Management of Traumatic Abdominal Inferior Vena Cava Injuries and Predictors of Its Mortality

Rashid Usman, Muhammad Jamil, Saira Ambreen, Raoon Khan, Shahid Majeed

Abstract

Objective

To document the experience of management of traumatic abdominal inferior vena cava (IVC) injuries and the impact of various perioperative variables on its mortality.

Study design

Cross sectional study.

Place & Duration of study

Military Trauma Centres, Combined Military Hospital Quetta, Lahore, Peshawar and Rawalpindi, from January 2005 to  January 2019.

Methodology

All consecutive patients with IVC injuries fulfilling the inclusion criteria, were included. Demographics, management and perioperative variables were recorded.

Results

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.

Conclusions

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.

Key words

Inferior vena cava, Vascular injury, Abdominal trauma, Venous injury.