Various conditions lead to requirement for vascular repair such as malignancy or trauma. The surgeon should choose a surgical plan considering multiple factors including medical condition as well as institutional, patient, and surgeon factors. Thereafter, the best decision on surgical planning should be made based on advantages and disadvantages of the selected choices [1, 2].
Restoring patency of SMV is a vital issue that can be achieved through end to end anastomosis in most patients [2, 3].
Variegated interposition grafts are available with their advantages and disadvantages. Autogenic vessels, such as great saphenous vein, can be too small in diameter and size for SMV flow drainage, especially in cancer cases. Femoral vein might lead to leg edema after operation. The internal jugular vein can be appropriate in terms of capacity, diameter, and length but similar morbidity in donor site resembles other allogenic vessels. However, Autologous grafts might suffer endothelial damage due to fibrosis, varicosis, and atherosclerosis [1, 2]. Sometimes, right great saphenous might have been used previously in coronary bypass surgery. Also, preparing autologous grafts may lead to morbidity of donation site and prolong the main surgery [1–6].
Cold – stored allogeneic vessels are at high risk for infection and rejection. Also, as all centers do not possess cryopreserved vascular graft bank, this option is not possible for all surgeons [2–4].
Synthetic grafts, such as polytetrafluoroethylene (PTFE) grafts, are more at risk of infection and thrombosis [1–4]. Suturing PTFE grafts is difficult due to their narrow and pliable walls, and high cost [3].
For the first time, successful peritoneal repair of vascular defect was performed by a French surgeon, Alexis carrel, in 1910 [3]. Later, Yoshioka demonstrated peritoneum grafts in a porcine model in 2001 for the reconstruction of portomesenteric vein [3].
Peritoneum grafts are safe, effective, available under emergency conditions, cost effective, and at low risk for infection, thrombosis, and blood loss. Besides, use of peritoneum grafts can shorten the time of operation compared to other methods [1–3].
Furthermore, some studies have reported no additional risk for thrombosis in peritoneal grafts in spite of not receiving antithrombotic agents. It should also be noted that the peritoneal mesothelium is capable of operating in compliance with native vasculature and cells [1–5].
In our case, due to the presence of tumor, SMV was enlarged and dilated. Therefore, there was size mismatch between saphenous veins with 3.4 mm in caliber versus SMV vein with 18 mm in caliber.
With due attention to multiple procedures including colectomy, salpingo – oophorectomy, and arrangement of colostomy, we had to shorten the time of operation. On the other hand, synthetic grafts were contraindicated due to full-blown colon. We did not have cryopreserved vascular graft bank in our center. Thus, peritoneal conduit was the best choice for our case.
In long-term follow-up after 3month, despite a narrow flow in CT scan, bowel condition was good which could be the reason for the formation of collateral circulation.