Inferior Caval Vein Research Articles

VExUS score improvement is associated with better outcomes in acute decompensated heart failure

Abstract Background Venous Excess Ultrasound Score (VExUS) has recently emerged as a non-invasive tool for venous congestion assessment in acute decompensated heart failure (ADHF). Although VExUS is associated with cardiorenal syndrome, the prognostic role regarding hard outcomes in ADHF is still unknown. Purpose To evaluate whether dynamic changes in VExUS within 72 hours after Cardiovascular Intensive Care Unit (CICU) admission is associated with in-hospital mortality in ADHF patients. Methods Prospective cohort study enrolling consecutive patients with ADHF admitted to CICU of a tertiary public hospital. VExUS evaluations ranging from 0 (no congestion) and 3 (severe congestion) and assessing the inferior vena cava, hepatic, and portal veins flow, were initially performed within 24 hours of admission and re-evaluated at 72 hours (third day) after treatment initiation. Changes in VExUS scores were compared between these two time points. Mann-Whitney test and logistic regression was performed to evaluate VExUS improvement association with mortality. Results Between October 2022 and January 2024, 81 patients were admitted to the CICU due to ADHF. Following the exclusion of 10 patients who were not assessed within the first 24 hours, 71 patients were included in the final analysis. Mean age was 65 ± 13.3 years, with 66.7% being male. Ischemic etiology was identified in 40.7%, and atrial fibrillation was present in 34.6%. Mean left ventricular ejection fraction was 27.4% ± 12.2, and 64.2% had right ventricular dysfunction. Upon admission, 73.2% were classified as B and 23.9% as C hemodynamic profiles. Overall in-hospital mortality was 25.9%. In-hospital mortality across VExUS categories assessed in the third day was 16.7%, 12.5%, 28.6% e 40%, for VExUS 0-3, respectively. The median VExUS variation between the two time points was greater in patients who survived [-1 vs. 0; p=0.030] and VExUS improvement at 72 hours was associated with a 46% decrease in hospital mortality for each class reduction (OR=0.536; 95% CI 0.29-0-81; p=0.043 - Figure 1). Conclusion Improvement in VExUS score between admission and 72 hours is associated with reduced in-hospital mortality. This finding highlights the potential role of dynamic VExUS monitoring for identifying delayed treatment response patients. Thus, changes in VExUS emerged as a prognostic tool offering a pathway to potentially intensify treatment strategies for high-risk patients with ADHF.VExUS score changes within 72 hours

Exercise testing in patients with tricuspid regurgitation undergoing transcatheter tricuspid valve intervention.

Transcatheter tricuspid valve intervention (TTVI) has shown promising results with persistent reduction of tricuspid regurgitation (TR) and improvements in functional class and quality of life (QOL). To analyze the impact of TTVI on maximal and submaximal exercise capacity (SEC). Constant work-rate exercise-time (CWRET) testing reflects SEC, which is more likely to be relevant for daily life activities and provides more differentiated physiological insight into the nature of exercise intolerance. Thus, 30 patients undergoing TTVI (21 direct annuloplasty and 9 edge-to-edge repair) received cardiopulmonary exercise testing (CPET) and CWRET (at 75% of maximum work rate in the initial CPET) before and 3months after TTVI. Patients' age was 80.5 [74.8-82.3] years and 53.3% were female. TR reduction ≥ 2 grades was achieved in 93.3% (TR grade ≤ moderate in 83.3%). Echocardiography revealed improved right ventricular (RV) characteristics with decreased RV basal diameter (47.0mm [43.0-54.3] vs. 41.5mm [36.8-48.0]; p < 0.001) and decreased inferior caval vein diameter. CWRET testing showed a significantly improved SEC (246.5s [153.8-416.8] vs. 338.5s [238.8-611.8] p = 0.001). Maximum oxygen uptake showed a positive trend without statistically significant differences (9.9ml/min/kg [8.6-12.4] vs. 11.7ml/min/kg [9.7-13.3]; p = 0.31). In contrast to the six-minute-walking distance (6MWD), SEC correlated moderately with effective regurgitation orifice area reduction (r = 0.385; p = 0.036), increased cardiac output (r = 0.378; p = 0.039), and improved QOL (r = 387; p = 0.035). Improvements in exercise capacity after TTVI mainly occur in the submaximal rather than in the maximal exercise range and correlate with hemodynamic effects and QOL. This may have a methodological impact on assessment of exercise capacity in these patients.

