• Annals of surgery · Dec 2023

    Validation of the Back-table Graft Arterial Anastomosis between the Splenic Artery and Superior Mesenteric Artery: Arterial Complications after a 21-year Single-center Experience of Pancreas Transplantation.

    • Joana Ferrer-Fàbrega, Gabriel Cárdenas, Víctor Sapena, Ángeles García-Criado, Marta Barrufet, Carles Pérez, Rocío García-Pérez, Ramón Rull, Miguel Ángel López-Boado, Emma Folch-Puy, Alba Torroella, Pedro Ventura-Aguiar, Federico Cofan, Enric Esmatjes, Antonio Amor, Fritz Diekmann, Laureano Fernández-Cruz, Juan Carlos García-Valdecasas, and Josep Fuster.
    • Hepatobiliopancreatic Surgery and Liver and Pancreatic Transplantation Unit, Department of Surgery, Institute Clínic of Digestive and Metabolic Diseases (ICMDiM), Hospital Clínic, Barcelona, Spain.
    • Ann. Surg. 2023 Dec 25.

    ObjectiveTo determine the role of the arterial splenomesenteric anastomosis (ASMA) vascular reconstruction technique in terms of arterial vascular complications in pancreas transplant (PT) recipients.Summary Background DataThe ASMA technique was first described in 1992 by Hospital Clínic Barcelona group. Regardless that the iliac Y-graft technique is the most frequently used worldwide, evidence of arterial complications and implications of using a different back-table reconstruction is conspicuously absent in the literature.MethodsDescriptive review of 407 PTs performed at a single center (1999-2019) by analyzing the type of arterial reconstruction technique, focusing on ASMA. The endpoints were the management of arterial complications and long-term patient and graft survival.ResultsASMA was performed in 376 cases (92.4%) and a Y-graft in 31 cases (7.6%). A total of 34 arterial complications (8.3%) were diagnosed. In the ASMA group (n=30, 7.9%) they comprised: 15 acute thrombosis; 4 stenosis; 1 pseudoaneurysm and 10 diverse chronic arterial complications while in the Y-graft group (n=4, 12.9%) 3 acute thrombosis and 1 chronic artery-duodenal fistula occurred. Graft salvage was achieved in 16 patients (53.3%) from the ASMA group and in 2 (50%) from the Y-graft. After a median follow-up of 129.2 (IQR 25-75%, 77.2 -182) months the overall graft and patient survival for the whole cohort at 1, 5, and 10 years was 86.7%, 79.5%, 70.5%, and 98.5%, 95.3%, 92.5%, respectively.ConclusionsThe ASMA proves to be a safe and more easily reproducible technique and should therefore be considered for first-line back-table reconstruction in the PT population.Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

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