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Ann Thorac Surg 2002;73:1692
© 2002 The Society of Thoracic Surgeons

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Correspondence

Replacement of the iliac vein

^a Department of Cardiothoracic Surgery, St. Jude Medical Center, 301 W Bastanchury, Suite 195, Fullerton, CA 92835, USA

e-mail: cdelcampo{at}pol.net

To the Editor

Handa and associates [1] replaced an avulsed iliac vein using a descending thoracic aortic homograft previously harvested from an 8-year-old child. The authors obtained this graft from their tissue bank and acknowledged they were fortunate to have a small size available. This graft was selected because of the inferior patency rates of prosthetic grafts in the venous system. A spiral saphenous vein graft was not used because of the need of expeditious immediate reconstruction.

My associates and I agree entirely with the statements of the authors and share their experience [2–4]. We have previously reported on emergency replacement of the retrohepatic vena cava [3] and a case similar to that of Handa and colleagues where we successfully replaced the left common iliac vein with a custom-made bovine pericardial tubular graft. The graft remained patent when reassessed 2 years later [5].

No uniform criteria have been established to standardize replacement of veins. Commercially available polytetrafluoroethylene grafts have been disappointing. The alternative provided by Handa and co-workers appears to have achieved a satisfactory result, but the follow-up of 3 months is too short. Very few hospitals have a tissue bank at their immediate disposal, which prevents a homograft from being used in emergency situations. Furthermore, finding the appropriate size can prove even more difficult. Sheaths of bovine pericardium are readily available in most hospitals where cardiac or vascular surgical procedures are performed. The pericardium can easily be tailored to specific diameters and lengths. Thus, one sheath can be used for replacement of any given vein. Avoiding storage of multiple sizes reduces cost. Further data are needed before broader recommendations can be made and uniform criteria can be established for replacement of veins in acute and, more specifically, chronic situations.

References

1. Handa A., Saito S., Moorjani N., Westaby S. Iliac vein replacement with a descending aortic homograft. Ann Thorac Surg 2001;72:957-958.[Abstract/Free Full Text]
2. Del Campo C., Casey T.M. Vena cava bypass with stented polytetrafluoroethylene bifurcated grafts. Tex Heart Inst J 1993;20:288-292.[Medline]
3. Del Campo C., Konok G.P. Use of a pericardial xenograft patch in repair of resected retrohepatic vena cava. Can J Surg 1994;37:59-61.[Medline]
4. Del Campo C., Love J., Bowes F. Prosthetic replacement of the superior vena cava with a custom-made pericardial graft: an experimental study. Can J Surg 1992;35:305-309.[Medline]
5. Del Campo C., Fonseca A. Replacement of the left common iliac vein with a custom-made bovine pericardium tubular graft. Tex Heart Inst J 2001;28:39-41.[Medline]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Carlos Del Campo Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Del Campo, C. Search for Related Content PubMed PubMed Citation Articles by Del Campo, C. Related Collections Peripheral vascular Related Articles