Journal of Trauma and Injury

  • 제36권2호
  • /
  • Pages.105-113
  • /
  • 2023
  • /
  • 2799-4317(pISSN)
  • /
  • 2287-1683(eISSN)
대한외상학회 (The Korean Society of Traumatology)
권호 표지
DOI QR코드

DOI QR Code

Experience of surgical treatments for abdominal inferior vena cava injuries in a regional trauma center in Korea

  • Jin Woo Park (Department of Surgery, Dankook University Hospital) ;
  • Dong Hun Kim (Division of Trauma Surgery, Department of Surgery, Dankook University College of Medicine)
  • 투고 : 2023.01.18
  • 심사 : 2023.03.28
  • 발행 : 2023.06.30
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Purpose: Inferior vena cava (IVC) injuries are a rare type of traumatic abdominal injuries that are challenging to treat and have a very high mortality rate. This study described our experience with the surgical treatment of traumatic IVC injuries, and we investigated the demographics, clinical profiles, and surgical outcomes of cases at a regional trauma center. Methods: Among the 16 patients who were treated for a traumatic IVC injury between January 2014 and March 2022, 14 underwent surgery. The surgical outcomes included overall mortality and 24-hour mortality, and we investigated the factors associated with these surgical outcomes. The 14 patients were divided into two groups according to the location of the IVC injury (retrohepatic IVC or higher vs. subhepatic IVC), and differences between the two groups were analyzed. Results: A body mass index (BMI) >23.0 kg/m2 (P=0.046), an elevated serum lactate level (P=0.043), and a shorter operation time (P=0.016) were associated with overall mortality. A higher BMI (P=0.050), higher serum lactate level (P=0.004), shorter operation time (P=0.005), and an injury at the retrohepatic IVC or higher level (P=0.031) were associated with 24-hour mortality. Younger age (P=0.028), higher BMI (P=0.005), more acidic pH, higher lactatemia (P=0.012), a higher hemoglobin level (P=0.012), and shorter door-to-operating room time (P=0.028) were associated with injury at the retrohepatic IVC or higher level. Patients with subhepatic IVC injuries had a high rate of direct repair (75.0%) and a significantly lower 24-hour mortality rate (37.5%, P=0.031). Conclusions: Subhepatic IVC injuries are easy to access and are usually expected to treat with a direct repair method. Injuries at the retrohepatic IVC or higher level are difficult to treat surgically and require a systematic and multidisciplinary treatment strategy.

키워드

참고문헌

  1. Rehman ZU. Inferior vena cava injuries: a clinical review. J Pak Med Assoc 2020;70:1069-71.
  2. Matsumoto S, Jung K, Smith A, Coimbra R. Management of IVC injury: repair or ligation? A propensity score matching analysis using the National Trauma Data Bank. J Am Coll Surg 2018;226:752-9. https://doi.org/10.1016/j.jamcollsurg.2018.01.043
  3. Sullivan PS, Dente CJ, Patel S, et al. Outcome of ligation of the inferior vena cava in the modern era. Am J Surg 2010;199:500-6. https://doi.org/10.1016/j.amjsurg.2009.05.013
  4. Burch JM, Feliciano DV, Mattox KL. The atriocaval shunt: facts and fiction. Ann Surg 1988;207:555-68. https://doi.org/10.1097/00000658-198805000-00010
  5. Castater CA, Carlin M, Parker VD, et al. Intra-abdominal inferior vena cava injuries: operative strategies and outcomes. Am Surg 2021;87:1316-26. https://doi.org/10.1177/0003134820973395
  6. Cudworth M, Fulle A, Ramos JP, Arriagada I. GCS as a predictor of mortality in patients with traumatic inferior vena cava injuries: a retrospective review of 16 cases. World J Emerg Surg 2013;8:59.
  7. Byerly S, Tamariz L, Lee EE, et al. A systematic review and meta-analysis of ligation versus repair of inferior vena cava injuries. Ann Vasc Surg 2021;75:489-96. https://doi.org/10.1016/j.avsg.2021.02.032
  8. Rosengart MR, Smith DR, Melton SM, May AK, Rue LW 3rd. Prognostic factors in patients with inferior vena cava injuries. Am Surg 1999;65:849-56. https://doi.org/10.1177/000313489906500909
  9. Meredith W, Rutledge R, Fakhry SM, Emery S, Kromhout-Schiro S. The conundrum of the Glasgow Coma Scale in intubated patients: a linear regression prediction of the Glasgow verbal score from the Glasgow eye and motor scores. J Trauma 1998;44:839-45. https://doi.org/10.1097/00005373-199805000-00016
  10. Graham JM, Mattox KL, Beall AC Jr, DeBakey ME. Traumatic injuries of the inferior vena cava. Arch Surg 1978;113:413-8. https://doi.org/10.1001/archsurg.1978.01370160071011
  11. Navsaria PH, de Bruyn P, Nicol AJ. Penetrating abdominal vena cava injuries. Eur J Vasc Endovasc Surg 2005;30:499-503. https://doi.org/10.1016/j.ejvs.2005.08.004
  12. Tsai R, Raptis C, Schuerer DJ, Mellnick VM. CT appearance of traumatic inferior vena cava injury. AJR Am J Roentgenol 2016;207:705-11. https://doi.org/10.2214/AJR.15.15870
  13. Giannakopoulos TG, Avgerinos ED. Management of peripheral and truncal venous injuries. Front Surg 2017;4:46.
  14. van Rooyen PL, Karusseit VO, Mokoena T. Inferior vena cava injuries: a case series and review of the South African experience. Injury 2015;46:71-5. https://doi.org/10.1016/j.injury.2014.06.016
  15. Brahmbhatt TS, Hernon M, Siegert CJ, Plauche L, Young LS, Burke P. Trauma and BMI mortality. Curr Obes Rep 2017;6:211-6. https://doi.org/10.1007/s13679-017-0264-9
  16. Baxter J, Cranfield KR, Clark G, Harris T, Bloom B, Gray AJ. Do lactate levels in the emergency department predict outcome in adult trauma patients? A systematic review. J Trauma Acute Care Surg 2016;81:555-66. https://doi.org/10.1097/TA.0000000000001156
  17. Byerly S, Cheng V, Plotkin A, Matsushima K, Inaba K, Magee GA. Impact of inferior vena cava ligation on mortality in trauma patients. J Vasc Surg Venous Lymphat Disord 2019;7:793-800. https://doi.org/10.1016/j.jvsv.2019.06.013
  18. Kobayashi LM, Costantini TW, Hamel MG, Dierksheide JE, Coimbra R. Abdominal vascular trauma. Trauma Surg Acute Care Open 2016;1:e000015.
  19. Chaib E, Saad WA, Fujimura I, Saad WA Jr, Gama-Rodrigues J. The main indications and techniques for vascular exclusion of the liver. Arq Gastroenterol 2003;40:131-6. https://doi.org/10.1590/S0004-28032003000200013
  20. Richardson JD, Franklin GA, Lukan JK, et al. Evolution in the management of hepatic trauma: a 25-year perspective. Ann Surg 2000;232:324-30. https://doi.org/10.1097/00000658-200009000-00004
  21. Richardson JD. Changes in the management of injuries to the liver and spleen. J Am Coll Surg 2005;200:648-69. https://doi.org/10.1016/j.jamcollsurg.2004.11.005