Use of Glutaraldehyde-Preserved Bovine Pericardium Patch in Vascular Repair of Portal Vein in a Patient with Pancreatic Cancer
Indian Journal of Surgery (Impact Factor: 0.26). 06/2013; 75(1). DOI: 10.1007/s12262-012-0655-9
Advanced-stage gastrointestinal tumors are aggressive and frequently invade blood vessels. Advances in endovascular surgery can repair blood vessels that may be infiltrated by a tumor. Currently there are many materials to do this, as the use of prostheses or implants and patches. In Mexico, the bovine pericardium preserved with glutaraldehyde has been used to treat incisional, inguinal, and diaphragmatic hernias and repair vascular defects with good results, low cost, and no allergic reaction from the patient. We report the case of a 47-year-old man, with a history of smoking and alcoholism, diagnosed with pancreatic adenocarcinoma. The tumor, with the use of endoscopic ultrasound, showed direct contact with the portal vein without invading the confluence of the mesenteric vein. During exploratory laparotomy, a tumor attached to the head of the pancreas of 4 cm × 4 cm was found, with tumor invasion of 1 cm × 2 cm on the outer sidewall of the portal vein. We performed pylorus-preserving pancreatoduodenectomy and tumor resection of the portal vein wall with placement of glutaraldehyde-preserved bovine pericardium patch to repair it. The intraoperative and immediate postoperative period arose without complications. The patient was discharged with good result and is currently under surveillance. We report this case to show a successful result using glutaraldehyde-preserved bovine pericardium to close vascular defects after resection of the tumor secondary to vascular invasion.
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ABSTRACT: Objective: To review the current crosslinking strategies for acelluar matrix scaffold, laying the foundation for subsequent experiment. Data sources: Data were mainly obtained from recent papers published in PubMed or indexed by Web of Science, with keyword like crosslinking. Results: Various crosslinking strategies, including chemical, physical and biological methods, have been introduced to facilitate the performance of fresh acellular matrix. Chemical crosslinking reagents, involved in synthetic and naturally derived agents, need to be eliminated before implantation in case of their potential biotoxicity, although several crosslinking agents with less toxicity and specific characteristics have been developed. Physical crosslinking methods present to be safe, additive-free and relatively controllable for rapid surface functionalization with no consideration of remaining radioactivity. Biological crosslinking strategies have attracted great interest, and have been demonstrated to enhance collagen-based crosslinking since their preparations do not need toxic or potentially biologically contaminated substances and can be carried out under physiological conditions. Conclusions: Kinds of crosslinking methods with its potential advantages have been developed to modify raw acelluar matrix, of which the performance are promising after being crosslinked by several crosslinking treatments. Further preclinical and clinical evaluations should be taken to vertify their safety and efficacy for the tissues and organs substitutes in tissue and regenerative medicine.
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ABSTRACT: Background: Pancreatectomy with venous reconstruction (VR) for pancreatic cancer (PC) is occurring more commonly. Few studies have examined the long-term patency of the superior mesenteric-portal vein confluence following reconstruction. Methods: From 2007 to 2013, patients who underwent pancreatic resection with VR for PC were classified by type of reconstruction. Patency of VR was assessed using surveillance computed tomographic imaging obtained from date of surgery to last follow-up. Results: VR was performed in 43 patients and included the following: tangential resection with primary repair (7, 16%) or saphenous vein patch (9, 21%); segmental resection with splenic vein division and either primary anastomosis (10, 23%) or internal jugular vein interposition (8, 19%); or segmental resection with splenic vein preservation and either primary anastomosis (3, 7%) or interposition grafting (6, 14%). All patients were instructed to take aspirin after surgery; low molecular weight heparin was not routinely used. An occluded VR was found in four (9%) of the 43 patients at a median follow-up of 13 months; median time to detection of thrombosis in the four patients was 72 days (range 16-238). Conclusions: Pancreatectomy with VR can be performed with high patency rates. The optimal postoperative pharmacologic therapy to prevent thrombosis requires further investigation.
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