Reconstruction of the internal jugular vein with triple-paneled great saphenous vein graft

Reconstruction of the internal jugular vein with triple-paneled great saphenous vein graft | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Reconstruction of the internal jugular vein with triple-paneled great saphenous vein graft Shimpei Miyamoto, Takeaki Hidaka, Osamu Fukuoka, Kou Fujisawa, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-1937373/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 16 Jan, 2023 Read the published version in World Journal of Surgical Oncology → Version 1 posted 7 You are reading this latest preprint version Abstract Background Reconstruction of the internal jugular vein with the great saphenous vein requires difficulty in overcoming size discrepancy. We describe a triple-paneled method of saphenous vein grafting for this purpose. Case presentation A 54-year-old man with a thyroid papillary carcinoma underwent total thyroidectomy and bilateral neck dissection. The right internal jugular vein was transected, and the resultant defect was 8 cm long. Harvested great saphenous vein graft 30 cm in length was divided into three pieces of equal length. Each piece was opened longitudinally and sutured together side-by-side like panels to make a composite graft of three-fold caliber. The defect of the internal jugular vein was reconstructed with this composite graft. The long-term patency of the internal jugular vein was achieved. Conclusions The triple-paneled method can be a versatile option for reconstructing the internal jugular vein with the great saphenous vein in terms of the diameter ratio between the two veins. internal jugular vein great saphenous vein vein graft reconstruction size discrepancy paneled method spiral method. Figures Figure 1 Figure 2 Figure 3 Figure 4 Background Simultaneous excision of bilateral internal jugular veins can lead to acute reduction of cerebral venous drainage and resultant serious morbidity, including facial edema, blindness, inappropriate anti-diuretic hormone hypersecretion, laryngeal edema, carotid artery rupture, cerebral vessel complications, and death.[ 1 ] In such cases, reconstruction of at least one side of the internal jugular vein(IJV)should be performed. Although various methods have been reported for reconstruction of the IJV, autologous vein grafting is the most ideal method for bypass in the venous system. The great saphenous vein is the most commonly used conduit as an autologous vein graft, but the problem is how to match its diameter with the diameter of the IJV. [ 2 – 4 ] In this case report, we describe a triple-paneled method of saphenous vein grafting for the IJV reconstruction. Case Presentation A 54-year-old man with a thyroid papillary carcinoma underwent total thyroidectomy and bilateral neck dissection. Metastatic cervical lymph nodes invaded bilateral IJVs. The right IJV was completely transected and the left IJV was partially transected. The resultant defect of the right IJV was approximately 8 cm in length (Fig. 1 ). The defect was reconstructed with a great saphenous vein graft. The right great saphenous vein, measuring 30 cm in length, was harvested through three small incisions in the medial thigh. The harvested graft was divided into three pieces of equal length and each piece was opened longitudinally. The three pieces were sutured together side-by-side with continuous suture using 6 − 0 polypropylene, finally wrapping around the surgical marker pen (Fig. 2 and Fig. 3 ). After that, this composite graft was interposed to the defect of the right IJV. Both ends were anastomosed with continuous suture in an end-to-end fashion using 6 − 0 polypropylene (Fig. 4 ). The wall defect of the left IJV was repaired by a patch graft taken from the ipsilateral external jugular vein. The postoperative course of the patient was uneventful. The patency of the right IJV was monitored using the color doppler ultrasonography (Video. 1). The bilateral IJVs were patent at the time of 10 months after surgery and the diameter of the right IJV was still large enough at 15 mm. There were no symptoms associated with increased intracranial pressure. Discussion The great saphenous vein is the most frequently used donor site for the IJV reconstruction. There have been some reports of the IJV reconstruction with great saphenous vein without any prefabrication; [ 5 , 6 ] however, these are not ideal because it is imperative that the size of the bypass conduit closely approximates that of the bypassed vein to achieve maximal flow and maintain long-term patency.