Outcome of ligation of the inferior vena cava in the modern era

Patrick S. Sullivan, Christopher J. Dente, Snehal Patel, Matthew Carmichael, Jahnavi K. Srinivasan, Amy D. Wyrzykowski, Jeffrey M. Nicholas, Jeffrey P. Salomone, Walter L. Ingram, Gary - Vercruysse, Grace S. Rozycki, David V. Feliciano

Research output: Contribution to journalArticle

38 Citations (Scopus)

Abstract

Background: Ligation of the significantly injured infrarenal inferior vena cava (IVC) is an accepted practice in the setting of damage control surgery. This is a report of inpatient management, outcomes, and long-term follow-up in 25 patients after IVC ligation. Methods: The records of patients with injuries to the IVC treated in an urban level I trauma center from 1995 to 2008 were reviewed. Demographics, injury severity, and outcome data were recorded. In addition, outpatient records were reviewed and telephone interviews were conducted to assess for the presence and severity of long-term sequelae. Results: One hundred patients had IVC injuries, and 25 (25%) underwent ligation. Location of injury was infrarenal in 54 patients, suprarenal in 21, retrohepatic in 15, and suprahepatic in 10. Twenty-two of 54 (41%) injuries to the infrarenal IVC and 3 of 21 (14%) injuries to the suprarenal IVC were ligated. Patients who underwent ligation had a significantly higher Injury Severity Score (ISS) (22 vs 15, P < .001), a higher transfusion requirement (26 U vs 12 U, P < .001), a longer hospital length of stay (78 days vs 26 days, P = .02), a longer intensive care unit length of stay (24 days vs 9 days, P < .001), and a higher mortality (59% vs 21%, P < .001). Ten of 13 early survivors of infrarenal IVC ligation received early below knee fasciotomy. Three other patients with normal compartment pressures were treated expectantly without development of a compartment syndrome. The 1 survivor of suprarenal ligation had below knee fasciotomies and had normal renal function by 1 month post injury, despite an initial creatinine elevation from .7 mg/dL to 3.2 mg/dL. Ten (40%) patients with IVC ligation survived to hospital discharge (9 infrarenal, 1 suprarenal), and long-term follow-up data are available in 8 patients (7 infrarenal, 1 suprarenal). At an average of 42 months (11-117 months), no patient has significant lower extremity edema or dysfunction. Conclusions: (1) Ligation of the infrarenal IVC is an acceptable damage control technique, although it remains associated with a high mortality. Ligation of the suprarenal IVC may be done, if necessary, although few survivors of this technique exist. (2) Early fasciotomy is generally required, but occasional patients may be treated expectantly, based on measurements of compartment pressures. (3) Long-term sequelae in survivors of IVC ligation for trauma are rare.

Original languageEnglish (US)
Pages (from-to)500-506
Number of pages7
JournalAmerican Journal of Surgery
Volume199
Issue number4
DOIs
StatePublished - Apr 2010
Externally publishedYes

Fingerprint

Inferior Vena Cava
Ligation
Wounds and Injuries
Survivors
Length of Stay
Knee
Pressure
Compartment Syndromes
Injury Severity Score
Mortality
Trauma Centers
Intensive Care Units
Inpatients
Lower Extremity
Edema
Creatinine
Outpatients
Demography
Interviews
Kidney

Keywords

  • Abdominal vascular injury
  • Damage control
  • Inferior vena cava
  • Ligation

ASJC Scopus subject areas

  • Surgery

Cite this

Sullivan, P. S., Dente, C. J., Patel, S., Carmichael, M., Srinivasan, J. K., Wyrzykowski, A. D., ... Feliciano, D. V. (2010). Outcome of ligation of the inferior vena cava in the modern era. American Journal of Surgery, 199(4), 500-506. https://doi.org/10.1016/j.amjsurg.2009.05.013

Outcome of ligation of the inferior vena cava in the modern era. / Sullivan, Patrick S.; Dente, Christopher J.; Patel, Snehal; Carmichael, Matthew; Srinivasan, Jahnavi K.; Wyrzykowski, Amy D.; Nicholas, Jeffrey M.; Salomone, Jeffrey P.; Ingram, Walter L.; Vercruysse, Gary -; Rozycki, Grace S.; Feliciano, David V.

In: American Journal of Surgery, Vol. 199, No. 4, 04.2010, p. 500-506.

