A Novel Technique of Hemorrhage Control for an Inferior Vena Cava Injury From an Abdominal Stab Wound Using Two...

Penetrating injuries to the inferior vena cava (IVC) caused by stab wounds are uncommon; however, mortality risk is high due to substantial bleeding. Managing these injuries is particularly challenging because of their retroperitoneal location and high venous flow, which complicate surgical interventions. Conventional treatments, including direct suturing and graft placement, are often difficult to perform in unstable patients. Although endovascular approaches are frequently used for aortic injuries, there is limited data for managing IVC injuries. Here, we present a novel case in which hemostasis was achieved using two intravascular balloon catheters, offering insights into a potentially effective technique for life-threatening vascular trauma. We report a case of a man in his 50s who was admitted to our hospital after a self-inflicted stab wound to the upper abdomen. At presentation, the patient was hemodynamically stable; however, imaging revealed a hematoma around the IVC below both renal veins, suggesting vessel injury. Bleeding was initially controlled with two balloon catheters positioned proximally and distally to the site of the suspected injury. The balloons were inflated to achieve temporary hemostasis, followed by surgical exploration. A 2.5 cm longitudinal tear on the right lateral wall of the IVC was identified and repaired using continuous sutures. Postoperatively, the patient recovered uneventfully, although a pulmonary embolism (a branch of the right pulmonary artery) without respiratory compromise was identified on imaging. Anticoagulant therapy was initiated, and no further complications were observed. This case demonstrates a novel option for hemorrhage control in IVC injuries by deploying two intravascular balloon catheters. This technique allows for the effective management of unexpected intraoperative bleeding and minimizes blood loss, suggesting its potential application in the treatment of complex vascular trauma. Further studies are needed to refine the indications for balloon deployment, placement techniques, and thrombosis prevention strategies to improve patient outcomes.