Successful repair of injured hepatic veins and inferior vena cava following blunt traumatic injury, by using cardiopulmonary bypass and hypothermic circulatory arrest

Abstract

Traumatic injury to the retrohepatic veins continues to carry high mortality rates. In the last few decades various management strategies have been proposed. However, treatment of such injuries still remains highly variable and technically challenging due to the surgically inaccessible location of these vessels and the consequent difficulty controlling bleeding. We report a successful repair of complete transection of the two main extraparenchymal hepatic veins and laceration of the retrohepatic inferior vena cava using cardiopulmonary bypass (CPB) and hypothermic circulatory arrest (HCA) following blunt abdominal trauma. Immediate CPB with or without HCA can be life-saving and should be considered for patients with complex isolated retrohepatic venous injuries.

Transient Budd-Chiari syndrome as an unpredictable complication of supradiaphragmatic inferior vena cava reconstruction after blunt thoracic trauma

“…Rapid and accurate preoperative diagnosis is essential, and HCA and CPB should be prepared for severe IVC injuries. [3] Reconstruction using an optimal graft should be considered. Moreover, a ringed graft is a synthetic graft with benefits such as availability and good patency.…”

“…[1] Emergent surgical management including primary repair, patch repair, or reconstruction with various grafts, is used to manage IVC injuries, but the optimal strategy for surgery remains controversial. [2,3] Immediate reconstruction of IVC using a graft is required to restore hepatic venous drainage and survival in cases of severe supradiaphragmatic IVC injury such as a transection. Prevention of complications, graft infection, or thrombosis after reconstruction is important to improve patency and survival rate.…”

A rare opportunity for conservative treatment in a case of blunt trauma to the supradiaphragmatic inferior vena cava

“…Patients who are stable or whose caval injuries have reached spontaneous vascular tamponade, typically through containment by the liver capsule, diaphragm or suspensory ligaments, have been successfully managed with conservative treatment [ 5 ]. Operative strategies have been employed for unstable patients, patients with large defects of the IVC and for patients whose caval hematomas are not contained [ 4 – 7 ]. The suprahepatic region of the IVC is challenging for surgical intervention, as it requires dividing the falciform ligament, cross clamping, mobilizing the damaged IVC segment and extending the abdominal incision into a full sternotomy.…”

Damage control – trauma care in the first hour and beyond: a clinical review of relevant developments in the field of trauma care

“…50 Blood loss may be immense, and case reports of endovascular balloon occlusion of the IVC, 81 atriocaval shunting, 82 and cardiopulmonary bypass and hypothermic circulatory arrest 83 describe successful methods with low numbers to reduce blood loss at the time of surgery. Endovascular therapy may have a role to play, and case reports exist of IVC endograft placement for surgical haemorrhage 84 and fenestrated endografting for juxtahepatic IVC injury via the right femoral vein.…”