1
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Choi D, Choi SH, Jung H, Kim J. CT findings of inferior vena cava trauma according to the level of injury: a retrospective analysis of 19 cases in a single trauma centre. Clin Radiol 2024; 79:e182-e188. [PMID: 37925364 DOI: 10.1016/j.crad.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 09/29/2023] [Accepted: 10/05/2023] [Indexed: 11/06/2023]
Abstract
AIM To analyse the clinicoradiological characteristics of traumatic inferior vena cava (IVC) injury level on preoperative computed tomography (CT). MATERIALS AND METHODS This retrospective study evaluated patients from a single trauma centre treated for traumatic IVC injury between January 2014 and January 2021. Data on demographics, mechanism of injury, Injury Severity Score, radiological findings on CT and angiography, IVC injury level in surgical findings, complications, and clinical outcomes were collected. RESULTS During the 8-year study period, 36 patients presented with traumatic IVC injury: 19 underwent preoperative CT with 17 (89%) blunt and two (11%) penetrating injuries. The most common primary CT sign was contour abnormality (53%, n=10), followed by intraluminal flap and active extravasation (21%, n=4). Among the secondary signs, hepatic laceration (53%, n=10) and retroperitoneal haemorrhage (53%, n=10) were the most common. Frequencies of primary and secondary signs were higher in the infrarenal and suprarenal than in the retrohepatic vena cava injuries. Diagnostic capability of preoperative CT for IVC injury differed according to the IVC level. The detection rate was the highest for an infrarenal vena cava injury at 100% (n=4), followed by that for a suprarenal, suprahepatic, and retrohepatic vena cava injuries at 75% (n=3), 43% (n=3), and 25% (n=1), respectively. CONCLUSION CT findings of traumatic IVC injuries may vary depending on the mechanism and anatomical site of injury. Familiarity with IVC injury imaging features may help in diagnosis and surgical treatment planning.
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Affiliation(s)
- D Choi
- Division of Trauma Surgery, Department of Surgery, Ajou University School of Medicine, Republic of Korea
| | - S H Choi
- Division of Trauma Surgery, Department of Surgery, Ajou University School of Medicine, Republic of Korea
| | - H Jung
- Division of Trauma Surgery, Department of Surgery, Ajou University School of Medicine, Republic of Korea
| | - J Kim
- Department of Radiology, Ajou University School of Medicine, Republic of Korea.
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2
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Choi D, Kang BH, Jung K, Lim SH, Moon J. Risk Factors and Management of Blunt Inferior Vena Cava Injury: A Retrospective Study. World J Surg 2023; 47:2347-2355. [PMID: 37423908 DOI: 10.1007/s00268-023-07110-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND Traumatic inferior vena cava (IVC) injuries are uncommon, but the mortality rate remains high at 38-70%. To date, most studies on traumatic IVC injuries have evaluated blunt rather than penetrating injuries. We aimed to identify the clinical features and risk factors that affect the prognosis of patients with blunt IVC injuries to improve treatment strategies for these patients. METHODS We retrospectively analyzed patients diagnosed with blunt IVC injury over 8 years at a single trauma center. Clinical and biochemical parameters; transfusion, surgical, and resuscitation methods; associated injuries; intensive care unit stay; and complications data were compared between survival and death groups to identify clinical features and risk factors of blunt IVC injury-related mortality. RESULTS Twenty-eight patients with blunt IVC injury were included during the study periods. Twenty-five (89%) patients underwent surgical treatment, and the mortality was 54%. The mortality rate according to the IVC injury location was the lowest for supra-hepatic IVC injury (25%, n = 2/8), whereas it was the highest for retrohepatic IVC injury (80%, n = 4/5). In the logistic regression analysis, Glasgow Coma Scale (GCS) (odds ratio [OR] = 0.566, 95% confidence interval [CI] [0.322-0.993], p = 0.047) and red blood cell (RBC) transfusion for 24 h (OR = 1.132, 95% CI [0.996-1.287], p = 0.058) were independent predictors for mortality. CONCLUSIONS Low GCS score and high-volume packed RBC transfusion requirements for 24 h were significant predictors of mortality in patients with blunt IVC injuries. Unlike IVC injuries caused by penetrating trauma, supra-hepatic IVC injuries caused by blunt trauma have a good prognosis.