[ 7 ] Therefore, the technical focus of the IJV reconstruction with the great saphenous vein is on how to deal with size discrepancy. In the field of vascular surgery, the most frequently used methods for reconstructing large veins with small vein grafts are the spiral method. [ 2 , 7 ] The spiral method involves opening the harvested great saphenous vein longitudinally, wrapping it in a spiral around a temporary tubular stent, and constructing a tube graft. Comerota et al. applied this method to the IJV reconstruction, and subsequent applications have been reported by several authors. [ 2 , 4 ] The advantage of this method is that the diameter of the graft can be as large as desired. The disadvantage of this method is that the suture lines become longer and more exposed to the bloodstream. When reconstructing a long IJV defect, the procedure becomes particularly cumbersome. Another disadvantage is that it is difficult to know the length of the graft needed. The paneled method is another commonly used method to reconstruct large veins with small vein grafts.[ 3 , 8 ] In this method, the graft is opened longitudinally, divided into several pieces, and sutured together side by side to increase the diameter. Although reports of the IJV reconstruction using the paneled method are rare compared to the spiral method, Urayama et al. reported the application of the double-paneled method to the IJV reconstruction in a case of bilateral radical neck dissection for tongue cancer. [ 3 ] They divided the saphenous vein graft into two equal parts and sutured them together to double the diameter. The main advantage is that it is technically simpler than the spiral method. The length of the suture lines is shorter than that of the spiral method. The length of each piece of the graft should be the same as the length of the defect and can be easily determined. The disadvantage is that the diameter of the composite graft is only twice as large as the great saphenous vein and usually narrower than that of the IJV. In this case, we reconstructed the right IJV with the triple-paneled method and were able to perfectly fit the difference in diameter. Pantoja et al. reported triple-paneled saphenous vein grafts to reconstruct the portmesenteric venous system after pancreaticoduodenectomy. [ 8 ] To the best of our knowledge, there have been no reports of the triple-paneled method being used for the IJV reconstruction. The reported diameter of the right IJV averages about 17 mm, while the diameter of the great saphenous vein averages about 5 mm at 5 cm distal to the saphenofemoral junction. [ 9 , 10 ] For these reasons, in most cases, the triple-paneled method is more suitable than the double-paneled method for the IJV reconstruction with a saphenous vein graft. The main drawback of the triple-paneled method is that the saphenous vein graft needs to be at least three times as long as the defect. The great saphenous vein can be harvested in a length of about 35 cm by making three or four small incisions from the inguinal area to the knee. In addition, by making additional incisions in the lower leg, a graft of about 70 cm can be harvested, which can be used for most IJV defects. Conclusions Saphenous vein grafts using the triple-paneled method can be a viable option of the IJV reconstruction. This method is simpler than the spiral method and is expected to increase the long-term patency rate. In addition, this method has the potential to expand the indications for autologous vein grafts in the reconstruction of large vessels that are currently reconstructed with synthetic grafts due to size limitations. Abbreviations IJV internal jugular vein Declarations Ethics approval and consent to participate Not applicable Consent for publication Written consent for publication was obtained from the patient. Availability of data and materials The datasets used and analyzed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that have no competing interests. Funding None Authors' contributions SM and MO were major contributors in writing the manuscript. SM, TH, OF, and KF analyzed and interpreted the patient data. All authors