Central venus cannulation during cardiac surgery as a possible new additional risk factor for late post-operative atrial fibrillation insurgence.

Postoperative atrial fibrillation (POAF) is the most frequent cardiac arrhythmia following cardiac operations. It has been associated with an increased risk of postoperative cerebrovascular complications, morbidity and mortality. The aim of this study is to evaluate if the type of venous cannulation to institute the cardiopulmonary bypass (CPB) during major cardiac surgery procedures can influence the rate of POAF and late FA onset. We collected data from 2087 consecutive patients who have been operated at our Institution from January 2016 to December 2018. To obtain two homogenous groups we performed a propensity match analyzes: Group 1 for whom the blood drain of the CPB has been granted via peripheral cannulation (PC) through the right common femoral vein and Group 2 with patients who underwent central cannulation (CC) with insertion of a drainage cannula in the right atrium or in the superior and inferior vein cava. POAF has been observed as statistically similar between the two groups. At 1250-day follow-up, While the incidence of POAF was 2.9% and 8.7% in the PC and CC groups, respectively (p = .04). our data seems to show that the two groups do not differ in terms of POAF, while the CC group may have a significantly higher rate of atrial fibrillation in the follow-up period.

Aorto caval fistulas.

The purpose of this paper is to examine and assess the outcomes following open repair in 39 patients who experienced aorto-caval fistula (ACF) resulting from the spontaneous rupture of an abdominal aortic aneurysm (AAA). We reviewed the clinical records of all patients surgically treated with open repair for ACF at the Clinic for Vascular and Endovascular Surgery of the Serbian Clinical Center in Belgrade, Serbia, from January 2012 to February 2023. All of the patients in this series were consecutive and had aorto-caval fistula from AAA. No patients were excluded from the procedure due to the life-threatening nature of the state. A follow-up assessment was performed during the follow-up examination or by telephone interview with the patient or a family member. All patients were male, with mean age 67.4±8.3 years (range: 52-83 years). The 30-day mortality rate in our cohort was 35.9%, with three (7.7%) intraoperative deaths, and 11 deaths in the postoperative period (28.2%). A total of 25 patients out of 39 (64.1%) in the original cohort have survived the surgery and the postoperative period and were followed-up for a total of 67.1 person-years. The mean follow-up was 3.7±2.2 years (range 0.25-8.4 years). Two patients (8.0%) died during the follow-up, 16 patients (64.0%) survived, and seven (28.0%) were lost to follow-up. The long-term mortality rate in the cohort that survived the postoperative period was 3.0/100 person-years. ACF caused by spontaneous AAA rupture into the inferior caval vein or iliac veins is a relatively rare, life-threatening condition which requires prompt treatment. An exact preoperative diagnosis is essential for perioperative strategy. As the comparison of our results with the results from contemporary literature indicates, wherever possible endovascular repair should be considered since it results might be superior to open repair.

