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. 1993 Jan;217(1):15–19. doi: 10.1097/00000658-199301000-00004

Liver resection under total vascular isolation. Variations on a theme.

S Emre 1, M E Schwartz 1, E Katz 1, C M Miller 1
PMCID: PMC1242728  PMID: 8424696

Abstract

Total vascular isolation (TVI) of the liver was employed during parenchymal transection in 16 patients undergoing hepatic resection for large tumors (mean diameter, 10.7 cm) located near hilar structures, hepatic veins, or the inferior vena cava (IVC). In 14 cases, TVI was achieved by clamping the suprahepatic and infrahepatic IVC and the porta hepatis, with or without aortic occlusion; in two, selective hepatic vein clamping was possible, obviating IVC occlusion. Procedures included standard and extended right and left lobectomies and caudate lobe resections. Concomitant resection and reconstruction of the portal vein (one case), IVC (one case), and bile duct (three cases) was required. Postoperative hepatic and renal failure did not occur. Mean intensive care unit and hospital stays were 2.8 +/- 1.9 and 12.5 +/- 5.2 days, respectively. There were two perioperative deaths. Total vascular isolation permits safe resection of large, critically located tumors that would otherwise present prohibitive operative risks.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bismuth H., Castaing D., Garden O. J. Major hepatic resection under total vascular exclusion. Ann Surg. 1989 Jul;210(1):13–19. doi: 10.1097/00000658-198907000-00002. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Delva E., Barberousse J. P., Nordlinger B., Ollivier J. M., Vacher B., Guilmet C., Huguet C. Hemodynamic and biochemical monitoring during major liver resection with use of hepatic vascular exclusion. Surgery. 1984 Mar;95(3):309–318. [PubMed] [Google Scholar]
  3. Delva E., Camus Y., Nordlinger B., Hannoun L., Parc R., Deriaz H., Lienhart A., Huguet C. Vascular occlusions for liver resections. Operative management and tolerance to hepatic ischemia: 142 cases. Ann Surg. 1989 Feb;209(2):211–218. doi: 10.1097/00000658-198902000-00012. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Fortner J. G., Shiu M. H., Kinne D. W., Kim D. K., Castro E. B., Watson R. C., Howland W. S., Beattie E. J., Jr Major hepatic resection using vascular isolation and hypothermic perfusion. Ann Surg. 1974 Oct;180(4):644–652. doi: 10.1097/00000658-197410000-00030. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Heaney J. P., Stanton W. K., Halbert D. S., Seidel J., Vice T. An improved technic for vascular isolation of the liver: experimental study and case reports. Ann Surg. 1966 Feb;163(2):237–241. doi: 10.1097/00000658-196602000-00013. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Huguet C., Nordlinger B., Bloch P., Conard J. Tolerance of the human liver to prolonged normothermic ischemia. A biological study of 20 patients submitted to extensive hepatectomy. Arch Surg. 1978 Dec;113(12):1448–1451. doi: 10.1001/archsurg.1978.01370240070012. [DOI] [PubMed] [Google Scholar]
  7. Huguet C., Nordlinger B., Galopin J. J., Bloch P., Gallot D. Normothermic hepatic vascular exclusion for extensive hepatectomy. Surg Gynecol Obstet. 1978 Nov;147(5):689–693. [PubMed] [Google Scholar]
  8. Huguet C., Vacher B., Delva E., Nordlinger B., Parc R., Loygue J. L'hépatectomie pour tumeur sous exclusion vasculaire. Evolution des idées sur une décade. A propos d'une expérience de 41 cas. Chirurgie. 1983;109(2):146–151. [PubMed] [Google Scholar]
  9. Miller C. M., Schwartz M. E., Nishizaki T. Combined hepatic and vena caval resection with autogenous caval graft replacement. Arch Surg. 1991 Jan;126(1):106–108. doi: 10.1001/archsurg.1991.01410250114020. [DOI] [PubMed] [Google Scholar]
  10. Nakamura S., Sakaguchi S., Kitazawa T., Suzuki S., Koyano K., Muro H. Hepatic vein reconstruction for preserving remnant liver function. Arch Surg. 1990 Nov;125(11):1455–1459. doi: 10.1001/archsurg.1990.01410230049009. [DOI] [PubMed] [Google Scholar]
  11. Raia S., Guijon P., Nogueira G. S., Perali O., Saad W. A. Hepatectomia direita ampliada com clampeamento temporário da veia cava inferior abaixo e acima do fígado. Rev Hosp Clin Fac Med Sao Paulo. 1970 May-Jun;25(3):165–174. [PubMed] [Google Scholar]
  12. Stephen M. S., Sheil A. G., Thompson J. F., Wilson T., Boland S. L. Aortic occlusion and vascular isolation allowing avascular hepatic resection. Arch Surg. 1990 Nov;125(11):1482–1485. doi: 10.1001/archsurg.1990.01410230076013. [DOI] [PubMed] [Google Scholar]

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