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Affiliation(s)
- Donghwan Choi
- Division of Trauma Surgery, Department of Surgery, Ajou University School of Medicine, 164 World Cup-ro, Yeongtong-gu, Suwon, 16499, Republic of Korea
| | - Byung Hee Kang
- Division of Trauma Surgery, Department of Surgery, Ajou University School of Medicine, 164 World Cup-ro, Yeongtong-gu, Suwon, 16499, Republic of Korea
| | - Kyoungwon Jung
- Division of Trauma Surgery, Department of Surgery, Ajou University School of Medicine, 164 World Cup-ro, Yeongtong-gu, Suwon, 16499, Republic of Korea
| | - Sang-Hyun Lim
- Department of Thoracic and Cardiovascular Surgery, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Jonghwan Moon
- Division of Trauma Surgery, Department of Surgery, Ajou University School of Medicine, 164 World Cup-ro, Yeongtong-gu, Suwon, 16499, Republic of Korea.
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3
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Kumari D, Kwak DH, Fergus J. Role of Interventional Radiology in the Management of Venous Trauma. Semin Intervent Radiol 2022; 39:508-514. [PMID: 36561937 PMCID: PMC9767770 DOI: 10.1055/s-0042-1757941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Traumatic injury to the large, central venous vasculature, although rare, is associated with high morbidity and mortality rates. Conventional open surgical treatment by repair or ligation can be technically challenging in anatomically difficult areas to expose. Furthermore, open surgical approach can release tension on the venous injury and result in uncontrollable bleeding. Endovascular techniques such as stenting and embolization can be used effectively for the treatment of traumatic venous injury. This article will discuss the morbidity and mortality associated with traumatic venous injuries, venous anatomy, endovascular treatment options, and management of traumatic venous injury.
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Affiliation(s)
- Divya Kumari
- Department of Radiology, University of Chicago Medicine, Chicago, Illinois
| | - Daniel H. Kwak
- Department of Radiology, University of Chicago Medicine, Chicago, Illinois
| | - Jonathan Fergus
- Department of Radiology, University of Chicago Medicine, Chicago, Illinois
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4
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Evans LL, Aarabi S, Durand R, Upperman JS, Jensen AR. Torso vascular trauma. Semin Pediatr Surg 2021; 30:151126. [PMID: 34930597 DOI: 10.1016/j.sempedsurg.2021.151126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Vascular injury within the chest or abdomen represents a unique challenge to the pediatric general surgeon, as these life- or limb-threatening injuries are rare and may require emergent treatment. Vascular injury may present as life-threatening hemorrhage, or with critical ischemia from intimal injury, dissection, or thrombosis. Maintaining the skillset and requisite knowledge to address these injuries is of utmost importance for pediatric surgeons that care for injured children, particularly for surgeons practicing in freestanding children's hospitals that frequently do not have adult vascular surgery coverage. The purpose of this review is to provide an overview of torso vascular trauma, with a specific emphasis in rapid recognition of torso vascular injury as well as both open and endovascular management options. Specific injuries addressed include blunt and penetrating mediastinal vascular injury, subclavian injury, abdominal aortic and visceral segment injury, inferior vena cava injury, and pelvic vascular injury. Operative exposure, vascular repair techniques, and damage control options including preperitoneal packing for pelvic hemorrhage are discussed. The role and limitations of endovascular treatment of each of these injuries is discussed, including endovascular stent graft placement, angioembolization for pelvic hemorrhage, and resuscitative endovascular balloon occlusion of the aorta (REBOA) in children.
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Affiliation(s)
- Lauren L Evans
- Division of Pediatric Surgery, UCSF Benioff Children's Hospitals, Department of Surgery, University of California San Francisco, San Francisco, CA 94611, USA.
| | - Shahram Aarabi
- UCSF-East Bay Surgery Program, Department of Surgery, University of California San Francisco, San Francisco, CA 94611, USA.
| | - Rachelle Durand
- UCSF Benioff Children's Hospitals, and Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA 94611, USA.
| | - Jeffrey S Upperman
- Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, USA.
| | - Aaron R Jensen
- Division of Pediatric Surgery, UCSF Benioff Children's Hospitals, Department of Surgery, University of California San Francisco, San Francisco, CA 94611, USA.
