The use of hypothermia and circulatory arrest to control intraoperative bleeding from the inferior vena cava.

Bleeding from the suprahepatic inferior vena cava (IVC) was encountered in a patient undergoing repeat liver resection for the fourth time due to a recurrence of colorectal liver metastases. Bleeding was observed from an IVC tear above the liver and it was not possible to control it with traditional clamping procedures including total vascular exclusion (a suprahepatic clamp). Hypothermia, cardioplegia, and circulatory arrest were all required to control the bleeding. The inferior vena cava was reconstructed with a pericardial patch. The patient recovered well and was discharged on the 14th postoperative day.