Alloplastic Vascular Grafts for Venous Interposition in Pancreatic Surgery: Readily Available and Reliable.

IF 7.5 1区医学 Q1 SURGERY

Annals of surgery Pub Date : 2024-11-07 DOI:10.1097/SLA.0000000000006581

Benedict Kinny-Köster, Arnaud Lambrecht, Viktoria Flossmann, Verena Steinle, Aghnia J Putri, Max Heckler, Jörg Kaiser, Thomas Hank, Susanne Roth, Beat P Müller-Stich, Oliver Strobel, Markus K Diener, Martin Schneider, Christoph Berchtold, Mohammed Al-Saeedi, Thilo Hackert, Arianeb Mehrabi, Markus W Büchler, Martin Loos

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引用次数: 0

Abstract

Objective: To investigate patency and clinical outcomes of alloplastic and other venous interposition graft materials in pancreatic surgery.

Background: Vascular pancreatic surgery is increasingly performed for locally advanced pancreatic neoplasms. Different than other centers, we prefer to use alloplastic vascular graft materials for superior mesenteric vein and portal vein interposition in pancreatic surgery. Advantages are off-the-shelf availability at any customizable length, different diameters, and ring-enforcement but proposed concerns are their thrombogenicity and fatal complications.

Methods: Patients who underwent elective pancreatic resections with mesoportal venous interposition grafts (ISGPS type 4) between 2003-2022 were identified from the institutional pancreatectomy registry. Alloplastic vascular grafts imply synthetic materials, either based on polytetrafluorethylene (PTFE) or polyethylene terephthalate (PET). Surgical details, clinicopathological, and follow-up data were analyzed. The patients were followed for graft patency by cross-sectional imaging.

Results: In this study, 201 patients with venous interposition grafts were included (23% simultaneous arterial resections). Total pancreatectomy (41%) and pancreatoduodenectomy (35%) were the most frequent procedures. Vascular graft materials were alloplastic in 180 patients (83% PTFE and 17% PET) with a median diameter of 10 mm and a median length of 33 mm (measurement by CT scan). Patency rates among all graft materials at 7-, 30-, and 90-days were 99%, 93%, and 87%. Alloplastic grafts demonstrated superior patency over other materials (hazard ratio 2.7, P=0.009), and PTFE reached a 1-year patency of 78%. The all-cause 90-day mortality rate was 10%. No graft infection occurred.

Conclusion: Alloplastic venous vascular grafts are safe and readily available tools in pancreatic surgery, especially for long-segmental mesoportal venous reconstructions.

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用于胰腺手术静脉置换的异体血管移植物：现成可靠。

摘要研究胰腺手术中异体和其他静脉插管移植材料的通畅性和临床效果：背景：血管性胰腺手术越来越多地用于局部晚期胰腺肿瘤。与其他中心不同，我们更倾向于在胰腺手术中使用异体血管移植材料进行肠系膜上静脉和门静脉插植。这种材料的优点是现成可用，长度可任意定制，直径各异，并具有环形加固功能，但我们担心其血栓形成性和致命并发症：方法：从胰腺切除术登记机构中筛选出2003-2022年间接受选择性胰腺切除术并使用门静脉间质插植术（ISGPS 4型）的患者。异体血管移植物是指基于聚四氟乙烯（PTFE）或聚对苯二甲酸乙二醇酯（PET）的合成材料。对手术细节、临床病理学和随访数据进行了分析。通过横断面成像对患者的移植物通畅性进行随访：结果：本研究共纳入 201 例静脉插管移植患者（23% 同时进行了动脉切除术）。最常见的手术是全胰切除术（41%）和胰十二指肠切除术（35%）。180 例患者的血管移植材料为异体材料（83% 为 PTFE，17% 为 PET），中位直径为 10 毫米，中位长度为 33 毫米（通过 CT 扫描测量）。所有移植物材料在 7 天、30 天和 90 天的通畅率分别为 99%、93% 和 87%。全塑移植物的通畅率高于其他材料（危险比为 2.7，P=0.009），PTFE 的 1 年通畅率为 78%。全因90天死亡率为10%。没有发生移植物感染：结论：异体塑性静脉血管移植物是胰腺手术中安全且易于使用的工具，尤其适用于长段皮质间静脉重建。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Annals of surgery 医学-外科

CiteScore

14.40

自引率

4.40%

发文量

687

审稿时长

4 months

期刊介绍： The Annals of Surgery is a renowned surgery journal, recognized globally for its extensive scholarly references. It serves as a valuable resource for the international medical community by disseminating knowledge regarding important developments in surgical science and practice. Surgeons regularly turn to the Annals of Surgery to stay updated on innovative practices and techniques. The journal also offers special editorial features such as "Advances in Surgical Technique," offering timely coverage of ongoing clinical issues. Additionally, the journal publishes monthly review articles that address the latest concerns in surgical practice.