Use of Extension Venous Graft for Pancreas Transplantation?

Robert J. Stratta, MD

Disclosures

July 17, 2002

Question

Is it necessary to use an extension venous graft in all cases for pancreas transplantation?

Response from Robert J. Stratta, MD

The use of a venous extension graft is rarely, if ever, indicated in pancreas transplantation. Some authors specifically caution against the use of a graft in any situation, stating that a short portal vein is preferable in order to minimize the risk of vascular thrombosis. Others advocate a graft in selected situations, such as placement of the pancreas graft on the left side, retransplantation, deep pelvis, obese recipient, or if the portal vein is cut adjacent to the splenic and superior mesenteric venous confluence. Although the portal vein always looks short on the back table, placement of stay sutures and dissection back to the confluence usually results in an adequate and safe length of vein for subsequent implantation. My personal bias is that the portal vein should neither be too short nor too long but "just right." If the extrapancreatic portal vein is less than 1 cm in length, then I usually place a graft from either the donor common or external iliac vein. The graft usually ends up getting trimmed such that the total length of extrapancreatic vein is only 2-3 cm. In my experience, grafts are only required in about 5% of cases. If the portal vein is cut short and the recipient anatomy is unknown, it is not unreasonable to place a graft on the vein during the bench preparation so that the extra length is available if needed. However, as noted above, dissection of the portal vein usually eliminates the need for this added vascular reconstruction, although I usually try to have a vein graft available and packaged with the pancreas in case I encounter an unusual anatomic situation. Of interest, with the portal-enteric drainage technique of pancreas transplantation, a clear-cut advantage is the ease and simplicity of the venous anastomosis, which is placed in the mid-abdomen rather than the pelvis, such that a short length of portal vein is preferred.

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