A SEARCH OF SOURCES OF BLEEDING FROM IVC LUMEN DURING REMOVAL OF TUMOR THROMBUS. ANATOMICAL STUDY

Introduction. Recently, Abbasi A. et al. found unpaired variant lumbar vein, which opens in the retrohepatic part of IVC in 38.8 % of cases. The authors believe that variant lumbar veins are a major cause of bleeding from an isolated area of the IVC during thrombectomy.

The purpose of this study was to investigate the sources of bleeding from the lumen of the IVC during the remove of tumor thrombus. We have studied the anatomy of the posterior tributaries of IVC, including adrenal, inferior diaphragmal veins, variant lumbar veins and lumbar veins of infrarenal IVC.

Materials and methods. Material of anatomical study included 35 fresh cadavers (no more than 48 hours after the death). For to study the IVC and its tributaries following procedure was used. After removal of complex of organs the sharp and blunt dissection of back surface of the inferior vena cava was performed. Wherein we was estimated topography and size of the right adrenal, inferior right diaphragmatic veins and lumbar veins of cavorenal and infrarenal IVC segments. Special attention is given to the search of a variant lumbar veins in retrohepatic and subhepatic parts of vena cava. Thereafter we opened IVC longitudinally and estimated the mouth of its main tributaries.

Results. Variant lumbar veins were detected in 34,3 % patients. The diameter of these vessels ranged from 1 to 2 mm and averaged 1.5 mm. The distance from the top edge of the mouth of the right renal vein to the mouth of the variant veins varied from 0 to 75 mm and averaged  19.6 mm. In 66,7 % of cases the variant veins go into the subhepatic IVC, in 25.0 % drained near at the top of the mouth of the renal veins (cavorenal segment) and only 8.3 % of cases – in the retrohepatic IVC. Considering the problem of bleeding from the lumbar veins during thrombectomy, we have identified a conditional «risk zone» of the lumbar veins of the infrarenal IVC standing in the area of vascular thrombus isolation. This «risk zone» included a section of 10 mm length below the mouth of the ipsilateral renal vein. Lumbar veins drainage in the «at risk» on the right side recorded in 57.6 % patients, on the left side in 15,2 %. The average distance from the right renal vein to the right upper lumbar vein did not exceed 8.3 mm, for left veins – 7,2 mm. The average diameter for right lumbar veins reached 4.6 mm, for left veins – 4,0 mm

Conclusion. Variant lumbar veins rarely are the main sources of bleeding during thrombectomy. From our point of view, leading role played in this matter superior right lumbar vein of infrarenal segment of the IVC, which drained into the inferior vena cava beside the mouth of the renal veins. These veins have an average diameter greater than 4.0 mm and occur in 57.6 % of cases. Before the operation a surgeon must be carefully planned of all steps of vascular thrombus isolation and evaluate the anatomy of the lumbar veins with data visual diagnostic methods.

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