Jornal Vascular Brasileiro
https://jvascbras.org/article/doi/10.1590/1677-5449.202401491
Jornal Vascular Brasileiro
Artigo Original

Tratamento de lesões penetrantes de veia cava retro-hepática: uma revisão sistemática

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

Adenauer Marinho de Oliveira Góes Junior; Simone de Campos Vieira Abib; Gustavo Henrique Dumont Kleinsorge; Daniella Adrea Araujo Rossi Vieira; Luis Carlos Uta Nakano; Mariseth Carvalho de Andrade

http://dx.doi.org/10.1590/1677-5449.202401491 J Vasc Bras, vol.24, e20240149, 2025
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Resumo

Contexto: 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.

Objetivos: Definir qual dessas técnicas apresenta menor mortalidade.

Métodos: 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.

Resultados: 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).

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

Palavras-chave

veia cava inferior; ferimentos e lesões; procedimentos endovasculares; procedimentos de tratamento; procedimentos cirúrgicos operatórios; revisão sistemática

Abstract

Background: 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.

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

Methods: 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.

Results: 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).

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

Keywords

inferior vena cava; wounds and injuries; endovascular procedures; therapeutics; surgical procedures; operative; systematic review

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