Background: Vein graft failure after bypass surgery is greatly increase in patients with diabetes mellitus. The cellular mechanisms underlying the cause of this failure are largely unexplored. Protein kinase B/AKT is ...Background: Vein graft failure after bypass surgery is greatly increase in patients with diabetes mellitus. The cellular mechanisms underlying the cause of this failure are largely unexplored. Protein kinase B/AKT is a mechanically sensitive regulator of cellular growth and apoptosis. Herein we examine whether diabetes affects the regulation of AKT in response to increased venous loading. Methods: Inferior venae cavae (IVC) from the non-diabetic lean (LNZ) and the diabetic obese?syndrome X Zucker(OSXZ) rats were isolated and incubated ex vivo under basal or pressurized conditions (120 mmHg). Protein expression, basal activation and the ability of increased pressure to activate AKT3 and apoptosis-related signaling were evaluated by immunoblot analysis. Results: Compared to that seen in the non-diabetic lean animals, increased venous pressure in the OSXZ rats was not characterized by increases in APAF-1 concentration, XIAP proteolysis, AIF cleavage, or Bad phosphorylation. This evidence of decreased apoptotic signaling was associated with increased basal p-AKT3 levels (+136% ± 13% P < 0.05 higher in the OSXZ vs. LNZ IVC). Conclusion: These data suggest that diabetes-associated increases in p-AKT3 may alter the ability of the IVC to undergo pressure induced apoptosis-related signaling. Further investigation is required to determine whether these changes are associated with the increased vein graft attrition seen in the diabetic population.展开更多
Background:Clear cell sarcoma of the kidney(CCSK)is a rare and highly aggressive pediatric renal malignancy with a marked propensity for metastatic spread.Cases of CCSK associated with inferior vena cava(IVC)tumor thr...Background:Clear cell sarcoma of the kidney(CCSK)is a rare and highly aggressive pediatric renal malignancy with a marked propensity for metastatic spread.Cases of CCSK associated with inferior vena cava(IVC)tumor thrombus(IVCTT)are exceptionally uncommon in the literature.We report a case of CCSK with IVCTT in a 15-month-old male infant.Case Description:We reported a case admitted in May 2020 for a 3-day history of fever and hematuria.Abdominal CT revealed an unevenly enhanced mass and low-density shadows within the IVC.The diagnosis of CCSK was confirmed via needle biopsy.The patient received 4 cycles of adjuvant chemotherapy.The initial surgery lasted 10 h with 600 mL blood loss,and primary closure was achieved.Postoperative management included 6 cycles of radiotherapy and 5 cycles of chemotherapy.In March 2022,CT detected IVCTT recurrence,requiring surgical intervention involving thrombus removal and partial IVC resection.This procedure lasted 8 h with 300 mL blood loss,followed by 5 additional chemotherapy cycles.The patient showed no sign of IVC obstruction,including varicose veins or lower limb edema,and maintained renal function throughout follow-up.However,Intracranial metastases were detected 15 months postoperatively.After the family opted against additional treatment,the patient succumbed to the disease.Conclusions:The management of CCSK associated with IVCTT should include consideration of IVC thrombectomy.In case of recurrent IVCTT with preserved collateral circulation,combined thrombus excision and partial IVC resection may be warranted.展开更多
BACKGROUND Laparoscopic liver resection(LLR)can be challenging due to the difficulty of establishing a retrohepatic tunnel under laparoscopy.Dissecting the third hepatic hilum before parenchymal transection often lead...BACKGROUND Laparoscopic liver resection(LLR)can be challenging due to the difficulty of establishing a retrohepatic tunnel under laparoscopy.Dissecting the third hepatic hilum before parenchymal transection often leads to significant liver mobilization,tumor compression,and bleeding from the short hepatic veins(SHVs).This study introduces a novel technique utilizing the ventral avascular area of the inferior vena cava(IVC),allowing SHVs to be addressed after parenchymal transection,thereby reducing surgical complexity and improving outcomes in in situ LLR.AIM To introduce and evaluate a novel LLR technique using the ventral avascular area of the IVC and compare its short-term outcomes with conventional methods.METHODS The clinical cohort data of patients with pathologically confirmed hepatocellular carcinoma or intrahepatic cholangiocarcinoma who underwent conventional LLR and novel LLR between July 2021 and July 2023 at the First Affiliated Hospital of Chongqing Medical University were retrospectively analyzed.In novel LLR,we initially separated the caudate lobe from the IVC using dissecting forceps along the ventral avascular area of the IVC.Then,we transected the parenchyma of the left and right caudate lobes from the caudal side to the cephalic side using the avascular area as a marker.Subsequently,we addressed the SHVs and finally dissected the root of the right hepatic vein or left hepatic vein.The short-term postoperative outcomes and oncological results of the two approaches