Abstract:

Interrupting the venous return from below the diaphragm is usually associated with sudden hypotension, hypovolemic cardiac failure, and increased bleeding secondary to acute venous hypertension and hepatic congestion. Shaw, Starzl, and Griffith developed a veno-veno bypass technique to shunt the somatic and splanchnic venous return around the retrohepatic vena cava to the superior vena cava. This permitted continuation of venous return and simultaneous blood warming, allowing surgeons to perform complex procedures in a dry operative field. These bypass techniques have evolved since their introduction in the 1980s and are now being applied for the removal of otherwise nonresectable tumors of the liver, adrenal gland, and kidney. Further, traumatic injuries to the hepatic veins and the retrohepatic cava associated with a high mortality rate can be repaired safely using vascular isolation techniques and bypass.

Authors:

Rob Granger, M.D.; Charles H. Scudamore, M.D., F.A.C.S., F.R.C.S. (C, Ed, Eng); Andrzej K. Buczkowski, M.D.; Emma J. Patterson, Bsc (Hon), M.D.; Steven Chung, B.Sc., M.Sc., Ph.D., M.D., F.R.C.S.C. - University of British Columbia, Vancouver, Canada

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