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.