were evaluated and compared.RESULTS A total of 256 patients were included,with 150(58.59%)undergoing conventional LLR and 106(41.41%)undergoing novel LLR.The novel technique resulted in significantly larger tumor resections(6.47±2.96 cm vs 4.01±2.33 cm,P<0.001),shorter operative times(199.57±60.37 minutes vs 262.33±83.90 minutes,P<0.001),less intraoperative blood loss(206.92±37.09 mL vs 363.34±131.27 mL,P<0.001),and greater resection volume(345.11±31.40 mL vs 264.38±31.98 mL,P<0.001)compared to conventional LLR.CONCLUSION This novel technique enhances liver resection outcomes by reducing intraoperative complications such as bleeding and tumor compression.It facilitates a safer,in situ removal of complex liver tumors,even in challenging anatomical locations.Compared to conventional methods,this technique offers significant advantages,including reduced operative time,blood loss,and improved overall surgical efficiency.展开更多
Persistent left superior vena cava(PLSVC)is a congenital anomaly where the left-sided vena cava,which usually regresses during fetal development,persists.Double superior vena cava resulting from a PLSVC is indeed a ra...Persistent left superior vena cava(PLSVC)is a congenital anomaly where the left-sided vena cava,which usually regresses during fetal development,persists.Double superior vena cava resulting from a PLSVC is indeed a rare phenomenon.In the general population,the incidence of this condition is reported to be between 0.3%and 2.1%.[1]While this anatomical variation is often asymptomatic and discovered incidentally,it becomes relevant in certain clinical scenarios.Indeed,the presence of a PLSVC and double superior vena cava can pose challenges as incorrect positioning and result in failure.展开更多
BACKGROUND Inferior vena cava(IVC)leiomyosarcomas are rare and aggressive tumors.Complete cure depends on achieving R0 resection,which often requires circumferential resection and reconstruction.Synthetic grafts have ...BACKGROUND Inferior vena cava(IVC)leiomyosarcomas are rare and aggressive tumors.Complete cure depends on achieving R0 resection,which often requires circumferential resection and reconstruction.Synthetic grafts have traditionally been used when venous continuity must be restored.However,the use of cadaveric IVC grafts for reconstruction has not been widely reported.CASE SUMMARY Herein,we present the case of a 64-year-old woman diagnosed with an intrahepatic IVC leiomyosarcoma with local invasion.The patient responded favorably to chemotherapy and subsequently underwent an en bloc right hepatectomy,retrohepatic IVC resection,and reconstruction with an interpositional cadaveric IVC graft.Serial imaging follow-ups until 2 years after the operation showed persistent patency of the graft and no graft-related complications.CONCLUSION Cadaveric IVC grafts are an alternative to synthetic grafts for reconstruction,with acceptable outcomes.Larger,long-term studies are necessary to validate these findings.展开更多
Various approaches to laparoscopic anatomic liver resection have been described.In this paper,the authors present a technique that utilizes the ventral avascular areas above the inferior vena cava.While many liver sur...Various approaches to laparoscopic anatomic liver resection have been described.In this paper,the authors present a technique that utilizes the ventral avascular areas above the inferior vena cava.While many liver surgeons partially adopt this elements of this method,few employ it to the full extent outlined here.Main-taining low central venous pressure during anesthesia is critical to this approach,as demonstrated by the operative images showing collapsed hepatic veins.This technique is particularly advantageous when the patient’s body mass index is low,the tumor is small(or large but deeply embedded within the liver parenchy-ma),and the overlying liver tissue is not excessively bulky or heavy.Nonetheless,following the conventional course along the Glissonean pedicle can be beneficial.The authors demonstrate notable skill in completing these procedures laparosco-pically.However,concerns over margin positivity and tumor recurrence remain,and follow up studies are needed to further validate the approach.展开更多
Objective:To explore the evidence-based nursing optimization strategy for catheter tip positioning during peripherally inserted central catheter(PICC)insertion in patients with persistent left superior vena cava(PLSVC...Objective:To explore the evidence-based nursing optimization strategy for catheter tip positioning during peripherally inserted central catheter(PICC)insertion in patients with persistent left superior vena cava(PLSVC).Methods:For one ovarian cancer patient with PICC malposition in the coronary sinus(CS)due to PLSVC,multimodal imaging techniques were integrated to accurately locate the catheter tip.The catheter position was adjusted based on evidence(withdrawing 5 cm),and a standardized nursing process was established,including personalized health education,catheter fixation and displacement monitoring,complication monitoring,establishment of a specialized disease information archive system,and formulation of a follow-up plan.Results:The catheter tip was successfully withdrawn from the coronary sinus(at the T8 level)to the middle and lower part of the PLSVC(at the T6 vertebral level),and the catheter functioned normally after adjustment.No complications such as arrhythmia or thrombosis occurred during the 332-day chemotherapy period.Conclusion:The PICC tip in PLSVC patients should be positioned in the middle and lower part of the PLSVC(at the T5–T7 vertebral level).This new standard can effectively avoid CS-related complications.The integration of multi-modal imaging techniques and evidence-based nursing management are key to ensuring safe infusion.展开更多
