Abdominal Vein Injuries

Abstract

Major abdominal venous trauma involving the inferior vena cava, mesenteric, portal, hepatic, renal, splenic, and iliac veins is associated with a high rate of morbidity and mortality due to challenges with surgical exposure, achieving proximal and distal control and repairing these injuries in a critically ill patient. The majority of these venous injuries are due to penetrating trauma, with 1 in 50 gunshot wounds involving the inferior vena cava. Retrohepatic IVC and hepatic vein injuries are best managed with packing to compress the liver posteriorly. Exposure should be performed for refractory bleeding but outcomes are poor. Outflow control of the IVC is best managed via right thoracoabdominal or medial sternotomy to access the intrapericardial supradiaphragmatic IVC. A Pringle maneuver with suprarenal IVC compression provides inflow control. Some blunt juxta- and infrarenal IVC injuries may be managed without retroperitoneal exploration unless there is active bleeding or suspicion of concomitant arterial injury, but most zone 1 retroperitoneal injuries should be explored. The left renal vein can be ligated if collaterals are intact. The right renal vein is short and usually requires repair or nephrectomy. Concomitant visceral and arterial injuries are common. Those with blunt trauma and a presentation of peritonitis, hemodynamic instability, or significant free abdominal fluid should be offered operative management. Survivors of both surgical and nonoperative management suffer venous thromboembolic events, proximal edema, and venous insufficiency.