Lessons Learned From Treating 114 Inferior Vena Cava Injuries at a Limited Resources Environment - A Single Center Experience

Góes, Adenauer Marinho de Oliveira; Silva, Karlene Thayane Barros da; Furlaneto, Ismari Perini; Abib, Simone de Campos Vieira

doi:10.1016/j.avsg.2021.08.048

Cited by 5 publications

(8 citation statements)

References 44 publications

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“…The current literature supports infrarenal IVC ligation in clinically instable patients and in cases with complex IVC lesion as part of damage control concept [16,24]. Supra-renal IVC ligation is rarely indicated due to its high mortality rates [ 25].…”

Section: Discussionmentioning

confidence: 99%

Inferior Vena Cava Injuries: Are we doing what we really must?

de Carvalho,

Jimenez,

Pedro

et al. 2024

Preprint

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Purpose: The Inferior Vena Cava (IVC) is one of the most frequent injured intraabdominal vessels and its treatment requires prompt action. Despite advances in reanimation in last decades, there has not been proportional improvement in IVC mortality. This report aims to discuss the mortality predictive factors including the adherence to balanced reanimation and damage control surgery (DCS) in daily trauma assistance, their repercussions on outcomes, comparing our institution outcomes to literature. Methods: Retrospective design analysis database records of trauma patients at Clinic Hospital of University of Campinas (HC-Unicamp) were performed to investigate IVC injuries patients with emphasis on the mortality predictive factors. Results: 74 patients were identified with IVC injury from January 1990 to August 2017. The mechanism predominant was penetrating with 87,8% (76,3% Gunshot). On arrival, 37,8% of all victims was hypotensive and the ISS median was 24,5. Regarding location of IVC, 68,5% were infrarenal, 12,2% were suprarenal, 18,9% retrohepatic. Simple repair was performed in 60,8%. Ligation was in 27% and atriocaval shunt was in 4,1%. There was not enough time to specific procedure in 8,1%. Associated intraabdominal injuries were present in 97,3%, and the mean of transfusional requirements was 9,1± 6,9 packed red blood cells. The overall mortality rate was 52.7%, with a mortality rate for infrarenal injuries of 39,2%. The DCS was adopted in 33,8% with 68% of mortality. Conclusion: A solid comprehension of shock reanimation has progressively been disseminated; however, trauma care professionals must assure that they are being applied with balanced reanimation and DCS.

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Section: Discussionmentioning

confidence: 99%

Inferior Vena Cava Injuries: Are we doing what we really must?

de Carvalho,

Jimenez,

Pedro

et al. 2024

Preprint

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“…É o caso, por exemplo, das lesões de artéria braquial associadas a fratura supracondiliana de úmero em crianças, quando a perfusão da mão está compensadasituação atualmente denominada pink pulseless hand 72,73 . Lesões tamponadas de cava retro-hepática também podem ser passíveis de condução expectante 10,55 , e critérios para não intervenção em lesões dos membros foram estabelecidos 2,64,67,70 .…”

Section: Discussionunclassified

“…Em ambas as situações, deve-se acompanhar a evolução dos membros inferiores e, se necessário, realizar a fasciotomia. A realização profilática não é obrigatória 1,17,55 .…”

Section: Quais Vasos Devem Ser Obrigatoriamente Reconstruídos?unclassified

Diretrizes brasileiras de diagnóstico e tratamento de lesões vasculares traumáticas