Case Letter Severe trauma has high morbidity and mortality rates,being the leading cause of death in young adults.Among all traumas,tra ffi c injuries are particularly lethal.^([1-2]) The injury severity score(ISS) ca...Case Letter Severe trauma has high morbidity and mortality rates,being the leading cause of death in young adults.Among all traumas,tra ffi c injuries are particularly lethal.^([1-2]) The injury severity score(ISS) can be used to assess trauma severity,with ISS of<9,9–15,16–24,and≥25 indicating minor,moderate,severe,and critical trauma,respectively.The ISS is correlated with mortality,morbidity,and hospitalization duration after injury.^([3-4]) Here,we report one patient who was admitted to our emergency intensive care unit(EICU) due to traumatic liver rupture and traumatic myocardial infarction complicated with inferior vena cava(IVC) thrombosis.展开更多
Persistent left superior vena cava(PLSVC)is a rare congenital anomaly that may complicate cardiac procedures when associated with a dilated coronary sinus(CS)and conduction disturbances.We report the case of a 27-year...Persistent left superior vena cava(PLSVC)is a rare congenital anomaly that may complicate cardiac procedures when associated with a dilated coronary sinus(CS)and conduction disturbances.We report the case of a 27-year-old male with Wilson’s disease who presented with complete heart block.Echocardiography showed biatrial enlargement and severe CS dilation,while contrast-enhanced computed tomography(CT)confirmed PLSVC draining into the CS without a bridging vein.Anatomical constraints prevented cardiac resynchronization therapy,and dual-chamber pacemaker implantation proved technically challenging due to lead placement difficulties.This case highlights the importance of thorough preoperative assessment and individualized pacing strategies in patients with PLSVC,in order to anticipate anatomical challenges and optimize outcomes.展开更多
BACKGROUND Acute pulmonary thromboembolism is a complication of venous thrombosis.Extracorporeal membrane oxygenation(ECMO),an effective rescue measure for rapid hemodynamic recovery,can be used in patients for whom t...BACKGROUND Acute pulmonary thromboembolism is a complication of venous thrombosis.Extracorporeal membrane oxygenation(ECMO),an effective rescue measure for rapid hemodynamic recovery,can be used in patients for whom thrombolysis therapy has failed.CASE SUMMARY This case report describes an extreme rescue process for a patient with a preset inferior vena cava(IVC)filter in a relatively economically underdeveloped area with an insufficient supply of consumables.In an emergency,veno-arterial ECMO was successfully initiated by intubation through the IVC filter to the right atrial opening without displacement of the filter during the entire process.CONCLUSION This study demonstrates that in resource-limited settings,femoral vein cannulation for veno-arterial ECMO is a feasible and safe option for patients with preimplanted IVC filters.展开更多
Intravenous leiomyomatosis(IVL)is a rare,histologically benign uterine smooth muscle tumor with malignant biological behavior due to its propensity for intravascular extension.[1]While gynecological in origin,its most...Intravenous leiomyomatosis(IVL)is a rare,histologically benign uterine smooth muscle tumor with malignant biological behavior due to its propensity for intravascular extension.[1]While gynecological in origin,its most severe manifestations are cardiovascular,arising from tumor propagation through the venous system into the inferior vena cava(IVC),right heart,and pulmonary arteries,mimicking thromboembolic disease.[2,3]This can lead to pulmonary embolism(PE),right heart obstruction,and even sudden cardiac death.[4]Diagnosis is challenging,often delayed by misdiagnosis as conventional PE.We present two cases of IVL initially presenting with PE,highlighting the critical cardiovascular implications and diagnostic pitfalls.展开更多
The development of innovative surgical techniques has been a constant and fundamental aspect in liver transplantation(LT)to address chronic organ shortage.Domino liver transplantation(DLT),initially performed by Furta...The development of innovative surgical techniques has been a constant and fundamental aspect in liver transplantation(LT)to address chronic organ shortage.Domino liver transplantation(DLT),initially performed by Furtado et al.in Lisbon in 1995,is an innovative technique in which a liver from a patient with a metabolic disorder is transplanted into a recipient with end-stage liver disease[1].展开更多