read and approved the final manuscript. Acknowledgements Not applicable References Kamizono K, Ejima M, Taura M, Masuda M. Internal jugular vein reconstruction: application of conventional type A and novel type K methods. J Laryngol Otol 2011;125(6):643–8. Comerota AJ, Harwick RD, White JV. Jugular venous reconstruction: a technique to minimize morbidity of bilateral radical neck dissection. J Vasc Surg 1986;3(2):322–9. Urayama H, Katada S, Matsumoto I, Ishida F, Ohmura K, Watanabe Y, et al. Reconstruction of jugular and portal blood flows using remodeled great saphenous vein grafts. Surg Today 1993;23(10):936–8. Fankhauser GT, Stone WM, Fu R, Money SR. Spiral vein graft for internal jugular bypass in a patient with multiple sclerosis and suspected chronic cerebrospinal venous insufficiency. Ann Vasc Surg 2013;27(5):673 e5-8. Dulguerov P, Soulier C, Maurice J, Faidutti B, Allal AS, Lehmann W. Bilateral radical neck dissection with unilateral internal jugular vein reconstruction. Laryngoscope 1998;108(11 Pt 1):1692–6. Katsuno S, Ishiyama T, Nezu K, Usami S. Three types of internal jugular vein reconstruction in bilateral radical neck dissection. Laryngoscope 2000;110(9):1578–80. Doty JR, Flores JH, Doty DB. Superior vena cava obstruction: bypass using spiral vein graft. Ann Thorac Surg 1999;67(4):1111–6. Pantoja JL, Chang K, Pellionisz PA, Woo K, Farley SM. Paneled Saphenous Vein Grafts Compared to Internal Jugular Vein Grafts in Venous Reconstruction after Pancreaticoduodenectomy. Ann Vasc Surg 2020;65:17–24. Tartiere D, Seguin P, Juhel C, Laviolle B, Malledant Y. Estimation of the diameter and cross-sectional area of the internal jugular veins in adult patients. Crit Care 2009;13(6):R197. Joh JH, Park HC. The cutoff value of saphenous vein diameter to predict reflux. J Korean Surg Soc 2013;85(4):169–74. Additional Declarations No competing interests reported. Supplementary Files Video1.wmv Cite Share Download PDF Status: Published Journal Publication published 16 Jan, 2023 Read the published version in World Journal of Surgical Oncology → Version 1 posted Editorial decision: Major revision 24 Aug, 2022 Reviews received at journal 22 Aug, 2022 Reviewers agreed at journal 12 Aug, 2022 Reviewers invited by journal 09 Aug, 2022 Editor assigned by journal 09 Aug, 2022 Submission checks completed at journal 08 Aug, 2022 First submitted to journal 07 Aug, 2022 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-1937373","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":127466798,"identity":"a941f457-15fb-4481-8b16-49bb309308c4","order_by":0,"name":"Shimpei Miyamoto","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA6klEQVRIiWNgGAWjYDACCcYGhgQgbT///MMHQJqHj2gtBhI8zAYgLWyEtUBpoBY2MJugFvnZza0bHrbZRZtL9x6r/JpjJ8PGwPzw0Q08WgzuHGy7kdiWnLtzzrm027LbkoEOYzM2zsGnRSIRpIU5t+FAgtltyW3MQC08bNL4tMjPAGupB2spltxWT1gLww2wlsO5G27kmDF+3HaYsBYDkJaEc8dzZ/YcS5Zm3Hach42ZgF/kZ6Q/u/mjrDq3n7354Mef26rt+dmbHz7G6zAQYITGBTMPmCSkHAz+QLX+IEr1KBgFo2AUjDQAAGxOTznJuXahAAAAAElFTkSuQmCC","orcid":"","institution":"The University of Tokyo","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Shimpei","middleName":"","lastName":"Miyamoto","suffix":""},{"id":127466799,"identity":"ec4cfd5e-e1bb-4ff2-9424-45d55ce96fe2","order_by":1,"name":"Takeaki Hidaka","email":"","orcid":"","institution":"The University of Tokyo","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Takeaki","middleName":"","lastName":"Hidaka","suffix":""},{"id":127466800,"identity":"9bab3550-89aa-487a-8b70-b200b0977376","order_by":2,"name":"Osamu Fukuoka","email":"","orcid":"","institution":"The University of Tokyo","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Osamu","middleName":"","lastName":"Fukuoka","suffix":""},{"id":127466801,"identity":"a9cc6af1-9d1e-4476-964a-1409b41c495c","order_by":3,"name":"Kou Fujisawa","email":"","orcid":"","institution":"The University of Tokyo","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Kou","middleName":"","lastName":"Fujisawa","suffix":""},{"id":127466802,"identity":"5e169450-8898-4e6e-8a60-d6a2ff80aa11","order_by":4,"name":"Mutusmi Okazaki","email":"","orcid":"","institution":"The University of Tokyo","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Mutusmi","middleName":"","lastName":"Okazaki","suffix":""}],"badges":[],"createdAt":"2022-08-07 