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J Thorac Cardiovasc Surg 2001;121:0187-0188
© 2001 The American Association for Thoracic Surgery

Brief Communications

Repair of lacerated inferior vena cava with the intravascular tube graft in redo cardiac surgery

Mehmet Rait Güney, MD, Nazan Aksoy, MD, Özge Sezerman, MD, stanbul, Turkey

From the Siyami Ersek Thoracic and Cardiovascular Surgery Center, stanbul, Turkey.

Received for publication May 16, 2000. Accepted for publication June 19, 2000. Address for reprints: Mehmet Rait Güney, MD, Tütüncü Mehmet Efendi Cad. Dr Rifatpaa Sok. Sema Apt No 21/37 Göztepe stanbul 81060 Turkey (E-mail: Dr.guney@superonline.com).

Laceration of the proximal inferior vena cava (IVC) is a rare but fatal complication of redo cardiac surgery if it is situated at the posterior supradiaphragmatic, juxtadiaphragmatic, or retrohepatic region of the IVC. Redo valve and congenital cardiac operations, which are performed by the transatrial approach, may carry the risk of IVC laceration. Laceration of the IVC, mostly at its posterior wall, may occur during application of a snare or Cooley clamp or from stretching of the incompletely liberated adherent IVC during traction on the atrium for valve exposure. The laceration may extend for a variable distance down the IVC. Not infrequently, this complication may also be encountered in other cardiovascular interventions (ie, IVC filter implantation, thrombectomy), some upper abdominal operations (ie, IVC fistula repair, thoracoabdominal aneurysm surgery, hepatic surgery), and in blunt or penetrating chest traumas. Different methods have been proposed to repair this complication, such as atriocaval shunt, lateral phleborrhaphy, patch plasty, total vascular occlusion, tube graft or duplicated saphenous interposition, and diaphragmatic or pericardial flap repair. However, the inaccessible location of some lacerations . . . [Full Text of this Article]