A rare opportunity for conservative treatment in a case of blunt trauma to the supradiaphragmatic inferior vena cava

Abstract

Injuries to the inferior vena cava (IVC) secondary to blunt trauma are rare and occur in only 1–10% of all blunt trauma patients. Management of these injuries has not been subjected to major studies, but several case reports and small retrospective studies have demonstrated that management can be tailored to the hemodynamic status of the patient; this is similar to the management of blunt liver injuries. Stable patients whose injuries have achieved local venous tamponade have been successfully treated without surgical intervention, while unstable patients require operative management. Regardless of patient status, however, IVC injuries are highly fatal with mortality rates between 70 and 90%. This report describes the case of a patient with a blunt traumatic injury to the supradiaphragmatic IVC with development of a pseudoaneurysm who was successfully managed conservatively.

Conservative treatment of suprahepatic pseudoaneurysm in a pediatric patient

“…The literature includes some cases of IVC aneurysms and pseudoaneuryss (1,2) , but no articles that deal specifically with pseudoaneurysms of the suprahepatic veins have been found, as in the case of the patient described in this article, probably because of its rarity. Bearing in mind that the suprahepatic portion of the IVC is the least frequently affected (1) , and that in most cases treatment is surgical, only three articles on the conservative treatment of this type of lesions in adults have been found (1)(2)(3) , and none in children.…”

“…The slow extravasation of blood leads to the formation of an unstable sac with a high risk of rupture (2) . Aneurysms and pseudoaneurysms of the inferior vena cava (IVC) are rare, with an incidence of less than 1% in blunt trauma (1)(2)(3) . Deceleration causes shearing of the vessel, which can lead to rapid and uncontrollable bleeding (1) .…”

Role of Interventional Radiology in the Management of Venous Trauma

“…12 Deceleration causes shear forces on vessels, including at the cavoatrial junction, the hepatic veins, and as the posterior attachments of the liver that are intimately associated with the IVC, which can quickly lead to rapid, uncontrollable exsanguination or cardiac tamponade. 13 It has been postulated that shearing forces present in blunt trauma specifically (vs. penetrating trauma), such as flexion, stretching, and twisting may contribute to larger and more irregular lacerations that result in active extravasation and vascular contour abnormalities ( Fig. 3 ).…”

腹部コンパートメント症候群を合併した保存的治療中の下大静脈損傷に対しABTHERA®を使用した1例(Successful conservative treatment for inferior vena caval injuries with abdominal compartment syndrome using ABTHERATM)

“…鈍的外傷で下大静脈損傷を来すことは非常に稀であり，死亡率は患者の状態に関係なく70～90%と報告されている。一般的に，タンポナーデ効果で循環動態が安定していれば保存的治療が選択されるが，不安定なら手術が検討される。肝後下大静脈の頻度が多く，外科的修復では心肺補助や血管移植を要したとする報告が目立つ 4), 5)。しかし，実際のところ血管移植・置換・パッチなどの手技は現実的ではなく，単純縫合による修復が困難ならパッキングを行うか，腎静脈下の損傷では結紮も覚悟しなければならないとされる 6), 7), 8)。本症例では，開腹ドレナージが終了した時点で循環動態が安定していたため保存的治療継続としたが，止血に対しopen abdominal managementがどこまで悪影響を及ぼすかについては未だ議論のあるところである。…”