PREDICTORS OF SURVIVAL AFTER INFERIOR VENA-CAVA INJURIES

In patients with inferior vena cava (IVC) injuries, predictors of surv ival are investigated. From 1987 to 1995, 27 IVC injuries were identif ied among 514 patients with vascular trauma. The ability of clinical d eterminants to predict survival were retrospectively assessed. NC inju ries occurred in 7 females and 20 males (mean age, 27.7 +/- 2.5 years) from both blunt (n = 14) and penetrating (n = 13) trauma. The mean re vised trauma score was 10.2 +/- 0.6. injuries were treated by primary repair (n = 22), ligation (n = 4), or prosthetic grafting (n = 1). Thi rteen patients died (48%), 10 within 12 hours of admission. Suprahepat ic (n = 2), retrohepatic (n = 12), suprarenal (n = 1), and intrarenal (n = 12) injuries were associated with 100, 67, 100, and 20 per cent m ortality, respectively. Blood transfusions (16 +/- 4 vs 23 +/- 4 units ), coagulation factor replacement (7 +/- 2 vs 7 +/- 2 units), and elec trolyte solution use (8.6 +/- 1.4 vs 9.6 +/- 1.4 L) were similar among survivors and nonsurvivors, Four complications [venous hypertension ( n = 2), IVC thrombosis (n = 1), and pulmonary embolus (n = 1)] occurre d in the 14 survivors (28.6%). Blunt injury, revised trauma score, fre e perforation, injury location, intraoperative hypotension, and blood loss were predictive of mortality. NC injuries remain extremely lethal and improved survival is associated with intrarenal penetrating injur ies and a contained hematoma.