Determinants of survival after inferior vena cava trauma

Jonathan Kuehne, Joseph Frankhouse, Greg Modrall, Shapour Golshani, Ihab Aziz, Demetrios Demetriades, Albert E. Yellin

Research output: Contribution to journalArticle

40 Scopus citations

Abstract

Inferior vena cava (IVC) injuries continue to be associated with mortality rates of 21 to 66 per cent despite advances in prehospital, surgical, and critical care. The purpose of this study was to evaluate outcome of patients with IVC injury after treatment at a major urban trauma center and to identify factors predictive of survival. Between 1989 and 1995, 158 patients presented to the Los Angeles County + University of Southern California Medical Center with IVC injuries. One hundred thirty-six patient records were available for review, and 69 data points were collected and analyzed. Mean age was 25 years (range, 6-54), and 122 (90%) patients were male. Mechanism of injury included gunshot in 83 (65%) patients, stab in 23 (17%) patients, shotgun in 7 (5%) patients, and blunt trauma in 18 (13%) patients. The mean Injury Severity Score was 25. Seventy (52%) patients were hypotensive. Eleven (8%) patients died before surgical intervention, and 25 (18%) patients died before operative repair. Repair (79), ligation (20), or observation (1) was accomplished in 100 (74%) patients. Overall survival was 48 per cent and 65 per cent in the 100 patients surviving to operative repair, including 5 of 20 patients requiring IVC ligation. Significant differences (P < 0.001) between survivors and nonsurvivors included Injury Severity Score, Glasgow Coma Score, hematocrit, hypotension, emergent thoracotomy, blood loss, level of injury, tamponade, and associated aortic injury. Logistic regression analysis, identified hypotension, anatomic level of injury, and associated aortic injury as significant predictor of outcome (P = 0.001). Survival is predominantly determined by severity and anatomic accessibility of the IVC injury and by the absence of associated major vascular injuries. Ligation may control otherwise exsanguinating injuries and should be considered early in the management of complex injuries.

Original languageEnglish (US)
Pages (from-to)976-981
Number of pages6
JournalAmerican Surgeon
Volume65
Issue number10
StatePublished - Oct 1 1999

ASJC Scopus subject areas

  • Surgery

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    Kuehne, J., Frankhouse, J., Modrall, G., Golshani, S., Aziz, I., Demetriades, D., & Yellin, A. E. (1999). Determinants of survival after inferior vena cava trauma. American Surgeon, 65(10), 976-981.