Intra-abdominal Inferior Vena Cava Injuries: Operative Strategies and Outcomes

Abstract

Visceral vascular injuries are relatively uncommon even in busy urban trauma centers. The inferior vena cava (IVC) is the most frequently injured visceral vein and can be a complex operative challenge. Despite advances in early volume resuscitation, improved transport times, prompt operative intervention, and hemorrhage control, mortality rates have remained largely unchanged. This article conducts an in-depth review of the literature surrounding IVC injuries and a detailed discussion of operative strategies and management as survivability is ultimately dependent on the grade of injury, location, and the presence of hemorrhagic shock.

Experience of surgical treatments for abdominal inferior vena cava injuries in a regional trauma center in Korea

“…In this study, the overall and 24-hour mortality rates after surgery were 78.6% and 64.3%, respectively. These outcomes are slightly worse than those noted in previous studies, where the overall mortality rates ranged between 20% and 70% [5,8,[10][11][12][13][14]. The worse outcomes in this study are probably because 13 of the 14 patients who underwent surgery had blunt trauma, which is a known risk factor for mortality in traumatic IVC injury [7].…”

“…Nevertheless, we were unable to save a patient with an infrarenal IVC injury despite using ligation. For a retrohepatic IVC injury, liver mobiliza-tion may be required to expose the segment, but massive hemorrhage from the injury site can occur with this procedure [5]. Therefore, in a retrohepatic IVC injury, without active bleeding or with only a contained hematoma, perihepatic gauze packing without mobilization should be performed [1].…”

“…Alternatively, an atriocaval shunt facilitates volume resuscitation during repair by isolating the injury site and maintaining venous return through a shunt using an endotracheal tube or a chest tube. As such, it can be used in a retrohepatic IVC injury with active bleeding, a large injury site, and extreme hemodynamic instability [4,5,20]. However, the reported outcomes of using an atriocaval shunt have also been unsatisfactory due to the severity of retrohepatic IVC injuries, the complexity of the procedure, the approach to the thorax, and delays in the decision to apply the procedure [4,20].…”

“…An atriocaval shunt can also be used to repair the retrohepatic IVC segment [4]. This variety of treatment methods illustrates the lack of consensus or guidelines, and survival rates have not significantly improved over time [5].…”