Intermittent vascular exclusion of the liver (without vena cava clamping) during major hepatectomy

Abstract

Intermittent vascular exclusion of the liver (IVEL) combines clamping of the hepatic pedicle with clamping of the main hepatic veins without interruption of caval flow. In this retrospective study, eight cases of total IVEL and eight of partial IVEL were analysed (involving only the middle and left hepatic veins) during major hepatectomy for malignant tumours. Liver parenchyma was pathological in nine cases. IVEL was feasible in 16 of the 18 attempts and was efficient in reducing bleeding during hepatectomy in 15 cases. Mean duration of IVEL was 60.2 (range 37-140) min, mean blood loss was 1230 (range 300-2800) ml and there were no postoperative complications related to the procedure. The major advantages of this technique of liver vascular exclusion (good tolerance and possibility of long duration) merit its inclusion in the list of different clamping techniques available for use during hepatectomy.

A five-year disease-free survival after combined hepatectomy and radiofrequency ablation of large hepatocellular carcinoma adjacent to vena cava

“…The formal isolation and encircling of the RHV has not been necessary in this case in order to interrupt the venous backflow. The vascular exclusion has been performed intermittently for short periods and as known this is well tolerated even from cirrhotic livers [8]. Another possibility is to perform intermittent total vascular exclusion with caval clamping -a technique that does not require a fluid overload and a special anesthesiologycal support [9].…”

Anesthesia in Liver Resections: Review

“…The TVE is useful in the resection of tumours adjacent to large vessels. This modality can also be intermitted, alternating periods of ischemia and reperfusion [18]. The venous return drops almost 50% and, consequently, of the minute volume.…”

Isquemia hepática normotérmica em ratos: estudo da lesão celular através do uso de clampeamento pedicular contínuo e intermitente

“…Teoricamente, nos pequenos intervalos em que o órgão era perfundido haveria retorno da atividade aeróbia, o que diminuiria a produção de ácido láctico e radicais livres, já sabidamente envolvidos na etiologia da lesão celular. Esta modalidade de clampeamento, o clampeamento intermitente, foi o objeto deste estudo 2,3 .…”

“…Com este objetivo foi desenvolvida a técnica de clampeamento pedicular intermitente, permitindo a restauração temporária do fluxo hepático em ciclos regulares 2,3 . O objetivo deste trabalho foi avaliar, através de um estudo experimental, se o clampeamento intermitente do pedículo hepático provoca menor lesão celular quando comparado ao clampeamento contínuo, o que poderia minimizar as conseqüências da isquemia hepática normotérmica.…”