Incidence of early portal venous thrombosis following pancreatic surgery with venous resection: a single-center experience POD1 ultrasound evaluation

Abstract Introduction Portal venous thrombosis (PVT) is a feared complication following pancreatectomy with venous resection, with reported rates ranging between 5% and 31%. Strategies to reduce PVT risk vary. This study evaluates early PVT incidence in patients undergoing venous resection using a standardized approach involving liberal Cattell Braasch maneuver, preference for end-to-end anastomosis, and intensified anticoagulation, combined with routine ultrasound assessment on postoperative day 1 (POD1). Method We conducted a retrospective cohort study of patients undergoing pancreatectomy with SMV and/or portal vein resection between 2020–2023 at Umeå University Hospital. The primary outcome was symptomatic PVT within 30 days. Secondary outcomes included detection of PVT or flow irregularity on POD1 ultrasound, and postoperative morbidity/mortality. Result A total of 60 patients were included (median age 69.4 years). Most underwent segmental venous resection (85%) and Whipple (48.3%) or total pancreatectomy (45%). The Cattell- Braasch maneuver was used in 88.3% of cases. POD1 ultrasound was performed in 95% (57/60) of patients. Only one patient (1.6%) developed symptomatic PVT—this patient did not undergo POD1 ultrasound. No PVT or flow irregularity was detected on any POD1 ultrasound. Major postoperative complications (Clavien-Dindo ≥3a) occurred in 15%, while 30- and 90-day mortality rates were 5% and 6.6%, respectively. Discussion A standardized surgical and postoperative protocol involving liberal use of the Cattell- Braasch maneuver, end-to-end anastomosis, and intensified anticoagulation appears to be associated with a low incidence of early PVT after venous resection in pancreatic surgery. POD1 ultrasound may be a valuable tool in early detection, potentially supporting risk stratification and timely intervention.