McPhee Arthur, Shaikhrezai Kasra, Berg Geoffrey
Department of Cardiothoracic Surgery, Golden Jubilee National Hospital, Clydebank, UK.
Interact Cardiovasc Thorac Surg. 2013 Sep;17(3):560-3. doi: 10.1093/icvts/ivt244. Epub 2013 Jun 4.
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether it is safe to divide the left innominate vein (LIV) in aortic arch surgery to improve access. Altogether, 228 relevant papers were found using the reported search, of which nine represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Following LIV division, the venous drainage takes place via multiple collateral systems such as the azygous/hemiazygous, the internal mammary veins, the lateral thoracic and superficial thoracoabdominal veins, vertebral venous plexus as well as the transverse sinus. The possible complications are mainly left upper limb swelling and neurological symptoms. In one case series of 14 patients, the LIV was divided and ligated to facilitate the exposure for aortic arch surgery. More than 2-year follow-up did not reveal upper limb oedema or neurological symptoms. In two cohorts of 52 patients, the LIV was ligated prior to the superior vena cava (SVC) resection for malignancy. During the mid-term follow-up, no neurological or upper limb symptoms were reported. Although in two studies with 72 and 70 patients undergoing SVC resection it was not specified how many of them had LIV ligation, no relevant complications were reported. In a report, LIV occlusion was observed in 4 patients undergoing left internal jagular vein catheterization for haemodialysis. The reported symptom was left arm swelling with no neurological problems. In a cohort of 18 patients undergoing SVC resection for malignancy and major vein reconstruction, 7 patients underwent ligation of the LIV with no neurological symptoms. It was also concluded that reconstruction of the LIV is not consistent with favourable patency. In a case series of 10 patients with central venous obstruction, collateral pathways to conduct efficient venous drainage were mapped. We conclude that division of the LIV is safe in selected patients and operations. Patients will initially have symptoms of central vein obstruction, but these will decrease with conservative management as collaterals form.
根据结构化方案撰写了一篇心脏外科的最佳证据主题。所探讨的问题是，在主动脉弓手术中为改善手术视野而切断左无名静脉（LIV）是否安全。通过报告的检索共找到228篇相关论文，其中9篇代表了回答该临床问题的最佳证据。现将这些论文的作者、期刊、发表日期和国家、研究的患者群体、研究类型、相关结局和结果制成表格。切断LIV后，静脉引流通过多个侧支循环系统进行，如奇静脉/半奇静脉、胸廓内静脉、胸外侧静脉和胸腹壁浅静脉、椎静脉丛以及横窦。可能的并发症主要是左上肢肿胀和神经症状。在一个包含14例患者的病例系列中，切断并结扎LIV以利于主动脉弓手术的暴露。超过2年的随访未发现上肢水肿或神经症状。在两个各有52例患者的队列中，为治疗恶性肿瘤在切除上腔静脉（SVC）之前结扎了LIV。在中期随访期间，未报告神经或上肢症状。尽管在两项分别有72例和70例接受SVC切除的患者的研究中，未明确其中有多少例进行了LIV结扎，但均未报告相关并发症。在一份报告中，观察到4例接受血液透析的左颈内静脉置管患者出现LIV闭塞。报告的症状是左臂肿胀，无神经问题。在一个包含18例因恶性肿瘤接受SVC切除并进行大静脉重建的患者队列中，7例患者结扎了LIV，无神经症状。研究还得出结论，LIV重建后的通畅情况不佳。在一个包含10例中心静脉阻塞患者的病例系列中，绘制了进行有效静脉引流的侧支途径。我们得出结论，在特定患者和手术中切断LIV是安全的。患者最初会出现中心静脉阻塞的症状，但随着侧支循环的形成，通过保守治疗这些症状会减轻。
