The enduring patency of primary inferior vena cava repair

Abstract

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.

Current trends and prospects of surgical techniques for hepatoblastoma

“…In situ repair is mainly used to correct small vascular wall defects. Some studies indicate that the loss of the internal diameter of the inferior vena cava by less than 20% will not affect the patency of blood vessels 22 . If in situ repair leads to lumen stenosis and affects blood flow, patch repair may be required.…”

“…Some studies indicate that the loss of the internal diameter of the inferior vena cava by less than 20% will not affect the patency of blood vessels. 22 If in situ repair leads to lumen stenosis and affects blood flow, patch repair may be required. Patch source materials include autologous blood vessels, the pericardium, the peritoneum, or artificial materials.…”

Technical Tips for Performing Suprahepatic Vena Cava Tumor Thrombectomy in Renal Cell Carcinoma without Using Cardiopulmonary Bypass

“…This allows a thorough examination of any residual tumor thrombus that may remain at the ostium of the renal vein. If the narrowing is >50% during the closure of cavotomy site with a running suture, a patch angioplasty should be performed to prevent complications due to IVC narrowing [ 48 , 49 ]. However, if a spiral cavotomy is performed, the degree of primary closure narrowing can be reduced.…”

Partial Inferior Vena Cava Reconstruction with Cryopreserved Aortic Homograft Following Resection for Malignancy

“…1 Renal cell carcinoma (RCC) is the most common neoplasm presenting with IVC tumor infiltration and 5 - 25% of RCC patients present with an associated caval tumor thrombus. 2,3 Multiple operative approaches exist to tumor thrombectomy of the IVC, including cavorrhaphy with primary suture repair 4 or segmental/wedge cava resection with patch venoplasty or interposition bypass. 1 Cardiopulmonary bypass (CPB) with or without deep hypothermic circulatory arrest is often used for IVC tumors with extension above the diaphragm as to allow a complete tumor thrombectomy.…”