Góes Junior,

Parreira,

Kleinsorge

et al. 2023

J. vasc. bras.

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Resumo Trauma é uma causa importante de morbimortalidade, que acomete principalmente jovens. A hemorragia incoercível é o principal mecanismo de óbito precoce nessas vítimas, e as lesões vasculares não compressíveis representam grandes desafios para os cirurgiões. O traumatismo vascular impacta diretamente a viabilidade de membros traumatizados, aumentando o risco de amputação. Nas últimas décadas, muitas condutas de diagnóstico e tratamento de lesões vasculares traumáticas foram modificadas. A angiotomografia suplantou a angiografia como padrão ouro para diagnóstico, as técnicas endovasculares foram incorporadas ao arsenal terapêutico e o conceito de “controle de danos” foi estabelecido. No entanto, há lacunas na literatura nacional sobre a normatização de condutas em trauma vascular, principalmente considerando as limitações do Brasil. Por isso, a Sociedade Brasileira de Angiologia e de Cirurgia Vascular e a Sociedade Brasileira de Atendimento Integrado ao Traumatizado revisaram a literatura disponível sobre trauma vascular e organizaram diretrizes sobre o diagnóstico e tratamento dessas lesões.

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“…Final pathology was reported according to the WHO Classification system and staged based on the 2018 AJCC Tumor, Node, and Metastasis Staging system 18–20 . IVC resection levels were classified according to the anatomic segment involved (infrarenal = above bifurcation of the iliac vein and below the renal veins, renal = at the level of the renal veins, suprarenal = above the level of the renal veins and below the inferior liver edge, and retrohepatic = above the inferior liver edge, posterior to the liver and below the diaphragm and the confluence of the hepatic veins) 21 . Examples of IVC ligations at the various levels are represented in Figure 1.…”

Section: Methodsmentioning

confidence: 99%

“…[18][19][20] IVC resection levels were classified according to the anatomic segment involved (infrarenal = above bifurcation of the iliac vein and below the renal veins, renal = at the level of the renal veins, suprarenal = above the level of the renal veins and below the inferior liver edge, and retrohepatic = above the inferior liver edge, posterior to the liver and below the diaphragm and the confluence of the hepatic veins). 21 Examples of IVC ligations at the various levels are represented in Figure 1. The number of organs resected was obtained from intraoperative surgical records and included partial removal of organs (liver and pancreas) and muscles (psoas and diaphragm).…”

Section: Introductionmentioning

confidence: 99%

Resection of retroperitoneal tumors with inferior vena cava involvement without caval reconstruction

Palacios

Schmeusser

Midenberg

et al. 2022

Journal of Surgical Oncology

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Background and Objectives: Retroperitoneal tumors with involvement of the inferior vena cava (IVC) often require resection of the IVC to achieve complete tumor removal. This study evaluates the safety and efficacy of IVC ligation without caval reconstruction.Methods: A retrospective chart review of patients who underwent IVC ligation (IVC-Ligation) and IVC resection with reconstruction (IVC-Reconstruction) at our institution between May 2004 and April 2021 was performed. Outcomes from the two surgical techniques were compared via univariate analysis using the Kruskal-Wallis test for continuous variables and Fisher's exact test for categorical variables.Results: Forty-nine IVC-Ligation and six IVC-Reconstruction surgeries were identified. There were no differences in baseline demographics, tumor characteristics, complication rates, postoperative morbidity, or overall 5-year survival between groups. IVC-Reconstruction patients were more likely to require intensive care unit admission (83% vs. 33%; p = 0.0257) and the IVC-Ligation cohort had a tendency to present with nondebilitating postoperative lymphedema (35% vs. 0%; p = 0.1615), which resolved for most patients.Conclusions: IVC-Ligation is a viable surgical option for select patients presenting with retroperitoneal tumors with IVC involvement and provides acceptable shortand medium-term outcomes.

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Lessons Learned From Treating 114 Inferior Vena Cava Injuries at a Limited Resources Environment - A Single Center Experience

Cited by 5 publications

References 44 publications

Inferior Vena Cava Injuries: Are we doing what we really must?

Inferior Vena Cava Injuries: Are we doing what we really must?

Diretrizes brasileiras de diagnóstico e tratamento de lesões vasculares traumáticas

Resection of retroperitoneal tumors with inferior vena cava involvement without caval reconstruction

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