Point of care ultrasound and shock: The value in bedside diagnosis and hemodynamic assessment in undifferentiated shock patients

Point of care ultrasound (POCUS) was introduced as a tool for critical care assessment in the 1990s and has since grown to be a tool for quantitative and qualitative data. Adopted initially by the emergency medicine community, it has recently been integrated into medical education for numerous specialties. It remains a valuable adjunct in the initial evaluation of patients as a widely available portable resource and provides real-time imaging. In patients who present in undifferentiated shock, visualization of the heart and lungs using POCUS can help delineate the cause of the clinical decompensation. Cardiac evaluation can look for right and left ventricular dysfunction, estimate left ventricle ejection fraction, evaluate for cardiac tamponade, and detect new wall motion abnormalities. Assessment of the lungs can add additional insight into underlying pathology. In patients who suffer cardiac arrest, POCUS can help identify any potentially reversible causes. It can also be used for hemodynamic assessment to aid in the resuscitation of patients with shock by evaluating of the inferior vena cava, hepatic, and renal veins. Here we provide a resource to describe not only the numerous benefits of POCUS in assessing and monitoring critically ill patients, but also the imaging findings of life-threatening diagnoses.

New studies with stable gastric pentadecapeptide protecting gastrointestinal tract. significance of counteraction of vascular and multiorgan failure of occlusion/occlusion-like syndrome in cytoprotection/organoprotection.

Since the early 1990s, when Robert's and Szabo's cytoprotection concept had already been more than one decade old, but still not implemented in therapy, we suggest the stable gastric pentadecapeptide BPC 157 as the most relevant mediator of the cytoprotection concept. Consequently, it can translate stomach and gastrointestinal mucosal maintenance, epithelium, and endothelium cell protection to the therapy of other tissue healing (organoprotection), easily applicable, as native and stable in human gastric juice for more than 24h. These overwhelm current clinical evidence (i.e., ulcerative colitis, phase II, no side effects, and no lethal dose (LD1) in toxicology studies), as BPC 157 therapy effectively combined various tissue healing and lesions counteraction. BPC 157 cytoprotection relevance and vascular recovery, activation of collateral pathways, membrane stabilizer, eye therapy, wound healing capability, brain-gut and gut-brain functioning, tumor cachexia counteraction, muscle, tendon, ligament, and bone disturbances counteraction, and the heart disturbances, myocardial infarction, heart failure, pulmonary hypertension, arrhythmias, and thrombosis counteraction appeared in the recent reviews. Here, as concept resolution, we review the counteraction of advanced Virchow triad circumstances by activation of the collateral rescuing pathways, depending on injury, activated azygos vein direct blood flow delivery, to counteract occlusion/occlusion-like syndromes starting with the context of alcohol-stomach lesions. Counteraction of major vessel failure (congested inferior caval vein and superior mesenteric vein, collapsed azygos vein, collapsed abdominal aorta) includes counteraction of the brain (intracerebral and intraventricular hemorrhage), heart (congestion, severe arrhythmias), lung (hemorrhage), and congestion and lesions in the liver, kidney, and gastrointestinal tract, intracranial (superior sagittal sinus), portal and caval hypertension, aortal hypotension, and thrombosis, peripherally and centrally.

Spontaneous rupture of hepatic hydatid cyst into the inferior vena cava and hepatic vein

Spontaneous rupture of hepatic hydatid cyst into the inferior vena cava and hepatic vein

Life expectancy in cancer patients with pulmonary thromboembolism: From clinical prognostic biomarkers and paraclinical investigations to therapeutic approaches (Review).

Pulmonary embolisms (PEs) are obstructions of the pulmonary arteries by thrombi, which are emboli and they most frequently originate from the deep venous system of the inferior limbs. Emboli can also come from the inferior vena cava, abdominal and pelvic veins, or the upper body venous system from the right atrium or ventricle of the heart. Thrombi can form in situ inside pulmonary arteries as well. A cancer patient is at a higher risk for thromboembolic phenomena given both the oncological pathological context and also due to the associated medical or surgical treatment they receive. PE is a high-risk medical emergency that is associated with an increased risk of early mortality, with sudden death occurring in 25% of patients. The long-term presence of this condition can result in thromboembolic pulmonary hypertension. The risk of mortality, both in the acute and long-term, is dependent on the severity of the acute form, the recurrence of the embolism and the associated conditions. The majority of deaths associated with PE can be prevented by early diagnosis. The aim of the present review was to describe the various biological and cellular parameters, together with known paraclinical investigations, to assist in the rapid diagnosis of PE. Mortality in patients with PE and neoplastic conditions may be reduced by initiating anticoagulant treatment as soon as possible. PE may be the first manifestation of an underlying silent malignancy or may represent a complication of an already diagnosed malignancy. Exclusion or confirmation of the diagnosis is of utmost importance to avoid unnecessary anticoagulant treatment associated with a high risk of bleeding or to start immediate anticoagulant treatment if required.