Objective To study the techniques and clinical applications of intra-vascular stenting in the treatment of superior vana cava obliteration syndrome (SVS). Methods In 9 cases of SVS, primary lesions were all confirme...Objective To study the techniques and clinical applications of intra-vascular stenting in the treatment of superior vana cava obliteration syndrome (SVS). Methods In 9 cases of SVS, primary lesions were all confirmed as malignancy (primary pulmonary carcinoma of right upper lobe) histolo-pathologically. By route of right femoral vein, SVS catheterization and DSA was made. The length of the strictures and the diameters of normal superior vana cavae (SVC) were measured for the choice of appropriate stents. The option of stemt diameter is 10% larger than that of normal SVCs. The upper and lower ends of the stent should be 1–2 cm protruding from the ends of the stricture. The stent was dilated with a balloon after its successful placement. Therapy of original lesions was continued together with anticoagulant. Stents were observed about their positions by fluoroscopy or chest films, and about patency of SVC by Doppler. Results After the placement of a stent, DSA revealed the contrast media in the SVCs passed along smoothly, diameters of SVCs almost normal, collateral branches diminished remarkably. Average SVC pressure was decreased from 26.4 cmH2O before the placement down to 15.7 cmH2O, with an obvious difference (P<0.01= by statistics. Related clinical symptoms and signs disappeared or relieved. Subsidised were swelling of head and neck, upper extremities and chest. Excretion of urine increased. Gorgeous superficial veins in the chest could not be detected any more. Conclusion The therapy of intra-vascular stenting to treat SVS is microinvasive, simple and effective. Key words superior vana cava syndrome - tumor - stent - image diagnosis - interventional therapy展开更多
We report the case of three female patients who were scheduled for surgical correction of residual left-to-right shunt after initial repair of sinus venosus atrial septal defect(SV-ASD)during childhood.After excluding...We report the case of three female patients who were scheduled for surgical correction of residual left-to-right shunt after initial repair of sinus venosus atrial septal defect(SV-ASD)during childhood.After excluding the possibility of an hemodynamic intervention,all three patients underwent a successful surgical closure through a right mini sub-axillary approach by using total peripheral cannulation for cardiopulmonary bypass and leaving the inferior vena cava completely un-snared allowing for an optimal visualization of the residual atrial septal communication and avoiding extensive dissection of mediastinal structures.展开更多
AIM: To explore the anatomical feasibility of portacaval shunt using a magnetic compression technique(MCT) in cadavers.METHODS: Computed tomography(CT) images of 30 portal hypertensive patients were obtained.The diame...AIM: To explore the anatomical feasibility of portacaval shunt using a magnetic compression technique(MCT) in cadavers.METHODS: Computed tomography(CT) images of 30 portal hypertensive patients were obtained.The diameters of the portal vein(PV),the inferior vena cava(IVC),and distance between the two structures were measured.Similar measurements were performed on 20 adult corpses.The feasibility of portacaval shunt based on those measurements was analyzed.First stage of the extrahepatic portacaval shunt using MCT was performed on five cadavers.Specifically,the PV and IVC were exposed through an abdominal incision of the cadavers.The parent magnet was introduced from the femoral vein and was delivered into the IVC by an anchor wire and a 5F Cook catheter.The daughter magnet was introduced into the PV through the splenic vein using aninterventional guide wire.When the daughter magnet met the parent magnet,they automatically clipped together and the first stage of the portacaval shunt was set up.RESULTS: The average diameters of the PV and the IVC measured from the 30 CT image were 14.39 ± 2.36 mm and 18.59 ± 4.97 mm,respectively,and the maximum and minimum distances between the PV and the IVC were 9.79 ± 4.56 mm and 9.50 ± 4.79 mm,respectively.From 20 cadavers,the average diameters of the PV and the IVC were 14.48 ± 1.47 mm and 24.71 ± 2.64 mm,and the maximum and minimum distances between the PV and the IVC were 10.14 ± 1.70 mm and 8.93 ± 1.17 mm,respectively.The distances between the PV and the IVC from both the CT images and the cadavers were within the effective length of portacaval anastomosis using MCT(30.30 ± 4.19 mm).The PV and IVC are in close proximity to each other with no intervening tissues or structures in between.Simulated surgeries of the first stage using MCT on five cadavers was successfully performed.CONCLUSION: Anatomically,extrahepatic portacaval shunt employing MCT is highly feasible in humans.展开更多