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5
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Prevalence and outcome of abdominal vascular injury in severe trauma patients based on a TraumaRegister DGU international registry analysis. Sci Rep 2021; 11:20247. [PMID: 34642399 PMCID: PMC8511261 DOI: 10.1038/s41598-021-99635-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 09/23/2021] [Indexed: 11/08/2022] Open
Abstract
This study details the etiology, frequency and effect of abdominal vascular injuries in patients after polytrauma based on a large registry of trauma patients. The impact of arterial, venous and mixed vascular injuries on patients' outcome was of interest, as in particular the relevance of venous vessel injury may be underestimated and not adequately assessed in literature so far. All patients of TraumaRegister DGU with the following criteria were included: online documentation of european trauma centers, age 16-85 years, presence of abdominal vascular injury and Abbreviated Injury Scale (AIS) ≥ 3. Patients were divided in three groups of: arterial injury only, venous injury only, mixed arterial and venous injuries. Reporting in this study adheres to the STROBE criteria. A total of 2949 patients were included. All types of abdominal vessel injuries were more prevalent in patients with abdominal trauma followed by thoracic trauma. Rate of patients with shock upon admission were the same in patients with arterial injury alone (n = 606, 33%) and venous injury alone (n = 95, 32%). Venous trauma showed higher odds ratio for in-hospital mortality (OR: 1.48; 95% CI 1.10-1.98, p = 0.010). Abdominal arterial and venous injury in patients suffering from severe trauma were associated with a comparable rate of hemodynamic instability at the time of admission. 24 h as well as in-hospital mortality rate were similar in in patients with venous injury and arterial injury. Stable patients suspected of abdominal vascular injuries should be further investigated to exclude or localize the possible subtle venous injury.
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6
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Imaging in traumatic injury to the inferior vena cava. Clin Radiol 2021; 76:787.e15-787.e25. [PMID: 34108097 DOI: 10.1016/j.crad.2021.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 05/14/2021] [Indexed: 11/21/2022]
Abstract
Inferior vena cava (IVC) injury is a rare but serious consequence of trauma. It presents with high scores on trauma assessment scales and is often life threatening. Factors that contribute to poor survival include delay and difficulty in diagnosis due to non-specific clinical features. As it is a relatively rare entity, imaging in IVC injury is not well described in the literature. As radiologists, it is vital that features of potential IVC injury are recognised promptly and findings relayed to the treating clinician in a timely manner to improve survival and reduce the risk of possible complications. Imaging features that should alert radiologists to IVC injury include contour abnormalities, active extravasation, pseudoaneurysm, and pericaval haematoma. Trauma to the IVC is associated with significant complications. These include exsanguination and refractory shock in the acute period while in the longer term, thrombosis can develop with potential for subsequent pulmonary embolism. Additionally, there are complications that may develop post-surgically including further haemorrhage, IVC stenosis, and infection. We review the spectrum of imaging findings in traumatic IVC injury, which are exemplified with cases from our practice. Furthermore, we discuss important factors to consider during interpretation and the challenges that a radiologist may encounter when making the diagnosis.
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7
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Aabdi M, Jabi R, Mellagui Y, Bkiyar H, Bouzinae M, Housni B. Inferior vena cava injury after blunt trauma: Case report. Int J Surg Case Rep 2021; 81:105791. [PMID: 33773374 PMCID: PMC8024919 DOI: 10.1016/j.ijscr.2021.105791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 03/15/2021] [Accepted: 03/16/2021] [Indexed: 11/23/2022] Open
Abstract
Inferior vena cava injury is a rare injury with high rate mortality. Few clinical cases have described the clinical findings and radiologic appearance of this kind of injury. We describe a rare clinical case of inferior vena cava hematoma. The management depends on the hemodynamic stability of the patient and the level of injury, it might be surgical, endoscopic.
Introduction inferior vena cava IVC injury is rare with lethal outcomes, the clinical signs depends on the location and associated injuries, andt he treatment might be endovascular, surgical. Clinical case A 25 years with no medical history was admitted to the emergency department after a car accident. After intubation and hemodynamic stabilization, the computerized tomography CT scan showed hepatic laceration with a rupture of the IVC in the retro-hepatic portion, he was admitted to the operation room for damage control laparotomy; the patient died 12 h after the operation despite appropriate management. Conclusion IVC are rare and lethal, the CT scan remains the gold standard and the evolution of endovascular techniques decreased the mortality rate.
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Affiliation(s)
- Mohammed Aabdi
- Anesthesiology and Intensive Care Unit Department, MOHAMMED VI University Hospital Center, Oujda, Morocco.
| | - Rachid Jabi
- General Surgery Department, Mohammed VI University Hospital Center, Mohammed I University, Morocco.
| | - Yassine Mellagui
- Anesthesiology and Intensive Care Unit Department, MOHAMMED VI University Hospital Center, Oujda, Morocco.
| | - Houssam Bkiyar
- Anesthesiology and Intensive Care Unit Department, MOHAMMED VI University Hospital Center, Oujda, Morocco.
| | - Mohammed Bouzinae
- General Surgery Department, Mohammed VI University Hospital Center, Mohammed I University, Morocco.
| | - Brahim Housni
- Anesthesiology and Intensive Care Unit Department, MOHAMMED VI University Hospital Center, Oujda, Morocco.
