Emergency Treatment of Iliocaval Vein Injury With an Aortic Unibody Stent Graft

Abstract

Introduction:

Injuries of the inferior vena cava (IVC) secondary to blunt trauma is a rare life-threatening condition that has a mortality rate up to 70%. Prompt diagnosis and treatment is mandatory. Endografts are commonly used in arterial trauma, but their use in veins injury is rarely reported in literature.

Case Report:

We report a case of a 72-year-old foreign woman with IVC injuries at confluence treated in an emergency setting. She arrived at the emergency room after a car crash. Computed tomography (CT) angiography showed rupture of iliocaval confluence with massive active bleeding. Endovascular repair was promptly performed using an aortic unibody stent graft to achieve bleeding control. One month CT angiography showed patency of the endograft and of both iliac veins, and no evidence of thrombotic apposition.

Conclusion:

Inferior vena cava injury has high mortality rate, and this novel approach may allow iliocaval repair in a successful and rapid manner. Moreover, the unibody endograft is suitable for reconstructing the IVC and both iliac veins simultaneously, showing great adaptability to the venous system.

Clinical Impact

This case suggests a new, although experimental, path for addressing severe venous traumas. The innovation lies in demonstrating that an “off-label” unibody aortic endograft can provide a minimally invasive option for highly complex ilio-caval confluence ruptures, where few other solution exist, potentially improving outcomes in these challenging scenarios.