Central Surgical Association| Volume 128, ISSUE 4, P572-578, October 2000

Download started.


Abdominal vena caval injuries: Outcomes remain dismal


      Background. The mortality rate for abdominal vena caval injuries remains high. We examined the experience of a level I trauma center to determine factors significant to the outcome in these injuries. Methods. Forty-seven patients were identified in a retrospective review (1989 to 1999) of patients were identified with abdominal vena caval injury. Data were analyzed by uni- and multivariate methods, including logistic regression. Results. Most of the individuals with abdominal vena caval injuries were young male patients who were injured by penetrating trauma and who were hypotensive on arrival. The severity of injury and the number of organs injured was high. The overall mortality rate was 55%. Nonsurvivors were more often hypotensive in the field with physiologic derangement consistent with hemorrhagic shock. Type and location of injury as well as method of repair were associated with death. Multiple regression analysis revealed that prehospital initial systolic blood pressure and intraoperative bicarbonate levels were independent predictors of survival. Conclusions. We identified factors related to poor outcome, including suprarenal and retrohepatic location of injury and variables that reflected the evolution of shock. Management should include appropriate resuscitation and ultimately may require novel operative techniques. (Surgery 2000;128:572-8.)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Graham JM
        • Mattox KL
        • Beall AC
        • Debakey ME.
        Traumatic injuries of the inferior vena cava.
        Arch Surg. 1978; 113: 413-418
        • Mattox KL
        • McCollum WB
        • Jordan GL
        • Beall AC
        • Debakey ME.
        Management of upper abdominal vascular trauma.
        Am J Surg. 1974; 128: 823-828
        • Rosengart MR
        • Smith DR
        • Melton SM
        • May AK
        • Rue III., LW
        Prognostic factors in patients with inferior vena cava injuries.
        Am Surg. 1999; 56: 849-856
        • Ombrellaro MP
        • Freeman MB
        • Stevens SL
        • Diamond DL
        • Goldman MH.
        Predictors of survival after inferior vena cava injuries.
        Am Surg. 1997; 63: 178-183
        • Wiencek RG
        • Wilson RF.
        Inferior vena cava injuries: the challenge continues.
        Am Surg. 1988; 54: 423-428
        • Millikan JS
        • Moore EE
        • Cogbill TH
        • Kashuk JL.
        Inferior vena cava injuries: a continuing challenge.
        J Trauma. 1983; 23: 207-212
        • Sirinek KR
        • Gaskill HV
        • Root HD
        • Levine BA.
        Truncal vascular injury: factors influencing survival.
        J Trauma. 1983; 23: 372-377
        • Byrne DE
        • Pass HI
        • Crawford FA.
        Traumatic vena caval injuries.
        Am J Surg. 1980; 140: 600-602
        • Kashuk JL
        • Moore EE
        • Millikan JS
        • Moore JB.
        Major abdominal vascular trauma: a unified approach.
        J Trauma. 1982; 22: 672-679
        • Coimbra R
        • Hoyt D
        • Winchell R
        • Simons R
        • Fortlage D
        • Garcia J.
        The ongoing challenge of retroperitoneal vascular injuries.
        Am J Surg. 1996; 172: 541-545
        • Khoury G
        • Sfeir R
        • Khalifeh M
        • Khoury SJ
        • Nabbout G.
        Penetrating trauma to the abdominal vessels.
        Cardiovasc Surg. 1996; 4: 405-407
        • Wiencek RG
        • Wilson RF.
        Abdominal venous injuries.
        J Trauma. 1986; 26: 771-777
        • Stewart MT
        • Stone HH.
        Injuries of the inferior vena cava.
        Am Surg. 1986; 52: 9-13
        • Burch JM
        • Feliciano DV
        • Mattox KL
        • Edelman M.
        Injuries of the inferior vena cava.
        Am J Surg. 1988; 156: 548-552
        • Klein SR
        • Baumgartner FJ
        • Bongard FS.
        Contemporary management strategy for major inferior vena caval injuries.
        J Trauma. 1994; 37: 35-42
        • Jackson MR
        • Olson DW
        • Beckett WC
        • Olsen SB
        • Robertson FM.
        Abdominal vascular trauma.
        Am Surg. 1992; 58: 622-626
        • Coimbra R
        • Prado PA
        • Araujo LH
        • Candelaria PAP
        • Caffaro RA
        • Rasslan S.
        Factors related to mortality in inferior vena cava injuries: a 5 year experience.
        Int Surg. 1994; 79: 138-141
        • Moore EE
        • Cogbill TH
        • Jurkovich GJ
        • McAninch JW
        • Champion HR
        • Gennarelli TA
        • et al.
        Organ injury scaling III: chest wall, abdominal vascular, ureter, bladder, and urethra.
        J Trauma. 1992; 33: 337-339
        • Parker S
        • O'Neill B
        • Haddon W
        The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care.
        J Trauma. 1974; 14: 187-196
        • Feliciano DV.
        Approach to major abdominal vascular injury.
        J Vasc Surg. 1988; 7: 730-736
        • Sharma PVP
        • Ivatury RR
        • Simon RJ
        • Vinzons AT.
        Central and regional hemodynamics determine optimal management of major venous injuries.
        J Vasc Surg. 1992; 16: 887-894