Anesthetic and Hemodynamic Considerations of Inferior Vena Cava Surgery

  • Daniel EyraudEmail author
  • Victoria Lepere


The hemodynamic changes in response to inferior vena cava clamping have been more studied during hepatic surgery than inferior vena cava (IVC) surgery. Indeed, cross clamping has been used for a long time in vascular surgery [1–3]; the strategy is relatively simple: either the disease is located below the hepatic venous confluence or the hemodynamic consequences are low and either it is located above or needs suprahepatic vena cava cross clamping. Cardiopulmonary bypass is usually indicated, with eventually a hypothermic arrest if a complex reconstruction, long or including the right atrium, is necessary or is indicated if there is a high risk of pulmonary embolism (carcinological or cruoric) [4, 5]. The situation is different in liver surgery. The use of bypass, even veno-venous bypass, is avoided other than in the context of liver transplantation, because the use of anticoagulants may entail the bleeding of the liver slice of hepatectomy or because the venous return by the IVC clamped above and below the hepatic venous confluence (combined with pedicle clamping) is low, apart from the liver transplantation where the end-stage liver cirrhotic patient presents hyperkinetic syndrome. The aim of this chapter is first to expose important anatomic and physiologic points about IVC circulation and second to describe the consequences of the different IVC clamping, according to the clamping site and the eventual association with aortic or liver clamping.


Inferior Vena Cava Venous Return Superior Vena Cava Right Atrial Pressure Hepatic Surgery 
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Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  1. 1.Department of Anesthesiology and Intensive Care Unit, Assistance Publique-Hôpitaux de Paris (AP-HP)Pitié-Salpêtrière University HospitalParisFrance
  2. 2.Department of Digestive, HPB Surgery, and Liver Transplantation, Assistance Publique-Hôpitaux de Paris (AP-HP)Pitié-Salpêtrière University HospitalParisFrance

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