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Injuries of the inferior vena cava
R F Buckman1, A S Pathak, M M Badellino
1Department of Surgery, Temple University Hospital, Philadelphia, Pennsylvania 19140, USA.
The Surgical Clinics of North America
|January 5, 2002
Summary
Injuries to the inferior vena cava (IVC) are often fatal, especially in shock or active bleeding. Trauma surgeons need anatomical knowledge for repair, but some retrohepatic wounds may be managed expectantly if bleeding stops.
Area of Science:
- Trauma Surgery
- Vascular Surgery
- Surgical Anatomy
Background:
- Injuries to the inferior vena cava (IVC) are associated with high mortality rates.
- Blunt and penetrating trauma can cause severe IVC damage, often leading to intraoperative exsanguination.
- Patient presentation with shock and failure to respond to resuscitation indicates a poor prognosis.
Purpose of the Study:
- To review the anatomical segments of the intra-abdominal IVC.
- To discuss exposure and repair techniques for IVC injuries.
- To provide guidance on managing retrohepatic IVC wounds.
Main Methods:
- Review of anatomical knowledge of the intra-abdominal IVC segments.
- Discussion of surgical techniques for IVC injury repair.
- Analysis of expectant management strategies for specific IVC wounds.
Main Results:
- Knowledge of IVC anatomy and exposure is critical for trauma surgeons.
- Most IVC injuries below the retrohepatic segment can be repaired using a lateral suture technique.
- Expectant management is appropriate for spontaneously stopped bleeding IVC wounds, particularly in the retrohepatic region, if no other major injuries are suspected.
Conclusions:
- Surgical intervention for IVC injuries requires detailed anatomical understanding.
- Lateral suture repair is effective for infra-retrohepatic IVC injuries.
- Non-operative management can be considered for stable, non-actively bleeding IVC injuries, especially in the retrohepatic location.