Major venous reconstruction using autologous peritoneal and posterior rectus sheath graft: A case report and literature review.

Major injuries to the inferior vena cava (IVC) are associated with high morbidity and mortality. In cases of extensive vascular loss where prosthetic material or autologous venous grafts are unavailable, the use of a fascial autograft represents a viable alternative. We present the case of an 80-year-old male patient with sepsis secondary to pyonephrosis. During nephrectomy, the patient sustained a circumferential infrarenal injury in the inferior vena cava. Owing to the impossibility of primary repair, the lack of available vascular prostheses at the institution, and the patient's hemodynamic instability, an emergency vascular reconstruction was performed using a tubularized autologous graft obtained from the parietal peritoneum and the posterior sheath of the rectus abdominis muscle. Postoperatively, the patient developed segmental graft thrombosis, an expected complication, which was managed conservatively with anticoagulation therapy. Clinical evolution was favorable, with partial recanalization and development of collateral venous circulation. The peritoneofascial autograft combined with the posterior rectus sheath represents a feasible and effective surgical option in vascular emergencies, particularly in contaminated fields, providing satisfactory early outcomes in terms of hemostasis and clinical recovery.