Despite Major Therapeutic Advances, Vena Caval Trauma Remains Associated with Significant Morbidity and Mortality

Abstract

Background: Penetrating inferior vena caval injuries remain a challenging operative entity. This study reviews our local experience with the injury over a nine-year period and attempts to contextualize it within the published literature that emanates from South Africa on the topic.

Methods: A single-centre retrospective review of prospectively collected data was performed of all patients who underwent a laparotomy for a penetrating IVC injury. Descriptive statistics were calculated for demographics, clinical and biochemical parameters, intraoperative data, ICU admission and outcomes.

Results: During the nine-year period, thirty-five patients sustained penetrating injuries to the IVC. Mechanism of injury included 25 low velocity gunshots (71%) and 10 stab wounds (29%). The anatomical location included two (6%) supra-renal, six (17%) juxta-renal and 27 (77%) infra-renal injuries. Venorrhaphy was performed in 22 cases (63%) and ligation in 13 (37%). Average ICU stay was 5.4 days. Thirteen patients died (37%), of which six (46%) died within 24 h of arrival.

Conclusion: Despite dramatic improvements in surgical trauma care over the last four decades, penetrating injury to the IVC carries a high mortality rate ranging from 31 to 37%. It is unlikely that further improvements can be achieved by refining operative techniques and approaches to resuscitation. Future endeavours must focus on applying the burgeoning understanding of endovascular surgery to these injuries.