Inferior vena cava injuries--the challenge continues.

The records of 67 patients with inferior vena cava (IVC) injuries seen from 1980-1986 were reviewed. The mortality rate (MR) overall was 57 per cent, and for specific portions of the IVC it was: retrohepatic - 60 per cent (9/15); suprarenal 59 per cent (16/27); pararenal - 45 per cent (5/11); and infrarenal - 57 per cent (8/14). Several prognostic factors were identified. Of 44 patients who presented to the emergency department (ED) with a BP less than 70 mm Hg, 33 (75%) died. Of 28 patients who experienced greater than 30 minutes of shock, 15 (83%) died. Of 26 patients presenting to the OR with a systolic blood pressure less than 70 mm Hg, 22 (85%) died. Of 40 patients who received greater than 10 units of blood in the ED and OR, 31 (78%) died. Of 19 patients who had a prelaparotomy thoracotomy with cross-clamping of the thoracic aorta for persistent severe shock (BP less than 70), nine responded rapidly with a sustained increase in systolic BP to greater than 90 mm Hg with four (44%) survivors. All ten patients who did not respond to prelaparotomy aortic cross-clamping died in the OR. Of seven patients with persistent shock (BP less than 70) without a prelaparotomy thoracotomy, there were no survivors. Six patients with retrohepatic IVC injuries underwent atrio-caval shunting with no survivors; of nine others with similar injuries treated without a shunt, six (67%) survived. Of 18 patients who received more than ten units of blood and survived the surgery, ten (56%) developed septic complications, and four of these patients died. Of 17 patients who received less than ten units of blood and survived the surgery, none became septic. Thus, early control of shock and bleeding is essential, not only to reduce mortality rate, but also later septic complications.