Fleming et al1 are to be commended for the excellent technical presentation of portal vein reconstruction using clear art work and intraoperative photographs. Their experience with 120 portomesenteric vein reconstructions spoke for the superiority of this autograft over the jugular vein, which is thin and difficult to handle.
With the development of liver and pancreas transplantation (more than 19 765 cases performed to date in the United States as reported by the United Network for Organ Sharing),2 the portomesenteric system has been approached very aggressively and the donor common iliac vein and other banked allograft vessels have been used successfully.
Nghiem DD. Spiral Vein Graft Replacement of Portomesenteric Vein Using Saphenous Vein. Arch Surg. 2006;141(2):217. doi:10.1001/archsurg.141.2.217-b