Case report: direct suture repair of inferior vena cava to rescue a stab patient with hepatic and caval injury through left hepatectomy and total vascular exclusion

A Novel Technique of Hemorrhage Control for an Inferior Vena Cava Injury From an Abdominal Stab Wound Using Two Balloon Occlusion Catheters: A Case Report

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.

Management of Inferior vena cava injury in a resource limited setup: A rare case report

INTRODUCTION AND IMPORTANCE

Traumatic injuries of the inferior Vena Cava (IVC) are rare among traumatic abdominal injuries. It accounts for fewer than 5 % of penetrating injuries and 0.5 % of blunt trauma injuries. Inferior vena cava injury has high Prehospital (30 % -50 %) and in-hospital (20 % - 66 %) mortality rates. Preoperative diagnosis of IVC injury is extremely difficult. Ligation, primary suture repair (venorrhaphy) and patch cavaplasty are among the management options for Inferior vena cava injury. Inferior vena cava injuries are rare and information is scarce especially in resource limited setups.

CASE PRESENTATION

A 22 years old female presented with right upper quadrant abdominal stab injury of 30 min duration. She was hypotensive and there was 3 × 2 cm right upper quadrant stab wound with breach of parietal peritoneum. The intraoperative finding was gallbladder perforation .duodenum through-through injury and suprarenal inferior vena cava 3 cm vertical laceration. Cholecystectomy, duodenal repair and direct suture repair (venorrhaphy) of IVC done. Post operatively patient had smooth course and discharged on her 9th pod day.

CLINICAL DISCUSSION

The most frequently injured segment of the IVC is the infra-renal IVC (39 %), then the retro-hepatic IVC (19 %), the supra-renal IVC (18 %), the para-renal IVC (17 %) and the supra-hepatic IVC (7 %). The suprahepatic IVC has the highest mortality rate (100 %), followed by mortality rates of the retro hepatic IVC (78 %), juxtarenal IVC (50 %), suprarenal IVC (33 %), and infrarenal IVC (33 %). Operative management includes ligation, primary suture repair (venorrhaphy) and patch cavaplasty using saphenous vein graft, autogenously peritoneo-fascial (APF) graft, synthetic graft such as Gore-Tex and Dacron.

CONCLUSION

Traumatic injury of the inferior Vena Cava is rare, however the mortality rate is high. Adequate resuscitation and early hemorrhage control (operation) can save the lives of IVC injured patients. We present a case of successful repair of IVC injury by venorrhaphy (suture repair) in a resource limited setup.

Endovascular thrombectomy and repair of suprarenal inferior vena cava thrombosis: A case series

OBJECTIVES

The objective of this study is to document the combined use of catheter-based thrombectomy/thrombolysis with endovascular repair of high-risk segments of the inferior vena cava in the setting of iatrogenic and traumatic injuries. While the use of endovascular techniques to treat caval thrombosis is well documented and often preferred due to its minimally invasive nature, there is still little literature that focuses on the nuances related to injury of high mortality areas of the IVC as a result of major trauma, transplant, and other surgical interventions.

METHODS

An IRB-approved retrospective review of all patients undergoing IVC thrombectomy was performed at a single tertiary care academic center between January 2018 and July 2021. Cases were subsequently selected based on those who underwent primary mechanical thrombectomy followed by endovascular stenting (or angioplasty). Among this cohort, four patients who underwent this procedure in the context of iatrogenic and traumatic injuries were included.

RESULTS

All four patients undergoing primary mechanical thrombectomy followed by endovascular stenting (or angioplasty) due to IVC thrombus and/or stenosis were technically successful with immediate positive clinical outcomes.

CONCLUSIONS

Mechanical thrombectomy in conjunction with IVC recanalization via stenting may be a useful intervention with promising technical success and positive clinical outcomes for occlusive thrombosis and IVC stenosis.