#1988 VExUS score as a method to guide diuretic treatment in CKD patients with congestive nephropathy by right heart failure

Abstract Background and Aims Congestive nephropathy is a kidney dysfunction caused by the impact of elevated venous pressures on renal hemodynamics and most of all it is due to right heart failure. Venous congestion can lead to a circulation vicious hormonal activation, increased intra-abdominal pressure, excessive renal tubular reabsorption of sodium and volume overload. In CKD with right heart failure, management of the patient is difficult because may be hard to identify a condition of fluid overload and when to stop intravenous diuretic treatment. Inferior caval vein (ICV) diameter and ICV index (reduction of diameter with respiration) have been used to identify fluid overload and guide diuretic treatment. However, in CKD patients with heart failure the ICV may not change rapidly and could overestimate the need of intravenous diuretics. This is why VExUS has been useful in both diagnosis and monitoring therapeutic. The VExUS method is a new approach, documented in the literature for the first time once in 2020. In this study we report the usefulness of the VExUS (Venous Excess Ultrasound Score) method for the diagnosis of overload volume and venous congestion and in setting an adequate therapy. It consists of Doppler evaluation of the abdominal veins: hepatic, portal and intrarenal. In fact, the acute renal failure, in the patients studied, is to be attributed in the first instance to venous congestion rather than underfilling, resulting from decompensation and therefore requiring diuretic therapy. Method This retrospective study was conducted in CKD patients (stages 3-4) with acute kidney injury (creatinine level: 6.3-2.6 mg/dl) due to right heart failure admitted at the U.O.C. Nephrology at the S. Maria della Pietà Hospital in Nola and UOC Nephrology of Univ. of Campania. The VExUS method defines 3 degrees (score 0-3) of congestion based on the severity of the anomalies on hepatic, portal and intrarenal venous Doppler. All patients have been treated with diuretics i.v. based on a VEXUS score&amp;gt;1, and then returned to oral treatment when VEXUS score returned to 0. VExUS assessment was performed at admission, repeated every 48 hours and the last score has been considered here (on average 1 week). The relationship between change in VExUS score and ICV index vs creatinine levels was studied by correlation analysis. Lung POCUS (point of care pulmonary ultrasonography) has also been used for all patients to identify a possible contemporary overload caused by LV failure. Results Thirty patients have been included. The use of diuretics reduced the VExUS score and the ICV diameter. However, diuretic treatment changed the ICV diameter by a smaller extent (−30%) compared to the VExUS score (−80%), and one patient showed clear reduction of VExUS score, without any modification of the ICV diameter, suggesting that the latter is a slower indicator of recovery compared to VExUS. Indeed, the change of VExUS score was highly correlated to the improvement of creatinine levels (Pearson's correlation 0.837, p &amp;lt; 0.001). The change of IVC diameter explained in comparison a smaller amount of variability of the creatinine improvement (Pearson's correlation 0.65, p = 0.008). Conclusion VExUS is a promising and reliable tool in the management of congestive nephropathy in patients with CKD and right heart failure. VExUS is superior to VCI diameter and should be used routinely, along with clinical, laboratory, and other ultrasound parameters, because of its usefulness, repeatability, low cost and ease of execution.

