Mochida Yuki, Sekiguchi Koya, Nishimura Hirotaka, Kaita Yasuhiko, Yamaguchi Yoshihiro
Department of Trauma and Critical Care Medicine, Kyorin University School of Medicine, Tokyo, JPN.
Cureus. 2025 Mar 22;17(3):e81009. doi: 10.7759/cureus.81009. eCollection 2025 Mar.
Penetrating injuries to the inferior vena cava (IVC) caused by stab wounds are uncommon; however, mortality risk is high due to substantial bleeding. Managing these injuries is particularly challenging because of their retroperitoneal location and high venous flow, which complicate surgical interventions. Conventional treatments, including direct suturing and graft placement, are often difficult to perform in unstable patients. Although endovascular approaches are frequently used for aortic injuries, there is limited data for managing IVC injuries. Here, we present a novel case in which hemostasis was achieved using two intravascular balloon catheters, offering insights into a potentially effective technique for life-threatening vascular trauma. We report a case of a man in his 50s who was admitted to our hospital after a self-inflicted stab wound to the upper abdomen. At presentation, the patient was hemodynamically stable; however, imaging revealed a hematoma around the IVC below both renal veins, suggesting vessel injury. Bleeding was initially controlled with two balloon catheters positioned proximally and distally to the site of the suspected injury. The balloons were inflated to achieve temporary hemostasis, followed by surgical exploration. A 2.5 cm longitudinal tear on the right lateral wall of the IVC was identified and repaired using continuous sutures. Postoperatively, the patient recovered uneventfully, although a pulmonary embolism (a branch of the right pulmonary artery) without respiratory compromise was identified on imaging. Anticoagulant therapy was initiated, and no further complications were observed. This case demonstrates a novel option for hemorrhage control in IVC injuries by deploying two intravascular balloon catheters. This technique allows for the effective management of unexpected intraoperative bleeding and minimizes blood loss, suggesting its potential application in the treatment of complex vascular trauma. Further studies are needed to refine the indications for balloon deployment, placement techniques, and thrombosis prevention strategies to improve patient outcomes.
由刺伤导致的下腔静脉（IVC）穿透伤并不常见；然而，由于大量出血，死亡风险很高。处理这些损伤极具挑战性，因为它们位于腹膜后且静脉血流高，这使得手术干预变得复杂。传统治疗方法，包括直接缝合和移植血管置入，在不稳定的患者中往往难以实施。尽管血管内治疗方法常用于主动脉损伤，但用于处理下腔静脉损伤的数据有限。在此，我们介绍一个新病例，其中使用两个血管内球囊导管实现了止血，为危及生命的血管创伤提供了一种潜在有效的技术见解。我们报告一例50多岁男性，因自伤上腹部刺伤入院。就诊时，患者血流动力学稳定；然而，影像学检查显示双侧肾静脉下方的下腔静脉周围有血肿，提示血管损伤。最初通过在疑似损伤部位近端和远端放置两个球囊导管控制出血。球囊充气以实现临时止血，随后进行手术探查。发现下腔静脉右侧壁有一处2.5厘米的纵向撕裂，并使用连续缝合进行修复。术后，患者恢复顺利，尽管影像学检查发现有肺栓塞（右肺动脉分支）但无呼吸功能障碍。开始抗凝治疗，未观察到进一步并发症。该病例展示了通过部署两个血管内球囊导管控制下腔静脉损伤出血的新选择。该技术允许有效处理术中意外出血并使失血最小化，表明其在复杂血管创伤治疗中的潜在应用。需要进一步研究以完善球囊部署的适应症、放置技术和血栓预防策略，以改善患者预后。
