Hepato-atrial anastomosis as emergency treatment for traumatic rupture of suprahepatic inferior vena cava and hepatic veins

Abstract

The case of a 21-year-old patient operated on as an emergency for traumatic rupture of the suprahepatic inferior vena cava (IVC) and hepatic vein (HVs) is presented. Since anatomic reconstruction of the ruptured vessels was considered unfeasible, a direct anastomosis was instituted between the right atrium and the liver capsule around the disrupted IVC and HVs, using extracorporeal circulation, deep hypothermia and circulatory arrest. Hemorrhage was easily controlled and the patient survived. As far as we know, this operation, originally developed for the treatment of the Budd-Chiari syndrome, has never been used before as a life saving procedure under the circumstances described.

Reconstruction of a total avulsion of the hepatic veins and the suprahepatic inferior vena cava secondary to blunt thoracoabdominal trauma

“…The injuries of the retrohepatic IVC are treated by atriocaval bypass in combination with Pringle's manoeuvre. It has been considered to be the most successful therapy of these fatal injuries [11][12][13]. However, different review articles still report a mortality rate of about 70% [13].…”

“…c Intrapericardial IVC tourniquet. d Cannulation of the ascending aorta Further described procedures for an injury of the suprahepatic IVC are Senning's procedure of direct hepato-atrial anastomosis [11,12] or completely conservative treatment in hemodynamically stable cases [15].…”

Control of Persistent Inferior Vena Caval Bleeding

“…Various direct and indirect techniques have been employed to repair the IVC, such as direct vein suturing, pericardial patching, cavoatrial shunting, balloon occlusion, direct repair with deep-hypothermic circulatory arrest, and hepatoatrial anastomosis with venovenous bypass. 1 –3 Such techniques are complex and time consuming and repair may not be successful. In this patient, external vein suturing, direct intraluminal repair, and external vein suturing with pericardial pledgets were carried out sequentially but each was unsuccessful in controlling the bleeding.…”

Management of a giant intracranial aneurysm using surface‐heparinized extracorporeal circulation and controlled deep hypothermic low flow perfusion. A case report

“…Thus, successfully performed thrombectomy of the pulmonary artery was described in three patients, whcrc the technique allowcd full visual control ( 16). Another report, or several surgical teams concomitantly controlling severe cancer of the kidney invading the vena cava ( 17), and also repairing a traumatic rupture of the inferior vena cava and the hepatic vein, during circulatory arrest, was recently described ( 18).…”