PERCUTANEOUS CORRECTION OF "BADLY ACCOMPANIED" MASSIVE TRICUSPID REGURGITATION

Abstract Background Tricuspid regurgitation (TR) is a common valvular pathology that impairs quality of life and survival. Tricuspid transcatheter edge–to–edge repair (t–TEER) has shown promising potential in the TR treatment. There remains several uncertainties such as timing of intervention in relation to clinical status, RV function, pulmonary artery pressure and many comorbidities that are often overlooked. Case Summary A 80–year–old man with dilated cardiomyopathy, persistent atrial fibrillation and biventricular defibrillator (ICD), was admitted to our centre for congestive heart failure (CHF). Echocardiography showed massive TR, severe right heart dilatation, increased systolic pulmonary artery pressure, severely dilated inferior vena cava (IVC) and hepatic veins with systolic flow reversal. We also found an uncommonly high blood flow coming to the right atrium from the IVC, due to an anomalous vascular communication between an intrahepatic portal branch and a hepatic vein, a so–called intrahepatic portosystemic venous shunt (IPSVS). Although these relatively rare shunts are usually not treated unless symptomatic, after a collective careful evaluation, we decided to proceed to the embolization of the IPSVS with a vascular plug, to make the t–TEER less challenging, safer and more durable. In better general conditions, after 2 months, the patient underwent the transcatheter tricuspid procedure with a single XTW TriClip™ (Abbott). At 3 months follow–up, the patient showed noticeable improvements in QoL, CHF signs and symptoms, echocardiographic parameters and exercise capacity. Discussion Appropriate timing of t–TEER is crucial not only to avoid irreversible RV damage and organ failure, but also to increase the success rate of the procedures. In this case we observed that the IPSVS treatment contributed significatively to improve the patient’s clinical status and to reduce the right heart volume overload before attempting the t–TEER. This combined approach facilitated the technical success of tricuspid procedure, that was itself challenging due to the ICD leads in the right chambers. Conclusion Patients’ selection and timing of percutaneous TR treatment are not clearly defined. This case shows that a winning strategy to approach challenging TR is to solve, before the tricuspid treatment, all the potentially treatable comorbidities that could negatively interfere with the technical success of the procedure itself and with the durability of TR reduction.

Successful management of postpartum venous thrombosis following splenectomy for traumatic splenic rupture: a case report.

Traumatic splenic rupture is rare in pregnant women; and multiple venous thromboses of the portal vein system, inferior vena cava and ovarian vein after caesarean section and splenectomy for splenic rupture has not been previously reported. This case report describes a case of multiple venous thromboses after caesarean section and splenectomy for traumatic splenic rupture in late pregnancy. A 34-year-old G3P1 female presented with abdominal trauma at 33+1 weeks of gestation. After diagnosis of splenic rupture, she underwent an emergency caesarean section and splenectomy. Multiple venous thromboses developed during the recovery period. The patient eventually recovered after anticoagulation therapy with low-molecular-weight heparin and warfarin. These findings suggest that in patients that have had a caesarean section and a splenectomy, which together might further increase the risk of venous thrombosis, any abdominal pain should be thoroughly investigated and thrombosis should be ruled out, including the possibility of multiple venous thromboses. Anticoagulant therapy could be extended after the surgery.

Perioperative Anaesthetic Management of a Large Paraganglioma Compressing Abdominal Aorta and Inferior Vena Cava: A Case Report

Paragangliomas (PGs) are rare neuroendocrine tumors that originate in the autonomic nervous system. Functionally, they are highly vascular and may be parasympathetic or sympathetic. Parasympathetic tumors are usually asymptomatic and inactive, located mostly in the skull base in the distribution of IX and X cranial nerves. In contrast, sympathetic tumors are highly active (secretes norepinephrine) and symptomatic and mainly located in the abdomen and pelvic regions. Surgical removal of these tumors is curative and key to favorable outcomes. Some of these tumors have malignant potential as well. Meticulous preoperative preparation is needed but many patients may still land up in hypertensive crises intraoperatively which should be managed promptly and cautiously by the anesthesia team to reduce morbidity and mortality during surgery. Here, we describe the successful anesthetic management of a patient diagnosed with large aortocaval PG abutting the aorta and compressing the inferior vena cava and bilateral renal veins.

