Contemporary Management and Outcomes of Injuries to the Inferior Vena Cava: A Prospective Multicenter Trial From PROspective Observational Vascular Injury Treatment.

Autor:	Stonko DP; Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA.; R Adams Cowley Shock Trauma Center, University of Maryland Medical System, Baltimore, MD, USA., Azar FK; St Mary's Medical Center, West Palm Beach, FL, USA; Florida Atlantic University, Boca Raton, FL, USA., Betzold RD; R Adams Cowley Shock Trauma Center, University of Maryland Medical System, Baltimore, MD, USA., Morrison JJ; R Adams Cowley Shock Trauma Center, University of Maryland Medical System, Baltimore, MD, USA., Fransman RB; Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA., Holcomb J; The University of Alabama at Birmingham, Birmingham, AL, USA., Bee T; University of Tennessee Health Science Center, Memphis, TN, USA., Fabian TC; University of Tennessee Health Science Center, Memphis, TN, USA., Skarupa DJ; University of Florida, Jacksonville, FL, USA., Stein DM; R Adams Cowley Shock Trauma Center, University of Maryland Medical System, Baltimore, MD, USA.; University of California, San Francisco, CA, USA., Kozar RA; R Adams Cowley Shock Trauma Center, University of Maryland Medical System, Baltimore, MD, USA., O'Connor JV; R Adams Cowley Shock Trauma Center, University of Maryland Medical System, Baltimore, MD, USA., Scalea TM; R Adams Cowley Shock Trauma Center, University of Maryland Medical System, Baltimore, MD, USA., DuBose JJ; R Adams Cowley Shock Trauma Center, University of Maryland Medical System, Baltimore, MD, USA., Feliciano DV; R Adams Cowley Shock Trauma Center, University of Maryland Medical System, Baltimore, MD, USA.
Jazyk:	angličtina
Zdroj:	The American surgeon [Am Surg] 2023 Apr; Vol. 89 (4), pp. 714-719. Date of Electronic Publication: 2021 Aug 13.
DOI:	10.1177/00031348211038556
Abstrakt:	Introduction: Injuries to the inferior vena cava (IVC), while uncommon, have a high mortality despite modern advances. The goal of this study is to describe the diagnosis and management in the largest available prospective data set of vascular injuries across anatomic levels of IVC injury. Methods: The American Association for the Surgery of Trauma PROspective Observational Vascular Injury Treatment (PROOVIT) registry was queried from November 2013 to January 2019. Demographics, diagnostic modalities, injury patterns, and management strategies were recorded and analyzed. Comparisons between anatomic levels were made using non-parametric Wilcoxon rank-sum statistics. Results: 140 patients from 19 institutions were identified; median age was 30 years old (IQR 23-41), 75% were male, and 62% had penetrating mechanism. The suprarenal IVC group was associated with blunt mechanism (53% vs 32%, P = .02), had lower admission systolic blood pressure, pH, Glasgow Coma Scale (GCS), and higher ISS and thorax and abdomen AIS than the infrarenal injury group. Injuries were managed with open repair (70%) and ligation (30% overall; infrarenal 37% vs suprarenal 13%, P = .01). Endovascular therapy was used in 2% of cases. Overall mortality was 42% (infrarenal 33% vs suprarenal 66%, P<.001). Among survivors, there was no difference in first 24-hour PRBC transfusion requirement, or hospital or ICU length of stay. Conclusions: Current PROOVIT registry data demonstrate continued use of ligation extending to the suprarenal IVC, limited adoption of endovascular management, and no dramatic increase in overall survival compared to previously published studies. Survival is likely related to IVC injury location and total injury burden.
Databáze:	MEDLINE
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