title: Bleeding during hepatectomy can be reduced by clamping the inferior vena cava below the liver.
abstract: BACKGROUND
  Control of blood loss is a crucial problem during hepatectomy. Bleeding from the inflow system can be controlled by the Pringle maneuver or selective vascular occlusion. Bleeding from the outflow system is closely related to central venous pressure (CVP). Therefore, in this study, we evaluated whether vascular outflow control by clamping the inferior vena cava (IVC) below the liver (IVC clamping) during hepatectomy is a safe and effective method to reduce blood loss and CVP.
  
  
  METHODS
  We reviewed the outcomes of 103 consecutive patients whose CVP values were >5 cm H(2)O and who had undergone right or left hemihepatectomy between 1995 and 2000. Forty-seven patients who underwent hepatectomy with IVC clamping (Group A) between 1998 and 2000 were compared with the previous 56 patients who underwent hepatectomy without IVC clamping between 1995 and 1997 (Group B).
  
  
  RESULTS
  The CVP decreased by 3.7 cm H(2)0 after IVC clamping. Estimated blood loss was 910 mL in Group A and 1177 mL in Group B. (P=.008) No severe renal or cardiovascular damage occurred after IVC clamping.
  
  
  CONCLUSIONS
  IVC clamping is very effective in reducing blood loss during hepatectomy when the CVP is elevated and cannot be reduced pharmacologically or by fluid restriction.
authors.affiliation: Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Takehito
authors.initials: T
authors.lastname: Otsubo
authors.forename: Ken
authors.initials: K
authors.lastname: Takasaki
authors.forename: Masakazu
authors.initials: M
authors.lastname: Yamamoto
authors.forename: Hideo
authors.initials: H
authors.lastname: Katsuragawa
authors.forename: Satoshi
authors.initials: S
authors.lastname: Katagiri
authors.forename: Kenji
authors.initials: K
authors.lastname: Yoshitoshi
authors.forename: Mie
authors.initials: M
authors.lastname: Hamano
authors.forename: Shun-Ichi
authors.initials: S
authors.lastname: Ariizumi
authors.forename: Yoshihito
authors.initials: Y
authors.lastname: Kotera
mesh_terms: D000368:Aged; D016063:Blood Loss, Surgical; D001803:Blood Transfusion; D002496:Central Venous Pressure; D003250:Constriction; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects*; D006801:Humans; D007668:Kidney / Q000503:physiopathology; D008107:Liver Diseases / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D014682:Vena Cava, Inferior