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8
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AlMulhim J, AlMutairi B, Qazi S, Mohammed MF. Retrohepatic IVC injury: A new treatment approach with arterial stent graft. Radiol Case Rep 2021; 16:560-563. [PMID: 33384757 PMCID: PMC7772524 DOI: 10.1016/j.radcr.2020.12.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 12/14/2020] [Accepted: 12/16/2020] [Indexed: 11/17/2022] Open
Abstract
Traumatic injuries to the inferior vena cava (IVC) are rare and among the most dreadful injuries encountered in evaluation of both penetrating and blunt traumatic settings. Clinical outcome of IVC injury is multifactorial with injuries being classically managed surgically. In this report, we present a case of 52 years old male patient with successfully treated blunt retrohepatic IVC injury utilizing arterial stent graft and anticoagulation regime without short-term complications. Evidence based standardized approach for endovascular management of IVC injury is not yet available. We hope that our report can contribute to worldwide procedure and postprocedural anticoagulation standardization.
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Affiliation(s)
- Johara AlMulhim
- King Faisal University, Ahsa, Saudi Arabia
- Corresponding author.
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9
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Castater CA, Carlin M, Parker VD, Sciarretta C, Koganti D, Nguyen J, Grant AA, Smith RN, Ramos CR, Sciarretta JD, Dente CJ, Rajani R, Todd SR. Intra-abdominal Inferior Vena Cava Injuries: Operative Strategies and Outcomes. Am Surg 2020; 87:1316-1326. [PMID: 33345550 DOI: 10.1177/0003134820973395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Visceral vascular injuries are relatively uncommon even in busy urban trauma centers. The inferior vena cava (IVC) is the most frequently injured visceral vein and can be a complex operative challenge. Despite advances in early volume resuscitation, improved transport times, prompt operative intervention, and hemorrhage control, mortality rates have remained largely unchanged. This article conducts an in-depth review of the literature surrounding IVC injuries and a detailed discussion of operative strategies and management as survivability is ultimately dependent on the grade of injury, location, and the presence of hemorrhagic shock.
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Affiliation(s)
- Christine A Castater
- 1371Emory University School of Medicine, 71741Grady Memorial Hospital, Atlanta, GA, USA
| | - Margo Carlin
- 1371Emory University School of Medicine, 71741Grady Memorial Hospital, Atlanta, GA, USA
| | | | | | - Deepika Koganti
- 1371Emory University School of Medicine, 71741Grady Memorial Hospital, Atlanta, GA, USA
| | - Jonathan Nguyen
- 1371Emory University School of Medicine, 71741Grady Memorial Hospital, Atlanta, GA, USA.,Morehouse School of Medicine, 71741Grady Memorial Hospital, Atlanta, GA, USA
| | - April A Grant
- 1371Emory University School of Medicine, 71741Grady Memorial Hospital, Atlanta, GA, USA
| | - Randi N Smith
- 1371Emory University School of Medicine, 71741Grady Memorial Hospital, Atlanta, GA, USA
| | - Christopher R Ramos
- 1371Emory University School of Medicine, 71741Grady Memorial Hospital, Atlanta, GA, USA
| | - Jason D Sciarretta
- 1371Emory University School of Medicine, 71741Grady Memorial Hospital, Atlanta, GA, USA
| | - Christopher J Dente
- 1371Emory University School of Medicine, 71741Grady Memorial Hospital, Atlanta, GA, USA
| | - Ravi Rajani
- 1371Emory University School of Medicine, 71741Grady Memorial Hospital, Atlanta, GA, USA
| | - Samual R Todd
- 1371Emory University School of Medicine, 71741Grady Memorial Hospital, Atlanta, GA, USA.,University of Utah School of Medicine, Salt Lake City, UT, USA
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10
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Balachandran G, Bharathy KGS, Sikora SS. Penetrating injuries of the inferior vena cava. Injury 2020; 51:2379-2389. [PMID: 32838960 DOI: 10.1016/j.injury.2020.08.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 08/16/2020] [Indexed: 02/02/2023]
Abstract
Inferior vena cava (IVC) injuries occur in 0.5-5% of cases of penetrating abdominal injury. Uncommonly encountered in general surgical and trauma practice, they remain extremely lethal despite advances in resuscitation and critical care. Important factors determining treatment outcomes are the hemodynamic status of the patient at presentation, the level and extent of injury, and the presence of associated injuries. Operative approaches and techniques for definitive repair are to be tailored to the condition of the patient, type of injury, and available expertise. In a patient with severe hemodynamic compromise, damage control principles take priority to stop bleeding and save life. The most commonly employed strategies are venorrhaphy or ligation. Retro-hepatic and supra-hepatic caval injuries are particularly challenging in terms of exposure and repair, and are associated with high fatality. Endovascular approaches are being used in select cases with success. This paper reviews in detail the epidemiology, injury patterns, management protocols, and outcomes of IVC injuries due to penetrating abdominal trauma.