BACKGROUND: Hepatic resection is the main treatment modality for hepatic tumors. Advances in diagnostic technique, preoperative preparation, surgical technique, and postoperative management increased the success rate....BACKGROUND: Hepatic resection is the main treatment modality for hepatic tumors. Advances in diagnostic technique, preoperative preparation, surgical technique, and postoperative management increased the success rate. The present study aimed to evaluate hepatectomy and resection of inferior vena cava tumor thrombus (IVCTT) in patients with hepatocellular carcinoma, and the relationship between IVCTT classification and selection of surgical technique. METHODS: We retrospectively reviewed 13 patients with hepatocellular carcinoma who had undergone hepatectomy with IVCTT resection between May 1997 and August 2009. Age, gender, diagnosis, findings of physical examination, results of preoperative laboratory investigations, radiological examination, criteria for resection, postoperative pathological results, incisions, operative technique, intraoperative transfusion, drains, and intraoperative and postoperative complications were evaluated for all patients. RESULTS: Type Ⅰ IVCTT (10 patients) was posterior to the liver and below the diaphragm; type Ⅱ IVCTT (2 patients) was above the diaphragm but still outside the atrium; and type Ⅲ IVCTT (1 patient) was above the diaphragm and in the right atrium. Type Ⅰ was treated by radical hepatectomy and removal of IVCTT with total hepatic vascular exclusion. Type Ⅱ was treated by radical hepatectomy and removal of IVCTT by incision of the diaphragm. Type Ⅲ was treated by hepatectomy and resection of the thrombus from the right atrium under cardiopulmonary bypass. There were no surgical complications and one patient has been survived for 4 years with cancer-free status. The median survival time was 18.2 months, and the 1-and 2-year survival rates were 53.8% and 15.4%, respectively. CONCLUSION: Surgical treatment is safe and feasible for treatment of IVCTT in patients with hepatocellular carcinoma, and surgical resectability can be judged according to the classification of tumor thrombus.展开更多
文摘Background: Vein graft failure after bypass surgery is greatly increase in patients with diabetes mellitus. The cellular mechanisms underlying the cause of this failure are largely unexplored. Protein kinase B/AKT is a mechanically sensitive regulator of cellular growth and apoptosis. Herein we examine whether diabetes affects the regulation of AKT in response to increased venous loading. Methods: Inferior venae cavae (IVC) from the non-diabetic lean (LNZ) and the diabetic obese?syndrome X Zucker(OSXZ) rats were isolated and incubated ex vivo under basal or pressurized conditions (120 mmHg). Protein expression, basal activation and the ability of increased pressure to activate AKT3 and apoptosis-related signaling were evaluated by immunoblot analysis. Results: Compared to that seen in the non-diabetic lean animals, increased venous pressure in the OSXZ rats was not characterized by increases in APAF-1 concentration, XIAP proteolysis, AIF cleavage, or Bad phosphorylation. This evidence of decreased apoptotic signaling was associated with increased basal p-AKT3 levels (+136% ± 13% P < 0.05 higher in the OSXZ vs. LNZ IVC). Conclusion: These data suggest that diabetes-associated increases in p-AKT3 may alter the ability of the IVC to undergo pressure induced apoptosis-related signaling. Further investigation is required to determine whether these changes are associated with the increased vein graft attrition seen in the diabetic population.
基金Research Project of Hunan Health Commission in 2023(D202304058618)Innovation Project of Hunan Science and Technology Department(2018SK504)National Nature Science Foundation of China(No.82203414).
文摘Background:Clear cell sarcoma of the kidney(CCSK)is a rare and highly aggressive pediatric renal malignancy with a marked propensity for metastatic spread.Cases of CCSK associated with inferior vena cava(IVC)tumor thrombus(IVCTT)are exceptionally uncommon in the literature.We report a case of CCSK with IVCTT in a 15-month-old male infant.Case Description:We reported a case admitted in May 2020 for a 3-day history of fever and hematuria.Abdominal CT revealed an unevenly enhanced mass and low-density shadows within the IVC.The diagnosis of CCSK was confirmed via needle biopsy.The patient received 4 cycles of adjuvant chemotherapy.The initial surgery lasted 10 h with 600 mL blood loss,and primary closure was achieved.Postoperative management included 6 cycles of radiotherapy and 5 cycles of chemotherapy.In March 2022,CT detected IVCTT recurrence,requiring surgical intervention involving thrombus removal and partial IVC resection.This procedure lasted 8 h with 300 mL blood loss,followed by 5 additional chemotherapy cycles.The patient showed no sign of IVC obstruction,including varicose veins or lower limb edema,and maintained renal function throughout follow-up.However,Intracranial metastases were detected 15 months postoperatively.After the family opted against additional treatment,the patient succumbed to the disease.Conclusions:The management of CCSK associated with IVCTT should include consideration of IVC thrombectomy.In case of recurrent IVCTT with preserved collateral circulation,combined thrombus excision and partial IVC resection may be warranted.
基金Supported by the General Project of the Natural Science Foundation of Chongqing,No.cstc2021jcyj-msxmX0604.
