors.lastname: Lall
authors.affiliation: Department of General Surgery, Mayo Clinic, Rochester, MN.
authors.forename: David M
authors.initials: DM
authors.lastname: Nagorney
authors.affiliation: Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN.
authors.forename: Peter
authors.initials: P
authors.lastname: Gloviczki
authors.affiliation: Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN.
authors.forename: Manju
authors.initials: M
authors.lastname: Kalra
authors.affiliation: Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN.
authors.forename: Audra
authors.initials: A
authors.lastname: Duncan
authors.affiliation: Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN.
authors.forename: Gustavo
authors.initials: G
authors.lastname: Oderich
authors.affiliation: Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN.
authors.forename: Barbara
authors.initials: B
authors.lastname: Toomey
authors.affiliation: Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN.
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Bower
mesh_terms: D000328:Adult; D000368:Aged; D000783:Aneurysm / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D001706:Biopsy; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation; D005260:Female; D005268:Femoral Vein / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000637:transplantation*; D006801:Humans; D008642:Mesenteric Veins / Q000503:physiopathology / Q000601:surgery*; D008875:Middle Aged; D010690:Phlebography / Q000379:methods; D011138:Polytetrafluoroethylene; D011169:Portal Vein / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications / Q000601:surgery; D011474:Prosthesis Design; D012082:Renal Veins / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000637:transplantation*; D012086:Reoperation; D012189:Retrospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014654:Vascular Patency
chemical_list: D011138:Polytetrafluoroethylene