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Kumari D, Kwak DH, Fergus J. Role of Interventional Radiology in the Management of Venous Trauma. Semin Intervent Radiol 2022; 39:508-514. [PMID: 36561937 PMCID: PMC9767770 DOI: 10.1055/s-0042-1757941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Traumatic injury to the large, central venous vasculature, although rare, is associated with high morbidity and mortality rates. Conventional open surgical treatment by repair or ligation can be technically challenging in anatomically difficult areas to expose. Furthermore, open surgical approach can release tension on the venous injury and result in uncontrollable bleeding. Endovascular techniques such as stenting and embolization can be used effectively for the treatment of traumatic venous injury. This article will discuss the morbidity and mortality associated with traumatic venous injuries, venous anatomy, endovascular treatment options, and management of traumatic venous injury.
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Affiliation(s)
- Divya Kumari
- Department of Radiology, University of Chicago Medicine, Chicago, Illinois
| | - Daniel H. Kwak
- Department of Radiology, University of Chicago Medicine, Chicago, Illinois
| | - Jonathan Fergus
- Department of Radiology, University of Chicago Medicine, Chicago, Illinois
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Martins PN, Buchwald JE, Movahedi B, Torres U, Emhoff T, Walker J, DeBusk MG, Bozorgzadeh A. Successful treatment of complete traumatic transection of the suprahepatic inferior vena cava with veno-venous and cardiopulmonary bypass with hypothermic circulatory arrest. Hepatobiliary Pancreat Dis Int 2021; 20:601-610. [PMID: 33468417 DOI: 10.1016/j.hbpd.2020.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 12/23/2020] [Indexed: 02/05/2023]
Affiliation(s)
- Paulo N Martins
- Department of Surgery, Division of Transplantation, University of Massachusetts, Worcester, MA 01655, USA
| | - Julianna E Buchwald
- Department of Surgery, Division of Transplantation, University of Massachusetts, Worcester, MA 01655, USA
| | - Babak Movahedi
- Department of Surgery, Division of Transplantation, University of Massachusetts, Worcester, MA 01655, USA
| | - Ulises Torres
- Department of Surgery, Division of Trauma, University of Massachusetts, Worcester, MA 01655, USA
| | - Timothy Emhoff
- Department of Surgery, Division of Trauma, University of Massachusetts, Worcester, MA 01655, USA
| | - Jennifer Walker
- Department of Surgery, Division of Cardiac Surgery, University of Massachusetts, Worcester, MA 01655, USA
| | - Michael G DeBusk
- Department of Surgery, Division of Trauma, University of Massachusetts, Worcester, MA 01655, USA
| | - Adel Bozorgzadeh
- Department of Surgery, Division of Transplantation, University of Massachusetts, Worcester, MA 01655, USA.
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Imaging in traumatic injury to the inferior vena cava. Clin Radiol 2021; 76:787.e15-787.e25. [PMID: 34108097 DOI: 10.1016/j.crad.2021.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 05/14/2021] [Indexed: 11/21/2022]
Abstract
Inferior vena cava (IVC) injury is a rare but serious consequence of trauma. It presents with high scores on trauma assessment scales and is often life threatening. Factors that contribute to poor survival include delay and difficulty in diagnosis due to non-specific clinical features. As it is a relatively rare entity, imaging in IVC injury is not well described in the literature. As radiologists, it is vital that features of potential IVC injury are recognised promptly and findings relayed to the treating clinician in a timely manner to improve survival and reduce the risk of possible complications. Imaging features that should alert radiologists to IVC injury include contour abnormalities, active extravasation, pseudoaneurysm, and pericaval haematoma. Trauma to the IVC is associated with significant complications. These include exsanguination and refractory shock in the acute period while in the longer term, thrombosis can develop with potential for subsequent pulmonary embolism. Additionally, there are complications that may develop post-surgically including further haemorrhage, IVC stenosis, and infection. We review the spectrum of imaging findings in traumatic IVC injury, which are exemplified with cases from our practice. Furthermore, we discuss important factors to consider during interpretation and the challenges that a radiologist may encounter when making the diagnosis.
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Balachandran G, Bharathy KGS, Sikora SS. Penetrating injuries of the inferior vena cava. Injury 2020; 51:2379-2389. [PMID: 32838960 DOI: 10.1016/j.injury.2020.08.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 08/16/2020] [Indexed: 02/02/2023]
Abstract
Inferior vena cava (IVC) injuries occur in 0.5-5% of cases of penetrating abdominal injury. Uncommonly encountered in general surgical and trauma practice, they remain extremely lethal despite advances in resuscitation and critical care. Important factors determining treatment outcomes are the hemodynamic status of the patient at presentation, the level and extent of injury, and the presence of associated injuries. Operative approaches and techniques for definitive repair are to be tailored to the condition of the patient, type of injury, and available expertise. In a patient with severe hemodynamic compromise, damage control principles take priority to stop bleeding and save life. The most commonly employed strategies are venorrhaphy or ligation. Retro-hepatic and supra-hepatic caval injuries are particularly challenging in terms of exposure and repair, and are associated with high fatality. Endovascular approaches are being used in select cases with success. This paper reviews in detail the epidemiology, injury patterns, management protocols, and outcomes of IVC injuries due to penetrating abdominal trauma.
