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June 1970

Membranous Obstruction of the Hepatic Portion of the Inferior Vena CavaSurgical Correction and Etiological Study

Author Affiliations

Kyoto, Japan
From the Second Surgical Division, Kyoto University Medical School, Kyoto, Japan.

Arch Surg. 1970;100(6):656-663. doi:10.1001/archsurg.1970.01340240024005

Two cases are reported of segmental occlusion of the hepatic inferior vena cava (IVC). One showed radiological evidence that the segmental lesion developed from a membranous occlusion during the course of hospitalization. In both cases, the caval obstruction was corrected by finger fracture. Patient 2 was cured, whereas patient 1, subjected to a heart-lung bypass, died in postoperative shock. An analysis is made of 74 operations performed in Japan for occlusion of the hepatic segment of the IVC. More favorable results were attained by the finger-fracture technique than by other procedures. On the basis of a review of 205 reported cases with obstruction of the hepatic IVC or hepatic veins, or both, these obstructive lesions were classified into seven types. Membranous lesions lying above the right hepatic vein orifice are particularly numerous. The etiological findings of the membranous lesions are discussed, and an attempt is made to explain the development of different types of membranous obstructions from the point of view of developmental anomalies.