Esophageal cancer complicated with azygos continuation of the inferior vena cava

Neoadjuvant (preoperative) therapy and combined modality therapy have become focuses of interest in the effort to prolong survival and to reduce recurrence rates in patients with esophageal cancer. Staging of the tumor is a critical step in establishing which therapeutic option is appropriate. Once surgical management is advocated, adequate medical imaging is crucial in determining individual anatomical variations. In this communication we report a case of a patient with azygos continuation who underwent chemoradiotherapy with successful downstaging of tumor status from T3-4 to T0 and a nodal status from N1 to N0 as evaluated by medical imaging and who then proceeded to curative surgical resection. This case highlights the potential ability of radiological techniques to confirm both anatomical variations and responses to neoadjuvant therapy.     

Absence of the retrohepatic inferior vena cava: what the surgeon should know

Anomalies of the inferior vena cava are rare and can easily be misdiagnosed if one is not aware of such variants. We report a case of a 57-year-old patient that had a percutaneous CT-guided biopsy of what was considered to be enlarged pericaval lymph nodes. This occurred because of the poor technique of the CT scan and the unawareness of such a condition. These changes were related to a proximal varicele of an absent, retrohepatic inferior vena cava. There was an extensive collateral network with filling of large azygos and hemiazygos veins draining through the posterior mediastinum into the superior vena cava. This case emphasizes the importance of correctly identifying vascular anomalies before the initiation of biopsy attempts in order to prevent the risk of major complications that could arise during such biopsy.     

A novel Fontan Y-graft for interrupted inferior vena cava and azygos continuation

Open in a separate window OBJECTIVESTo evaluate the hemodynamicdynamic advantage of a new Fontan surgical template that is intended for complex single-ventricle patients with interrupted inferior vena cava-azygos and hemi-azygos continuation. The new technique has emerged from a comprehensive pre-surgical simulation campaign conducted to facilitate a balanced hepatic flow and somatic Fontan pathway growth after Kawashima procedure.METHODSFor 9 patients, aged 2 to18 years, majority having poor preoperative oxygen saturation, a pre-surgical computational fluid dynamics customization is conducted. Both the traditional Fontan pathways and the proposed novel Y-graft templates are considered. Numerical model was validated against in vivo phase-contrast magnetic resonance imaging data and in vitro experiments.RESULTSThe proposed template is selected and executed for 6 out of the 9 patients based on its predicted superior hemodynamic performance. Pre-surgical simulations performed for this cohort indicated that flow from the hepatic veins (HEP) do not reach to the desired lung. The novel Y-graft template, customized via a right- or left-sided displacement of the total cavopulmonary connection anastomosis location resulted a drastic increase in HEP flow to the desired lung. Orientation of HEP to azygos direct shunt is found to be important as it can alter the flow pattern from 38% in the caudally located direct shunt to 3% in the cranial configuration with significantly reversed flow. The postoperative measurements prove that oxygen saturation increased significantly (P-value = 0.00009) to normal levels in 1 year follow-up.CONCLUSIONSThe new Y-graft template, if customized for the individual patient, is a viable alternative to the traditional surgical pathways. This template addresses the competing hemodynamic design factors of low physiological venous pressure, high postoperative oxygen saturation, low energy loss and balanced hepatic growth factor distribution possibly assuring adequate lung development.Date and number of IRB approval25 October 2019, 280011928-604.01.01.     

Repair of retrohepatic inferior vena cava injury

A 10 years old child was brought to the Emergency Department of Combined Military Hospital (CMH), Lahore with a history of trivial injury due to fall from a bicycle. He was found to be having severe intraperitoneal hemorrhage. Immediate resuscitation in the emergency department could not revive his vital parameters. He was operated upon in emergency and found to be having grade V hepatic injury extending into retrohepatic inferior vena cava. Child was operated under general anesthesia and recovered well postoperatively without any residual complication.     

Duplication of the vena cava inferior with a continuation into the vena azygos. A report of a rare case]

The embryogenesis of the inferior vena cava is a complicated process involving development, regression, anastomosis and replacement of three pairs of venous channels (posterior cardinal, subcardinal and supracardinal). A rare case of concurrent duplication and azygos continuation of the inferior vena cava is presented; it is caused by an altered development of subcardinal and supracardinal venous channels. This anomaly, without other congenital malformations (splenic or cardiac), has been previously described only in six cases in the literature. In this case contrast-enhanced CT enabled the correct diagnosis to be made. The subsequent cavography confirmed the CT report.     

肝后下腔静脉非医源性损伤修复方法探讨

目的　探讨伴发于肝外伤的肝后下腔静脉损伤的修复方法。　方法　对 6例肝后下腔静脉损伤患者采用压迫阻断受损肝后下腔静脉本身并阻断第一肝门 ,在无血状态下缝合下腔静脉裂口。　结果　修复 6例肝后下腔静脉损伤 ,下腔静脉裂口长度平均为 2 9cm(1 5～ 4cm) ,下腔静脉阻断时间平均为 9 2min(6～ 15min) ,第一肝门阻断时间平均为 2 0 5min(15～ 2 9min) ,全组患者均顺利恢复 ,B超、CT检查证实肝后下腔静脉通畅 ,无狭窄。　结论　肝外伤伴发的肝后下腔静脉撕裂伤可通过直接压迫阻断受损下腔静脉进行修复。     

肝脏肿瘤切除术中肝后下腔静脉损伤的处理

目的 探讨肝脏肿瘤切除术中肝后下腔静脉损伤的处理方法及适应证。方法 采用了分步全肝血流阻断、指压、指捏及肝创面对拢缝合４种方法,处理１６例下腔静脉损伤者。结果 全部患者即刻止血,无再出血,无手术死亡,随访６￣１８个月,均存活。结论 方法简单、实用、省时、安全,为控制肝切除术中大出血的有效方法。     

肝后下腔静脉前间隙的解剖及临床应用进展

肝后下腔静脉前间隙是指位于肝背侧下腔静脉窝和下腔静脉（inferior vena eava，IVC）之间的一段相对少血管区，为一潜在性间隙。其起点为肝尾状叶背侧IVC的第1支肝短静脉，即右下肝静脉（inferior righth epatic vein，IRHV）的左侧，止点为肝右静脉及肝左静脉和肝中静脉共干间的间隙上缘（肝上静脉窝）。存此间隙内存在有重要解剖学意义的第2肝门（左、中、右肝静脉出肝处）和第3肝门（肝短静脉出肝处）。     

游离肝后下腔静脉行右肝切除77例体会

目的 探讨肝后下腔静脉手术游离方法.方法 解剖暴露77例肝后下腔静脉右侧壁并游离其后壁.结果 77例右肝均部分翻转于切口外,术后顺利恢复.结论 切断右肾上腺是游离肝后下腔静脉的关键;暴露肝后下腔静脉右侧壁是充分游离右肝的技术标准之一.     

Leiomyosarcoma of the inferior vena cava.

The thirty-second case of leiomyosarcoma of the inferior vena cava and the twelfth resectable patient in the series is presented. A review of the literature demonstrates a marked female preponderance (5 to 1). The most common presenting symptom is right abdominal pain and a palpable mass. The different surgical problems generated by the involved segment of the cava are discussed. Noteworthy is the high incidence of Budd-Chiari syndrome owing to hepatic vein obstruction with involvement of the upper third of the cava in the postmortem cases. An argument is developed for debulking the tumor for palliation when it is not completely removable.