Technique of hepatic vascular exclusion for extensive liver resection

Huguet, C; Addario-Chieco, Paola; Gavelli, A; Arrigo, Ettore; Harb, Joseph M.; Clement, Régine Roger

doi:10.1016/0002-9610(92)90567-b

Cited by 163 publications

(109 citation statements)

References 6 publications

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“…More extensive involvement of the IVC requires the use of a patch or segmental resection with graft replacement. In such cases, TVE may be used [6][7][8][9] . This may be achieved by applying vascular clamps to the IVC below and above the liver, with concomitant interruption of hepatic blood inflow using a Pringle maneuver [10] .…”

Section: Discussionmentioning

confidence: 99%

“…This may be achieved by applying vascular clamps to the IVC below and above the liver, with concomitant interruption of hepatic blood inflow using a Pringle maneuver [10] . This approach is further facilitated by the tolerable prolonged periods (60-90 min) of continuous warm hepatic ischemia in patients with normal livers [8,11,12] . Attention should be paid to patients with cirrhotic livers, where the ischemic time is much shorter and the risk of bleeding is higher.…”

Section: Discussionmentioning

confidence: 99%

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Resection and reconstruction of the inferior vena cava for neoplasms

Vladov¹,

Mihaylov²,

Belev³

et al. 2012

WJGS

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AIM:To evaluate the results of an aggressive surgical approach of resection and reconstruction of the inferior vena cava (IVC). METHODS:The approach to caval resection depends on the extent and location of tumor involvement. The supra-and infra-hepatic portion of the IVC was dissected and taped. Left and right renal veins were also taped to control the bleeding. In 12 of the cases with partial tangential resection of the IVC, the flow was reduced to less than 40% so that the vein was primarily closed with a running suture. In 3 of the cases, the lumen of the vein was significantly reduced, requiring the use of a polytetrafluoroethylene (PTFE) patch. In 2 of the cases with segmental resection of the IVC, a PTFE prosthesis was used and in 1 case, the IVC was resected without reconstruction due to shunting the blood through the azygos and hemiazygos veins. RESULTS:The mean operation time was 266 min (230-310 min) with an average intraoperative blood loss of 300 mL (200-2000 mL). The patients stayed in intensive care unit for 1.8 d (1-3 d). Mean hospital stay was 9 d (7-15 d). Twelve patients (66.7%) had no complications and 6 patients (33.3%) had the following complications: acute bleeding in 2 patients; bile leak in 2 patients; intra abdominal abscess in 1 patient; pulmonary embolism in 2 patients; and partial thrombosis of the patch in 1 patient. General complications such as pneumonia, pleural effusion and cardiac arrest were observed in the same group of patients. In all but 1 case, the complications were transient and successfully controlled. The mortality rate was 11.1% (n = 2). One patient died due to cardiac arrest and pulmonary embolism in the operation room and the second one died 2 d after surgery due to coagulopathy. With a median follow-up of 24 mo, 5 (27.8%) patients died of tumor recurrence and 11 (61.1%) are still alive, but three of them have a recurrence on computed tomography. CONCLUSION:There are a variety of options for reconstruction after resection of the IVC that offers a higher resectable rate and better prognosis in selected cases.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Resection and reconstruction of the inferior vena cava for neoplasms

Vladov¹,

Mihaylov²,

Belev³

et al. 2012

WJGS

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“…It has been implicated in the pathogenesis of a variety of clinical conditions including trauma, thermal injury, hypovolemic and endotoxin shock, reconstructive vascular surgery, liver transplantation, and liver resectional surgery [1][2][3][4][5][6][7].…”

Section: What Is Hepatic Microvascular Dysfunction?mentioning

confidence: 99%

Microvascular dysfunction induced by reperfusion injury and protective effect of ischemic preconditioning

