title: Resection and reconstruction of the inferior vena cava for neoplasms.
abstract: OBJECTIVE
  To evaluate the results of an aggressive surgical approach of resection and reconstruction of the inferior vena cava (IVC).
  
  
  METHODS
  The approach to caval resection depends on the extent and location of tumor involvement. The supra- and infra-hepatic portion of the IVC was dissected and taped. Left and right renal veins were also taped to control the bleeding. In 12 of the cases with partial tangential resection of the IVC, the flow was reduced to less than 40% so that the vein was primarily closed with a running suture. In 3 of the cases, the lumen of the vein was significantly reduced, requiring the use of a polytetrafluoroethylene (PTFE) patch. In 2 of the cases with segmental resection of the IVC, a PTFE prosthesis was used and in 1 case, the IVC was resected without reconstruction due to shunting the blood through the azygos and hemiazygos veins.
  
  
  RESULTS
  The mean operation time was 266 min (230-310 min) with an average intraoperative blood loss of 300 mL (200-2000 mL). The patients stayed in intensive care unit for 1.8 d (1-3 d). Mean hospital stay was 9 d (7-15 d). Twelve patients (66.7%) had no complications and 6 patients (33.3%) had the following complications: acute bleeding in 2 patients; bile leak in 2 patients; intra abdominal abscess in 1 patient; pulmonary embolism in 2 patients; and partial thrombosis of the patch in 1 patient. General complications such as pneumonia, pleural effusion and cardiac arrest were observed in the same group of patients. In all but 1 case, the complications were transient and successfully controlled. The mortality rate was 11.1% (n = 2). One patient died due to cardiac arrest and pulmonary embolism in the operation room and the second one died 2 d after surgery due to coagulopathy. With a median follow-up of 24 mo, 5 (27.8%) patients died of tumor recurrence and 11 (61.1%) are still alive, but three of them have a recurrence on computed tomography.
  
  
  CONCLUSIONS
  There are a variety of options for reconstruction after resection of the IVC that offers a higher resectable rate and better prognosis in selected cases.
authors.affiliation: Nikola Nikolov Vladov, Vassil Ivanov Mihaylov, Nikolai Vassilev Belev, Ventzislav Metodiev Mutafchiiski, Ivelin Rumenov Takorov, Sergei Kirilov Sergeev, Evelina Hristova Odisseeva, Hepato-biliary, Pancreatic and Transplant Surgery, Military Medical Academy, Sofia 1606, Bulgaria.
authors.forename: Nikola Nikolov
authors.initials: NN
authors.lastname: Vladov
authors.forename: Vassil Ivanov
authors.initials: VI
authors.lastname: Mihaylov
authors.forename: Nikolai Vassilev
authors.initials: NV
authors.lastname: Belev
authors.forename: Ventzislav Metodiev
authors.initials: VM
authors.lastname: Mutafchiiski
authors.forename: Ivelin Rumenov
authors.initials: IR
authors.lastname: Takorov
authors.forename: Sergei Kirilov
authors.initials: SK
authors.lastname: Sergeev
authors.forename: Evelina Hristova
authors.initials: EH
authors.lastname: Odisseeva