title: Endovascular stenting of mesenterico-portal vein stenosis to reduce blood flow through venous collaterals prior to pancreatoduodenectomy.
abstract: BACKGROUND
  When the mesenterico-portal vein is stenosed due to tumor related compression, venous collaterals develop and flow occurs antegrade towards the portal vein through the collateral tributaries. Undertaking pancreatoduodenectomy for pancreatic cancer in this setting may result in significant blood loss during the process of ligation of these tributaries.
  
  
  METHODS
  We describe the technique of endovascular stenting of the mesenterico-portal vein to reduce flow within these collateral tributaries and hence blood loss, to facilitate extended pancreatoduodenectomy and vein resection.
  
  
  CONCLUSIONS
  Percutaneous transhepatic placement of endovascular stent into a stenotic mesentero-portal vein facilitates pancreatoduodenectomy by reducing operative time, which would otherwise be required in dealing with the extensive venous collaterals and hence also reducing blood loss.
authors.affiliation: Department of Gastrointestinal Surgery, Discipline of Surgery, University of Sydney, Sydney, NSW, Australia, terence.c.chua@gmail.com.
authors.forename: Terence C
authors.initials: TC
authors.lastname: Chua
authors.forename: Frank
authors.initials: F
authors.lastname: Wang
authors.forename: Richard
authors.initials: R
authors.lastname: Maher
authors.forename: Sivakumar
authors.initials: S
authors.lastname: Gananadha
authors.forename: Anubhav
authors.initials: A
authors.lastname: Mittal
authors.forename: Jaswinder S
authors.initials: JS
authors.lastname: Samra
mesh_terms: D001783:Blood Flow Velocity; D016063:Blood Loss, Surgical / Q000517:prevention & control; D003097:Collateral Circulation; D003251:Constriction, Pathologic; D057510:Endovascular Procedures; D006439:Hemodynamics; D006801:Humans; D008642:Mesenteric Veins / Q000473:pathology*; D061646:Operative Time; D010190:Pancreatic Neoplasms / Q000150:complications* / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy; D011169:Portal Vein / Q000473:pathology*; D015607:Stents; D016896:Treatment Outcome