Reuters Health Information (2011-04-12): Vena cava clamping reduces hepatic resection blood loss
Drug & Device Development
Vena cava clamping reduces hepatic resection blood loss
Last Updated: 2011-04-12 12:19:05 -0400 (Reuters Health)
NEW YORK (Reuters Health) - Infrahepatic inferior vena cava clamping reduces blood loss during hepatic resection. However, it may also increase the risk of postoperative pulmonary embolism, German researchers report in a March 15th online paper in the Annals of Surgery.
Dr. Jurgen Weitz of the University of Heidelberg and colleagues note that central venous pressure (CVP) reduction, primarily by fluid restriction and diuretics, effectively reduces intraoperative blood loss. Clamping may offer an alternative approach without the potential risk of hemodynamic instability associated with fluid restriction.
Nevertheless, vascular occlusion techniques remain controversial, and to investigate further, the team studied 152 patients scheduled for elective hepatic resection. They were randomized to clamping or to anesthesiological interventions.
Despite higher CVP values during resection, clamping significantly reduced total intraoperative blood loss (550 mL versus 900 mL). This was also true of blood loss during parenchymal transection (150 mL versus 400 mL).
Postoperative mortality was higher in the clamping group (6.1% versus 3.2%). Total morbidity rates were almost identical at just over 58%.
Although none of the clamping patients showed intraoperative hemodynamic instability, this was true of four controls (6.3%).
However, four clamping patients had pulmonary embolism compared to none of the controls. Two of these patients died, but, say the investigators, both "had severe posthepatectomy liver failure and their death could not be linked directly to pulmonary embolism."
Nevertheless, the team adds that the "significantly higher incidence of pulmonary embolism... requires critical evaluation within further prospective and adequately powered studies."
Infrahepatic inferior vena cava clamping may "prevent intraoperative episodes of hemodynamic instability and based on the available data may be recommended for patients without severe comorbidities," the authors conclude.
Ann Surg 2011.