Cavo-Atrial Inferior Vena Cava (IVC) Restoration With Polytetrafluoroethylene Graft: Overcoming Lethal Injuries

Injuries to the inferior vena cava (IVC) carry high risks and mortality rates. We present a case of suprahepatic IVC injury that was successfully treated with polytetrafluoroethylene (PTFE) graft insertion without cardiopulmonary bypass. A 46-year-old woman was transferred to our trauma centre after a high-speed motor vehicle collision. Computed tomography (CT) revealed a suprahepatic IVC injury with an expanding hematoma within the diaphragmatic muscle. Via a thoracoabdominal approach, total vascular occlusion allowed evacuating the hematoma under control to allow IVC injury assessment. A large defect in the suprahepatic IVC was noted with a near-complete transection at the level of the hepatocaval confluence. A PTFE graft was successfully inserted restoring continuity between the right atrium and hepatic veins. The patient recovered and remains well two years post-trauma. Injuries to the IVC are uncommon and often fatal. Effective coordination between specialties can facilitate positive outcomes even in the most complex clinical scenarios. IVC injuries may be survivable when managed at high-volume expert centres with intensive care, anaesthesia, and surgical expertise.