Blunt Aortic / Inferior Vena Cava Injury: Are We Consistently Providing the Same Level of Care?

Alda Chavez,Luis O Chavez,Monica Leon,Salim Surani

doi:10.7759/cureus.6832

Abstract

Major vascular traumatic injuries have a higher pre-hospital and in-hospital mortality rate. The different mechanisms of injury and anatomy of the aorta and inferior vena cava (IVC) make the management a constant challenge to surgeons and clinicians. Blunt traumatic aortic injury (BTAI) can occur at the thoracic or abdominal level, each of which possesses different considerations. Blunt traumatic inferior vena cava injury (BTIVCI) also has important diagnostic challenges since the lesion may not be as evident in the IVC as compared to the aorta, possibly due to lower caval pressures or the ability to self-tamponade from adjacent structures. Endovascular management has significantly increased in the past years, and despite an improvement in mortality, the approach to aortic and IVC injuries is not well standardized. Diagnostic imaging helps to classify the extent of the lesions and guide towards the best therapeutic options for each case. Conservative management, in some cases, has shown to reduce mortality, and close follow-up has proven good outcomes. Future research will provide more evidence to determine the best approach to BTAI and BTIVCI for better long-term outcomes. This article aims to provide an updated review of the current literature regarding diagnosis, classification, and management of BTAI and BTIVCI.

Highlights

BackgroundTrauma-related injuries are a leading cause of death worldwide that have increased over the last two decades [1]
In the last two decades, endovascular management for blunt trauma vascular injuries has significantly increased from 0.4% in 2002 to 13.2% in 2010
The overall mortality from aortic and inferior vena cava (IVC) blunt trauma decreased from 48.8% in 2002 to 28.7% in 2014, with a more significant reduction in the Blunt traumatic aortic injury (BTAI) group [1]

Summary

Introduction

Trauma-related injuries are a leading cause of death worldwide that have increased over the last two decades [1]. In the last two decades, endovascular management for blunt trauma vascular injuries has significantly increased from 0.4% in 2002 to 13.2% in 2010 Parallel to these findings, the overall mortality from aortic and IVC blunt trauma decreased from 48.8% in 2002 to 28.7% in 2014, with a more significant reduction in the BTAI group [1]. Trends are similar to thoracic BTAI management, with an increasing endovascular approach, as an open surgical repair is associated with higher mortality [1, 19]. Treatment modalities include definitive vascular repair, damage control procedures (ligation, packing) or conservative approach The latter usually is restricted to patients who are stable and whose injuries have self-tamponade or contained by adjacent organs (usually the liver, suspensory ligaments, and the diaphragm) [20, 22, 28]. Management with early endovascular management for hemorrhage control, followed by open repair with good results, has been reported [29]

Conclusions

Findings

Disclosures