文摘BACKGROUND Laparoscopic liver resection(LLR)can be challenging due to the difficulty of establishing a retrohepatic tunnel under laparoscopy.Dissecting the third hepatic hilum before parenchymal transection often leads to significant liver mobilization,tumor compression,and bleeding from the short hepatic veins(SHVs).This study introduces a novel technique utilizing the ventral avascular area of the inferior vena cava(IVC),allowing SHVs to be addressed after parenchymal transection,thereby reducing surgical complexity and improving outcomes in in situ LLR.AIM To introduce and evaluate a novel LLR technique using the ventral avascular area of the IVC and compare its short-term outcomes with conventional methods.METHODS The clinical cohort data of patients with pathologically confirmed hepatocellular carcinoma or intrahepatic cholangiocarcinoma who underwent conventional LLR and novel LLR between July 2021 and July 2023 at the First Affiliated Hospital of Chongqing Medical University were retrospectively analyzed.In novel LLR,we initially separated the caudate lobe from the IVC using dissecting forceps along the ventral avascular area of the IVC.Then,we transected the parenchyma of the left and right caudate lobes from the caudal side to the cephalic side using the avascular area as a marker.Subsequently,we addressed the SHVs and finally dissected the root of the right hepatic vein or left hepatic vein.The short-term postoperative outcomes and oncological results of the two approaches were evaluated and compared.RESULTS A total of 256 patients were included,with 150(58.59%)undergoing conventional LLR and 106(41.41%)undergoing novel LLR.The novel technique resulted in significantly larger tumor resections(6.47±2.96 cm vs 4.01±2.33 cm,P<0.001),shorter operative times(199.57±60.37 minutes vs 262.33±83.90 minutes,P<0.001),less intraoperative blood loss(206.92±37.09 mL vs 363.34±131.27 mL,P<0.001),and greater resection volume(345.11±31.40 mL vs 264.38±31.98 mL,P<0.001)compared to conventional LLR.CONCLUSION This novel technique enhances liver resection outcomes by reducing intraoperative complications such as bleeding and tumor compression.It facilitates a safer,in situ removal of complex liver tumors,even in challenging anatomical locations.Compared to conventional methods,this technique offers significant advantages,including reduced operative time,blood loss,and improved overall surgical efficiency.
文摘Persistent left superior vena cava(PLSVC)is a congenital anomaly where the left-sided vena cava,which usually regresses during fetal development,persists.Double superior vena cava resulting from a PLSVC is indeed a rare phenomenon.In the general population,the incidence of this condition is reported to be between 0.3%and 2.1%.[1]While this anatomical variation is often asymptomatic and discovered incidentally,it becomes relevant in certain clinical scenarios.Indeed,the presence of a PLSVC and double superior vena cava can pose challenges as incorrect positioning and result in failure.
文摘BACKGROUND Inferior vena cava(IVC)leiomyosarcomas are rare and aggressive tumors.Complete cure depends on achieving R0 resection,which often requires circumferential resection and reconstruction.Synthetic grafts have traditionally been used when venous continuity must be restored.However,the use of cadaveric IVC grafts for reconstruction has not been widely reported.CASE SUMMARY Herein,we present the case of a 64-year-old woman diagnosed with an intrahepatic IVC leiomyosarcoma with local invasion.The patient responded favorably to chemotherapy and subsequently underwent an en bloc right hepatectomy,retrohepatic IVC resection,and reconstruction with an interpositional cadaveric IVC graft.Serial imaging follow-ups until 2 years after the operation showed persistent patency of the graft and no graft-related complications.CONCLUSION Cadaveric IVC grafts are an alternative to synthetic grafts for reconstruction,with acceptable outcomes.Larger,long-term studies are necessary to validate these findings.
文摘Various approaches to laparoscopic anatomic liver resection have been described.In this paper,the authors present a technique that utilizes the ventral avascular areas above the inferior vena cava.While many liver surgeons partially adopt this elements of this method,few employ it to the full extent outlined here.Main-taining low central venous pressure during anesthesia is critical to this approach,as demonstrated by the operative images showing collapsed hepatic veins.This technique is particularly advantageous when the patient’s body mass index is low,the tumor is small(or large but deeply embedded within the liver parenchy-ma),and the overlying liver tissue is not excessively bulky or heavy.Nonetheless,following the conventional course along the Glissonean pedicle can be beneficial.The authors demonstrate notable skill in completing these procedures laparosco-pically.However,concerns over margin positivity and tumor recurrence remain,and follow up studies are needed to further validate the approach.
文摘Objective:To explore the evidence-based nursing optimization strategy for catheter tip positioning during peripherally inserted central catheter(PICC)insertion in patients with persistent left superior vena cava(PLSVC).Methods:For one ovarian cancer patient with PICC malposition in the coronary sinus(CS)due to PLSVC,multimodal imaging techniques were integrated to accurately locate the catheter tip.The catheter position was adjusted based on evidence(withdrawing 5 cm),and a standardized nursing process was established,including personalized health education,catheter fixation and displacement monitoring,complication monitoring,establishment of a specialized disease information archive system,and formulation of a follow-up plan.Results:The catheter tip was successfully withdrawn from the coronary sinus(at the T8 level)to the middle and lower part of the PLSVC(at the T6 vertebral level),and the catheter functioned normally after adjustment.No complications such as arrhythmia or thrombosis occurred during the 332-day chemotherapy period.Conclusion:The PICC tip in PLSVC patients should be positioned in the middle and lower part of the PLSVC(at the T5–T7 vertebral level).This new standard can effectively avoid CS-related complications.The integration of multi-modal imaging techniques and evidence-based nursing management are key to ensuring safe infusion.
