Two cases of open and video-assisted thoracoscopic approaches to superior vena cava in combat trauma in Ukraine

Abstract

Aim: to analyze the clinical features and surgical outcomes of combat-related superior vena cava injuries and to determine the optimal operative strategy considering the mechanism of injury, severity of the patient’s condition, and associated thoracic damage.

Materials and methods. The article presents two clinical cases of combat trauma involving injury to the superior vena cava treated in Zaporizhzhia Military Hospital, Ukraine. Both patients sustained penetrating thoracic injuries caused by explosive fragments during hostilities. Clinical data, imaging findings, intraoperative observations, surgical techniques, and postoperative outcomes were analyzed. Two different surgical approaches were used depending on the patient’s clinical condition, injury characteristics, and anatomical localization of the vascular damage: open surgical repair and video-assisted thoracoscopic surgery. Particular attention was paid to the mechanism of injury, associated thoracic damage, hemodynamic stability, and the feasibility of minimally invasive intervention in combat trauma settings.

Results. In the first case, the patient underwent open surgical repair of the superior vena cava due to the severity of injury and associated thoracic damage. In the second case, a video-assisted thoracoscopic approach was successfully used for removal of the foreign body and repair of the vascular wall. Both patients survived and demonstrated favorable postoperative outcomes without major complications. These cases illustrate that modern combat injuries caused by low-velocity fragments may allow delayed surgical management due to temporary sealing of the vascular defect by the fragment itself. This phenomenon may facilitate planned surgical intervention after evacuation to a specialized medical facility.

Conclusions. Injuries of the superior vena cava in combat trauma are rare but potentially life-threatening conditions that require prompt diagnosis and individualized surgical management. Both open surgery and video-assisted thoracoscopic techniques can be effective treatment options. The choice of surgical approach should depend on the patient’s physiological status, the mechanism of injury, the extent of associated thoracic damage, and the overall survivability potential.