Retrohepatic vena cava lesion: which we cannot forget?

Abstract

Vascular lesions are the leading cause of death after abdominal trauma. Among them, the inferior vena cava (IVC) lesion, especially its retrohepatic portion, is one of the most severe, rare, and complicated treatment. The difficult access and delicate anatomical relationships do not favor hemostasis. The etiology of the lesion is variable, resulting from penetrating trauma (transection and/or laceration), blunt or, more rarely, iatrogenic causes. After the initial approach of the polytraumatized patient, the identification of vascular damage must be early, so that surgical treatment of those patients presenting severe hypovolemic shock can be successful. Therapeutic options include tamponade of the lesion through adequate hepatic packaging, digital compression, or repair of the lesions after exposure of the retrohepatic area. In injuries that have not been controlled with tamponade, the total hepatic vascular exclusion is the treatment of choice. In extreme cases, the atriocaval shunt can be performed; however, compared with the vascular isolation technique, the latter showed a better survival rate. Besides, conservative treatment in selected cases of traumatic lesions of retrograde hepatic IVC is feasible and a priority because of the high mortality intrinsic to the surgical procedure. In this sense, the present review reinforces the need for continuous clinical and surgical improvement to obtain outcomes with a better prognosis, especially in retrohepatic vena cava lesions.