Research output: Contribution to journalArticle

Sullivan, PS, Dente, CJ, Patel, S, Carmichael, M, Srinivasan, JK, Wyrzykowski, AD, Nicholas, JM, Salomone, JP, Ingram, WL, Vercruysse, G, Rozycki, GS & Feliciano, DV 2010, 'Outcome of ligation of the inferior vena cava in the modern era', American Journal of Surgery, vol. 199, no. 4, pp. 500-506. https://doi.org/10.1016/j.amjsurg.2009.05.013
Sullivan PS, Dente CJ, Patel S, Carmichael M, Srinivasan JK, Wyrzykowski AD et al. Outcome of ligation of the inferior vena cava in the modern era. American Journal of Surgery. 2010 Apr;199(4):500-506. https://doi.org/10.1016/j.amjsurg.2009.05.013
Sullivan, Patrick S. ; Dente, Christopher J. ; Patel, Snehal ; Carmichael, Matthew ; Srinivasan, Jahnavi K. ; Wyrzykowski, Amy D. ; Nicholas, Jeffrey M. ; Salomone, Jeffrey P. ; Ingram, Walter L. ; Vercruysse, Gary - ; Rozycki, Grace S. ; Feliciano, David V. / Outcome of ligation of the inferior vena cava in the modern era. In: American Journal of Surgery. 2010 ; Vol. 199, No. 4. pp. 500-506.
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abstract = "Background: Ligation of the significantly injured infrarenal inferior vena cava (IVC) is an accepted practice in the setting of damage control surgery. This is a report of inpatient management, outcomes, and long-term follow-up in 25 patients after IVC ligation. Methods: The records of patients with injuries to the IVC treated in an urban level I trauma center from 1995 to 2008 were reviewed. Demographics, injury severity, and outcome data were recorded. In addition, outpatient records were reviewed and telephone interviews were conducted to assess for the presence and severity of long-term sequelae. Results: One hundred patients had IVC injuries, and 25 (25{\%}) underwent ligation. Location of injury was infrarenal in 54 patients, suprarenal in 21, retrohepatic in 15, and suprahepatic in 10. Twenty-two of 54 (41{\%}) injuries to the infrarenal IVC and 3 of 21 (14{\%}) injuries to the suprarenal IVC were ligated. Patients who underwent ligation had a significantly higher Injury Severity Score (ISS) (22 vs 15, P < .001), a higher transfusion requirement (26 U vs 12 U, P < .001), a longer hospital length of stay (78 days vs 26 days, P = .02), a longer intensive care unit length of stay (24 days vs 9 days, P < .001), and a higher mortality (59{\%} vs 21{\%}, P < .001). Ten of 13 early survivors of infrarenal IVC ligation received early below knee fasciotomy. Three other patients with normal compartment pressures were treated expectantly without development of a compartment syndrome. The 1 survivor of suprarenal ligation had below knee fasciotomies and had normal renal function by 1 month post injury, despite an initial creatinine elevation from .7 mg/dL to 3.2 mg/dL. Ten (40{\%}) patients with IVC ligation survived to hospital discharge (9 infrarenal, 1 suprarenal), and long-term follow-up data are available in 8 patients (7 infrarenal, 1 suprarenal). At an average of 42 months (11-117 months), no patient has significant lower extremity edema or dysfunction. Conclusions: (1) Ligation of the infrarenal IVC is an acceptable damage control technique, although it remains associated with a high mortality. Ligation of the suprarenal IVC may be done, if necessary, although few survivors of this technique exist. (2) Early fasciotomy is generally required, but occasional patients may be treated expectantly, based on measurements of compartment pressures. (3) Long-term sequelae in survivors of IVC ligation for trauma are rare.",
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AU - Sullivan, Patrick S.

AU - Dente, Christopher J.

AU - Patel, Snehal

AU - Carmichael, Matthew

AU - Srinivasan, Jahnavi K.

AU - Wyrzykowski, Amy D.

AU - Nicholas, Jeffrey M.

AU - Salomone, Jeffrey P.

AU - Ingram, Walter L.

AU - Vercruysse, Gary -

AU - Rozycki, Grace S.

AU - Feliciano, David V.

