[An experimental study on bloodless hepatic resection under vascular exclusion with atrioportacaval shunt (HVE-APCS)]

We developed a new technique--atrioportacaval shunt (APCS) both to increase the blood-return volume and to decompress the portal system and the inferior vena cava below the occlusion during hepatic vascular exclusion (HVE) in canine. A balloon catheter with a hole on its side was inserted up into inferior vena cava (IVC) through a venotomy just above the confluence of the bilateral renal veins, until the tip with the balloon was at the level of diaphragm. The caudal outside IVC was passed into portal vein. HVE-APCS was performed with clamping hepatic pedicle, tightening an umbilical tape around IVC immediately above the confluence of bilateral suprarenal veins, and finally inflating the balloon. Blood of the portal system and IVC below the occlusion was allowed to return to the right atrium through the catheter. The experimental results showed that HVE-APCS is characteristic of simplicity and safety, and of less harmful effect on the systemic hemodynamics. Because of the portal decompression, the recirculation injury to the ischemic liver was mild. It is concluded that HVE-APCS is an ideal method to control the bleeding from the major hepatic veins and retrohepatic vena cava.