title: Clinical outcomes related to the level of clamping in inferior vena cava surgery.
abstract: OBJECTIVE
  In most cases of inferior vena cava (IVC) surgery, IVC clamping is required owing to several factors, including renal cell carcinoma with IVC thrombus extension and IVC leiomyosarcoma. Various clinical results were compared following IVC clamping by classifying clamping levels into juxtarenal, infrahepatic, and suprahepatic. In particular, the risk factors of postoperative thrombosis after IVC clamping were assessed comparatively.
  
  
  METHODS
  Eighty-four patients who underwent IVC clamping owing to IVC pathology between 2002 and 2012 were retrospectively reviewed with regard to RBC transfusion, operation time, clamping time, liver and kidney functions, duration of hypotension, blood pressure (BP) drops, pulmonary thromboembolism (PTE), venous thrombosis, ICU stay duration, hospital stay duration, 30-day morbidity, and 30-day mortality. In addition, various clinical results were compared when postoperative thrombosis occurred after IVC clamping.
  
  
  RESULTS
  Values for operation time, clamping time, units of RBC transfused, duration of hypotension, severity of BP drops, use of cardiopulmonary bypass (CPB), aspartate aminotransferase, the use of inotropes, IVC patency, ICU stay, and hospital stay duration were significantly higher in the suprahepatic clamping group than in the other clamping groups. In addition, CPB use and IVC clamping level were significant risk factors for postoperative thrombosis after IVC clamping.
  
  
  CONCLUSIONS
  Although IVC clamping is a prerequisite for IVC surgery, operative durations, units of RBC transfused, and length of hospital stays increase with higher clamping levels. In addition, CPB use and IVC clamping level are significant risk factors for postoperative thrombosis. In IVC surgery with higher clamping levels, prompt hemodynamic support and proper anticoagulation therapy are important.
authors: Division of Transplantation and Vascular Surgery, Department of Surgery, Korea University Anam Hospital, Seoul, Korea.
authors: Heungman
authors: H
authors: Jun
authors: Youngjin
authors: Y
authors: Han
authors: Hojong
authors: H
authors: Park
authors: Sung
authors: S
authors: Shin
authors: Yong-Pil
authors: YP
authors: Cho
authors: Tae-Won
authors: TW
authors: Kwon
mesh_terms: D000328:Adult; D000368:Aged; D001219:Aspartate Aminotransferases / Q000097:blood; D001794:Blood Pressure; D002292:Carcinoma, Renal Cell / Q000473:pathology / Q000601:surgery*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects; D002316:Cardiotonic Agents / Q000627:therapeutic use; D003250:Constriction; D003422:Critical Care; D017707:Erythrocyte Transfusion / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007022:Hypotension / Q000209:etiology; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D012189:Retrospective Studies; D012307:Risk Factors; D017131:Thrombectomy / Q000009:adverse effects / Q000379:methods*; D013997:Time Factors; D014682:Vena Cava, Inferior / Q000601:surgery*; D020246:Venous Thrombosis / Q000209:etiology* / Q000601:surgery
chemical_list: D002316:Cardiotonic Agents; D001219:Aspartate Aminotransferases
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