Florou Evangelia, Anand Upali, Govindu Emeema, Gregory Stephen, Prachalias Andreas
Hepato-Pancreato-Biliary Surgery, King's College Hospital, London, GBR.
Hepato-Pancreato-Biliary Interventional Radiology, King's College Hospital, London, GBR.
Cureus. 2024 Nov 20;16(11):e74099. doi: 10.7759/cureus.74099. eCollection 2024 Nov.
Injuries to the inferior vena cava (IVC) carry high risks and mortality rates. We present a case of suprahepatic IVC injury that was successfully treated with polytetrafluoroethylene (PTFE) graft insertion without cardiopulmonary bypass. A 46-year-old woman was transferred to our trauma centre after a high-speed motor vehicle collision. Computed tomography (CT) revealed a suprahepatic IVC injury with an expanding hematoma within the diaphragmatic muscle. Via a thoracoabdominal approach, total vascular occlusion allowed evacuating the hematoma under control to allow IVC injury assessment. A large defect in the suprahepatic IVC was noted with a near-complete transection at the level of the hepatocaval confluence. A PTFE graft was successfully inserted restoring continuity between the right atrium and hepatic veins. The patient recovered and remains well two years post-trauma. Injuries to the IVC are uncommon and often fatal. Effective coordination between specialties can facilitate positive outcomes even in the most complex clinical scenarios. IVC injuries may be survivable when managed at high-volume expert centres with intensive care, anaesthesia, and surgical expertise.
下腔静脉（IVC）损伤具有高风险和死亡率。我们报告一例肝上型下腔静脉损伤病例，该病例在未进行体外循环的情况下通过插入聚四氟乙烯（PTFE）移植物成功治疗。一名46岁女性在高速机动车碰撞后被转至我们的创伤中心。计算机断层扫描（CT）显示肝上型下腔静脉损伤，膈肌内有不断扩大的血肿。通过胸腹联合入路，完全血管阻断使血肿在可控状态下得以清除，以便评估下腔静脉损伤情况。发现肝上型下腔静脉有一个大的缺损，在肝腔静脉汇合处几乎完全横断。成功插入PTFE移植物，恢复了右心房和肝静脉之间的连续性。患者康复，创伤后两年情况良好。下腔静脉损伤并不常见，且常是致命的。即使在最复杂的临床情况下，各专科之间的有效协作也能促成良好的结果。在具备重症监护、麻醉和外科专业知识的大容量专家中心进行处理时，下腔静脉损伤患者可能存活。
