Vena cava injury repair

There are few reports of single vena cava injury, and more combined with arterial injury. When the superior vena cava or inferior vena cava ruptures in the pericardium, acute cardiac tamponade is formed without exception, and is often diagnosed as a cardiac trauma before surgery. Most of the vena cava injuries are caused by penetrating injuries. The amount of blood loss after injury is large, and the mortality rate is higher when the diagnosis and treatment are delayed. However, depending on the type, location and size of the lesion, there is a large difference in the amount and speed of bleeding. In 1974, Mattox reported a 40% mortality rate for superior vena cava injury and a 17% mortality rate for superior inferior vena cava injury.

Treatment of diseases: abdominal aortic vena cava

Indication

Vena cava injury repair is applicable to:

Preoperative diagnosis is very difficult. Anyone who is suspected of such a large blood vessel injury should be surgically explored in time.

Preoperative preparation

Hemodynamic monitoring should be performed strictly before surgery. Quickly replenish blood volume and correct shock. If you suspect acute cardiac tamponade, you should do a pericardial puncture in time or do a pericardial fenestration under the xiphoid process.

Surgical procedure

1. The chest midline incision or the right anterior and fourth external intercostal thoracotomy.

2. Expose the vena cava, find the source of the bleeding, use the fingers to stop the bleeding, and accelerate the blood transfusion to make up for the blood loss.

3. The non-invasive vascular clamp is used to close part of the lumen or to repair the vena cava damage by intravenous intravenous shunt.

4. The internal shunt method is to insert a catheter with a side hole through the right atrial appendage into the superior or inferior vena cava, and tighten the tourniquet around the vein at the distal and proximal ends of the laceration to control the bleeding of the rupture.

5. Repair the vena cava rupture with non-invasive suture, most of which can be sutured.

6. When the fracture injury can not be directly repaired, the end-to-end anastomosis can be tried after trimming the wound; if the defect is too long or the tension is too high, the blood vessel patch or the autologous pericardium or autologous vein repair is used.

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