[Reconstruction of caval veins]

Area of Science:

• Vascular Surgery
• Surgical Oncology
• Trauma Surgery

Background:

• Caval vein injuries are uncommon but associated with significant morbidity and mortality.
• Diagnosis is often delayed until surgical exploration, especially in penetrating trauma.
• These injuries can result from penetrating wounds or iatrogenic causes during other surgical procedures.

Purpose of the Study:

• To evaluate the feasibility and outcomes of caval vein reconstruction.
• To analyze different surgical techniques for repairing caval vein damage.
• To compare reconstructive methods regarding long-term patency.

Main Methods:

• Retrospective analysis of 31 patients undergoing caval vein reconstruction (SVC in 5, IVC in 26).
• Categorization of injuries into penetrating trauma and iatrogenic causes.
• Surgical interventions included vascular suture, patch repair, and, in limited cases, ligation.

Main Results:

• Overall mortality was 22.6% (7/31 patients), with deaths occurring intraoperatively or in the early postoperative period.
• Complications included shock, hypovolemia, venous bleeding, and pulmonary embolism.
• 77.4% of patients with traumatic and iatrogenic caval vein injuries were discharged successfully.
• Two patients with postoperative bleeding and one with peritonitis had favorable outcomes after redo surgery.

Conclusions:

• Caval vein reconstruction is a complex procedure with a high risk of severe complications and mortality.
• Vascular suture and patch repair are effective reconstructive techniques, offering better long-term patency than synthetic grafts.
• Ligation of the infrarenal inferior vena cava may be considered in extremely ill patients as a last resort.