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Affiliation(s)
- Gayatri Balachandran
- Department of Surgical Gastroenterology, Institute of Digestive & HPB Sciences, Sakra World Hospital, SY No.52/2 & 52/3, Devarabeesanahalli, Oppsite Intel, VarthurHobli, Bengaluru, Karnataka 560103, india
| | - Kishore G S Bharathy
- Department of Surgical Gastroenterology, Institute of Digestive & HPB Sciences, Sakra World Hospital, SY No.52/2 & 52/3, Devarabeesanahalli, Oppsite Intel, VarthurHobli, Bengaluru, Karnataka 560103, india
| | - Sadiq S Sikora
- Department of Surgical Gastroenterology, Institute of Digestive & HPB Sciences, Sakra World Hospital, SY No.52/2 & 52/3, Devarabeesanahalli, Oppsite Intel, VarthurHobli, Bengaluru, Karnataka 560103, india.
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11
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Leon M, Chavez LO, Chavez A, Surani S. Blunt Aortic / Inferior Vena Cava Injury: Are We Consistently Providing the Same Level of Care? Cureus 2020; 12:e6832. [PMID: 32181075 PMCID: PMC7051116 DOI: 10.7759/cureus.6832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Major vascular traumatic injuries have a higher pre-hospital and in-hospital mortality rate. The different mechanisms of injury and anatomy of the aorta and inferior vena cava (IVC) make the management a constant challenge to surgeons and clinicians. Blunt traumatic aortic injury (BTAI) can occur at the thoracic or abdominal level, each of which possesses different considerations. Blunt traumatic inferior vena cava injury (BTIVCI) also has important diagnostic challenges since the lesion may not be as evident in the IVC as compared to the aorta, possibly due to lower caval pressures or the ability to self-tamponade from adjacent structures. Endovascular management has significantly increased in the past years, and despite an improvement in mortality, the approach to aortic and IVC injuries is not well standardized. Diagnostic imaging helps to classify the extent of the lesions and guide towards the best therapeutic options for each case. Conservative management, in some cases, has shown to reduce mortality, and close follow-up has proven good outcomes. Future research will provide more evidence to determine the best approach to BTAI and BTIVCI for better long-term outcomes. This article aims to provide an updated review of the current literature regarding diagnosis, classification, and management of BTAI and BTIVCI.
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Affiliation(s)
- Monica Leon
- General Surgery, ABC Medical Center, Mexico City, MEX
| | - Luis O Chavez
- Internal Medicine, Texas Tech University Health Sciences Center, El Paso, USA
| | - Alda Chavez
- Faculty of Medicine and Psychology, Autonomous University of Baja California, Tijuana, MEX
| | - Salim Surani
- Internal Medicine, Texas A&M Health Science Center, Bryan, USA
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12
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Choi HI, Kim YK, Choi SI, Kim K. Spontaneous rupture of inferior vena cava. Am J Emerg Med 2017; 35:1383.e3-1383.e4. [PMID: 28579295 DOI: 10.1016/j.ajem.2017.05.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 05/26/2017] [Indexed: 11/28/2022] Open
Abstract
Spontaneous ruptures of the inferior vena cava (IVC) are rare. The mortality rate is high associated with all IVC injuries despite prompt resuscitation or operation. We present a case of 68-year-old women with spontaneous IVC dissection, presented as acute chest pain. Chest CT demonstrated a large amount of hemopericardium, and dilated inferior vena cava (IVC), suggesting cardiac tampon. Subsequently, hypovolemic shock and cardiac arrest occurred. After resuscitation, abdomen CT angiography was taken to find bleeding focus. Second CT demonstrated massive contrast extravasation to pericardial space due to rupture of IVC. Patient expired due to multi-organ failure.
