The iatrogenic injury of double vena cava due to misdiagnosis during the radical nephroureterectomy and cystectomy

Mao, Yuliang; Zhu, Shuchai; Zhang, Wei

doi:10.1186/s12957-015-0469-x

Cited by 9 publications

(15 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…To prevent complications reported with cavoportal anastomosis (lower torso edema, lower limb deep vein thrombosis, and pulmonary embolism), (5) the left IVC could be interrupted below its junction with the LRV and then anastomosed end-to-side to the right IVC. (8) Adaptation is needed for other anomalies of the IVC in the donor or the recipient. (9,10) In summary, when ligation of the LRV is indicated during LT, a meticulous search for anomalies of the IVC should be performed preoperatively to adapt venous inflow reconstruction accordingly during…”

Section: Discussionmentioning

confidence: 99%

Duplicate inferior vena cava in liver transplantation: A note of caution when left renal vein ligation is needed

Osseis¹,

Lim²,

Salloum³

et al. 2016

Liver Transpl

View full text Add to dashboard Cite

In the case of a hemodynamically significant splenorenal shunt (SRS; spontaneous [5%-12%] (1) or surgical), ligation of the left renal vein (LRV) at its root into the inferior vena cava (IVC) is indicated during liver transplantation (LT) in the following 2 situations:1. To improve the flow through portoportal anastomosis and prevent portal blood steal through the splenorenal siphon. (2,3) 2. To perform renoportal anastomosis in case of stage IV portal vein thrombosis. (4)(5)(6) In this setting, the presence of a duplicate IVC should be diagnosed up front because inadvertent ligation of the duplicate left IVC misdiagnosed with the LRV might result in extensive thrombosis of the left IVC, iliac, and leg deep veins.We report here, for the first time, a case of a cadaveric LT in a recipient with large SRS where a duplicate left IVC was ligated inadvertently. Case ReportA 55-year-old man with hepatocellular carcinoma and alcoholic cirrhosis was referred to our department for LT. This patient had severe portal hypertension and recurrent episodes of hepatic encephalopathy. Preoperative computed tomography (CT) showed a large patent SRS (Fig. 1A). Upon Doppler ultrasonography (DUS), the portal vein was patent with hepatofugal monophasic flow diverted to the SRS. The LT procedure's plan included preservation of the native IVC and ligation of the LRV to optimize the portal vein flow during LT and to prevent any blood steal through the SRS siphon. (3) At the time of surgery, the LRV was approached by following the infrahepatic IVC downward. The vein identified as the LRV at its root into the IVC was taped. No mobilization of the right colon or Kocher maneuver was required. Following portal reperfusion (cold ischemia time 5 5 hours), the portal flow upon DUS showed drastically improved portal flow upon clamping of the taped vein. This was subsequently ligated. Arterial and biliary reconstructions were then performed as usual. At postoperative day 1, a massive left leg edema was found. DUS revealed thrombosis extending from the left iliac vein to the left femoral vein. CT diagnosed the duplicate IVC (Fig. 1B) and extensive thrombosis of the left IVC from its ligation on the left border of the right IVC to the left femoral vein (Fig. 2). Retrospective analysis of the pretransplant CT demonstrated that the anatomical variation was already visible: the left-sided inferior vena cava (L-IVC) ran parallel to the left side of the abdominal aorta to receive the LRV and then crossed the aorta anteriorly to join the contralateral right-sided inferior vena cava (R-IVC) and to drain into a common suprarenal IVC (Fig. 1B). Curative anticoagulation was initiated. At 9 months, the patient is alive with normal DUS and no sequelae. The left iliac vein and IVC are partially repermeabilized.Abbreviations: CT, computed tomography; DUS, Doppler ultrasonography; IVC, inferior vena cava; L-IVC, left-sided inferior vena cava; LRV, left renal vein; LT, liver transplantation; R-IVC, right-sided inferior vena cava; SRS, splenorenal shunt. Address re...

show abstract

Section: Discussionmentioning

confidence: 99%

Duplicate inferior vena cava in liver transplantation: A note of caution when left renal vein ligation is needed

Osseis¹,

Lim²,

Salloum³

et al. 2016

Liver Transpl

View full text Add to dashboard Cite

show abstract

“…Klinički je veoma važno preoperativno dijagnostikovanje ove anomalije kod planiranja abdominalne i vaskularne hirurgije, transplantacione hirugije bubrega i jetre, ili traume (3,4,6). Naime, ukoliko kod pacijenta postoji LVCI, hirurg može napraviti izmenu u hirurškom planu, pa da se umesto klasične medijalne laparatomije odluči za desni retroperitonealni pristup (6).…”

