Background: Juxtahepatic vena cava (JHC) injury is difficult to handle because of JHC injury's specific position and liver obstruction. The traditional shunt method initially appeared to be useful but ultimately failed. Simple and effective methods are needed to solve it.
Methods: Firstly, the clinical data, including the computed tomography images, of 120 patients were collected. In addition, a JHC digital model was constructed based on computed tomography images. According to the digital model data, a circulation loop simulating the blood flow in the JHC was established. Secondly, we analyzed the hemodynamics of a JHC shunt with pig blood. Finally, the new shunt was designed based on the data obtained. The shunt consists of a covered stent and transfer device and was tested.
Results: The JHC has a three-dimensional cylindrical structure. The mean (SD) length of the retrohepatic vena cava is 78.21 (9.83) mm, which shows correlations with the patient's age and weight (r = -0.343 and 0.271, respectively, p < 0.05). An equation is obtained as follows: retrohepatic vena cava (millimeter) = 71.23 - 0.293 × age (year) + 0.32 × weight (kilogram). The shunt diameters must be 10 mm and 12 mm to maintain the blood pressure difference Point a and Point b at approximately 3.75 mm Hg (5 cm H2O), when the flow rate is 3,000 mL/min and 5,000 mL/min, respectively. The stent graft showed effective hemostasis in tests. However, it failed when the inferior vena cava was pulled harder.
Conclusion: A temporary stent graft as a new shunt for JHC injury has not been previously reported. It is a combination of both a traditional operation and a simple endovascular technique, which showed effective hemostasis in tests.
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