Shunting for Portal Vein Reconstruction

Jon Quatromoni, MD, MSTR

Product Details
Product ID: ACS-6208
Year Produced: 2020
Length: 6 min.


A 59 year old female with a history of pancreatic adenocarcinoma involving the portal vein was taken to the operating room with curative intent by surgical oncology for a Whipple procedure. The tumor was found to involve the portal vein circumferentially. Thus, a segment of portal vein was removed along with the oncologic specimen and reconstructed using cadaveric descending thoracic aortic homograft. Given the time consuming nature of both the graft preparation (i.e., thawing) and complex vascular reconstruction, the portal vein was shunted during the reconstruction in order to maintain mesenteric venous drainage and thus limit ischemia to the bowel and liver. The interposition bypass graft was a technical success and there were no complications resulting from the temporary placement of the Argyle shunt in the portal vein. This procedural modification is a technique well known to vascular surgeons from its role in maintaining cerebral perfusion during carotid endarterectomy, and as shown in this case, it can be employed in this novel context safely, effectively, with high potential benefit, and little downside.