Abdominal vena caval injuries: Outcomes remain dismal

Background. The mortality rate for abdominal vena caval injuries remains hi gh. We examined the experience of a level I trauma center to determine fact ors significant to the outcome in these injuries. Methods. Forty-seven patients were identified in, a retrospective review (1 989 to 1999) of patients were identified with abdominal vena caval injury. Data were analyzed by uni- and multivariate methods, including logistic reg ression. Results. Most of the individual with abdominal vena caval injuries were you ng male patients who were injured by penetrating trauma and who were hypote nsive on arrival. The severity of injury and the number of organs injured w as high. The overall mortality rate was 55%. Nonsurvivors were more often h ypotensive in the field with physiologic derangement consistent with hemorr hagic shock. Type and location of injury as well as method of repair were a ssociated with death. Multiple regression analysis revealed that prehospita l initial systolic blood pressure and intraoperative bicarbonate levels wer e independent predictors of survival. Conclusions. We identified factors related to poor outcome, including supra renal and retrohepatic location of injury and variables that reflected the evolution of shock. Management should include appropriate resuscitation and ultimately may require novel operative techniques.