<p>Systematic Review of the Management of Retro-Hepatic Inferior Vena Cava Injuries</p>

Abstract

Background: Retro-hepatic inferior vena cava (RHIVC) injuries resulting from blunt or penetrating abdominal trauma are rare but devastating events that remain a considerable challenge to even the most experienced doctors, which continue to carry a considerable mortality. Aim: To establish a better understanding of the management of RHIVC injuries and to identify any adjuncts or operative methods that were associated with an increased survival. Methods: A systematic review of the MEDLINE database was conducted using Medical Search Headings and exploded keywords and phrases. Studies were screened and subjected to inclusion/exclusion criteria. Data were extracted in a methodical manner collecting population demographics, morbidity, mortality and operative intervention, where provided. Operative strategies were compared and discussed. Results: An initial search identified 483 articles. Following duplicate removal and abstract screening, 85 full-text articles were assessed with 25 meeting the desired criteria and were, therefore, included in the systematic review. Key operative strategies and complications were identified and discussed. Conclusion:The wide variety of operative interventions in the management of RHIVC liver injuries described attest to the increased efforts to improve outcomes. The overall improvement in mortality can be noted since the earlier descriptions reported mortality approaching 100% compared to the 52% reported in this review. An algorithm has been proposed based on these findings and our experiences for the management of RHIVC injuries.

Endovascular thrombectomy and repair of suprarenal inferior vena cava thrombosis: A case series

“…While infrarenal IVC injury is associated with the lowest mortality rate of 25%, both suprarenal and retrohepatic injuries are more severe in nature with mortality rates between 60 and 100%. 1,2 This vast difference is attributed to the different anatomic relationships of the IVC along with operator expertise in accessing each of these segments for open repair. Specific challenges include mobilizing the retrohepatic caval segment which can lead to ongoing hemorrhage and increasing coagulopathy.…”