The GSV is the most frequently used donor vein for IJV reconstruction. Although such a reconstruction can be performed with an intact GSV [5, 6], this is not ideal because the diameter of the bypass conduit is much smaller than that of the native IJV, which reduces flow and threatens long-term patency . Therefore, techniques have been devised to deal with the size discrepancy.
The most frequently used technique for reconstructing large veins using small vein grafts is the spiral method [2, 7], which entails longitudinal opening of the harvested GSV graft, wrapping it in a spiral around a temporary tubular stent, and constructing a tube graft. IJV reconstruction using this technique has been reported by several authors [2, 4]. The spiral method enables tailoring the graft diameter to the required size; however, the sutures are exposed to the bloodstream and the suture lines can be quite long. Moreover, reconstruction of a long IJV defect can be particularly cumbersome. Another disadvantage is that it is difficult to know the length of the graft needed.
The paneled method is another commonly used technique [3, 8]. With this method, the graft is opened longitudinally and divided into several pieces. The pieces are then sutured together side by side to create a cylinder of larger diameter. Urayama et al. described a double-paneled method to reconstruct an IJV in a patient who underwent bilateral radical neck dissection for tongue cancer . They divided the GSV graft into two equal parts and sutured them together to double the diameter. The main advantage of the double-paneled method is its simplicity. In addition, the suture lines are shorter than those of the spiral method. The length of each piece of the graft should be the same as the length of the defect, which can be easily determined. The main disadvantage is that the maximum graft diameter is only twice that of the GSV, which is still usually narrower than that of the IJV.
In our patient, the right IJV was reconstructed using a triple-paneled method, which perfectly fit the required diameter. Pantoja et al. reported the use of triple-paneled saphenous vein grafts to reconstruct the portomesenteric venous system after pancreaticoduodenectomy . To the best of our knowledge, this is the first report of a triple-paneled GSV graft being used for IJV reconstruction. The average diameter of the right IJV is approximately 17 mm, while that of the GSV 5 cm distal to the saphenofemoral junction is approximately 5 mm [9, 10]. Therefore, the triple-paneled GSV method is better suited for IJV reconstruction than the double-paneled method.
The main drawback of the triple-paneled method is that the graft needs to be at least three times as long as the defect. A GSV graft approximately 35 cm in length can be harvested using three or four small incisions between the inguinal area and the knee. If additional incisions are made in the lower leg, a 70-cm graft can be harvested, which should be adequate for most IJV defects.