Surgical management of renal cell carcinoma with subhepatic inferior vena cava tumor thrombus: a case report and review of the literature

BackgroundRenal cell carcinomas are the most common form of kidney cancer in adults. In addition to metastasizing in lungs, soft tissues, bones, and the liver, it also spreads locally. In 2–10% of patients, it causes a thrombus in the renal or inferior vena cava vein; in 1% of patients thrombus reaches the right atrium. Surgery is the only curative option, particularly for locally advanced disease. Despite the advancements in laparoscopic, robotic and endovascular techniques, for this group of patients, open surgery continues to be among the best options.Case reportHere we present a case of successful tumor thrombectomy from the infrahepatic inferior vena cava combined with renal vein amputation and nephrectomy. Our patient, a 58 year old Albanian woman presented to the doctors office with flank pain, weight loss, fever, high blood pressure, night sweats, and malaise. After a comprehensive assessment, which included urine analysis, complete blood count, electrolytes, renal and hepatic function tests, as well as ultrasonography and computed tomography, she was diagnosed with left kidney renal cell carcinoma involving the left renal vein and subhepatic inferior vena cava. After obtaining informed consent from the patient we scheduled her for surgery, which went well and without complications. She was discharged one week after to continue treatment with radiotherapy, chemotherapy, and immunotherapy.ConclusionOpen surgery is a safe and efficient way to treat renal cell carcinoma involving the renal vein and inferior vena cava. It is superior to other therapeutic modalities. When properly done it provides acceptable long time survival and good quality of life to patients.

Vena cava replacement and major hepatectomy for liver tumors: international multicenter retrospective cohort study.

Involvement of the inferior vena cava (IVC) and hepatic veins has been considered a relative contraindication to hepatic resection for primary and metastatic liver tumors. However, patients affected by tumors extending to the IVC have limited therapeutic options and suffer worsening of quality of life due to IVC compression. Cases of primary and metastatic liver tumors with vena cava infiltration from 10 international centers were collected (7 European, 1 US, 2 Brazilian, 1 Indian) were collected. Inclusion criteria for the study were major liver resection with concomitant vena cava replacement. Clinical data and short-term outcomes were analyzed. Thirty-six cases were finally included in the study. Median tumor max size was 98mm (range: 25-250). A biliary reconstruction was necessary in 28% of cases, while a vascular reconstruction other than vena cava in 34% of cases. Median operative time was 462min (range: 230-750), with 750 median ml of estimated blood loss and a median of one pRBC transfused intraoperatively (range: 0-27). Median ICU stay was 4 days (range: 1-30) with overall in-hospital stay of 15 days (range: 3-46), postoperative CCI score of 20.9 (range: 0-100), 12% incidence of PHLF grade B-C. Five patients died in a 90-days interval from surgery, one due to heart failure, one due to septic shock, and three due to multiorgan failure. With a median follow-up of 17 months (interquartile range: 11-37), the estimated 5 years overall survival was 48% (95% CI: 27-66%), and 5-year cumulative incidence of tumor recurrence was 55% (95% CI: 33-73%). Major liver resections with vena cava replacement can be performed with satisfactory results in expert HPB centers. This surgical strategy represents a feasible alternative for otherwise unresectable lesions and is associated with favorable prognosis compared to nonoperative management, especially in patients affected by intrahepatic cholangiocarcinoma.