文摘Case Letter Severe trauma has high morbidity and mortality rates,being the leading cause of death in young adults.Among all traumas,tra ffi c injuries are particularly lethal.^([1-2]) The injury severity score(ISS) can be used to assess trauma severity,with ISS of<9,9–15,16–24,and≥25 indicating minor,moderate,severe,and critical trauma,respectively.The ISS is correlated with mortality,morbidity,and hospitalization duration after injury.^([3-4]) Here,we report one patient who was admitted to our emergency intensive care unit(EICU) due to traumatic liver rupture and traumatic myocardial infarction complicated with inferior vena cava(IVC) thrombosis.
文摘Persistent left superior vena cava(PLSVC)is a rare congenital anomaly that may complicate cardiac procedures when associated with a dilated coronary sinus(CS)and conduction disturbances.We report the case of a 27-year-old male with Wilson’s disease who presented with complete heart block.Echocardiography showed biatrial enlargement and severe CS dilation,while contrast-enhanced computed tomography(CT)confirmed PLSVC draining into the CS without a bridging vein.Anatomical constraints prevented cardiac resynchronization therapy,and dual-chamber pacemaker implantation proved technically challenging due to lead placement difficulties.This case highlights the importance of thorough preoperative assessment and individualized pacing strategies in patients with PLSVC,in order to anticipate anatomical challenges and optimize outcomes.
文摘BACKGROUND Acute pulmonary thromboembolism is a complication of venous thrombosis.Extracorporeal membrane oxygenation(ECMO),an effective rescue measure for rapid hemodynamic recovery,can be used in patients for whom thrombolysis therapy has failed.CASE SUMMARY This case report describes an extreme rescue process for a patient with a preset inferior vena cava(IVC)filter in a relatively economically underdeveloped area with an insufficient supply of consumables.In an emergency,veno-arterial ECMO was successfully initiated by intubation through the IVC filter to the right atrial opening without displacement of the filter during the entire process.CONCLUSION This study demonstrates that in resource-limited settings,femoral vein cannulation for veno-arterial ECMO is a feasible and safe option for patients with preimplanted IVC filters.
基金supported by the Capital Medical University Undergraduate Innovation Project 2025(XSKY20-25251).
文摘Intravenous leiomyomatosis(IVL)is a rare,histologically benign uterine smooth muscle tumor with malignant biological behavior due to its propensity for intravascular extension.[1]While gynecological in origin,its most severe manifestations are cardiovascular,arising from tumor propagation through the venous system into the inferior vena cava(IVC),right heart,and pulmonary arteries,mimicking thromboembolic disease.[2,3]This can lead to pulmonary embolism(PE),right heart obstruction,and even sudden cardiac death.[4]Diagnosis is challenging,often delayed by misdiagnosis as conventional PE.We present two cases of IVL initially presenting with PE,highlighting the critical cardiovascular implications and diagnostic pitfalls.
文摘The development of innovative surgical techniques has been a constant and fundamental aspect in liver transplantation(LT)to address chronic organ shortage.Domino liver transplantation(DLT),initially performed by Furtado et al.in Lisbon in 1995,is an innovative technique in which a liver from a patient with a metabolic disorder is transplanted into a recipient with end-stage liver disease[1].
文摘Objective To study the techniques and clinical applications of intra-vascular stenting in the treatment of superior vana cava obliteration syndrome (SVS). Methods In 9 cases of SVS, primary lesions were all confirmed as malignancy (primary pulmonary carcinoma of right upper lobe) histolo-pathologically. By route of right femoral vein, SVS catheterization and DSA was made. The length of the strictures and the diameters of normal superior vana cavae (SVC) were measured for the choice of appropriate stents. The option of stemt diameter is 10% larger than that of normal SVCs. The upper and lower ends of the stent should be 1–2 cm protruding from the ends of the stricture. The stent was dilated with a balloon after its successful placement. Therapy of original lesions was continued together with anticoagulant. Stents were observed about their positions by fluoroscopy or chest films, and about patency of SVC by Doppler. Results After the placement of a stent, DSA revealed the contrast media in the SVCs passed along smoothly, diameters of SVCs almost normal, collateral branches diminished remarkably. Average SVC pressure was decreased from 26.4 cmH2O before the placement down to 15.7 cmH2O, with an obvious difference (P<0.01= by statistics. Related clinical symptoms and signs disappeared or relieved. Subsidised were swelling of head and neck, upper extremities and chest. Excretion of urine increased. Gorgeous superficial veins in the chest could not be detected any more. Conclusion The therapy of intra-vascular stenting to treat SVS is microinvasive, simple and effective. Key words superior vana cava syndrome - tumor - stent - image diagnosis - interventional therapy
文摘We report the case of three female patients who were scheduled for surgical correction of residual left-to-right shunt after initial repair of sinus venosus atrial septal defect(SV-ASD)during childhood.After excluding the possibility of an hemodynamic intervention,all three patients underwent a successful surgical closure through a right mini sub-axillary approach by using total peripheral cannulation for cardiopulmonary bypass and leaving the inferior vena cava completely un-snared allowing for an optimal visualization of the residual atrial septal communication and avoiding extensive dissection of mediastinal structures.
