Temporary endovascular prosthetics of the inferior vena cava in case of damage to its subhepatic segment is an innovative approach to the treatment of severe liver injuries


Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription Access

Abstract

Severe liver injuries with ruptures of the inferior vena cava constitute one of the unresolved problems of damage surgery. Mortality with such an injury reaches 80% or more. The authors proposed a method of hybrid intervention, which consists of complete vascular isolation of the liver by performing Pringle and temporary arthroplasty of the inferior vena cava with a removable stent - graft installed through access to the femoral vein. In an experiment on two large pigs, liver damage of the V degree was simulated, and a removable stent graft was implanted. When angiography received a picture of the vascular isolation of the liver, and clinically achieved a complete stop of bleeding, allowing the operation to be performed on a «dry» liver. Unlike balloon occlusion of the damaged segment of the inferior vena cava, a stent - graft will enable you to save blood flow to the heart and avoid circulatory arrest. There were no fatal outcomes during the operation. Thus, the method of temporary arthroplasty of the inferior vena cava can be considered as an alternative way to stop bleeding with severe liver injuries, accompanied by blood loss from the hepatic veins or the posthepatic department of the inferior vena cava.

Full Text

Restricted Access

About the authors

V. A Reva

The S.M.Kirov Military Medical Academy MD RF; I.I.Dzhanelidze scientific institute of emergency medicine MH RF

Email: vreva@mail.ru
Saint-Petersburg, Russia

I. M Samokhvalov

The S.M.Kirov Military Medical Academy MD RF

Email: igor-samokhvalov@mail.ru
Saint-Petersburg, Russia

K. P Golovko

The S.M.Kirov Military Medical Academy MD RF

Saint-Petersburg, Russia

A. M Nosov

The S.M.Kirov Military Medical Academy MD RF

Saint-Petersburg, Russia

K. N Demchenko

The S.M.Kirov Military Medical Academy MD RF

Saint-Petersburg, Russia

A. N Petrov

The S.M.Kirov Military Medical Academy MD RF

Saint-Petersburg, Russia

S. E Voronin

The V.A.Almazov National Medical Research Center MH RF

Saint-Petersburg, Russia

A. A Mikulich

I.I.Dzhanelidze scientific institute of emergency medicine MH RF

Saint-Petersburg, Russia

I. S Zheleznyak

The S.M.Kirov Military Medical Academy MD RF

Saint-Petersburg, Russia

A. V Denisov

The S.M.Kirov Military Medical Academy MD RF

Saint-Petersburg, Russia

References

  1. Петров А.Н. Повреждения супраренального отдела нижней полой вены и кровеносных сосудов ворот печени: топографо-анатомическое и экспериментальное обоснование хирургической тактики: Автореф. дис.. канд. мед. наук. - СПб, 2002. - 22 с.
  2. Рева В.А., Самохвалов И.М., Юдин А.Б., Денисов А.В., Телицкий С.Ю. и др. Временное эндоваскулярное протезирование артерий - новое решение в лечении тяжелой сосудистой травмы // Воен.-мед. журн. - 2017. - Т. 338, № 9. - C. 15-19.
  3. Сигуа Б.В., Земляной В.П., Дюков А.К. и др. Математическое обоснование конструкции двухбаллонного трехканального эндокавального катетера для сосудистой изоляции печени при ее массивных повреждениях методом рентгенокомпьютерного моделирования // Вестн. эксперимент. и клин. хир. - 2015. - № 1 (8). - C. 75-81.
  4. Burch J.M., Feliciano D.V., Mattox K.L. The atriocaval shunt. Facts and fiction // Ann. Surg. - 1988. - Vol. 2017, N 5. - P. 555-568.
  5. Chun Y., Cho S.K., Clark W.S. et al. A retrievable rescue stent graft and radiofrequency positioning for rapid control of noncompressible hemorrhage // J. Trauma Acute Care Surg. - 2017. - Vol. 83, N 2. - P. 249-255.
  6. Coccolini F., Catena F., Moore E.E. et al. WSES classification and guidelines for liver trauma // WJES. - 2016. - Vol. 50, N 11. - P. 1-8.
  7. Go C., Chun Y.J., Kuhn J. et al. Damage control of caval injuries in a porcine model using a retrievable Rescue stent // J. Vasc. Surg. Ven. Lymph. Disord. - 2018. - Vol. 6, N 5. - P. 646-656.
  8. Hirshberg A., Mattox K.L. Top Knife: art and craft in trauma surgery. - TFM Publishing Ltd, 2005. - 244 p.
  9. Huerta S., Bui T.D., Nguyen T.H. et al. Predictors of mortality and management of patients with traumatic inferior vena cava injuries // Am. Surg. - 2006. - Vol. 72, N 4. - P. 290-296.
  10. Izawa Y., Hishikawa S., Mato T. et al. A new occlusion device for temporary hemostasis of the vena cava is as effective as total hepatic vascular isolation in a porcine model of retro-hepatic injury // Europ. J. Trauma Emerg. Surg. - 2018. - Vol. 44, Suppl. 2. - P. S296.
  11. Kim J., Jeong E., Park Y.C. et al. Damage control surgery and staged hepatectomy after vena caval stent for retrohepatic vena caval injury // Europ. J. Trauma Emerg. Surg. - 2019. - Vol. 45, Suppl. 1. - P. S44.
  12. Ordonez C.A., Herrera-Escobar J.P., Parra M.W. et al. A severe traumatic juxtahepatic blunt venous injury // J. Trauma Acute Care Surg. - 2016. - Vol. 80, N 4. - P. 674-676.
  13. Ward J., Alarcon L., Peitzman A.B. Management of blunt liver injury: what is new? // Europ. J. Trauma Emerg. Surg. - 2015. - Vol. 41, N 3. - P. 229-237.

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

Copyright (c) 2021 Reva V.A., Samokhvalov I.M., Golovko K.P., Nosov A.M., Demchenko K.N., Petrov A.N., Voronin S.E., Mikulich A.A., Zheleznyak I.S., Denisov A.V.


СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ: № 01975 от 30.12.1992.

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies