[THE CONTROL OF BLEEDING FROM THE LUMEN OF THE ISOLATED INFERIOR VENA CAVA SEGMENT WHEN REMOVING THE TUMOR THROMBUS]

The paper analyzes surgical methods of bleeding control from the lumen of the isolated inferior vena cava (IVC) segment during thrombectomy. The study included 13 patients with IVC tumor thrombus. The sources of bleeding were divided into variant lumbar veins and lumbar veins of the infrarenal IVC segment. Variant lumbar veins were classified as vessels entering IVC at its posterior surface at suprarenal level. The volume of blood loss from the lumen of the isolated IVC segment during thrombectomy ranged from 100 to 3500 ml with an average of 507.3 ml. The main sources of bleeding were lumbar veins of the infrarenal IVC segment, located at a distance of less than 10 mm from the mouth of the right renal vein (85.7%). Variant veins were found much rarer--in 35.7% of cases. Their orifice diameter and, consequently, the blood loss volume was significantly smaller than those in the group of bleeding from infrarenal lumbar vessels. In 2 (15.4%) cases, the mouths of the venous tributaries were stitched inside the vena cava. In 6 (46.2%) patients the bleeding was stopped by applying a clamp to lumbar veins following the blood clot removal. This maneuver proved successful in 4 (66.7%) of those cases. In the remaining 5 (38.5%) cases, the bleeding was stopped by compression of probable variant or lumbar vein mouth localization with finger or cotton swab. If unable to stop bleeding in the described way, the blood from IVC lumen was evacuated by suction, and cavatomy was closed as quickly as possible. Given the low effectiveness, high complexity and risk of the available methods of IVC lumen bleeding control, visual information about the location and the number of possible sources of bleeding should be obtained preoperatively.