Inferior vena cava injuries--a continuing challenge

J Trauma. 1983 Mar;23(3):207-12. doi: 10.1097/00005373-198303000-00005.

Abstract

The mortality from abdominal vena cava trauma remains in excess of 33% despite advances in prehospital and intraoperative care. During the 7-year period ending December 1981, 58 patients with vena cava injuries were treated at our institution. Thirty-nine (67%) were due to gunshot wounds, nine to stab injuries, and ten to blunt trauma. Overall mortality was 38%. Predictors of poor survival were: 1) presence of shock upon hospital arrival; 2) multiple abdominal vascular injuries; and 3) injuries in the retrohepatic segment. Only two (17%) of 12 patients survived retrohepatic wounds despite various shunting techniques. Of the remaining 12 deaths, 11 (92%) had associated major vascular trauma that included four portal system, three aortic, and three iliac artery injuries. This contrasts to a 96% survival rate for the 28 patients without associated abdominal vascular injuries. Our experience underscores the importance of rapid resuscitation, early operation, and searching for associated vascular injuries before a time-consuming repair of the vena cava is undertaken. Improving the survival of patients with blunt retrohepatic cava and hepatic vein trauma remains a dilemma.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Blood Vessels / injuries
  • Child
  • Child, Preschool
  • Female
  • Humans
  • Male
  • Middle Aged
  • Shock / etiology
  • Vena Cava, Inferior / injuries*
  • Vena Cava, Inferior / surgery
  • Wounds, Gunshot / complications
  • Wounds, Nonpenetrating / complications
  • Wounds, Stab / complications