Retrohepatic Inferior Vena Cava Injury Following Blunt Trauma: An Interdisciplinary Team Approach
Clark Murray, Dorothy Liu, Jorge Acevedo Herman, Paulo Martins, Bruce Simon, Adel Bozorgzadeh, Michael DeBusk
University of Massachusetts Medical School
Background: Retrohepatic inferior vena cava (IVC) injury is a rare, high mortality complication of blunt trauma. The location of these injuries combined with high likelihood of extension superiorly to the cavoatrial junction leads to the need for complex repairs bridging between the abdomen and mediastinum in patients who have suffered large physiologic insults from trauma. The ideal management of these patients is unclear due to their rarity and complexity.
Methods: The trauma registry at a single center level I trauma center was reviewed from 2013-2020 for blunt inferior vena cava injuries. A retrospective chart review was performed of identified patients excluding sub-hepatic inferior vena cava injuries and any penetrating injuries. Operative reports were reviewed for the presence of trauma, hepatobiliary, and cardiac surgical teams as well as patient outcomes.
Results: 8 patients were identified with blunt retrohepatic inferior vena cava injuries. Of these, 3 were managed by trauma surgery alone, 2 by trauma surgery with either cardiac surgery or hepatobiliary surgery, and 3 with all three services present in the operating room simultaneously. Only the patients with all three services present in the operating room had completion of the inferior vena cava repair with one patient surviving to hospital discharge.
Conclusion: Blunt retrohepatic inferior vena cava injuries are complex and benefit from interdisciplinary management. Protocols implemented to notify these teams upon identification of these injuries may lead to increased patient survival.
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