Management of Peripheral and Truncal Venous Injuries

Abstract

Civilian injuries are increasing according to the World Health Organization, and this is attributed mainly to road traffic accidents and urban interpersonal violence. Vascular injuries are common in these scenarios and are associated with high morbidity and mortality rates. Associated peripheral venous trauma is less likely to lead to death and controversy remains whether ligation or repair should be the primary approach. Conversely, non-compressible truncal venous insult can be lethal due to exsanguination, thus a high index of suspicion is crucial. Operative management is demanding with fair results but recent endovascular adjuncts demonstrate promising results and seem to be the way forward for these serious conditions.

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

“…Any change in hemodynamics or poor hemodynamic response to rapid volume resuscitation may indicate free rupture into the peritoneal cavity. [33][34][35] In conjunction with surgical exploration, prevention of intraoperative hypothermia and a 1:1:1 transfusion resuscitation ratio is necessary by the surgical team. Operative strategies historically have evolved to include today's traditional vascular surgical techniques including lateral venorrhaphy, patch, ligation, patch cavoplasty, or shunts.…”

Retrohepatic IVC injury: A new treatment approach with arterial stent graft

“…Over the past few decades, even with advances in imaging of trauma with multidetector CT and improved clinical care, the overall survival rate of IVC injury has not shown significant improvement [1 , 8] . Classically, IVC injury is repaired surgically with only a few cases reported in the literature about the successful endovascular management of the IVC injury.…”

“…Traumatic injuries to the inferior vena cava (IVC) are rare and among the most dreadful injuries encountered in evaluation of both penetrating and blunt traumatic settings, carrying a high mortality rate as almost 30%-50% of diagnosed cases die before reaching a health care facility [1] . Furthermore, only 50% of those who survive the accident will make it until discharge.…”

Deep venous stenting in trauma – What is the role?

“…In high volume veins, haemorrhage is often fatal: iliac, portal and mesenteric vein injuries have a mortality of 50-70%, and 30-50% of isolated inferior vena cava (IVC) injuries succumb in the pre-hospital setting. 3 During the Second World War, peripheral vein ligation was favoured in both isolated venous injuries and in injuries involving the concomitant artery. 4 Venous repair was not taken up until the Korean War, when evidence of reduced morbidity by maintaining venous outflow began to emerge.…”

“…Where repair is not possible, ligation is tolerated well. 3 Truncal injuries are more difficult to access surgically and often involve larger or high flow veins. Patients suffering from truncal vein injuries often have associated thoraco-abdominal organ injuries, as well as a physiological response to trauma.…”