07:14:12","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-1937373/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-1937373/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12957-023-02902-4","type":"published","date":"2023-01-16T18:23:56+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":25052465,"identity":"bd4faa85-b9ec-491c-9f4c-09e4446285f6","added_by":"auto","created_at":"2022-08-10 16:47:55","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":3521623,"visible":true,"origin":"","legend":"\u003cp\u003eIntraoperative appearance after tumor resection \u003c/p\u003e\u003cp\u003eThe left side is craniad. The black arrow indicates the proximal stump of the right internal jugular vein and the white arrow indicates the distal stump.\u003c/p\u003e","description":"","filename":"Fig.1.png","url":"https://assets-eu.researchsquare.com/files/rs-1937373/v1/9311221295be28f98ab49a67.png"},{"id":25052463,"identity":"4429b941-672e-4c0a-9a39-da502c6444de","added_by":"auto","created_at":"2022-08-10 16:47:55","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":5157196,"visible":true,"origin":"","legend":"\u003cp\u003eHarvested great saphenous vein grafts\u003c/p\u003e\u003cp\u003eThe graft is divided into three pieces of equal length and each piece was opened longitudinally.\u003c/p\u003e","description":"","filename":"Fig.2.png","url":"https://assets-eu.researchsquare.com/files/rs-1937373/v1/94480e8e11cebb1ab09ee8bd.png"},{"id":25053050,"identity":"a7a20ac8-e0cd-4191-9520-8d545cef046d","added_by":"auto","created_at":"2022-08-10 16:52:56","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":5300974,"visible":true,"origin":"","legend":"\u003cp\u003eThe triple-paneled graft after prefabrication around the skin marker pen\u003c/p\u003e","description":"","filename":"Fig.3.png","url":"https://assets-eu.researchsquare.com/files/rs-1937373/v1/fa4a5bc17df0ebeeeb6fc794.png"},{"id":25052466,"identity":"bc86ffb8-3afd-4195-9424-e4ea23f5a43e","added_by":"auto","created_at":"2022-08-10 16:47:55","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":3581493,"visible":true,"origin":"","legend":"\u003cp\u003eIntraoperative appearance after reconstruction of the right internal jugular vein\u003c/p\u003e\u003cp\u003eThe left side is craniad.\u003c/p\u003e","description":"","filename":"Fig.4.png","url":"https://assets-eu.researchsquare.com/files/rs-1937373/v1/1a7565666946c2445a14efc1.png"},{"id":44717836,"identity":"cad81f96-af55-435e-9a2e-11e36b68fe42","added_by":"auto","created_at":"2023-10-16 18:40:14","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":9299802,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-1937373/v1/e7281730-3409-4605-bc78-b8c8fdb5f250.pdf"},{"id":25052467,"identity":"a7a1ffc2-5aec-425d-ac02-c00b20600d4d","added_by":"auto","created_at":"2022-08-10 16:47:56","extension":"wmv","order_by":6,"title":"","display":"","copyAsset":false,"role":"supplement","size":8197148,"visible":true,"origin":"","legend":"","description":"","filename":"Video1.wmv","url":"https://assets-eu.researchsquare.com/files/rs-1937373/v1/2acc702a084fd28e0d293a3d.wmv"}],"financialInterests":"No competing interests reported.","formattedTitle":"Reconstruction of the internal jugular vein with triple-paneled great saphenous vein graft","fulltext":[{"header":"Background","content":"\u003cp\u003eSimultaneous excision of bilateral internal jugular veins can lead to acute reduction of cerebral venous drainage and resultant serious morbidity, including facial edema, blindness, inappropriate anti-diuretic hormone hypersecretion, laryngeal edema, carotid artery rupture, cerebral vessel complications, and death.[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] In such cases, reconstruction of at least one side of the internal jugular vein(IJV)should be performed.\u003c/p\u003e \u003cp\u003eAlthough various methods have been reported for reconstruction of the IJV, autologous vein grafting is the most ideal method for bypass in the venous system. The great saphenous vein is the most commonly used conduit as an autologous vein graft, but the problem is how to match its diameter with the diameter of the IJV. [\u003cspan additionalcitationids=\"CR3\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eIn this case report, we describe a triple-paneled method of saphenous vein grafting for the IJV reconstruction.