Renal Transplant in a Patient with Extensive Thrombosis of Inferior Vena Cava and Bilateral Iliofemoral Veins

A 43-year-old male diagnosed with end-stage renal disease on hemodialysis with extensive thrombosis in the inferior vena cava and bilateral iliofemoral vein underwent renal transplantation at our institute. Thrombosis in the major vein can have serious consequences for the success of the transplantation. The common anastomosing vein during renal transplantation is the right external iliac vein, but due to extensive thrombosis, left native nephrectomy with the orthotopic placement of the donor kidney was done. During surgery, the donor renal vein was anastomosed with the left renal vein, and the donor renal artery was anastomosed with the aorta. Postsurgery, the creatinine level showed a progressive decline over time and the patient was discharged home.

Laparoscopic hepatectomy for hepatocellular adenoma using the hepatic vein as anatomic markers,How I do it.(with video)

TechniqueHepatocellular adenoma (HCA) is a benign monoclonal tumour that originates from mature hepatocytes.Liver resection is recommended in case of overt malignant transformation to hepatocellular carcinoma.However, hepatobiliary surgeries are technically challenging in patients with giant HCA (GHCA) owing to the risk of catastrophic intraoperative bleeding and difficulty with its control during laparoscopic treatment. We present a technical note on the utilization of the hepatic vein as anatomical landmarks for laparoscopic removal of giant hepatic glands, without intraoperative ultrasonography and with the aid of an augmented reality navigation system during surgery. ResultsThis video shows aA 37-year-old man was recommended treatment for a progressively increasing HCA (from 3 to 10 cm in a year) involving the right hepatic vein (RHV), inferior vena cava (IVC) and middle hepatic vein (MHV), resulting in the invisibility of the above intrahepatic anatomic markers in CT. Laparoscopic hepatectomy was performed using the hepatic vein as anatomic markers in a treatment centre specialising in minimally invasive surgeries. The procedure involved fully mobilising the right liver, transecting the parenchyma along the demarcation line in the caudal-to-cranial direction, exposing the involved caudal MHV, isolating and transecting the involved RHV and preserving the integrity of the involved IVC. ConclusionsLaparoscopic hepatectomy for intractable GHCA using the involved intrahepatic anatomic markers is feasible and effective. It reduces pre-operative haemorrhage and open conversion rates while maximising postoperative hepatic function.

Resection and reconstruction of the largest abdominal vein system (the inferior vena cava, hepatic, and portal vein): a narrative review.

As tumors invade major abdominal veins, surgical procedures are transformed from simple and basic to complicated and challenging. In this narrative review, we focus on what is currently known and not known regarding the technical aspects of major abdominal venous resection and its reconstruction, patency, and oncologic benefit in a cross-cutting perspective. A systematic literature search was performed in PubMed and Semantic Scholar from inception up to October 18, 2023. We reviewed 106 papers by title, abstract, and full text regarding resection or reconstruction of the inferior vena cava, hepatic vein confluence, portal vein (PV), and middle hepatic vein (MHV) tributaries in living donor liver transplantation (LDLT) in a cross-cutting perspective. The oncologic benefit of aggressive hepatic vein resection with suitable reconstruction against adenocarcinoma remains unclear, and further studies are required to clarify this point. A superior mesenteric/PV resection is now a universal, indispensable, and effective procedure for pancreatic ductal adenocarcinoma. Although many case series using tailor-made autologous venous grafts have been reported, not only size mismatch but also additional surgical incisions and a longer operation time remain obstacles for venous reconstruction. The use of autologous alternative tissue remains only an alternative procedure because the patency rate of customized tubular conduit type to interpose or replace the resected vein is not known. Unlike arterial replacement, venous replacement using synthetic vascular grafts is still rarely reported and there are several inherent limitations except for reconstruction of tributaries of MHV in LDLT. Various approaches to abdominal vein resection and replacement or reconstruction are technically feasible with satisfactory results. Synthetic vascular grafts may be appropriate but have a certain rate of complications.

