The management of pancreatic tumor adherence to the lateral wall of the superior mesenteric and portal veins (SMPV) represents the most challenging technical aspect of pancreaticoduodenectomy (PD). Prior studies have demonstrated that partial or segmental venous resection and reconstruction is an ideal means of managing tumor adherence to the SMPV. Options for conduit during SMPV reconstruction include synthetic or autogenous vein grafts; however, the infectious risks of PD make autogenous tissue preferable. Our institution has extensive experience with use of the superficial femoral vein (SFV) for aortic and venous reconstruction. We describe herein the use of the SFV in the reconstruction of the SMPV in patients undergoing PD and vein resection for periampullary tumors. Our early experience with this specific technique has generated several observations. First, our experience has confirmed that safe performance of SMPV resection and graft placement requires complete dissection of the specimen and SMPV away from the superior mesenteric artery and retroperitoneal attachments. Second, we have found that harvesting of a short segment of SFV is easily achieved and safe in these patients if one adheres to the technique of SFV harvest as described by Clagett et al.1 Lastly, the SFV vein is an excellent size match for the SMPV, and its superior handling properties and durability make it our preferred conduit for SMPV reconstruction at the time of PD for cancer.
Fleming JB, Barnett CC, Clagett GP. Superficial Femoral Vein as a Conduit for Portal Vein Reconstruction During Pancreaticoduodenectomy. Arch Surg. 2005;140(7):698–701. doi:10.1001/archsurg.140.7.698