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.
|
Parameter |
Favorable |
Unfavorable |
|
blood loss |
limited (up to 20 units) |
massive |
|
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 |
contained |
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 |
where:
• 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.
Recommendations:
(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
Specialty: Surgery, orthopedic, Emergency Medicine, Critical Care, Surgery, general, Cardiology
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