Inferior vena cava injuries: Are we doing what we really must?

Abstract

Objectives: The inferior vena cava (IVC) is one of the most frequent injured intra-abdominal vessels and its treatment requires prompt action. Despite advances in reanimation in last decades, there has not been proportional improvement in IVC mortality. This report aims to discuss the mortality predictive factors including the adherence to balanced reanimation and damage control surgery (DCS) in daily trauma assistance, their repercussions on outcomes, comparing our institution outcomes to literature.

Material and methods: A retrospective design analysis was made through database records of trauma patients at Clinic Hospital of University of Campinas, UNICAMP in order to investigate patients with IVC injuries, putting an emphasis on mortality predictive factors.

Results: Seventy-four patients were identified with IVC injury from January 1990 to August 2017. Predominant mechanism was penetrating with 87.8% (76.3% gunshot). On arrival, 37.8% of all of the victims were hypotensive, and ISS median was 24.5. Regarding location of IVC, 68.5% were infrarenal, 12.2% were suprarenal, 18.9% retrohepatic. Simple repair was performed in 60.8%. Ligation was carried out in 27% and atriocaval shunt was performed in 4.1%. There was not enough time for specific procedure in 8.1%. Associated intra-abdominal injuries were present in 97.3%, and the mean of transfusional requirements was 9.1 ± 6.9 for packed red blood cells. Overall mortality rate was 52.7%, with a mortality rate for infrarenal injuries being 39.2%. Damage control surgery was adopted in 33.8%, with 68% mortality.

Conclusion: A solid comprehension of shock reanimation has progressively been disseminated; however, trauma care professionals must assure that they are being applied with balanced reanimation and DCS.