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N2 - Background: Ligation of the significantly injured infrarenal inferior vena cava (IVC) is an accepted practice in the setting of damage control surgery. This is a report of inpatient management, outcomes, and long-term follow-up in 25 patients after IVC ligation. Methods: The records of patients with injuries to the IVC treated in an urban level I trauma center from 1995 to 2008 were reviewed. Demographics, injury severity, and outcome data were recorded. In addition, outpatient records were reviewed and telephone interviews were conducted to assess for the presence and severity of long-term sequelae. Results: One hundred patients had IVC injuries, and 25 (25%) underwent ligation. Location of injury was infrarenal in 54 patients, suprarenal in 21, retrohepatic in 15, and suprahepatic in 10. Twenty-two of 54 (41%) injuries to the infrarenal IVC and 3 of 21 (14%) injuries to the suprarenal IVC were ligated. Patients who underwent ligation had a significantly higher Injury Severity Score (ISS) (22 vs 15, P < .001), a higher transfusion requirement (26 U vs 12 U, P < .001), a longer hospital length of stay (78 days vs 26 days, P = .02), a longer intensive care unit length of stay (24 days vs 9 days, P < .001), and a higher mortality (59% vs 21%, P < .001). Ten of 13 early survivors of infrarenal IVC ligation received early below knee fasciotomy. Three other patients with normal compartment pressures were treated expectantly without development of a compartment syndrome. The 1 survivor of suprarenal ligation had below knee fasciotomies and had normal renal function by 1 month post injury, despite an initial creatinine elevation from .7 mg/dL to 3.2 mg/dL. Ten (40%) patients with IVC ligation survived to hospital discharge (9 infrarenal, 1 suprarenal), and long-term follow-up data are available in 8 patients (7 infrarenal, 1 suprarenal). At an average of 42 months (11-117 months), no patient has significant lower extremity edema or dysfunction. Conclusions: (1) Ligation of the infrarenal IVC is an acceptable damage control technique, although it remains associated with a high mortality. Ligation of the suprarenal IVC may be done, if necessary, although few survivors of this technique exist. (2) Early fasciotomy is generally required, but occasional patients may be treated expectantly, based on measurements of compartment pressures. (3) Long-term sequelae in survivors of IVC ligation for trauma are rare.

AB - Background: Ligation of the significantly injured infrarenal inferior vena cava (IVC) is an accepted practice in the setting of damage control surgery. This is a report of inpatient management, outcomes, and long-term follow-up in 25 patients after IVC ligation. Methods: The records of patients with injuries to the IVC treated in an urban level I trauma center from 1995 to 2008 were reviewed. Demographics, injury severity, and outcome data were recorded. In addition, outpatient records were reviewed and telephone interviews were conducted to assess for the presence and severity of long-term sequelae. Results: One hundred patients had IVC injuries, and 25 (25%) underwent ligation. Location of injury was infrarenal in 54 patients, suprarenal in 21, retrohepatic in 15, and suprahepatic in 10. Twenty-two of 54 (41%) injuries to the infrarenal IVC and 3 of 21 (14%) injuries to the suprarenal IVC were ligated. Patients who underwent ligation had a significantly higher Injury Severity Score (ISS) (22 vs 15, P < .001), a higher transfusion requirement (26 U vs 12 U, P < .001), a longer hospital length of stay (78 days vs 26 days, P = .02), a longer intensive care unit length of stay (24 days vs 9 days, P < .001), and a higher mortality (59% vs 21%, P < .001). Ten of 13 early survivors of infrarenal IVC ligation received early below knee fasciotomy. Three other patients with normal compartment pressures were treated expectantly without development of a compartment syndrome. The 1 survivor of suprarenal ligation had below knee fasciotomies and had normal renal function by 1 month post injury, despite an initial creatinine elevation from .7 mg/dL to 3.2 mg/dL. Ten (40%) patients with IVC ligation survived to hospital discharge (9 infrarenal, 1 suprarenal), and long-term follow-up data are available in 8 patients (7 infrarenal, 1 suprarenal). At an average of 42 months (11-117 months), no patient has significant lower extremity edema or dysfunction. Conclusions: (1) Ligation of the infrarenal IVC is an acceptable damage control technique, although it remains associated with a high mortality. Ligation of the suprarenal IVC may be done, if necessary, although few survivors of this technique exist. (2) Early fasciotomy is generally required, but occasional patients may be treated expectantly, based on measurements of compartment pressures. (3) Long-term sequelae in survivors of IVC ligation for trauma are rare.

KW - Abdominal vascular injury

KW - Damage control

KW - Inferior vena cava

KW - Ligation

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