\u003c/p\u003e"},{"header":"Case Presentation","content":"\u003cp\u003eA 54-year-old man with a thyroid papillary carcinoma underwent total thyroidectomy and bilateral neck dissection. Metastatic cervical lymph nodes invaded bilateral IJVs. The right IJV was completely transected and the left IJV was partially transected. The resultant defect of the right IJV was approximately 8 cm in length (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe defect was reconstructed with a great saphenous vein graft. The right great saphenous vein, measuring 30 cm in length, was harvested through three small incisions in the medial thigh. The harvested graft was divided into three pieces of equal length and each piece was opened longitudinally. The three pieces were sutured together side-by-side with continuous suture using 6\u0026thinsp;\u0026minus;\u0026thinsp;0 polypropylene, finally wrapping around the surgical marker pen (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). After that, this composite graft was interposed to the defect of the right IJV. Both ends were anastomosed with continuous suture in an end-to-end fashion using 6\u0026thinsp;\u0026minus;\u0026thinsp;0 polypropylene (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). The wall defect of the left IJV was repaired by a patch graft taken from the ipsilateral external jugular vein.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe postoperative course of the patient was uneventful. The patency of the right IJV was monitored using the color doppler ultrasonography (Video. 1). The bilateral IJVs were patent at the time of 10 months after surgery and the diameter of the right IJV was still large enough at 15 mm. There were no symptoms associated with increased intracranial pressure.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe great saphenous vein is the most frequently used donor site for the IJV reconstruction. There have been some reports of the IJV reconstruction with great saphenous vein without any prefabrication; [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] however, these are not ideal because it is imperative that the size of the bypass conduit closely approximates that of the bypassed vein to achieve maximal flow and maintain long-term patency.[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] Therefore, the technical focus of the IJV reconstruction with the great saphenous vein is on how to deal with size discrepancy.\u003c/p\u003e \u003cp\u003eIn the field of vascular surgery, the most frequently used methods for reconstructing large veins with small vein grafts are the spiral method. [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] The spiral method involves opening the harvested great saphenous vein longitudinally, wrapping it in a spiral around a temporary tubular stent, and constructing a tube graft. Comerota et al. applied this method to the IJV reconstruction, and subsequent applications have been reported by several authors. [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] The advantage of this method is that the diameter of the graft can be as large as desired. The disadvantage of this method is that the suture lines become longer and more exposed to the bloodstream. When reconstructing a long IJV defect, the procedure becomes particularly cumbersome. Another disadvantage is that it is difficult to know the length of the graft needed.\u003c/p\u003e \u003cp\u003eThe paneled method is another commonly used method to reconstruct large veins with small vein grafts.[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] In this method, the graft is opened longitudinally, divided into several pieces, and sutured together side by side to increase the diameter. Although reports of the IJV reconstruction using the paneled method are rare compared to the spiral method, Urayama et al. reported the application of the double-paneled method to the IJV reconstruction in a case of bilateral radical neck dissection for tongue cancer. [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] They divided the saphenous vein graft into two equal parts and sutured them together to double the diameter. The main advantage is that it is technically simpler than the spiral method. The length of the suture lines is shorter than that of the spiral method. The length of each piece of the graft should be the same as the length of the defect and can be easily determined. The disadvantage is that the diameter of the composite graft is only twice as large as the great saphenous vein and usually narrower than that of the IJV.