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Affiliation(s)
- Hyoung In Choi
- Department of Radiology, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
| | - Yeo Koon Kim
- Department of Radiology, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Republic of Korea.
| | - Sang Il Choi
- Department of Radiology, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Republic of Korea
| | - Kyuseok Kim
- Department of Emergency Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Republic of Korea
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13
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Chandhok P, Civil ID. Intraabdominal Vascular Injuries in Blunt Trauma: Spectrum of Presentation, Severity and Management Options. CURRENT TRAUMA REPORTS 2017. [DOI: 10.1007/s40719-017-0078-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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14
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15
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Bianchini Massoni C, Di Saverio S, Catena F, Coniglio C, Caspani ML, Biscardi A, Gallitto E, Gordini G, Tugnoli G. Infrarenal inferior vena cava injury after blunt trauma. Vasc Med 2015; 20:84-5. [DOI: 10.1177/1358863x14565375] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Claudio Bianchini Massoni
- Vascular Surgery Department, University of Bologna, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Salomone Di Saverio
- Trauma Surgery Unit, Maggiore Hospital Regional Trauma Center – Bologna Local Health District, Bologna, Italy
| | - Fausto Catena
- Emergency and Trauma Surgery Department, Maggiore Hospital of Parma, Parma, Italy
| | - Carlo Coniglio
- Trauma ICU/Trauma Center, Department of Emergency, Maggiore Hospital – Bologna Local Health District, Bologna, Italy
| | - Maria Luisa Caspani
- Emergency and Trauma Surgery Department, Maggiore Hospital of Parma, Parma, Italy
| | - Andrea Biscardi
- Trauma Surgery Unit, Maggiore Hospital Regional Trauma Center – Bologna Local Health District, Bologna, Italy
| | - Enrico Gallitto
- Vascular Surgery Department, University of Bologna, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Giovanni Gordini
- Trauma ICU/Trauma Center, Department of Emergency, Maggiore Hospital – Bologna Local Health District, Bologna, Italy
| | - Gregorio Tugnoli
- Trauma Surgery Unit, Maggiore Hospital Regional Trauma Center – Bologna Local Health District, Bologna, Italy
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16
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Matthees NG, Mankin JA, Kalinkin OM, Richardson RR. A rare opportunity for conservative treatment in a case of blunt trauma to the supradiaphragmatic inferior vena cava. J Surg Case Rep 2013; 2013:rjt092. [PMID: 24968427 PMCID: PMC3853105 DOI: 10.1093/jscr/rjt092] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Injuries to the inferior vena cava (IVC) secondary to blunt trauma are rare and occur in only 1-10% of all blunt trauma patients. Management of these injuries has not been subjected to major studies, but several case reports and small retrospective studies have demonstrated that management can be tailored to the hemodynamic status of the patient; this is similar to the management of blunt liver injuries. Stable patients whose injuries have achieved local venous tamponade have been successfully treated without surgical intervention, while unstable patients require operative management. Regardless of patient status, however, IVC injuries are highly fatal with mortality rates between 70 and 90%. This report describes the case of a patient with a blunt traumatic injury to the supradiaphragmatic IVC with development of a pseudoaneurysm who was successfully managed conservatively.
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Affiliation(s)
| | - James A Mankin
- Department of Trauma Surgery, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Olga M Kalinkin
- Department of Radiology, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Randy R Richardson
- Department of Radiology, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
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17
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Genovese EA, Fonio P, Floridi C, Macchi M, Maccaferri A, Ianora AAS, Cagini L, Carrafiello G. Abdominal vascular emergencies: US and CT assessment. Crit Ultrasound J 2013; 5 Suppl 1:S10. [PMID: 23902665 PMCID: PMC3711735 DOI: 10.1186/2036-7902-5-s1-s10] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Acute vascular emergencies can arise from direct traumatic injury to the vessel or be spontaneous (non-traumatic).The vascular injuries can also be divided into two categories: arteial injury and venous injury.Most of them are life-treatening emergencies, sice they may cause an important ipovolemic shock or severe ischemia in their end organ and require prompt diagnosis and treatment.In the different clinical scenarios, the correct diagnostic approach to vascular injuries isn't firmly established and advantages of one imaging technique over the other are not obvious.Ultrasound (US) is an easy accessible, safe and non-invasive diagnostic modality but Computed Tomography (CT) with multiphasic imaging study is an accurate modality to evaluate the abdominal vascular injuries therefore can be considered the primary imaging modality in vascular emergencies.The aim of this review article is to illustrate the different imaging options for the diagnosis of abdominal vascular emergencies, including traumatic and non traumatic vessel injuries, focusing of US and CT modalities.