Abdominal Compartment Syndrome: Definitions, Epidemiology, and Management

Abdominal compartment syndrome (ACS) is a multifaceted and potentially life-threatening medical condition characterized by elevated intra-abdominal pressure. While ACS was initially associated with trauma, it has become evident that this syndrome can manifest in various clinical scenarios.&#x0D; The prevalence of ACS varies across diverse patient populations and clinical settings. Risk factors such as obesity, intra-abdominal tumors, ascites, and major surgery heighten the vulnerability to developing ACS. The pathophysiology of ACS involves a cascade of events compromising organ perfusion. This includes the compression of the inferior vena cava and renal veins, leading to reduced venous return and impaired renal blood flow, which can result in renal failure.&#x0D; Accurate diagnosis of ACS relies on the measurement of intra-abdominal pressure, often performed through bladder pressure measurement. Management encompasses a range of supportive measures, careful patient positioning, ventilatory support, and strategies to reduce intra-abdominal volume. Surgical decompression becomes necessary when conservative approaches fail, although this decision must consider individual patient factors.&#x0D; This review underscores the evolving landscape of ACS and emphasizes the imperative for continued research to address uncertainties in pathophysiology, diagnostic criteria, and management strategies. Enhanced understanding and refined approaches hold the potential to significantly improve outcomes for at-risk or affected patients.

Estimation of the inferior caval vein saturation using high-fidelity non-invasive haemodynamic values and validation of modelled estimates.

Monitoring venous saturation allows identification of inadequate systemic oxygen delivery. The aim was to develop a model using non-invasive haemodynamic variables to estimate the inferior caval vein saturation and to determine its prognostic utility. This is a single-centre, retrospective study. A Bayesian Pearson's correlation was conducted to model the inferior caval vein saturation. Next, a Bayesian linear regression was conducted for data from all the patients and from only those with parallel circulation. Venous saturation estimations were developed. The correlation of these estimates to the actual inferior caval vein saturation was assessed. The resulting models were then applied to two validation cohorts: biventricular circulation (arterial switch operation) and parallel circulation (Norwood operation). One hundred and thirteen datasets were collected across 15 patients. Of which, 65% had parallel circulation. In all patients, the measured and estimated inferior caval vein saturations had a moderate and significant correlation with a coefficient of 0.64. In patients with parallel circulation, the measured and estimated inferior caval vein saturation had a moderate and significant correlation with a coefficient of 0.61. In the biventricular circulation cohort, the estimated inferior caval vein saturation had an area under the curve of 0.71 with an optimal cut-off of 49. In the parallel circulation cohort, the estimated interior caval vein saturation had an area under the curve of 0.83 with an optimal cut-off of 24%. The inferior caval vein saturation can be estimated utilising non-invasive haemodynamic data. This estimate has correlation with measured inferior caval vein saturations and offers prognostic utility.

Renal vein valves: a prevalence, microanatomical and histological study.

In the modern era of robotic renal procedures and diagnostics, an even more detailed anatomical understanding than hitherto is necessary. Valves of the renal veins (RVV) have been underemphasized and have been disputed by some authors, and few textbooks describe them. The current anatomical study was performed to address such shortcomings in the literature. One hundred renal veins were studied in fifty adult formalin-fixed cadavers. Renal veins were removed from the abdomen after sectioning them flush with their entrance to the renal hilum. The inferior vena cava was then incised longitudinally and opened, and RVV were examined grossly and histologically. A classification scheme was developed and applied to our findings. Nineteen RVVs were observed in the fifty cadavers (38%). Four (8%) valves were found on right sides and fifteen (30%) on left sides. The valves were seen as cord/band-like, folds, and single and double leaflets. Histologically, they were all extensions of the tunica intima. On the basis of our study, RVV are not uncommon. They were more common on left sides, and on both sides, they were found within approximately one centimeter of the junction of the inferior vena cava and renal vein. Although the function of such valves cannot be inferred from this anatomical study, the structures of the Single leaflet valve (TS2) and Double leaflet valve (TS3) valves suggest they could prevent venous reflux from the IVC into the kidney.