Rodas Edgar B, Leichtle Stefan, Mallah Mike, Alexander Kyle J, Patterson Sierra L, French William B, Procter Levi, Potter Jessica, Strife Brian J, Fernandez Leopoldo, Aboutanos Michel B
Department of Surgery, Virginia Commonwealth University, Richmond, Virginia, USA.
Surgery Service Line, Inova Fairfax Medical Campus, Falls Church, Virginia, USA.
Trauma Surg Acute Care Open. 2025 Jul 20;10(3):e001882. doi: 10.1136/tsaco-2025-001882. eCollection 2025.
We describe the surgical dilemma of an adult male who arrived with a penetrating injury to the suprarenal inferior vena cava (IVC), where conventional intraoperative hemorrhage control failed. Our team innovated by using an atriocaval shunt for temporization of the injury during resuscitation, enabling us to return to the operating room and perform primary repair. Notably, the prolonged use of the atriocaval shunt as a damage control strategy represents a novel application, as it remained in place for several hours-a first in reported cases. We detail this technique, the multidisciplinary approach to managing concomitant severe injuries, and the resulting complications and outcomes. This case highlights the challenges of managing suprarenal IVC injuries and demonstrates the potential role of prolonged atriocaval shunting as a damage control strategy.
我们描述了一名成年男性患者的手术困境，该患者因肾上腺下腔静脉（IVC）穿透伤入院，传统的术中出血控制方法失败。我们的团队创新地使用了心房腔静脉分流术在复苏过程中暂时处理损伤，使我们能够返回手术室进行一期修复。值得注意的是，将心房腔静脉分流术作为损伤控制策略长期使用是一种新的应用，因为它在体内留置了数小时——这在已报道的病例中尚属首次。我们详细介绍了该技术、处理伴随严重损伤的多学科方法以及由此产生的并发症和结果。该病例突出了处理肾上腺下腔静脉损伤的挑战，并展示了长期心房腔静脉分流术作为损伤控制策略的潜在作用。