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Holly BP, Steenburg SD. Multidetector CT of blunt traumatic venous injuries in the chest, abdomen, and pelvis. Radiographics 2012; 31:1415-24. [PMID: 21918052 DOI: 10.1148/rg.315105221] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Venous injuries as a result of blunt trauma are rare. Even though current protocols for multidetector computed tomography (CT) of patients with trauma are designed to evaluate primarily the solid organs and arteries, blunt venous injuries may nevertheless be identified, or at least suspected, on the basis of the multidetector CT findings. Venous injuries are associated with high morbidity and mortality rates. Diagnosis of a possible venous injury is crucial because the physical findings of a venous injury are nonspecific and may be absent. This article aims to make the radiologist aware of various venous injuries caused by blunt trauma and to provide helpful hints to aid in the identification of venous injuries. Multidetector CT technology, in combination with interactive manipulation of the raw dataset, can be useful in the creation of multiplanar reconstructed images and in the identification of a venous injury caused by blunt trauma. Familiarity with direct and indirect signs of venous injuries, as well as with examples of blunt traumatic venous injuries in the chest, abdomen, and pelvis, will help in the diagnosis of these injuries.
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Affiliation(s)
- Brian P Holly
- Department of Diagnostic Radiology, University of Maryland Medical Center, Baltimore, MD 21201, USA.
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Kashima I, Mochizuki Y, Okamoto M. Repair of lacerated intrapericardial inferior vena cava after cardiac massage. Ann Thorac Surg 2011; 92:1510-2. [PMID: 21958806 DOI: 10.1016/j.athoracsur.2011.03.125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2011] [Revised: 02/22/2011] [Accepted: 03/25/2011] [Indexed: 11/27/2022]
Abstract
We successfully undertook surgical treatment of intrapericardial laceration of the inferior vena cava caused by external cardiac massage in a patient with acute coronary syndrome. Injury to the inferior vena cava without blunt trauma is very rare, and diagnostic imaging does not show it clearly, making it difficult to diagnose. Rapid and accurate judgment and management are necessary, because the mortality due to this injury is very high.
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Affiliation(s)
- Ichiro Kashima
- Department of Cardiovascular Surgery, Ashikaga Red Cross Hospital, Ashikaga, Tochigi, Japan.
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Does CT evidence of a flat inferior vena cava indicate hypovolemia in blunt trauma patients with solid organ injuries? ACTA ACUST UNITED AC 2011; 70:1358-61. [PMID: 21378583 DOI: 10.1097/ta.0b013e3181f31e37] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Nonoperative management for selective patients with solid organ injuries from blunt trauma has gained wide acceptance. However, for trauma surgeons, it is often difficult to estimate a patient's circulatory volume. Some authors have proposed that the presence of a collapsed inferior vena cava (IVC) on computed tomography (CT) scan correlates with inadequate circulatory volume. Our aim was to verify whether CT evidence of a flat IVC (FI) is an indicator of hypovolemia in blunt trauma patients with solid organ injuries. METHODS We conducted a retrospective chart review of all blunt trauma patients with solid organ injuries admitted to our Medical Center from July 2003 to September 2006. Of the 226 patients reviewed, 29 had CT evidence of FI. We compared Injury Severity Scores, hemodynamic parameters, fluid and blood transfusion requirements, mortality rate, and hospital course between patients with (FI group) and without FI (non-FI [NFI] group). RESULTS The FI group had higher rates of intensive care unit admission and mortality, in addition to longer intensive care unit stays, when compared with the NFI group. In addition, the patients in the FI group needed larger amounts of fluid and blood transfusions and presented lower hemoglobin levels during the first week of admission; furthermore, the majority deteriorated to a state of shock in the emergency department. CONCLUSIONS CT evidence of FI is a good indicator of hypovolemia and an accurate predictor for prognosis in trauma patients with blunt solid organ injuries.
