HP39P USE OF THE SUPERFICIAL FEMORAL VEIN AS A CONDUIT FOR PORTAL VEIN RECONSTRUCTION DURING PANCREATICODUODENECTOMY

One of the challenging and controversial aspects of pancreatic surgery is the management of tumours adherent to the superior mesenteric and portal veins (SMPV). Options include venous resection with patch or primary closure and reconstruction of the portal vein with autogenous or synthetic conduits. The internal jugular vein has been popular. The use of the superficial femoral vein (SFV) has been reported recently. It is well established as a conduit in various other scenarios, mainly in the reconstruction of a neoaortoiliac system for infected prosthetic aortic grafts. Its large calibre, good handling properties, high patency rate, and resistance to infection are characteristics that make it excellent for both venous and arterial substitutes. Experience has shown that it can be harvested with minimal venous morbidity in the donor limb. We present a case of complete encasement of the SMPV by a slow-growing pancreatic tumour. Significant dilatation of the common bile duct and pancreatic duct along with chronic pancreatitis in the tail facilitated resection. Mesenteric venous return was collateralized to haemorrhoidal portosystemic shunts via ileocaecal and pericolic veins and a very large inferior mesenteric vein (IMV). Venous excision included portal vein to 5 mm below the bifurcation, 10 mm of splenic vein and 15 mm of superior mesenteric vein. As the splenic vein was well drained to the IMV, only the superior mesenteric vein was reconstructed with an end to end bypass to the portal vein using SFV. The superior handling properties, similar calibre to the portal vein, and low morbidity of SFV harvest of this length make it an attractive option as a conduit for portal vein reconstruction during pancreaticoduodenectomy.