Management of Traumatic Abdominal Inferior Vena Cava Injuries and Predictors of Its Mortality
Rashid Usman, Muhammad Jamil, Saira Ambreen, Raoon Khan, Shahid Majeed
To document the experience of management of traumatic abdominal inferior vena cava (IVC) injuries and the impact of various perioperative variables on its mortality.
Cross sectional study.
Place & Duration of study
Military Trauma Centres, Combined Military Hospital Quetta, Lahore, Peshawar and Rawalpindi, from January 2005 to January 2019.
All consecutive patients with IVC injuries fulfilling the inclusion criteria, were included. Demographics, management and perioperative variables were recorded.
Out of 42 patients with mean age 26.8 ± 3.3 year, there were 32 (76.2%) males. Penetrating injury was the cause in 28 (66.7%) patients. Most common injury site was infra renal segment (76.2%). Commonest type of injury was partial laceration (n=12 - 28.5%) and most common repair performed was primary venorrhaphy in 14 (38.9%) cases followed by ligation in 10 (27.8%). Overall mortality rate was 42.8% (n=18). In terms of repair; the mortality rate was highest for ligation (60%), me_chanism of injury [OR 1.11 (95% CI: 1.03-1.38), P = 0.002], systolic BP [OR 1.11 (95% CI: 1.02-1.33), P = 0.002], high serum lactate levels [OR 1.29 (95% CI: 1.09-1.44), P = 0.002], concomitant solid organ injury [OR 1.05 (95% CI: 1.01-1.35), P = 0.002], concomitant extra abdominal injuries, PRCT [OR 1.21 (95% CI: 1.11-1.67), P = 0.037] and prolonged ICU stay [OR 1.09 (95% CI: 1.02-1.44), P= 0.003]; were found to be independent positive predictors of higher mortality.
Abdominal IVC injury is associated with high mortality with supra hepatic injuries being almost fatal. Best results are achieved with primary repair and ligation has poor outcome.
Inferior vena cava, Vascular injury, Abdominal trauma, Venous injury.