Ligation of the Suprarenal Vena Cava after a Gunshot Wound

Ivy, Michael E.; Possenti, Paul; Atweh, Nabil; Sawyer, Mark D.; Bryant, G P; Caushaj, Philip F.

doi:10.1097/00005373-199809000-00042

Cited by 8 publications

(12 citation statements)

References 17 publications

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“…Whereas infrarenal caval ligation has been done more often, there is a reluctance to ligate the suprarenal cava and there are only anecdotal reports of the same [3,4,[10][11][12][13]. It is noteworthy that all the four patients in our series who underwent a caval ligation did so at the suprarenal level without any significant sequelae.…”

Section: Discussionmentioning

confidence: 69%

“…The documented case reports of caval ligation are anecdotal. Ivy et al collected a total of 23 patients with infrarenal caval ligation and six reports of suprarenal ligation apart from their patient [4]. We could identify 40 subsequent successful caval ligations, all of them being in the context of trauma or IVC tumour resection [5][6][7][8][9].…”

Section: Discussionmentioning

confidence: 99%

“…Oedema goes on to become permanent in 2% of them [17]. Ivy et al reported one patient who following a suprarenal ligation of the IVC developed extensive pedal oedema and an abdominal compartment syndrome [4]. It is quite possible that this patient had an aggravated postoperative course because of an associated caval thrombus extending to the iliac vein bifurcation, in effect having a block of both the suprarenal and the infrarenal IVC.…”

Section: Discussionmentioning

confidence: 99%

“…Transient defects in the renal function are also observed following caval ligation [4,11,12]. This manifests as oliguria/anuria and hematuria with rising creatinine levels.…”

Section: Discussionmentioning

confidence: 99%

“…Trauma to the infrarenal cava has a mortality of 25%, whereas injuries between the renal veins and the hepatic veins carry a mortality of 41-55%. The mortality rates for caval injuries at or above the level of the hepatic veins are in excess of 80% [4]. Mortality following IVC injury is related to persistent haemorrhage, associated hypotension, hypothermia, coagulopathy and acidosis [4].…”

Section: Discussionmentioning

confidence: 99%

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Is the inferior vena cava dispensable?

Jones

Shun

2007

Pediatr Surg Int

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Inferior vena caval (IVC) ligation during surgery is considered prohibitively risky. Most of the IVC ligations reported in the literature have been in the context of trauma damage control. There are only anecdotal reports in the literature of a successful elective ligation of the IVC in children. Records from a paediatric tertiary care centre were reviewed over a 20-year period to identify and evaluate patients who underwent an intentional ligation of the IVC during elective surgery. The reports from the literature of IVC ligations were reviewed. The physiologic and anatomic basis for the sequelae of IVC ligation was examined. Intentional ligation of the IVC was done in four patients. Apart from pedal oedema and ascites lasting for 1 and 9 months, respectively, in two of them, none of these patients had any long-term sequelae related to the ligation of their IVC. Adequate collaterals providing satisfactory drainage were demonstrated by Doppler studies postoperatively. We suggest that during surgery, when other options are absent, the IVC can be safely ligated in children, providing a therapeutic benefit to the patient.

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Section: Discussionmentioning

confidence: 69%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…Transient defects in the renal function are also observed following caval ligation [4,11,12]. This manifests as oliguria/anuria and hematuria with rising creatinine levels.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Is the inferior vena cava dispensable?

Jones

Shun

2007

Pediatr Surg Int

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Management of Penetrating Trauma to the Major Abdominal Vessels

2016

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Penetrating abdominal vascular injuries result in significant mortality. In the pre-hospital phase of care, Bscoop and run^is the optimal strategy while on-scene interventions are restricted only to basic airway maneuvers. Early in-hospital diagnosis and operative interventions are prerequisites for survival in vascular trauma. Hypotension and peritonitis following penetrating abdominal trauma mandate immediate access to the operating room with vascular surgery capabilities. Patients presenting in extremis should be managed with a resuscitative thoracotomy in the emergency department. The majority of abdominal vascular injuries surviving to the operating room are subjected to damage control intervention. In hemodynamically stable patients, diagnostic modality of choice is computed tomography angiography and endovascular interventions are evolving.

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