Abstract
Although injuries to the inferior vena cava (IVC) are relatively rare in Japan, emergency abdominal surgery pertaining to these injuries is justifiably considered as one of the most difficult and challenging areas of surgery. IVC injures often cause massive bleeding followed by hypovolemic shock, and are almost always associated with multiple organ injuries such as the liver, small and large intestines, pancreas and kidney. IVC injuries and associated lesions have been divided into the suprahepatic, retrohepatic, suprarenal, renal and infrarenal segments. One half to one third of IVC injuries occur in the infrarenal segment. Retrohepatic vena cava injury is rare but the most lethal among IVC injuries since it is associated with high-grade liver injury. In this article, we review the clinical features of IVC injuries in the Japanese literature, and discuss the concepts and procedures pertaining to surgical repair for injuries including use of occlusive clamping methods, atriocaval shunts, Pringle's maneuver, autologous blood recovery systems, aortic balloon occlusive catheters, supraceliac aortic cross-clamping and extracorporeal circulation. In addition, we present a case of a ruptured infected infrarenal abdominal aortic aneurysm, where the patient underwent IVC replacement with an E-PTFE graft concomitant with aortic aneurysmal repair.
