Factors related to mortality in inferior vena cava injuries. A 5 year experience

Forty-nine patients sustaining Inferior Vena Cava (IVC) injuries, during a 5 year period were retrospectively analyzed in order to assess those factors related to early deaths. Mean age was 32 and 45 were male. GSW was the most frequent mechanism of injury (59.2%), followed by SW (28.6%) and blunt trauma (12.2%). There were 4 injuries in the supra diaphragmatic IVC, 14 retrohepatic, 16 suprarenal and the remaining 15 were in the infrarenal portion of the IVC. Twenty patients were in shock and 8 were unstable on admission. The liver was the most frequently injured organ in association with IVC and there were also 7 concomitant abdominal vascular injuries. Venorrhaphy was performed in 28 patients, IVC ligature in 5, intracaval shunt in 3 and in the remaining 13, only temporary hemostasis was attempted. Mortality rate was 100% in supra diaphragmatic injuries, 71.4% in retrohepatic, 68.8% in suprarenal and 33% in infrarenal injuries. There was a significant difference when comparing mortality rate in stable against shock or unstable patients on admission (p < 0.001), as well as in those with diaphragmatic IVC injuries compared with all other injury sites together (p < 0.05). Hemodynamic instability on admission was the most important cause of early deaths, and all patients with concomitant abdominal vascular injuries also died.