Inferior vena cava repair using serosal patch of small bowel: an experimental study

To evaluate the feasibility and results of using serosal patch of small bowel for repair and replacement of inferior vena cava [IVC] after resection of a part of infra-renal IVC in an animal model, as it may be encountered in extensive tumors of retroperitoneal and trauma patients

Methods: Five healthy sheep of both sexes were prepared. After general anesthesia and laparotomy, a defect with 1 cm width and 4cm length was made on anterior aspect of infra-renal IVC, and then an adjacent loop of small bowel was brought and sutured continuously to cover the defect of IVC as a patch graft. The observation period was two months

Results: Three of five IVCs were macroscopically patent without stenosis and thrombosis. Pathologic assay revealed complete endothelialization of serosal surface of the patch of small bowel loop. One of IVCs was completely occluded in gross evaluation and fibrous formation in pathologist review. The sheep had no sign of venous hypertension and edema of limbs. One sheep died at the night of first operation due to internal bleeding

Conclusion: Serosal patch of small bowel is an accessible and feasible alternative in repair and reconstruction of IVC especially when there is restriction for use of prosthetic material in a contaminated space of abdomen

Inferior vena cava reconstruction by gallbladder patch: An experimental design

Objective: To evaluate the efficacy of the gallbladder for reconstruction of the inferior vena cava in a canine model

Methods: The experimental study was conducted on 5 dogs; an oval window with a diameter of [4×1 cm] was made in the inferior vena cava and then repaired using the autologous gallbladder patch with preservation of gallbladder function. The patency and functionality of the graft were assessed macroscopically and microscopically at 2 months postoperatively

Results: All the dogs were euthanized at 2 months, showing excellent patency of the vena cava macroscopically. In the microscopic examination, all the patches were completely endothelialized. No evidence of infection and inflammation and thrombosis was noted

Conclusion: The gallbladder patch is an available and safe alternate for reconstruction of the inferior vena cava at least in animal model. However, further well designed prospective studies are needed to confirm this hypothesis

Traumatic aneurysm of innominate artery resulting in tracheal stenosis and rapidly progressive respiratory failure; a case report and literature review

Traumatic injuries to great vessels are relative common in trauma practice. Blunt thoracic trauma may result in dissection injury to aorta and innominate artery. We herein present a late presentation of traumatic innominate artery aneurysm. A29-year-old woman presented with dyspnea to our emergency department. She had previous motor-vehicle accident a month before presentation for which had undergone chest tube insertion. She was diagnosed to have traumatic aneurysm of innominate artery resulting in tracheal stenosis resulting in acute life threatening respiratory failure. She underwent simultaneous aneurysm resection and tracheal reconstruction. She was uneventfully discharged from hospital. Any post-traumatic respiratory and cardiovascular symptoms may propound an undiagnosed serious injury to the great vessels. Extra and repetitive imaging studies may help us in better evaluation of traumatized patients with high energy mechanisms and sharp injuries to chest and neck

Tracheal reconstruction by re-inforced Gore-Tex in esophageal submuscular tunneling: an experimental study

Tracheal reconstructions are aimed at rearranging or replacing parts of the tracheal tissue by different techniques. Here we introduce a new technique for tracheal reconstruction. In 10 adult dogs, after intubation with an endotracheal tube, a segment of trachea including seven tracheal rings was resected circumferentially. A submuscular tunnel was induced between mucosal and muscular layers of the adjacent esophagus lying right next to the trachea. The esophageal submuscular tunnel starts and ends exactly at the level of distal and proximal ends of tracheal resection, respectively. Inforced Gore-Tex passed through the esophageal submuscular tunnel the distal segment of trachea and end-to-end anastomosis were made between distal ends of Gore-Tex and trachea, then endotracheal tube removed and the same procedure was made for proximal ends of Gore-Tex and trachea. Afterward, the proximal and distal ends of the esophageal tunnel were approximated to proximal and distal tracheal parts over the anastomosis. All dogs, except one due to anesthetic problem, survived and tolerated the operation; the first two dogs experienced postoperative fever, aspiration pneumonia, and died due to tracheoesophageal fistula. All survived animals were eating and barking well. We started to scarify dogs at least 6 and 12 weeks after operation for microscopy and pathologic examination. The Gore-Texes were patent and supported externally with fibrous connective tissue in esophageal tunneling, with in growth of respiratory epithelium on inner surfaces. Air tightness, good re-epithelialization, and relatively no limitation of esophageal length and no risk of luminal collapse are advantages of tracheal reconstruction by submuscular esophageal tunneling. This new method is worthy of further investigation, as it is technically feasible and easy to implement