The use of biological grafts for reconstruction of the inferior vena cava is a safe and valid alternative: results in 32 patients in a single institution

Pulitanò, Carlo; Crawford, Michael; Ho, Phong; Gallagher, James J.; Joseph, David; Stephen, Michael S.; Sandroussi, Charbel

doi:10.1111/hpb.12029

Cited by 47 publications

(45 citation statements)

References 20 publications

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“…Our literature search identified only three studies reporting the use of bovine pericardial grafts for abdominal vein reconstruction. The study of Pulitanó et al investigates the performance of bovine pericardium as inferior vena cava reconstruction in 10 patients [14]. Although this study compares the performance of two biological grafts (bovine pericardium and autogenous peritoneo-fascial) in a series of surgical patients with various underlying diseases, the results suggest a comparable outcome of this method compared with synthetic materials.…”

Section: Resultsmentioning

confidence: 99%

“…Although synthetic materials such as polytetrafluoroethylene (PTFE) are available in different lengths and diameters, still the optimal material and surgical method for vascular reconstruction remain undefined [13]. The use of biological grafts in abdominal surgery has been proposed previously, reporting favorable biocompatible features, low risk of infection and a high degree of flexibility to ensure individual matching of conduit and venous diameter [14]. Although biological grafts are widely used in cardiovascular surgery including heart valve replacement, vascular conduits and patch angioplasty after carotid endarterectomy, its use for abdominal vein replacement has not entered the surgical mainstream so far [15,16].…”

Section: Introductionmentioning

confidence: 99%

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Bovine Pericardium for Portal Vein Reconstruction in Abdominal Surgery: A Surgical Guide and First Experiences in a Single Center

et al. 2015

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Background: Resection and reconstruction of infiltrated vessels achieve resectability of extended pancreatic tumors. The aim of the present study was to assess the feasibility of bovine pericardium as graft material for the individualised portal vein reconstruction and demonstrate a surgical technique for abdominal vein repair. Methods: We performed a MEDLINE search to review the methods for complex abdominal vein reconstruction in the course of extended pancreatectomy. Moreover, clinical data of patients receiving portal vein reconstruction using a bovine pericardial patch at our institution were retrospectively analyzed. Results: Based on the results of a review of the literature, autologous venous grafts using the internal jugular vein represent the most popular option for segmental portal vein reconstruction in case of impossible direct suture. At our center, segmental portal vein reconstruction with bovine pericardial patch in course of pancreatic surgery was performed in 4 patients. No case of vascular complications such as occlusion, segmental stenosis or thrombosis occurred. Conclusions: Our experience suggests a surgical procedure for an individual size-matched portal vein reconstruction using bovine pericardium. Although first results appear promising, prospective studies are required to objectively assess the patency of bovine pericardium compared with autologous and synthetic interposition grafts for portal vein reconstruction.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Bovine Pericardium for Portal Vein Reconstruction in Abdominal Surgery: A Surgical Guide and First Experiences in a Single Center

et al. 2015

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“…20 In rare cases where the IVC is resected before robust collaterals have been established, reconstruction with PTFE or autologous conduits are suitable options. 7, 21, 22 One recent study, published by Benkirane et al , explored IVC resection and reconstruction with PTFE in 26 cancer patients. 6 They had a median follow-up of 28 months, during which time 19.2% of grafts thrombosed ( n =5).…”

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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“…12 In the absence of intraabdominal contamination, ringed polytetrafluoroethylene is often used for vascular reconstruction, 13 whereas in a contaminated setting, femoral vein offers an excellent conduit. [14][15][16] Femoral vein provides a durable, longsegment, large-caliber vein for reconstruction.…”

Section: -511mentioning

confidence: 99%

“…There are studies showing an absence of leg edema after IVC ligation. 6,12 However, in our institution, we do see patients presenting to the clinic after emergency IVC ligation with worsening leg edema, many several years after ligation, when reconstruction may be hazardous because of extensive collateral vein development and a scarred retroperitoneum. In our institution, traumatic IVC injuries are rare.…”

Section: -511mentioning

confidence: 99%

Staged Reconstruction of the Inferior Vena Cava After Gunshot Injury

Droz

Matsuura

2016

Journal of Vascular Surgery

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A 23-year-old man with a gunshot injury to the abdomen and cardiac arrest requiring emergency department thoracotomy had a transection of the distal inferior vena cava (IVC) and small bowel injury. Because of persistent hemorrhagic shock, the IVC was ligated. During the next 3 days, he developed worsening bilateral leg edema. He was taken back for reanastomosis of his small bowel and reconstruction of the IVC using autologous femoral vein harvested from the right leg. We think that patients requiring ligation of the vena cava with worsening leg edema can benefit from a staged reconstruction of the IVC. (J Vasc Surg Cases and Innovative Techniques 2017;3:136-8.) Penetrating injuries of the inferior vena cava (IVC) carry a high mortality. [1][2][3][4][5] In a hemodynamically unstable patient, ligation of the vena cava often becomes necessary as a lifesaving measure. We describe a delayed reconstruction of the IVC using autologous femoral vein after stabilization of the patient. This case demonstrates the value of working with the trauma team in successful resuscitation of severe shock, acidosis, and hypothermia and in control of abdominal contamination before a venous bypass. The patient has consented to this case presentation. CASE REPORTA 23-year-old man arrived in the trauma bay with severe hypotension after a gunshot injury to the abdomen. During emergency department resuscitation, the patient arrested, requiring thoracotomy and aortic cross-clamping. The patient was placed on massive transfusion protocol and transported to the operating room for exploration, with findings of a transected distal IVC involving both origins of the common iliac veins. His aorta and iliac arteries were intact. Because of his persistent hemorrhagic shock, the IVC and both iliac veins were ligated (Fig 1).A segment of small bowel was also injured and treated with we harvested the right femoral vein, between the deep and popliteal veins, and created a bifurcated bypass (Fig 2). The patient was discharged home on clopidogrel and graded compression stockings. His venous duplex ultrasound study at 2 weeks showed a patent bypass. At 1-month follow-up, his incisions were healed and he had no residual leg edema. DISCUSSIONIVC injuries are rare and more often the result of penetrating trauma, occurring in approximately 0.02% of gunshot wounds to the abdomen. 2,6 Mortality of IVC injuries is quoted in most series to be around 50%. 1,2 Factors associated with increased mortality are hypotension on arrival to the emergency department, associated major vascular injury, and level of IVC injury, with proximal injuries carrying the highest mortality (suprahepatic).

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The use of biological grafts for reconstruction of the inferior vena cava is a safe and valid alternative: results in 32 patients in a single institution

Cited by 47 publications

References 20 publications

Bovine Pericardium for Portal Vein Reconstruction in Abdominal Surgery: A Surgical Guide and First Experiences in a Single Center

Bovine Pericardium for Portal Vein Reconstruction in Abdominal Surgery: A Surgical Guide and First Experiences in a Single Center

The enduring patency of primary inferior vena cava repair

Staged Reconstruction of the Inferior Vena Cava After Gunshot Injury

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