Outcome of ligation of the inferior vena cava in the modern era

Sullivan, Patrick S.; Dente, Christopher J.; PatelSnehal, G; Carmichael, Matthew; Srinivasan, Jahnavi K.; Wyrzykowski, Amy D.; Nicholas, Jeffrey M.; Salomone, Jeffrey P.; Ingram, Walter L.; Vercruysse, Gary; Rozycki, Grace S.; Feliciano, David V.

doi:10.1016/j.amjsurg.2009.05.013

Cited by 92 publications

(72 citation statements)

References 17 publications

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“…In contrast, ligation of the suprarenal IVC has few survivors. 7,8 Consequently, ligation of the infrarenal IVC might be an acceptable damage control procedure, in cases presenting no realistic alternative for preservation of the IVC. Ligation of the suprarenal IVC should be avoided to the greatest degree possible.…”

Section: Discussionmentioning

confidence: 99%

Inferior vena cava injury caused by an anteriorly migrated cage resulting in ligation: case report

Ariyoshi¹,

Sano²,

Kawamura³

2016

SPI

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Anterior dislodgement of the transforaminal lumbar interbody fusion (TLIF) cage is one of the severe complications seen in this procedure, which may cause an intraoperative major vessel injury. The objective of this report is to present a rare case of inferior vena cava (IVC) injury during revision surgery for removal of the anteriorly migrated cage. The authors describe a case of 74-year-old woman with lumbar spinal canal stenosis and degenerative scoliosis. During the TLIF surgery, an inserted titanium cage at the L4–5 level dislodged anteriorly to the retroperitoneal space without massive bleeding from the disc space. In the second surgery, which was performed via an anterior retroperitoneal approach to remove the migrated cage, massive torrential bleeding occurred because of IVC injury. The laceration in the posterior wall of the IVC necessitated ligation of this vessel and both common iliac veins by a vascular surgeon. Postoperative edema of the lower extremities after ligation of the vessels was well tolerated, and the patient showed almost full recovery. For removal surgery of an anteriorly migrated cage, the surgeon should be well prepared for the risk of IVC injury, including requesting the attendance of a vascular surgeon. Ligation of the infrarenal IVC is an acceptable solution in irreparable IVC injury.

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Section: Discussionmentioning

confidence: 99%

Inferior vena cava injury caused by an anteriorly migrated cage resulting in ligation: case report

Ariyoshi¹,

Sano²,

Kawamura³

2016

SPI

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“…Fasciotomies should be considered after ligation of the IVC when high compartment pressures are obtained or clinically incompressible compartments are identified [7]. Primary suture in injuries to the suprarenal IVC is preferred, although ligation is a life-saving and acceptable modality [1,7].…”

Section: Discussionmentioning

confidence: 99%

A Successful Management of Juxta-Renal Inferior Vena Cava Injury After Penetrating Trauma: A Case Report

Hashempour¹,

Motalebi²,

Sm³

et al. 2016

J Trauma Treat

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Here, in the present case the authors report a patient with IVC injury repaired by venorrhpy and it can be performed by a team led by general surgeon. Inferior vena cava injuries remain a challenge for the skill, experience and diligence of a surgeon. Not only vascular surgeons, but all surgeons should be familiar with the principles of their treatment. A case of the inferior vena cava injury encountered after penetrating abdominal trauma in old age man with hemorrhagic shock with about 4 cm vertical tear of juxta-renal vena cava, survived due to immediate transportation, appropriate and successful perioperative fluid and blood resuscitation, prompt surgical management with team approach and critical postoperative surgical management without any residual complication. IVC injuries are associated with high mortality. Patients presenting with clinical and physiological evidence of shock and who require "damage control" surgery are more likely to suffer a worse outcome, particularly when multiple physiological derangements are present.

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“…2,6 Mortality of IVC injuries is quoted in most series to be around 50%. 1,2 Factors associated with increased mortality are hypotension on arrival to the emergency department, associated major vascular injury, and level of IVC injury, with proximal injuries carrying the highest mortality (suprahepatic).…”

Section: Discussionmentioning

confidence: 99%

“…There are studies showing an absence of leg edema after IVC ligation. 6,12 However, in our institution, we do see patients presenting to the clinic after emergency IVC ligation with worsening leg edema, many several years after ligation, when reconstruction may be hazardous because of extensive collateral vein development and a scarred retroperitoneum. In our institution, traumatic IVC injuries are rare.…”

Section: -511mentioning

confidence: 99%

Staged Reconstruction of the Inferior Vena Cava After Gunshot Injury

Droz

Matsuura

2016

Journal of Vascular Surgery

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A 23-year-old man with a gunshot injury to the abdomen and cardiac arrest requiring emergency department thoracotomy had a transection of the distal inferior vena cava (IVC) and small bowel injury. Because of persistent hemorrhagic shock, the IVC was ligated. During the next 3 days, he developed worsening bilateral leg edema. He was taken back for reanastomosis of his small bowel and reconstruction of the IVC using autologous femoral vein harvested from the right leg. We think that patients requiring ligation of the vena cava with worsening leg edema can benefit from a staged reconstruction of the IVC. (J Vasc Surg Cases and Innovative Techniques 2017;3:136-8.) Penetrating injuries of the inferior vena cava (IVC) carry a high mortality. [1][2][3][4][5] In a hemodynamically unstable patient, ligation of the vena cava often becomes necessary as a lifesaving measure. We describe a delayed reconstruction of the IVC using autologous femoral vein after stabilization of the patient. This case demonstrates the value of working with the trauma team in successful resuscitation of severe shock, acidosis, and hypothermia and in control of abdominal contamination before a venous bypass. The patient has consented to this case presentation. CASE REPORTA 23-year-old man arrived in the trauma bay with severe hypotension after a gunshot injury to the abdomen. During emergency department resuscitation, the patient arrested, requiring thoracotomy and aortic cross-clamping. The patient was placed on massive transfusion protocol and transported to the operating room for exploration, with findings of a transected distal IVC involving both origins of the common iliac veins. His aorta and iliac arteries were intact. Because of his persistent hemorrhagic shock, the IVC and both iliac veins were ligated (Fig 1).A segment of small bowel was also injured and treated with we harvested the right femoral vein, between the deep and popliteal veins, and created a bifurcated bypass (Fig 2). The patient was discharged home on clopidogrel and graded compression stockings. His venous duplex ultrasound study at 2 weeks showed a patent bypass. At 1-month follow-up, his incisions were healed and he had no residual leg edema. DISCUSSIONIVC injuries are rare and more often the result of penetrating trauma, occurring in approximately 0.02% of gunshot wounds to the abdomen. 2,6 Mortality of IVC injuries is quoted in most series to be around 50%. 1,2 Factors associated with increased mortality are hypotension on arrival to the emergency department, associated major vascular injury, and level of IVC injury, with proximal injuries carrying the highest mortality (suprahepatic).

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Outcome of ligation of the inferior vena cava in the modern era

Cited by 92 publications

References 17 publications

Inferior vena cava injury caused by an anteriorly migrated cage resulting in ligation: case report

Inferior vena cava injury caused by an anteriorly migrated cage resulting in ligation: case report

A Successful Management of Juxta-Renal Inferior Vena Cava Injury After Penetrating Trauma: A Case Report

Staged Reconstruction of the Inferior Vena Cava After Gunshot Injury

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