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Kaoutzanis C, Evangelakis E, Kokkinos C, Kaoutzanis G. Successful repair of injured hepatic veins and inferior vena cava following blunt traumatic injury, by using cardiopulmonary bypass and hypothermic circulatory arrest. Interact Cardiovasc Thorac Surg 2011; 12:84-86. [DOI: 10.1510/icvts.2010.249722] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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22
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Bourkiza R, Hegade V, Menon J. Fatal avulsion of inferior vena cava following blunt abdominal trauma. Br J Hosp Med (Lond) 2010; 71:352-3. [PMID: 20551878 DOI: 10.12968/hmed.2010.71.6.48458] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- R Bourkiza
- Department of Surgery, Basildon and Thurrock University Hospital, Nethermayne, Basildon, Essex
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Vaidya SS, Bhargava P, Marder CP, Dighe MK. Inferior vena cava dissection following blunt abdominal trauma. Emerg Radiol 2010; 17:339-42. [DOI: 10.1007/s10140-010-0864-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2010] [Accepted: 02/18/2010] [Indexed: 11/28/2022]
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Cole K, Shadis R, Sullivan TR. Retrohepatic hematoma causing caval compression after blunt abdominal trauma. JOURNAL OF SURGICAL EDUCATION 2009; 66:48-50. [PMID: 19215898 DOI: 10.1016/j.jsurg.2008.09.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2008] [Revised: 07/24/2008] [Accepted: 09/17/2008] [Indexed: 05/27/2023]
Abstract
Blunt injury to the inferior vena cava (IVC) is a rare event, which occurs in 1% to 10% of blunt-trauma patients. Injuries usually result from deceleration, which causes atriocaval rupture or tearing of the hepatic veins, and are sometimes complicated by uncontrollable hemorrhage. An unusual case of focal extrinsic compression of the vessel caused by retrohepatic hemorrhage is reported, which ultimately has required no operative intervention and seems to have had no long-term ill effects. The literature on blunt injury to the IVC is reviewed, which includes a review of posttraumatic Budd-Chiari syndrome.
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Affiliation(s)
- Karin Cole
- Department of Surgery, Abington Memorial Hospital, Abington, Pennsylvania, USA.
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Daly KP, Ho CP, Persson DL, Gay SB. Traumatic Retroperitoneal Injuries: Review of Multidetector CT Findings. Radiographics 2008; 28:1571-90. [PMID: 18936022 DOI: 10.1148/rg.286075141] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Multidetector computed tomography (CT) represents a significant advance in CT technology and can allow the accurate assessment of trauma patients, including the detection of traumatic retroperitoneal injuries, many of which are clinically occult. Retroperitoneal injuries include duodenal, pancreatic, vascular, renal, and adrenal injuries. Abnormal blood, fluid, or air within the retroperitoneal spaces may be isolated findings but can also occur in association with these injuries, and their recognition is the key to correctly identifying the injury. Accurate characterization of injury with CT can affect clinical management and can help minimize unnecessary laparotomies. Equivocal findings at initial abdominal CT should prompt close clinical follow-up with possible imaging follow-up, particularly for suspected occult duodenal and pancreatic injuries.
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Affiliation(s)
- Kevin P Daly
- Department of Radiology, University of Virginia Health System, Charlottesville, VA, USA.
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Ridereau-Zins C, Lebigot J, Bouhours G, Casa C, Aubé C. Traumatismes abdominaux : les lésions élémentaires. ACTA ACUST UNITED AC 2008; 89:1812-32. [DOI: 10.1016/s0221-0363(08)74489-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Anderson SW, Lucey BC, Rhea JT, Soto JA. 64 MDCT in multiple trauma patients: imaging manifestations and clinical implications of active extravasation. Emerg Radiol 2007; 14:151-9. [PMID: 17483969 DOI: 10.1007/s10140-007-0600-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2006] [Accepted: 02/27/2007] [Indexed: 10/23/2022]
Abstract
The finding of active hemorrhage on computed tomography (CT) in trauma patients has been shown to have significant clinical implications and has been incorporated into numerous CT grading schema. As CT technology has advanced, the sensitivity for detection of active hemorrhage in the trauma population has significantly improved. Currently, with the improved spatial and temporal resolution afforded by 64 multidetector computed tomography (64 MDCT) technology, the clinical implications of the CT findings of active extravasation may need to be reconsidered. This article illustrates the various imaging manifestations of active extravasation throughout the body using 64 MDCT. Additionally, protocol issues specific to the findings of active hemorrhage using 64 MDCT are detailed, including novel interpretation techniques, which offer aid in detecting and characterizing hemorrhage. Finally, the clinical implication of active extravasation using this new technology is discussed. Although more sensitive to the detection of small hemorrhagic foci and with clinical implications highly dependent upon location, active bleeding remains as a salient finding that affects subsequent clinical management of trauma patients.
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Affiliation(s)
- Stephan W Anderson
- Department of Radiology, Boston University Medical Center, 88 East Newton Street, 2nd Floor, Boston, MA 02215, USA.
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