\u003c/p\u003e \u003cp\u003eIn this case, we reconstructed the right IJV with the triple-paneled method and were able to perfectly fit the difference in diameter. Pantoja et al. reported triple-paneled saphenous vein grafts to reconstruct the portmesenteric venous system after pancreaticoduodenectomy. [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] To the best of our knowledge, there have been no reports of the triple-paneled method being used for the IJV reconstruction. The reported diameter of the right IJV averages about 17 mm, while the diameter of the great saphenous vein averages about 5 mm at 5 cm distal to the saphenofemoral junction. [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] For these reasons, in most cases, the triple-paneled method is more suitable than the double-paneled method for the IJV reconstruction with a saphenous vein graft.\u003c/p\u003e \u003cp\u003eThe main drawback of the triple-paneled method is that the saphenous vein graft needs to be at least three times as long as the defect. The great saphenous vein can be harvested in a length of about 35 cm by making three or four small incisions from the inguinal area to the knee. In addition, by making additional incisions in the lower leg, a graft of about 70 cm can be harvested, which can be used for most IJV defects.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eSaphenous vein grafts using the triple-paneled method can be a viable option of the IJV reconstruction. This method is simpler than the spiral method and is expected to increase the long-term patency rate. In addition, this method has the potential to expand the indications for autologous vein grafts in the reconstruction of large vessels that are currently reconstructed with synthetic grafts due to size limitations.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eIJV \u0026nbsp;internal jugular vein\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten consent for publication was obtained from the patient.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSM and MO were major contributors in writing the manuscript. SM, TH, OF, and KF analyzed and interpreted the patient data. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003cstrong\u003e \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eKamizono K, Ejima M, Taura M, Masuda M. Internal jugular vein reconstruction: application of conventional type A and novel type K methods. J Laryngol Otol 2011;125(6):643\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eComerota AJ, Harwick RD, White JV. Jugular venous reconstruction: a technique to minimize morbidity of bilateral radical neck dissection. J Vasc Surg 1986;3(2):322\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUrayama H, Katada S, Matsumoto I, Ishida F, Ohmura K, Watanabe Y, et al. Reconstruction of jugular and portal blood flows using remodeled great saphenous vein grafts. Surg Today 1993;23(10):936\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFankhauser GT, Stone WM, Fu R, Money SR. Spiral vein graft for internal jugular bypass in a patient with multiple sclerosis and suspected chronic cerebrospinal venous insufficiency. Ann Vasc Surg 2013;27(5):673 e5-8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDulguerov P, Soulier C, Maurice J, Faidutti B, Allal AS, Lehmann W. Bilateral radical neck dissection with unilateral internal jugular vein reconstruction. Laryngoscope 1998;108(11 Pt 1):1692\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKatsuno S, Ishiyama T, Nezu K, Usami S. Three types of internal jugular vein reconstruction in bilateral radical neck dissection. Laryngoscope 2000;110(9):1578\u0026ndash;80.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDoty JR, Flores JH, Doty DB. Superior vena cava obstruction: bypass using spiral vein graft. Ann Thorac Surg 1999;67(4):1111\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePantoja JL, Chang K, Pellionisz PA, Woo K, Farley SM. Paneled Saphenous Vein Grafts Compared to Internal Jugular Vein Grafts in Venous Reconstruction after Pancreaticoduodenectomy. Ann Vasc Surg 2020;65:17\u0026ndash;24.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTartiere D, Seguin P, Juhel C, Laviolle B, Malledant Y. Estimation of the diameter and cross-sectional area of the internal jugular veins in adult patients. Crit Care 2009;13(6):R197.