Sage Journals: Discover world-class research

Abstract

Purpose:

To report the use of a fenestrated stent-graft to manage a traumatic rupture of the juxtahepatic inferior vena cava (IVC).

Case Report:

A 62-year-old man was involved in a traffic accident and hospitalized for severe right leg fractures. Computed tomography also uncovered liver contusion and retroperitoneal hematoma. The next day, he became hemodynamically unstable; a huge retroperitoneal hematoma had developed from a rupture of the juxtahepatic IVC. An emergent procedure to implant a self-expanding fenestrated stent-graft was successful in repairing the IVC injury and maintaining hepatic venous return. The patient recovered and continues in good health with a patent endograft 16 months after treatment.

Conclusions:

This experience supports the efficacy of fenestrated endograft implantation for emergent repair of IVC injuries, although proper facilities, an experienced interventional team, and an assortment of devices must be available.

Keywords

stent-graft hepatic vein retroperitoneal hematoma Gianturco Z stent Dacron graft

Get full access to this article

View all access options for this article.

References

Parke

Stanley

Berlin

. Infrarenal vena caval injury following blunt trauma: CT findings. J Comput Assist Tomogr. 1993; 17: 154–157.

Halpern

Aldrete

. Factors influencing mortality and morbidity from injuries to the abdominal aorta and inferior vena cava. Am J Surg. 1979; 137: 384–388.

Klein

Baumgartner

Bongard

. Contemporary management strategy for major inferior vena caval injuries. J Trauma. 1994; 37: 35–42.

Schwartz

Pentecost

Teitelbaum

. Radiologic diagnosis of superior vena cava laceration. J Vasc Interv Radiol. 1993; 4: 573–575.

Khaneja

Pizzi

Barie

. Management of penetrating juxtahepatic inferior vena cava injuries under total vascular occlusion. J Am Coll Surg. 1997; 184: 469–474.

Hansen

Bernadas

West

. Abdominal vena caval injuries: Outcomes remain dismal. Surgery. 2000; 128: 572–578.

Kuehne

Frankhouse

Modrall

. Determinants of survival after inferior vena cava trauma. Am Surg. 1999; 65: 976–981.

Rosengart

Smith

Melton

. Prognostic factors in patients with inferior vena cava injuries. Am Surg. 1999; 65: 849–856.

Carr

Kralovich

Patton

. Primary venorrhaphy for traumatic inferior vena cava injuries. Am Surg. 2001; 67: 207–214.

10.

Petersen

Uchida

. Long-term results of treatment of benign central venous obstructions unrelated to dialysis with expandable Z stents. J Vasc Interv Radiol. 1999; 10: 757–766.

11.

Zhang

. Ultrasonically guided inferior vena cava stent placement: Experience in 83 cases. J Vasc Interv Radiol. 1999; 10: 85–91.

12.

Dutta

Garg

Agarwal

. Blocking of the hepatic vein outflow by neointima covering a Wallstent across a membranous stenosis of the inferior vena cava. Cardiovasc Intervent Radiol. 1999; 22: 521–523.

13.

Makutani

Kichikawa

Uchida

. Effect of antithrombotic agents on the patency of PTFE-covered stents in the inferior vena cava: An experimental study. Cardiovasc Intervent Radiol. 1999; 22: 232–238.

14.

Chin

Petersen

Timmermans

. Stent-graft in the management of superior vena cava syndrome. Cardiovasc Intervent Radiol. 1996; 19: 302–304.

15.

Gill

Ettles

Nicholson

. Recurrent superior vena caval obstruction due to invasion by malignant thymoma: Treatment using a stent-graft. Br J Radiol. 2000; 73: 1015–1017.