V.N. Lesovoy, D.V. Shchukin, I.A. Garagatiy, M.M. Polyakov, G.G. Khareba, N.M. Andonieva, O.O. Altukhov, P.V. Mozzhakov

Prediction of blood loss from an isolated inferior vena cava (IVC) portion during vena cava thrombectomy

One of the most important problems of inferior vena cava tumor thrombi removal is a massive intraoperative blood loss. In order to predict bleeding from the lumen of the inferior vena cava during thrombectomy we used puncture of the IVC lumen within the thrombus vascular isolation area with detection of venous pressure levels and determination of correlation between the results of puncture test and the level of blood loss.

This test was performed in 25 cases. Tumor thrombi in 10 (40.0%) patients reached the cavo-renal IVC section, in 7 (28.0%) patients - subhepatic IVC, in 5 (20.0%) patients - retrohepatic IVC, and in 3 (12.0%) patients thrombi penetrated the supradiaphragmatic segment of the inferior vena cava or the right atrium. Positive puncture test included two criteria: the level of venous pressure above 30 cm of water column and filling of the tube with blood after its descent below the vena cava level and re-raising. If one of the criteria was positive, and the other was not, the test was considered positive.

Puncture test including the criteria of tube refilling with blood, has high specificity and positive predictive value (100%) with sensitivity of 81.3%. For “venous pressure” parameter, the values of the biggest part of information content indicators exceed 80%. However, this test is not informative enough for massive thrombi that completely fill in the lumen of the inferior vena cava.

The use of described technique allows defining a group of patients at high risk of caval bleeding during thrombectomy. This group of patients requires careful isolation of the lumbar veins in the region of cavo-renal anastomosis up to the stage of cavotomy and evacuation of the thrombus.