Percutaneous Trans-Hepatic Recanalization of Occluded Prosthetic Graft after Pancreatoduodenectomy with Venous Reconstruction for Pancreatic Cancer

Nils Degrauwe¹Didier Roulin¹Vincent Dunet¹Nermin Halkic²Nicolas Demartines¹Antonia Digklia¹Nicolas Villard¹Alban Denys¹Georgia Tsoumakidou¹Rafael Duran^1*

• ¹Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
• ²Hirslanden Clinique Cecil, Lausanne, Vaud, Switzerland

To investigate feasibility, safety, and efficacy of percutaneous transhepatic endovascular recanalization and stenting after venous graft thrombosis in pancreatic cancer patient who underwent pancreatoduodenectomy (PD) with venous reconstruction and assess risk factors of occlusion. Methods: Retrospective, Institutional Review Board approved study. Clinical characteristics of 227 patients who underwent PD were compared among patients who underwent PD with/without porto-mesenteric venous resection (PMVR) +/-prosthetic graft interposition. Results: Out of 227 patients, 18 (8%) underwent PD with PMVR and prosthetic graft interposition. Seven out of 18 patients occluded their prosthetic graft. Occlusion was symptomatic in most cases (86%) and associated with tumor recurrence in 43%. On univariable logistic regression analysis, small postoperative graft diameter (OR:0.141; 95%CI 0.021-0.970) and caudal anastomosis diameter measured on CT (OR:0.226; 95%CI 0.059-0.859) were clear predictors of graft occlusion (p=0.047 and p=0.029, respectively). Interventional recanalization was performed in 5 patients. Technical success was 100%, with no complications. Discussion: Percutaneous trans-hepatic prosthetic graft recanalization and stenting is feasible and may be considered a safe and an effective technique with immediate restoration of porto-mesenteric blood flow and symptoms relief. Small grafts and venous anastomoses diameters are particularly at risk of thrombosis.