Outcome of iatrogenic injuries to the abdominal and pelvic veins

Mandolfino, T; Canciglia, Aldo; Taranto, Filippo; D'Alfonso, Mario; Tonante, A; Mamo, Marcello; Sturniolo, G

doi:10.1007/s00595-008-3793-8

Cited by 15 publications

(16 citation statements)

References 19 publications

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“…Mandolfino et al conducted a retrospective study of 30 patients undergoing venous repair after sustaining an abdominal or pelvic iatrogenic injury. 16 Of these, 33% ( n =10) had an IVC injury, 6 of which were repaired primarily, with 4 requiring an interposition PTFE graft. They reported a mortality of 40% ( n =4), 3 patients from multi-system organ failure and 1 intraoperatively from blood loss.…”

Section: Discussionmentioning

confidence: 99%

The enduring patency of primary inferior vena cava repair

Mansukhani

Havelka

Helenowski

et al. 2017

Surgery

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Objective Inferior vena cava (IVC) repair after planned and unplanned venotomy is performed by either interposition bypass, patch venopasty, or lateral venorrhaphy and primary repair. Primary repair of the IVC avoids the use of foreign material and allows an all-autologous repair in an expeditious fashion. The purpose of this study was to demonstrate the utility of IVC repair, determine the degree of IVC stenosis and examine clinical outcomes after primary repair. Methods Single-center retrospective review of patients who underwent primary IVC repairs between January 2002 and January 2014 at a tertiary care center. Primary repair followed lateral venorrhaphy for tumor extraction or for repair of an iatrogenic IVC injury. Patient demographics, cross-sectional vena cava dimensions, and patient outcomes were tabulated. Results In total, 47 (30 men and 17 women) patients underwent primary IVC repair (median age 58 years, range 31-83 years). Twenty-six patients (15 men and 11 women) underwent en bloc radical nephrectomy, IVC tumor thrombus extraction, and primary lateral venorrhaphy (median age 61 years, range 39-83 years). The majority, 92% of these patients, had renal cell carcinoma (RCC) on final pathology, with a median follow-up period of 39 months (range 1-108 months). Twenty-one patients (15 men and 6 women) underwent primary repair for iatrogenic IVC injury (median age 54 years, range 31-82 years). Median follow-up period was 18.5 months (3-110 months). Clinic follow up with postoperative imaging was obtained in 76.9% of those undergoing tumor thrombus extraction (n=20) and 76.2% of those undergoing repair of an iatrogenic injury (n=16). Overall there was a 13% infra-renal IVC diameter loss, 17% IVC diameter loss at the level of the renal veins, and 10% supra-renal IVC diameter loss when comparing postoperative with preoperative imaging. All patients remained asymptomatic; therefore, IVC narrowing associated with primary repair was clinically insignificant. Conclusion Primary IVC repair is associated with less than 20% IVC diameter loss, and does not compromise venous outflow from the extremities. Primary IVC repair is a safe and expeditious technique that provides excellent clinical outcomes and long-term patency.

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Section: Discussionmentioning

confidence: 99%

The enduring patency of primary inferior vena cava repair

Mansukhani

Havelka

Helenowski

et al. 2017

Surgery

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“…Rapid vascular control and venous repair improve early and late outcome. (7) Serious complications can be minimized by immediate recognition and prompt repair of iatrogenic vascular injuries. Close collaboration with a vascular surgeon during resection of tumours in proximity to the vascular structures may be helpful in preventing iatrogenic vascular injuries.…”

Section: Discussionmentioning

confidence: 99%

Surgical management of major Vascular Injuries during Abdominal pelvic Surgery: - How I do? - A series of 15 cases

Naithani¹

2013

IOSR-JDMS

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“…Im gleichen operativen Setting schlussfolgerten Glebova et al nach der Analyse von 173 Patienten nach Resektion der V. portae oder V. mesenterica superior, dass insbesondere direkte Anastomosen, Patchplastiken und autologe Interponate, wenn diese spannungsfrei erfolgen können, bevorzugt werden sollten, während der Einsatz von alloplastischen Interponaten mit einer Odds Ratio von 8,12 (95 %-KI 1,1-74) ein unabhängiger Prädiktor für eine postoperative Pfortaderthrombose war [20]. Bei Verletzungen der Beckenvenen und der V. cava inferior im Rahmen der radikalen Tumorchirurgie führten Mandolfino et al bei 30 Patienten erfolgreich die direkte Venennaht (56 %), End-zu-End-Anastomose (10 %) und die Interposition von Venengrafts (33 %) durch [21]. Die bei unseren Patienten am häufigsten eingesetzten gefäßchirurgischen Techniken waren die Thrombembolektomie (60 %), insbesondere zusätzlich bei der Rekonstruktion arterieller und venöser Verletzungen zum Beheben von lokalen Thromben nach temporärer Okklusion zur Blutungskontrolle.…”

Section: Materials Und Methodenunclassified

Vaskuläre Komplikationen und Notfälle in der onkologischen Viszeralchirurgie – was muss ein Viszeralchirurg können und wissen

et al. 2017

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Continuous improvements in perioperative and neoadjuvant therapy concepts nowadays permit more extensive tumor resections with curative intention. In patients with arterial or venous tumour involvement in preoperative imaging, physicians with expertise in vascular surgery should be involved in the planning phase of the operation. Unexpected vascular complications during abdominal surgery demand prompt management by the oncological surgeon. However, skills in vascular surgery are still not obligatory for the visceral surgeon in training. This topic is controversial and is therefore the focus of the present study. From 2010 - 2015, a total of 126 patients underwent visceral operations involving vascular surgical interventions. Of these, 30 operations were performed as radical tumour resections. Retrospective data acquisition was performed with a minimum follow-up of 12 months. Aside from comprehensive characterisation of patients and their diseases, an outcome analysis was conducted. Furthermore, visceral surgery training programs in accordance with all 17 German federal medical associations were analysed and compared with respect to vascular surgery teaching. Vascular surgery was necessary in most patients, due to lesions of the mesentericoportal venous system (n = 11; 37%) and visceral arteries (n = 14; 47%). Techniques involved were mostly vascular sutures, reanastomosis or patch plastic surgery (n = 19; 63%) and venous thrombectomy/arterial embolectomy (n = 18; 60%). Hospital mortality was 3%. During follow-up, 33% of oncological patients died, whereas solely venous injury was an independent adverse prognostic variable (arterial vs. venous complications: HR 0.028; 95%-CI 0.002 - 0.442; p = 0.01). Skills in vascular surgery are optional for up to 12 months within visceral surgery training. Intraoperative vascular complications in visceral surgical oncology are rare but pose severe risks for the patients. Their management requires basic knowledge and skills in vascular anatomy, preparation and skills to ensure immediate safe control of bleeding, as well as suture techniques and interposition grafts. Current training and specialisation in visceral surgery does not include obligatory vascular surgery teaching, so that this issue needs reevaluation.

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Outcome of iatrogenic injuries to the abdominal and pelvic veins

Abstract: Iatrogenic vein injuries can occur during radical surgery for cancer and are associated with high morbidity and mortality as a result of massive bleeding. Rapid vascular control and venous repair improve early and late outcome.

Cited by 15 publications

References 19 publications

The enduring patency of primary inferior vena cava repair

The enduring patency of primary inferior vena cava repair

Surgical management of major Vascular Injuries during Abdominal pelvic Surgery: - How I do? - A series of 15 cases

Vaskuläre Komplikationen und Notfälle in der onkologischen Viszeralchirurgie – was muss ein Viszeralchirurg können und wissen

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