Control of Inferior Vena Cava Injury Using Percutaneous Balloon Catheter Occlusion

Abstract

Traumatic inferior vena cava (IVC) injuries are highly lethal and require prompt surgical intervention. Traditional methods of vascular control include manual compression, gentle clamping or balloon occlusion catheters. These open methods require direct dissection into the hematoma for visualization, which can lead to massive hemorrhage. We present a case of percutaneously delivered balloon catheter occlusion for vascular control prior to repair of an infrarenal IVC injury as a potential alternative. This approach achieves complete occlusion of the injury site and allow easier repair of the IVC, thereby reducing operative time and blood loss.

Modern Advances in Vascular Trauma

“…96 Given the success with external balloon control, the concept of endovascular application of occlusion has grown. 95 Most of the current literature is single case reports, but the technique has attractive potential. As in the case of endovascular repair, endovascular control of hemorrhage requires further study.…”

“…Use has been described recently for penetrating arterial injuries, inferior vena cava control, major hepatic vascular injury, and pelvic exsanguination. 95,96 The breadth of experience is limited but proponents advocate that it results in reduced blood loss, especially in difficult exposures, avoids entering the hematoma without proximal control, reduces operative time, and, in select cases, can be paired with endovascular covered stent repairs. A 10-year retrospective experience of externally placed balloon catheters published in 2011 examined outcomes in 44 patients.…”

Blunt Aortic / Inferior Vena Cava Injury: Are We Consistently Providing the Same Level of Care?

“…Endovascular therapy for BTIVCI has also up-trended through the years from 0.3% in 2000 to 4.2% in 2014 in the United States. This advance in management is of extreme importance since in-hospital mortality for BTIVCI is most commonly caused by intraoperative exsanguination [21,29]. BTIVICI with pseudo-aneurysm and/or free rupture has been successfully treated with an endovascular approach [30].…”

“…BTIVICI with pseudo-aneurysm and/or free rupture has been successfully treated with an endovascular approach [30]. Management with early endovascular management for hemorrhage control, followed by open repair with good results, has also been reported [29].…”

Damage control – trauma care in the first hour and beyond: a clinical review of relevant developments in the field of trauma care

“…50 Blood loss may be immense, and case reports of endovascular balloon occlusion of the IVC, 81 atriocaval shunting, 82 and cardiopulmonary bypass and hypothermic circulatory arrest 83 describe successful methods with low numbers to reduce blood loss at the time of surgery. Endovascular therapy may have a role to play, and case reports exist of IVC endograft placement for surgical haemorrhage 84 and fenestrated endografting for juxtahepatic IVC injury via the right femoral vein.…”