Ombrellaro et al identified factors associated with survival in patients with injury to the inferior vena cava. This is a rare but often fatal injury. The authors are from the University of Tennessee in Knoxville.


Because of the amount of blood that flows through the inferior vena cava, exsanguination at the trauma site or during transport is not unusual.




blood loss

limited (up to 20 units)


mechanism of injury

penetrating (usually gunshot or knife)

blunt trauma

location of injury

below the renal veins

above the renal veins

injury severity score (ISS)

low ISS

high ISS (>= 35)

revised trauma score (RTS)

high RTS

low RTS (<= 10)

retroperitoneal hematoma


free perforation

intraoperative blood pressure

normotensive to mild hypotension

severe hypotension

mean ischemia interval

short (less than 30 minutes)

prolonged (an hour or more)

postoperative course


multiple organ failure, sepsis, ARDS



• Blood loss may be limited if there is tamponade by surrounding structures. With free perforation of a hematoma there is limited control on blood loss.



(1) rapid resuscitation with definitive control of hemorrhage

(2) warming of blood products, crystalloids and OR to reduce hypothermia

(3) complete exposure to identify all injuries, including to intrathoracic organs


Damage to the inferior vena cava can be repaired by many methods including:

(1) ligation

(2) cavoplasty or grafts with venous or synthetic material


Complications that may occur:

(1) thrombosis with or without pulmonary embolism

(2) venous hypertension


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