Cardiopulmonary bypass as adjunct for repair of iliac vein confluence injury

This report discusses the management of iatrogenic injuries to the iliac vein confluence that occurred during open aortic reconstruction in two patients. Both patients underwent open aortic reconstruction via a midline transperitoneal approach with suprarenal aortic control during which injuries to the common iliac vein occurred that propagated to the confluence. The injuries were repaired using cardiopulmonary bypass with mild to moderate hypothermia to control blood flow and blood pressure, allowing for optimal exposure and visualization of the injuries for successful repair. The low-flow/low-pressure state, along with drop suction tips in the injured vein segment, facilitated visualization of the injury, enabling patch angioplasty. Additionally, the immediate return of lost blood mitigated the adverse effects of massive blood loss and transfusion requirements. Mild to moderate hypothermia also provided protection against ischemic neurological injury. Cardiopulmonary bypass may serve as a life-saving adjunct in managing this highly lethal complication.