Maruhashi Takaaki, Saku Keita, Maruki Hideo, Oi Marina, Asari Yasushi
Department of Emergency and Critical Care Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan.
Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
Trauma Surg Acute Care Open. 2024 Nov 18;9(1):e001618. doi: 10.1136/tsaco-2024-001618. eCollection 2024.
Retrohepatic inferior vena cava (IVC) injuries remain among the most lethal and serious liver injuries. Gauze packing is currently the first choice for IVC injuries; however, laparotomy itself poses the risk of circulatory collapse. Thus, less invasive treatment strategies are needed.
In this study, we conducted an animal experiment to replicate and validate successful treatments for an actual case of retrohepatic IVC injury that we had encountered.
A woman in her 80s presented to our hospital due to cardiac arrest caused by a pulmonary artery embolism. Venoarterial extracorporeal membrane oxygenation (ECMO) was introduced, and the patient was resuscitated. After resuscitation, contrast-enhanced CT revealed liver and retrohepatic IVC injuries, possibly caused by chest compressions. Liver injury was treated using transarterial embolization of the left hepatic artery. To treat the retrohepatic IVC injury, ECMO flow was increased to enhance the negative drainage pressure. The extravasation of the contrast medium had resolved in IVC angiography, and we opted for nonoperative management. The patient's hemodynamic status gradually stabilized, and ECMO was withdrawn on day 6. We confirmed these findings in a dog model of retrohepatic IVC injury.
Our findings from the patient and the animal model suggest that the flow diversion effect of ECMO can effectively manage active bleeding from the IVC by inserting a drainage cannula across the injured lesion. We think this procedure represents a novel treatment option for retrohepatic IVC injuries.
肝后下腔静脉（IVC）损伤仍然是最致命和严重的肝脏损伤之一。纱布填塞目前是IVC损伤的首选治疗方法；然而，剖腹手术本身存在循环衰竭的风险。因此，需要侵入性较小的治疗策略。
在本研究中，我们进行了一项动物实验，以复制和验证我们遇到的一例实际肝后IVC损伤的成功治疗方法。
一名80多岁的女性因肺动脉栓塞导致心脏骤停被送往我院。采用静脉-动脉体外膜肺氧合（ECMO）治疗，患者复苏成功。复苏后，增强CT显示肝脏和肝后IVC损伤，可能是由胸外按压引起的。肝损伤采用左肝动脉经动脉栓塞治疗。为了治疗肝后IVC损伤，增加了ECMO流量以提高负压引流。IVC血管造影显示造影剂外渗已消失，我们选择了非手术治疗。患者的血流动力学状态逐渐稳定，第6天停用ECMO。我们在肝后IVC损伤的犬模型中证实了这些发现。
我们在患者和动物模型中的研究结果表明，ECMO的分流作用可以通过在损伤部位插入引流管有效地控制IVC的活动性出血。我们认为这种方法代表了一种治疗肝后IVC损伤的新选择。