Cutrn

Perrelli

Cavalieri

et al. 2002

Free Radical Biology and Medicine

150

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Abstract-Hepatic ischemia/reperfusion injury has immediate and deleterious effects on the outcome of patients after liver surgery. The precise mechanisms leading to the damage have not been completely elucidated. However, there is substantial evidence that the generation of oxygen free radicals and disturbances of the hepatic microcirculation are involved in this clinical syndrome. Microcirculatory dysfunction of the liver seems to be mediated by sinusoidal endothelial cell damage and by the imbalance of vasoconstrictor and vasodilator molecules, such as endothelin (ET), reactive oxygen species (ROS), and nitric oxide (NO). This may lead to no-reflow phenomenon with release of proinflammatory cytokines, sinusoidal plugging of neutrophils, oxidative stress, and as an ultimate consequence, hypoxic cell injury and parenchymal failure. An inducible potent endogenous mechanism against ischemia/reperfusion injury has been termed ischemic preconditioning. It has been suggested that preconditioning could inhibit the effects of different mediators involved in the microcirculatory dysfunction, including endothelin, tumor necrosis factor-␣, and oxygen free radicals. In this review, we address the mechanisms of liver microcirculatory dysfunction and how ischemic preconditioning could help to provide new surgical and/or pharmacological strategies to protect the liver against reperfusion damage.

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“…In case of injury to RHIVC, approach to stop bleeding varies from traditional clamping procedures including total vascular exclusion to hypothermia, cardioplegia, and circulatory arrest that are made during operation [3]. Various types of vascular exclusion during hepatectomy have been used to reduce operative blood loss and postoperative complications [4][5][6][7][8]. However, it should be pointed out that when total hepatic blood fl ow is excluded cardiac output suddenly decreases and arrhythmia or cardiac arrest may result.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, out of good exposure may not permit to perform any type of vascular occlusion to reduce blood loss in case of RHIVC injury. Digital compression is applicable to patients whose conditions are critical and for whom total vascular exclusion can not be prepared for in advance or in patients who have only a few small IVC ruptures [8]. Otherwise, performing vascular occlusion with any vascular clamps or some other instruments to control bleeding may cause additional trauma and excessive hemorrhage which can be resulted in death.…”

Section: Discussionmentioning

confidence: 99%

Management of hemorrhage of retro hepatic inferior vena cava injury during piggy-back technique for liver transplantation

et al. 2008

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Background Injury to large abdominal vessels is still one of the most terrifying results of trauma or intraoperative faults, as the management of the hemorrhage is hardly diffi cult due to being torrentially and unaware of the proper reparation. The controversial problem is which technique should be preferred in case of injury to RHIVC and how can it be managed with minimal risk. Patients and MethodsOver two-year period, we retrospectively analyzed the patients who had undergone adultto-adult liver transplantation and collected data about the injuries to RHIVC during recipient hepatectomy. All patients were treated with the same surgical technique including digital compression and continuous suturing the tear.Results Twenty fi ve patients (21 male, 4 female) were detected. The causative factors for end stage liver disease included hepatitis B, hepatitis C with or without hepatocellular carcinoma, autoimmune hepatitis, alcoholic hepatitis, cryptogenic hepatitis, Wilson disease, and nonalcoholic steatohepatitis. Mean diameter of the injury was measured 0.5 cm (range: 0.2-1.6). Only three patients (12%) had more than one injury. Mean amount of blood loss between injury and repair was 130 cc (40-350 cc). There was no operative mortality.Conclusion Calmness of the operative team followed by the appropriate surgical approach is the key of the success in case of any injury to RHIVC. Digital compression technique can be enough to prevent massive bleeding and repair the injury tract without any vascular exclusion that may result with serious postoperative complications. We proposed this technique because of its ability by most surgeon and easy to perform in a safe way.

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Technique of hepatic vascular exclusion for extensive liver resection

Cited by 163 publications

References 6 publications

Resection and reconstruction of the inferior vena cava for neoplasms

Resection and reconstruction of the inferior vena cava for neoplasms

Microvascular dysfunction induced by reperfusion injury and protective effect of ischemic preconditioning

Management of hemorrhage of retro hepatic inferior vena cava injury during piggy-back technique for liver transplantation

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