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJoh JH, Park HC. The cutoff value of saphenous vein diameter to predict reflux. J Korean Surg Soc 2013;85(4):169\u0026ndash;74.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"world-journal-of-surgical-oncology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"wjso","sideBox":"Learn more about [World Journal of Surgical Oncology](http://wjso.biomedcentral.com)","snPcode":"12957","submissionUrl":"https://submission.nature.com/new-submission/12957/3","title":"World Journal of Surgical Oncology","twitterHandle":"@OncoBioMed","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"internal jugular vein, great saphenous vein, vein graft, reconstruction, size discrepancy, paneled method, spiral method.","lastPublishedDoi":"10.21203/rs.3.rs-1937373/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-1937373/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e \u0026nbsp;Reconstruction of the internal jugular vein with the great saphenous vein requires difficulty in overcoming size discrepancy. We describe a triple-paneled method of saphenous vein grafting for this purpose. \u003c/p\u003e\u003cp\u003e\u003cstrong\u003eCase presentation \u0026nbsp;\u003c/strong\u003eA 54-year-old man with a thyroid papillary carcinoma underwent total thyroidectomy and bilateral neck dissection. The right internal jugular vein was transected, and the resultant defect was 8 cm long. Harvested great saphenous vein graft 30 cm in length was divided into three pieces of equal length. Each piece was opened longitudinally and sutured together side-by-side like panels to make a composite graft of three-fold caliber. The defect of the internal jugular vein was reconstructed with this composite graft. The long-term patency of the internal jugular vein was achieved. \u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e\u0026nbsp;The triple-paneled method can be a versatile option for reconstructing the internal jugular vein with the great saphenous vein in terms of the diameter ratio between the two veins.\u003c/p\u003e","manuscriptTitle":"Reconstruction of the internal jugular vein with triple-paneled great saphenous vein graft","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2022-08-10 16:47:53","doi":"10.21203/rs.3.rs-1937373/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Major revision","date":"2022-08-24T04:33:48+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2022-08-22T21:00:41+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"19090d28-5df3-4e6f-9822-ad3d05c6e085","date":"2022-08-12T08:01:35+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2022-08-09T20:37:25+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2022-08-09T04:05:59+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2022-08-08T23:36:05+00:00","index":"","fulltext":""},{"type":"submitted","content":"World Journal of Surgical Oncology","date":"2022-08-07T07:05:25+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"world-journal-of-surgical-oncology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"wjso","sideBox":"Learn more about [World Journal of Surgical Oncology](http://wjso.biomedcentral.com)","snPcode":"12957","submissionUrl":"https://submission.nature.com/new-submission/12957/3","title":"World Journal of Surgical Oncology","twitterHandle":"@OncoBioMed","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f59b47f4-6e5b-4475-8c02-481dff42ef16","owner":[],"postedDate":"August 10th, 2022","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2023-10-16T18:37:40+00:00","versionOfRecord":{"articleIdentity":"rs-1937373","link":"https://doi.org/10.1186/s12957-023-02902-4","journal":{"identity":"world-journal-of-surgical-oncology","isVorOnly":false,"title":"World Journal of Surgical Oncology"},"publishedOn":"2023-01-16 18:23:56","publishedOnDateReadable":"January 16th, 2023"},"versionCreatedAt":"2022-08-10 16:47:53","video":"","vorDoi":"10.1186/s12957-023-02902-4","vorDoiUrl":"https://doi.org/10.1186/s12957-023-02902-4","workflowStages":[]},"version":"v1","identity":"rs-1937373","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-1937373","identity":"rs-1937373","version":["v1"]},"buildId":"rHA-KDH7Qsr4HCuvH75dn","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}