Treatment of penetrating injuries to the retrohepatic inferior vena cava: a systematic review

TL;DR

This paper reviews different treatment methods for a serious type of vein injury and finds that all methods have similar high mortality rates.

Contribution

The study systematically compares treatment techniques for retrohepatic vena cava injuries and finds no significant difference in mortality rates.

Findings

16 studies with 96 cases were analyzed, showing a 53.8% mortality rate.

No significant difference in mortality was found between treatment techniques.

Endovascular/hybrid techniques were used less frequently than other methods.

Abstract

Injuries to the retrohepatic vena cava are associated with high mortality rates and vascular control must be obtained prior to exposure. Various treatment techniques have been described, including triple hepatic vascular exclusion, atriocaval shunt, and endovascular and hybrid strategies.

To determine which of these is associated with the lowest mortality rate.

A systematic literature review was conducted, guided by the Cochrane Handbook and PRISMA guidelines. The PUBMED, LILACS, Embase, Web of science, and Scopus databases were searched and Ryyan software was employed to manage the studies identified.

Sixteen studies were selected, reporting 96 cases, in 49 of which the patients were treated with triple hepatic exclusion, in 38 with an atriocaval shunt, and in 9 with endovascular or hybrid techniques, with the third of these groups being statistically less frequent (p < 0.0001). The mortality rate was 53.8%, with no statistically significant differences between any of the techniques studied (p = 0.9085).

Injuries to the retrohepatic vena cava had similar mortality rates regardless of the technique employed for treatment.

As lesões da veia cava retro-hepática apresentam alta mortalidade e requerem controle vascular prévio à sua exposição. Para seu tratamento, foram descritas técnicas como a tríplice exclusão hepática, o shunt átrio-caval e técnicas endovasculares ou híbridas.

Definir qual dessas técnicas apresenta menor mortalidade.

Foi realizada uma revisão sistemática da literatura, orientada pelo Cochrane Handbook e pela declaração Preferred Reporting Items for Systematic Reviews and Meta-Analyses. As bases de dados PubMed, Literatura Latino-Americana e do Caribe em Ciências da Saúde, Embase, Web of Science e Scopus foram pesquisadas, e o software Rayyan foi utilizado para o gerenciamento dos estudos.

Ao todo, 16 estudos foram selecionados, resultando em 96 casos: 49 pacientes foram tratados com tríplice exclusão hepática, 38 com shunt átrio-caval e 9 com técnicas endovasculares ou híbridas, sendo estas últimas significativamente menos frequentes na amostra (p < 0,0001). A mortalidade global foi de 53,8%, sem diferença estatisticamente significativa entre as técnicas analisadas (p = 0,9085).

As lesões da veia cava retro-hepática apresentaram mortalidade semelhante, independentemente da técnica utilizada para o tratamento.

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