基金Supported by Key Project of Clinical Discipline of Ministry of Health Subordinates of China,No.2010105
文摘AIM: To explore the anatomical feasibility of portacaval shunt using a magnetic compression technique(MCT) in cadavers.METHODS: Computed tomography(CT) images of 30 portal hypertensive patients were obtained.The diameters of the portal vein(PV),the inferior vena cava(IVC),and distance between the two structures were measured.Similar measurements were performed on 20 adult corpses.The feasibility of portacaval shunt based on those measurements was analyzed.First stage of the extrahepatic portacaval shunt using MCT was performed on five cadavers.Specifically,the PV and IVC were exposed through an abdominal incision of the cadavers.The parent magnet was introduced from the femoral vein and was delivered into the IVC by an anchor wire and a 5F Cook catheter.The daughter magnet was introduced into the PV through the splenic vein using aninterventional guide wire.When the daughter magnet met the parent magnet,they automatically clipped together and the first stage of the portacaval shunt was set up.RESULTS: The average diameters of the PV and the IVC measured from the 30 CT image were 14.39 ± 2.36 mm and 18.59 ± 4.97 mm,respectively,and the maximum and minimum distances between the PV and the IVC were 9.79 ± 4.56 mm and 9.50 ± 4.79 mm,respectively.From 20 cadavers,the average diameters of the PV and the IVC were 14.48 ± 1.47 mm and 24.71 ± 2.64 mm,and the maximum and minimum distances between the PV and the IVC were 10.14 ± 1.70 mm and 8.93 ± 1.17 mm,respectively.The distances between the PV and the IVC from both the CT images and the cadavers were within the effective length of portacaval anastomosis using MCT(30.30 ± 4.19 mm).The PV and IVC are in close proximity to each other with no intervening tissues or structures in between.Simulated surgeries of the first stage using MCT on five cadavers was successfully performed.CONCLUSION: Anatomically,extrahepatic portacaval shunt employing MCT is highly feasible in humans.
基金supported by a grant from the Chinese Key Project for Infectious Diseases (2008ZX10002-025)
文摘BACKGROUND: Hepatic resection is the main treatment modality for hepatic tumors. Advances in diagnostic technique, preoperative preparation, surgical technique, and postoperative management increased the success rate. The present study aimed to evaluate hepatectomy and resection of inferior vena cava tumor thrombus (IVCTT) in patients with hepatocellular carcinoma, and the relationship between IVCTT classification and selection of surgical technique. METHODS: We retrospectively reviewed 13 patients with hepatocellular carcinoma who had undergone hepatectomy with IVCTT resection between May 1997 and August 2009. Age, gender, diagnosis, findings of physical examination, results of preoperative laboratory investigations, radiological examination, criteria for resection, postoperative pathological results, incisions, operative technique, intraoperative transfusion, drains, and intraoperative and postoperative complications were evaluated for all patients. RESULTS: Type Ⅰ IVCTT (10 patients) was posterior to the liver and below the diaphragm; type Ⅱ IVCTT (2 patients) was above the diaphragm but still outside the atrium; and type Ⅲ IVCTT (1 patient) was above the diaphragm and in the right atrium. Type Ⅰ was treated by radical hepatectomy and removal of IVCTT with total hepatic vascular exclusion. Type Ⅱ was treated by radical hepatectomy and removal of IVCTT by incision of the diaphragm. Type Ⅲ was treated by hepatectomy and resection of the thrombus from the right atrium under cardiopulmonary bypass. There were no surgical complications and one patient has been survived for 4 years with cancer-free status. The median survival time was 18.2 months, and the 1-and 2-year survival rates were 53.8% and 15.4%, respectively. CONCLUSION: Surgical treatment is safe and feasible for treatment of IVCTT in patients with hepatocellular carcinoma, and surgical resectability can be judged according to the classification of tumor thrombus.
