V.N. Lesovoy, D.V. Shchukin, V.N. Demchenko, T.I. Ermolenko

Surgical anatomy of supradiaphragmal segment of the inferior vena cava and the problems venacavathrombectomy

The study is devoted structural features of the supradiafragmal inferior vena cava in relation to the problems of removing the tumor thrombus without cardiopulmonary bypass.

The material of this study included 35 fresh cadavers. The topography of supradiafragmal IVC, size and localization of diaphragmatic veins, as well as the right phrenic nerve and its branches were estimated. After opening the pericardium was fixed distance between the sheets of the visceral pericardium covering intrapericardial IVC.

The mouths of the phrenic veins at the level of supradiafragmal IVC were detected only in 11,4% of patients. Their number varied from 1 to 2 and an average diameter not exceeding 2,0 mm. In most cases, diaphragmatic vein penetrated into the IVC at the level or below the diaphragm. The mouths of these vessels mainly localized on the front semicircle of IVC, had an average diameter 2,6 mm. The distance between the sheets of the pericardium in the posterior wall of the IVC ranged from 2 to 16 mm and averaged 9,2 mm. Pericardial «mesentery» in 65,7% of cases was on the 8-hour conditional dial. The right phrenic nerve and its branches visualized only on the thorax side. He passed through the posterior-lateral surface of the fibrous pericardium and intruded in the diaphragm next to inferior vena cava (7-8 hours conditional dial). In most cases, the nerve was surrounded by a loose fatty tissue and can be easily withdrawn from the surface of the pericardial-phrenic transition to a distance of 7-10 mm.

The results of the study demonstrated the feasibility and safety of the transdiafragmal accesses to the intrapericardial inferior vena cava without opening the pericardium.