Inferior Vena Cava Injuries: Are we doing what we really must?

Abstract

Abstract Purpose: The Inferior Vena Cava (IVC) is one of the most frequent injured intraabdominal vessels and its treatment requires prompt action. Despite advances in reanimation in last decades, there has not been proportional improvement in IVC mortality. This report aims to discuss the mortality predictive factors including the adherence to balanced reanimation and damage control surgery (DCS) in daily trauma assistance, their repercussions on outcomes, comparing our institution outcomes to literature. Methods: Retrospective design analysis database records of trauma patients at Clinic Hospital of University of Campinas (HC-Unicamp) were performed to investigate IVC injuries patients with emphasis on the mortality predictive factors. Results: 74 patients were identified with IVC injury from January 1990 to August 2017. The mechanism predominant was penetrating with 87,8% (76,3% Gunshot). On arrival, 37,8% of all victims was hypotensive and the ISS median was 24,5. Regarding location of IVC, 68,5% were infrarenal, 12,2% were suprarenal, 18,9% retrohepatic. Simple repair was performed in 60,8%. Ligation was in 27% and atriocaval shunt was in 4,1%. There was not enough time to specific procedure in 8,1%. Associated intraabdominal injuries were present in 97,3%, and the mean of transfusional requirements was 9,1± 6,9 packed red blood cells. The overall mortality rate was 52.7%, with a mortality rate for infrarenal injuries of 39,2%. The DCS was adopted in 33,8% with 68% of mortality. Conclusion: A solid comprehension of shock reanimation has progressively been disseminated; however, trauma care professionals must assure that they are being applied with balanced reanimation and DCS.