scholarly journals The Falciform Ligament for Mesenteric and Portal Vein Reconstruction in Local Advanced Pancreatic Tumor: A Surgical Guide and Single-Center Experience

HPB Surgery ◽  
2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
T. Malinka ◽  
F. Klein ◽  
T. Denecke ◽  
U. Pelzer ◽  
J. Pratschke ◽  
...  
Keyword(s):  
Blood Flow ◽  
Portal Vein ◽  
Pancreatic Tumor ◽  
Falciform Ligament ◽  
Optimal Size ◽  
Venous Blood Flow ◽  
Single Center ◽  
Venous Reconstruction ◽  
Portal Vein Reconstruction ◽  
Local Advanced

Background. Since local tumor infiltration to the mesenteric-portal axis might represent a challenging assignment for curative intended resectability during pancreatic surgery, appropriate techniques for venous reconstruction are essential. In this study, we acknowledge the falciform ligament as a feasible and convenient substitute for mesenteric and portal vein reconstruction with high reliability and patency for local advanced pancreatic tumor. Methods. A retrospective single-center analysis. Between June 2017 and January 2018, a total of eleven consecutive patients underwent pancreatic resections with venous reconstruction using falciform ligament. Among them, venous resection was performed in nine cases by wedge and in two cases by full segment. Patency rates and perioperative details were reviewed. Results. Mean clamping time of the mesenteric-portal blood flow was 34 min, while perioperative mortality rate was 0%. By means of Duplex ultrasonography, nine patients were shown to be patent on the day of discharge, while two cases revealed an entire occlusion of the mesenteric-portal axis. Orthograde flow demonstrated a mean value of 34 cm/s. All patent grafts on discharge revealed persistent patency within various follow-up assessments. Conclusion. The falciform ligament appears to be a feasible and reliable autologous tissue for venous blood flow reconstruction with high postoperative patency. Especially the possibility of customizing graft dimensions to the individual needs based on local findings allows an optimal size matching of the conduit. The risk of stenosis and/or segmental occlusion may thus be further reduced.

Portal and splanchnic haemodynamics in patients with advanced post-hepatitic cirrhosis and in healthy adults

1998 ◽  
Vol 39 (2) ◽  
pp. 152-156
Author(s):  
H. Dinç ◽  
A. Sari ◽  
H. Resit Gümele ◽  
N. Cihanyurdu ◽  
A. Baki
Keyword(s):  
Blood Flow ◽  
Portal Vein ◽  
Venous Blood ◽  
Resistive Index ◽  
Venous Blood Flow ◽  
Blood Flows ◽  
Portal Venous Blood Flow ◽  
Portal Venous Blood ◽  
The Mean ◽  
Duplex Doppler

Purpose: to assess portal and splanchnic haemodynamics, and splanchnic vascular resistance in patients with advanced post-hepatitic cirrhosis and in healthy volunteers, by means of duplex Doppler ultrasound (US) Material and Methods: the duplex Doppler US examination was performed in 16 patients with cirrhosis and in 24 healthy volunteers. We investigated vessel diameters, mean flow velocities, and mean blood flows in the portal vein, the superior mesenteric artery (SMA), and the splenic artery (SA), and measured the resistive index values of SMA and SA Results: the mean portal venous blood flow in patients with cirrhosis (829 ± 264 ml/min) was not statistically different from those in the volunteers (734 ± 194 ml/min). the ratio of the SMA and SA blood flows (621 ml/min) to the portal venous blood flow (734 ml/min) was 0.85 in the control subjects. the mean portal venous blood flow (1261 ml/min) and the portal venous velocity (14.6 cm/s) were higher in the patients with recanalized para-umbilical veins than in the volunteers and in the patients without recanalized para-umbilical veins. the SMA and SA blood flows were significantly increased in patients with cirrhosis compared with volunteers. Splanchnic inflow (the sum of the SMA and SA blood flows) was higher than the portal blood flow in patients with cirrhosis except in the subjects with recanalized para-umbilical veins. SMA and SA resistive index values were significantly higher in these patients than in the volunteers Conclusion: Splanchnic blood flow and splanchnic vascular impedance increased significantly in patients with advanced post-hepatitic cirrhosis. Splanchnic inflow must not exceed portal venous blood flow in patients with recanalized para-umbilical veins. Portal vein velocity and portal venous blood flow measurements alone are not useful parameters for discriminating patients with cirrhosis from healthy subjects

Feasibility of bile duct as venous graft for venous reconstruction in pancreatic surgery: An animal experimental study

Vascular ◽  
2020 ◽  
Vol 28 (4) ◽  
pp. 450-456
Author(s):  
Ji-Long Fan ◽  
Cheng Lu ◽  
Xing-Long Dai ◽  
Xian Liu ◽  
Hao Ma ◽  
...  
Keyword(s):  
Bile Duct ◽  
Portal Vein ◽  
Poor Prognosis ◽  
Pancreatic Surgery ◽  
Jugular Vein ◽  
Color Doppler ◽  
Venous Graft ◽  
Venous Reconstruction ◽  
Animal Experimental Study ◽  
Portal Vein Reconstruction

Objective Pancreatic cancer is a kind of high malignant tumor with a poor prognosis. The aim is to determine whether the dilated bile duct can be used to reconstruct the vessels. Methods An animal model of jugular vein and portal vein reconstruction was established using the bile duct. A total of 20 landrace pigs were selected to undergo jugular vein reconstruction or portal vein reconstruction using the bile duct as a patch or bridge. The patency was evaluated by color Doppler, the reconstructed segments were removed and examined macroscopically and histologically at specified intervals, and the results were compared with synthetic vessels (IMPRA straight, 10s03-19). Results The lumen was patent, although a low level thrombosis was observed when jugular or portal vein patching was used. For bridging, stenosis of the lumen was observed, and necrosis appeared when the bile duct was used for bridging, indicating that it is feasible to reconstruct the jugular vein and portal vein with a bile duct patch. However, the bridge was not feasible possibly due to loss of blood supply, and consequent necrosis and fibrosis. Conclusion The bile duct is technically feasible, but the outcomes are unsatisfactory.

