Autologous Graft for Venous Vascular Reconstruction in Hepatopancreatobiliary Surgery: A Single Center Experience.

Background: Achieving R0 resection in hepatopancreatobiliary (HBP) surgery frequently necessitates venous resection and reconstruction. Autologous grafts offer a promising solution, particularly in complex resections where infection risk or graft availability limit the use of synthetic or donor grafts. However, clinical data on the outcomes of autologous venous grafts remain limited. This study aimed to evaluate the safety and feasibility of autologous grafts in venous reconstruction during HBP surgery.

Methods: We retrospectively reviewed 34 consecutive patients who underwent hepatic vein (HV), inferior vena cava (IVC), or portal vein (PV) reconstruction using autologous grafts between January 2019 and November 2024. Graft materials included peritoneum, saphenous vein, renal vein, and round ligament, selected at the surgeon's discretion. Reconstruction techniques were classified as patch or tubular. The primary outcomes were graft patency, perioperative complications, and graft-related morbidity.

Results: Among the 34 patients, HV, IVC, and PV reconstructions were performed in 52.9%, 23.5%, and 23.5%, respectively. The most commonly used grafts were peritoneum (41.1%) and saphenous vein (23.5%). Patch and tubular reconstructions accounted for 58.9% and 41.1% of cases, respectively. Major postoperative complications (≥ Clavien-Dindo grade IIIa) occurred in 20.5% of patients. Graft-related complications, including thrombosis, were observed in 8.8%. The estimated 3-year patency rate was 91.2%. No graft-related mortality was observed.

Conclusions: Autologous grafts provide a safe and effective option for venous reconstruction in HBP surgery, offering high patency and low complication rates. These findings support the use of autologous grafts as a flexible and reliable technique in complex HBP cases. Further multicenter studies with larger cohorts and longer follow-up are necessary to validate these outcomes and refine graft selection criteria.