Section: Prikaz Slučajaunclassified

“…Naime, ukoliko kod pacijenta postoji LVCI, hirurg može napraviti izmenu u hirurškom planu, pa da se umesto klasične medijalne laparatomije odluči za desni retroperitonealni pristup (6). Prilikom interventnih vaskularnih procedura kod ovih pacijenata mogu nastati teškoće tokom kateterizacije desnog srca, kao i plasiranja "vena kava" filtera (2, 7).…”

Section: Prikaz Slučajaunclassified

Left-sided inferior vena cava: A case report

Jankovic¹,

Vojinović²,

Pavković³

2016

Medicinski casopis

View full text Add to dashboard Cite

UVODLevostrana vena cava inferior (LVCI) izuzetno se retko javlja (učestalost je 0,2-0,5%) i predstavlja jednu od najvažnijih anatomskih varijacija u spektru urođenih anomalija ovog krvnog suda (1).Anatomske varijacije krvnih sudova najčešće su posledica složenog embrionalnog razvoja. Embriogeneza VCI takođe je složen proces i odvija se 4-8. gestacijske nedelje, uključuje nastajanje, spajanje i regresiju tri para embrionalnih vena: posterokardinalnih, suprakardinalnih, subkardinalnih, kao i vv. vitelina, od kojih će se razviti hepatični segment VCI (2,3). LVCI nastaje regresijom desne suprakardinalne vene uz prisustvo leve suprakardinalne vene (1).Normalno formirana VCI anatomski je podeljena na hepatični, suprarenalni, renalni i infrarenalni segment. Nastaje u visini desne strane korpusa L5 spajanjem leve i desne zajedničke ilijačne vene, potom se pruža naviše i udesno od aorte, prolazi kroz otvor VCI na dijafragmi, nastavlja put kranijalno i završava se na donjem zidu desne pretkomore srca (4). Na svom putu kroz abdomen prima brojne parijetalne i visceralne pritoke.

show abstract

“…In view of the fact that, each pair of veins is identical in origin but not in fate, the unusual development of these venous systems, for unknown reason/s, causes variations of the IVC and alter the venous map of the abdomen (Artico et al). Its pathogenesis is generally attributed to the failure of regression of the left supracardinal vein (Mao et al, 2015).…”

Section: Introductionmentioning

confidence: 99%

Double Inferior Vena Cava Detected by CT Venography and Confirmed by Magnetic Resonance Venography: Embryogenesis and Literature Review

et al. 2016

View full text Add to dashboard Cite

SUMMARY:A hospital based prospective study was conducted from July 2001 to July 2015 at the Department of Radiology, Jordan University Hospital, Amman, Jordan. During that period, five cases of double inferior vena cava (DIVC) were discovered among a cohort of 7722 patients (3861 men and 3861 women, 49.5±16.9 years, range 16-78 years). Cases were diagnosed by contrast-enhanced Spiral CT venography (CTV) and confirmed by turbo three-dimensional (3D) time-of-flight contrast-enhanced MR venography. The majority of patients 3166 (41 %) were referred for staging and follow-up of malignancy, postoperative complications 1777 (23 %), nonspecific abdominal pain 1467 (19 %), preoperative assessment 849 (11 %) and trauma 463 (6 %). Magnetic resonance venography showed higher sensitivity, diagnostic accuracy and noninvasive modality for assessment of IVC map. MRV is a more useful, noninvasive modality for assessment of IVC map. DIVC is a common anomaly, its incidence in our study found to be 0.064 %. The incidence, literature review, embryogenesis, and importance of this anomaly are discussed. In addition, sample figures of relevant cases are provided.

show abstract

The iatrogenic injury of double vena cava due to misdiagnosis during the radical nephroureterectomy and cystectomy

Cited by 9 publications

References 7 publications

Duplicate inferior vena cava in liver transplantation: A note of caution when left renal vein ligation is needed

Duplicate inferior vena cava in liver transplantation: A note of caution when left renal vein ligation is needed

Left-sided inferior vena cava: A case report

Double Inferior Vena Cava Detected by CT Venography and Confirmed by Magnetic Resonance Venography: Embryogenesis and Literature Review

Contact Info

Product

Resources

About