J Vasc Surg Venous Lymphat Disord 2019 Mar 26;7(2):247-250. Epub 2018 Nov 26.
Division of Vascular Surgery, Department of Surgery, Advocate Illinois Masonic Medical Center, Chicago, Ill.
In this case, a 22-year-old man sustained multiple gunshot wounds to the abdomen, which required in extremis surgical exploration with damage control laparotomy and hemostatic resuscitation in the surgical intensive care unit. Diagnostic angiography was negative and an inferior vena cava (IVC) injury was suspected. He was returned to the operating room, where the infrarenal IVC was accessed by direct puncture and venography demonstrated active extravasation of the suprarenal vena cava. The injury was successfully sealed with two overlapping endovascular aortic grafts, with care taken to preserve flow from the renal and hepatic veins. He made a full recovery and was discharged home on hospital day 20. Outpatient follow-up computed tomography at 2 months revealed a patent stent with preserved branches. Stent graft repair of penetrating IVC injury can be lifesaving and warrants further investigation.