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Affiliation(s)
- Gayatri Balachandran
- Department of Surgical Gastroenterology, Institute of Digestive & HPB Sciences, Sakra World Hospital, SY No.52/2 & 52/3, Devarabeesanahalli, Oppsite Intel, VarthurHobli, Bengaluru, Karnataka 560103, india
| | - Kishore G S Bharathy
- Department of Surgical Gastroenterology, Institute of Digestive & HPB Sciences, Sakra World Hospital, SY No.52/2 & 52/3, Devarabeesanahalli, Oppsite Intel, VarthurHobli, Bengaluru, Karnataka 560103, india
| | - Sadiq S Sikora
- Department of Surgical Gastroenterology, Institute of Digestive & HPB Sciences, Sakra World Hospital, SY No.52/2 & 52/3, Devarabeesanahalli, Oppsite Intel, VarthurHobli, Bengaluru, Karnataka 560103, india.
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Traumatic inferior vena cava dissection. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2016. [DOI: 10.1016/j.jvscit.2016.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Vaidya SS, Bhargava P, Marder CP, Dighe MK. Inferior vena cava dissection following blunt abdominal trauma. Emerg Radiol 2010; 17:339-42. [DOI: 10.1007/s10140-010-0864-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2010] [Accepted: 02/18/2010] [Indexed: 11/28/2022]
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Puwanant S, Click RL, Kalra M, Farley DR, Chandrasekaran K. Incidental detection of inferior vena caval dissection by intraoperative high frequency vascular duplex ultrasonography. Echocardiography 2007; 24:269-71. [PMID: 17313640 DOI: 10.1111/j.1540-8175.2007.00386.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Inferior vena caval (IVC) dissection has been rarely reported. This could be due to less susceptibility of the venous structure to dissect or under recognition of this entity. We first report a case of IVC dissection detected by high frequency surface ultrasonography following tumor thrombectomy of adrenal cortical carcinoma. This report described the value of intraoperative surface echocardiography and reviewed previous literatures with regard to IVC dissection.
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Affiliation(s)
- Sarinya Puwanant
- Division of Cardiovascular Diseases, Department of Internal Medicine, Department of Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA
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Sung YM, Choe YH, Park SW, Park PW, Sung CO. Retroperitoneal arteriovenous malformation extending through the inferior vena cava into the heart and causing inferior vena cava dissection. Eur Radiol 2004; 15:1173-7. [PMID: 15232712 DOI: 10.1007/s00330-004-2370-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2004] [Revised: 03/23/2004] [Accepted: 04/26/2004] [Indexed: 10/26/2022]
Abstract
We present a case of retroperitoneal arteriovenous malformation extending through the inferior vena cava into the heart, which was associated with dissection of the inferior vena cava in a 32-year-old female. Computed tomography and magnetic resonance imaging showed a double-lumen inferior vena cava and a rod-like solid component attached to a sac-like lesion in the right heart chambers. Digital subtraction angiography showed an arteriovenous malformation draining to the inner lumen of the inferior vena cava.
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Affiliation(s)
- Yon Mi Sung
- Department of Radiology and Center for Imaging Science, Sungkyunkwan University School of Medicine, Kangnam-gu, Seoul, South Korea
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DeCou JM, Abrams RS, Gauderer MW. Seat-belt transection of the pararenal vena cava in a 5-year-old child: survival with caval ligation. J Pediatr Surg 1999; 34:1074-6. [PMID: 10442592 DOI: 10.1016/s0022-3468(99)90568-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Blunt traumatic disruption of the inferior vena cava is associated with high mortality and is rare in children. A seat-belted 5-year-old girl sustained, in a motor vehicle accident, pararenal caval transection, right renal vein transection, laceration of the right kidney, duodenal injury, and a second lumbar vertebral fracture. Damage-control surgery consisted of inferior vena caval and right renal vein ligation and temporary abdominal wall silo closure. She is alive and well 10 months after the accident, with no sequelae of caval ligation and with normal right renal function.
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Affiliation(s)
- J M DeCou
- Department of Pediatric Surgery, The Children's Hospital of Greenville Hospital System, SC 29605-4253, USA
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