Arterial reconstruction with donor iliac vessels during pancreas transplantation

An intraoperative approach to arterial injury or inadequate flow

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Background: Outcome of pancreas transplantation (PTX) has improved because of use of novel immunosuppression and advances in surgical technique. It is not uncommon for severe atherosclerosis in patients with type 1 insulin-dependent diabetes mellitus or the presence of a previously transplanted organ to limit the options for vascular anastomosis. Herein we report the novel application of donor iliac arterial interposition grafts for arterial reconstruction in patients with severe iliac artery arteriosclerosis, and/or previous transplant who develop an arterial injury or stenosis during surgery. Methods: In five patients undergoing PTX, the external iliac artery was severely atherosclerotic and/or occupied by a previous vascular anastomosis. In four of the five patients, an arterial intimal dissection became apparent. The external iliac artery was excised and reconstructed with donor iliac artery interposition graft (end-to-end anastomosis). Pancreas or kidney was engrafted onto this arterial interposition graft (end-to-side anastomosis). Results: There was no operative morbidity related to this surgical approach. All grafts functioned well after transplantation. Distal lower extremities have no evidence of vascular insufficiency with mean follow-up of 26 months (7-45 months). Conclusion: This surgical technique is an acceptable option during PTX for the patient with severe iliac artery arteriosclerosis with intraoperative intimal dissection or stenosis, or perhaps those with challenging arterial access.

Original languageEnglish
Pages (from-to)286-290
Number of pages5
JournalClinical Transplantation
Volume19
Issue number2
DOIs
StatePublished - Apr 1 2005

Fingerprint

Pancreas Transplantation
Iliac Artery
Tissue Donors
Transplants
Tunica Intima
Wounds and Injuries
Blood Vessels
Arteriosclerosis
Dissection
Pathologic Constriction
Type 1 Diabetes Mellitus
Immunosuppression
Pancreas
Lower Extremity
Atherosclerosis
Transplantation
Insulin
Morbidity
Kidney

Keywords

  • Arterial reconstruction
  • Interposition graft
  • Pancreas transplantation

ASJC Scopus subject areas

  • Transplantation
  • Immunology

Cite this

@article{e87ae160bed3412f86ab9daa05275f54,
title = "Arterial reconstruction with donor iliac vessels during pancreas transplantation: An intraoperative approach to arterial injury or inadequate flow",
abstract = "Background: Outcome of pancreas transplantation (PTX) has improved because of use of novel immunosuppression and advances in surgical technique. It is not uncommon for severe atherosclerosis in patients with type 1 insulin-dependent diabetes mellitus or the presence of a previously transplanted organ to limit the options for vascular anastomosis. Herein we report the novel application of donor iliac arterial interposition grafts for arterial reconstruction in patients with severe iliac artery arteriosclerosis, and/or previous transplant who develop an arterial injury or stenosis during surgery. Methods: In five patients undergoing PTX, the external iliac artery was severely atherosclerotic and/or occupied by a previous vascular anastomosis. In four of the five patients, an arterial intimal dissection became apparent. The external iliac artery was excised and reconstructed with donor iliac artery interposition graft (end-to-end anastomosis). Pancreas or kidney was engrafted onto this arterial interposition graft (end-to-side anastomosis). Results: There was no operative morbidity related to this surgical approach. All grafts functioned well after transplantation. Distal lower extremities have no evidence of vascular insufficiency with mean follow-up of 26 months (7-45 months). Conclusion: This surgical technique is an acceptable option during PTX for the patient with severe iliac artery arteriosclerosis with intraoperative intimal dissection or stenosis, or perhaps those with challenging arterial access.",
keywords = "Arterial reconstruction, Interposition graft, Pancreas transplantation",
author = "Moon, {Jang I L} and Gaetano Ciancio and Burke, {George W}",
year = "2005",
month = "4",
day = "1",
doi = "10.1111/j.1399-0012.2005.00339.x",
language = "English",
volume = "19",
pages = "286--290",
journal = "Clinical Transplantation",
issn = "0902-0063",
publisher = "Wiley-Blackwell",
number = "2",

}

TY - JOUR

T1 - Arterial reconstruction with donor iliac vessels during pancreas transplantation

T2 - An intraoperative approach to arterial injury or inadequate flow

AU - Moon, Jang I L

AU - Ciancio, Gaetano

AU - Burke, George W

PY - 2005/4/1

Y1 - 2005/4/1

N2 - Background: Outcome of pancreas transplantation (PTX) has improved because of use of novel immunosuppression and advances in surgical technique. It is not uncommon for severe atherosclerosis in patients with type 1 insulin-dependent diabetes mellitus or the presence of a previously transplanted organ to limit the options for vascular anastomosis. Herein we report the novel application of donor iliac arterial interposition grafts for arterial reconstruction in patients with severe iliac artery arteriosclerosis, and/or previous transplant who develop an arterial injury or stenosis during surgery. Methods: In five patients undergoing PTX, the external iliac artery was severely atherosclerotic and/or occupied by a previous vascular anastomosis. In four of the five patients, an arterial intimal dissection became apparent. The external iliac artery was excised and reconstructed with donor iliac artery interposition graft (end-to-end anastomosis). Pancreas or kidney was engrafted onto this arterial interposition graft (end-to-side anastomosis). Results: There was no operative morbidity related to this surgical approach. All grafts functioned well after transplantation. Distal lower extremities have no evidence of vascular insufficiency with mean follow-up of 26 months (7-45 months). Conclusion: This surgical technique is an acceptable option during PTX for the patient with severe iliac artery arteriosclerosis with intraoperative intimal dissection or stenosis, or perhaps those with challenging arterial access.

AB - Background: Outcome of pancreas transplantation (PTX) has improved because of use of novel immunosuppression and advances in surgical technique. It is not uncommon for severe atherosclerosis in patients with type 1 insulin-dependent diabetes mellitus or the presence of a previously transplanted organ to limit the options for vascular anastomosis. Herein we report the novel application of donor iliac arterial interposition grafts for arterial reconstruction in patients with severe iliac artery arteriosclerosis, and/or previous transplant who develop an arterial injury or stenosis during surgery. Methods: In five patients undergoing PTX, the external iliac artery was severely atherosclerotic and/or occupied by a previous vascular anastomosis. In four of the five patients, an arterial intimal dissection became apparent. The external iliac artery was excised and reconstructed with donor iliac artery interposition graft (end-to-end anastomosis). Pancreas or kidney was engrafted onto this arterial interposition graft (end-to-side anastomosis). Results: There was no operative morbidity related to this surgical approach. All grafts functioned well after transplantation. Distal lower extremities have no evidence of vascular insufficiency with mean follow-up of 26 months (7-45 months). Conclusion: This surgical technique is an acceptable option during PTX for the patient with severe iliac artery arteriosclerosis with intraoperative intimal dissection or stenosis, or perhaps those with challenging arterial access.

KW - Arterial reconstruction

KW - Interposition graft

KW - Pancreas transplantation

UR - http://www.scopus.com/inward/record.url?scp=15844411863&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=15844411863&partnerID=8YFLogxK

U2 - 10.1111/j.1399-0012.2005.00339.x

DO - 10.1111/j.1399-0012.2005.00339.x

M3 - Article

VL - 19

SP - 286

EP - 290

JO - Clinical Transplantation

JF - Clinical Transplantation

SN - 0902-0063

IS - 2

ER -