From the Guidelines
The mortality rate for penetrating trauma to the Inferior Vena Cava (IVC) is approximately 50%, as reported in the most recent and highest quality study available 1. This high mortality rate is primarily due to the IVC's large diameter, thin walls, and high blood flow, which can lead to rapid exsanguination when injured. Mortality varies significantly based on several factors, including:
- The anatomical location of the injury (retrohepatic and suprahepatic injuries having mortality rates as high as 80-90%)
- The presence of associated injuries to other organs
- The patient's hemodynamic status upon arrival
- The time elapsed between injury and definitive surgical intervention. Patients who arrive in shock have significantly worse outcomes, as noted in the management of bleeding following major trauma 1. The mechanism of injury also impacts survival rates, with gunshot wounds generally carrying a higher mortality than stab wounds due to their more destructive nature. Immediate surgical intervention with damage control techniques, including direct repair, ligation in select cases, or the use of temporary intravascular shunts, is essential for improving survival chances, as outlined in the european guideline on management of major bleeding and coagulopathy following trauma: sixth edition 1. Advances in trauma care systems, including rapid transport, damage control resuscitation with balanced blood product administration, and improved surgical techniques have helped reduce mortality rates over recent decades, though IVC injuries remain among the most challenging traumatic vascular injuries to manage. The use of intraoperative cell salvage (ICS) during traumatic haemorrhage may also offer advantages for patients who refuse transfusion and in a resource-constrained environment, potentially including pre-hospital blood salvage, when transport and access to blood products are challenging 1.
From the Research
Mortality Rate for Penetrating Trauma to the Inferior Vena Cava (IVC)
- The mortality rate for penetrating trauma to the IVC is high, with studies indicating a range of mortality rates.
- A study from 2015 2 reported a mortality rate of 37% for patients with IVC injuries due to gunshot wounds.
- Another study from 2011 3 mentioned that penetrating injuries of the IVC are associated with a high mortality rate of approximately 78%.
- A study from 2006 4 found that the mortality rate for traumatic IVC injuries was 56%, with no difference in mortality based on the mechanism of injury (blunt or penetrating).
- The location of the IVC injury also plays a role in mortality, with injuries closer to the heart associated with increased mortality 4.
- Factors such as the Glasgow Coma Scale (GCS) score and the volume of packed red blood cell transfusion have been identified as independent predictors of mortality in patients with IVC injuries 5, 4.
- Treatment at high-volume penetrating trauma centers has been associated with lower mortality rates for penetrating trauma patients, including those with IVC injuries 6.