Falciform ligament tubular graft for mesenteric‐portal vein reconstruction during pancreaticoduodenectomy 

2021 ◽  
Author(s):  
Silvio M. P. Balzan ◽  
Vinicius G. Gava ◽  
Alexandre Rieger ◽  
Marcelo A. Magalhães ◽  
Alex Schwengber ◽  
...  
Keyword(s):  
Portal Vein ◽  
Falciform Ligament ◽  
Portal Vein Reconstruction

H2S contributes to the hepatic arterial buffer response and mediates vasorelaxation of the hepatic artery via activation of KATP channels

2008 ◽  
Vol 295 (6) ◽  
pp. G1266-G1273 ◽  
Author(s):  
Nikolai Siebert ◽  
Daniel Cantré ◽  
Christian Eipel ◽  
Brigitte Vollmar
Keyword(s):  
Blood Flow ◽  
Portal Vein ◽  
Hepatic Artery ◽  
Buffer Capacity ◽  
Venous Blood ◽  
Control Level ◽  
Vena Cava ◽  
Arterial Blood Flow ◽  
Venous Blood Flow ◽  
Arterial Blood

Hepatic blood supply is uniquely regulated by the hepatic arterial buffer response (HABR), counteracting alterations of portal venous blood flow by flow changes of the hepatic artery. Hydrogen sulfide (H2S) has been recognized as a novel signaling molecule with vasoactive properties. However, the contribution of H2S in mediating the HABR is not yet studied. In pentobarbital-anesthetized and laparotomized rats, flow probes around the portal vein and hepatic artery allowed for assessment of the portal venous (PVBF) and hepatic arterial blood flow (HABF) under baseline conditions and stepwise reduction of PVBF for induction of HABR. Animals received either the H2S donor Na2S, DL-propargylglycine as inhibitor of the H2S synthesizing enzyme cystathionine-γ-lyase (CSE), or saline alone. Additionally, animals were treated with Na2S and the ATP-sensitive potassium channel (KATP) inhibitor glibenclamide or with glibenclamide alone. Na2S markedly increased the buffer capacity to 27.4 ± 3.0% ( P < 0.05 vs. controls: 15.5 ± 1.7%), whereas blockade of H2S formation by DL-propargylglycine significantly reduced the buffer capacity (8.5 ± 1.4%). Glibenclamide completely reversed the H2S-induced increase of buffer capacity to the control level. By means of RT-PCR, Western blot analysis, and immunohistochemistry, we observed the expression of both H2S synthesizing enzymes (CSE and cystathionine-β-synthase) in aorta, vena cava, hepatic artery, and portal vein, as well as in hepatic parenchymal tissue. Terminal branches of the hepatic afferent vessels expressed only CSE. We show for the first time that CSE-derived H2S contributes to HABR and partly mediates vasorelaxation of the hepatic artery via activation of KATP channels.

Direct effects of various catecholamines on liver circulation in dogs

1976 ◽  
Vol 230 (5) ◽  
pp. 1394-1399 ◽  
Author(s):  
LJ Hirsch ◽  
T Ayabe ◽  
G Glick
Keyword(s):  
Blood Flow ◽  
Portal Vein ◽  
Venous Blood ◽  
Arterial Blood Flow ◽  
Venous Blood Flow ◽  
Portal Vein Pressure ◽  
Beta Receptor ◽  
Liver Sinusoids ◽  
Arterial Blood ◽  
Portal Venous Blood

As measured by electromagnetic blood flow transducers, direct infusion of epinephrine, norepinephrine, and dopamine into the portal vein (PV) produced a 40-50% decrease in hepatic arterial (HA) blood flow; isoproterenol increased HA flow by about 69%. No changes in PV flow or pressure were observed. Direct HA infusion of the vasoconstrictors decreased HA flow by amounts comparable to those occurring after PV infusion. However, HA infusion of isoproterenol increased HA flow only 15% suggesting a difference in beta-receptor population in the two vessels. When infused directly into the superior mesenteric artery (SMA), epinephrine and norepinephrine reduced SMA flow by about 45% and PV flow by 20-25%; HA flow increased 6-8%. Infusion of isoproterenol and dopamine into SMA increased SMA flow by 115% and 206% and PV flow by 60% and 70%, respectively, whereas HA flow decreased by 25% and 50%. Portal vein pressure increased less than 3 mmHg. Alpha- and beta-receptor blockade of the liver did not change significantly the alterations in hepatic arterial blood flow that were secondary to changes in portal venous blood flow. It is likely that regulation of hepatic arterial flow resides in mechanisms located within the liver sinusoids.

Autologous falciform ligament graft for portal vein reconstruction during pancreatoduodenectomy’

2021 ◽  
Author(s):  
Maria Galofré Recasens ◽  
Eric Herrero Fonollosa ◽  
Maria Isabel García Domingo ◽  
Esteban Cugat Andorrà
Keyword(s):  
Portal Vein ◽  
Falciform Ligament ◽  
Portal Vein Reconstruction
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