Treatment algorithm and management of retrohepatic vena cava injuries

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Despite advances in trauma care, injuries to the inferior vena cava (IVC) continue to have a high mortality rate, ranging from 33% to 75%.1–3 The retrohepatic IVC (RHIVC) is a particularly lethal region in which to sustain an injury, because the vessel is relatively fixed to the liver, and difficult to access and control. Patients with RHIVC injuries that survive to arrival at a trauma center will typically have a contained retroperitoneal hematoma. If this hematoma ruptures before laparotomy, survival is rare, with mortality rates reported as high as 100%.3
Management principles for injuries to the RHIVC consist of a combination of packing, additional exposure to gain vascular control, direct repair, and in some cases, shunting. The management of this severe injury requires rapid decision making and stepwise progression through a defined treatment algorithm (Fig. 1) as described in the following video technique article with supplemental digital online content. All videos are of procedures performed during teaching sessions on fresh non-embalmed cadavers and in accord with the standard operating procedures of the University of Southern California Fresh Tissue Dissection Laboratory.
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