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Anesthetic and Hemodynamic Considerations of Inferior Vena Cava Surgery

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Surgery of the Inferior Vena Cava

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Abstract

The hemodynamic changes in response to inferior vena cava clamping have been more studied during hepatic surgery than inferior vena cava (IVC) surgery. Indeed, cross clamping has been used for a long time in vascular surgery [1–3]; the strategy is relatively simple: either the disease is located below the hepatic venous confluence or the hemodynamic consequences are low and either it is located above or needs suprahepatic vena cava cross clamping. Cardiopulmonary bypass is usually indicated, with eventually a hypothermic arrest if a complex reconstruction, long or including the right atrium, is necessary or is indicated if there is a high risk of pulmonary embolism (carcinological or cruoric) [4, 5]. The situation is different in liver surgery. The use of bypass, even veno-venous bypass, is avoided other than in the context of liver transplantation, because the use of anticoagulants may entail the bleeding of the liver slice of hepatectomy or because the venous return by the IVC clamped above and below the hepatic venous confluence (combined with pedicle clamping) is low, apart from the liver transplantation where the end-stage liver cirrhotic patient presents hyperkinetic syndrome. The aim of this chapter is first to expose important anatomic and physiologic points about IVC circulation and second to describe the consequences of the different IVC clamping, according to the clamping site and the eventual association with aortic or liver clamping.

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Authors and Affiliations

  1. Department of Anesthesiology and Intensive Care Unit, Assistance Publique-Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière University Hospital, 43-87 Boulevard de l’Hôpital, Paris, 75013, France

    Daniel Eyraud MD PhD & Victoria Lepere MD

  2. Department of Digestive, HPB Surgery, and Liver Transplantation, Assistance Publique-Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière University Hospital, 43-87 Boulevard de l’Hôpital, Paris, 75013, France

    Daniel Eyraud MD PhD

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  1. Daniel Eyraud MD PhD
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  2. Victoria Lepere MD
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Correspondence to Daniel Eyraud MD PhD .

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Editors and Affiliations

  1. Service de chirurgie hépato-biliaire, pancréatique et transplantation hépatique, Hôpital Henri-Mondor, Créteil, France

    Daniel Azoulay

  2. Service de chirurgie hépato-biliaire, pancréatique et transplantation hépatique, Hôpital Henri-Mondor, Créteil, France

    Chetana Lim

  3. Service de chirurgie hépato-biliaire, pancréatique et transplantation hépatique, Hôpital Henri-Mondor, Créteil, France

    Chady Salloum

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Eyraud, D., Lepere, V. (2017). Anesthetic and Hemodynamic Considerations of Inferior Vena Cava Surgery. In: Azoulay, D., Lim, C., Salloum, C. (eds) Surgery of the Inferior Vena Cava. Springer, Cham. https://doi.org/10.1007/978-3-319-25565-1_2

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  • DOI: https://doi.org/10.1007/978-3-319-25565-1_2

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-25563-7

  • Online ISBN: 978-3-319-25565-1

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