Atrial caval shunt in the management of juxtahepatic venous injuries

From July 1, 1991 through June 30, 1992, six patients with major juxtahepatic venous injuries were treated with atrial caval shunts. One patient had suffered a gunshot injury; the other five were victims of blunt trauma. All six patients were in shock state on admission, and five of the six had associated injuries, with injury severity scores ranging from 25 to 66. Major hepatic resection was required in five patients. Four patients died intraoperatively from exanguination. In two cases, the atrial caval shount effectively arrested the hemorrhage, allowing for successful surgical repair of the venous injuries. One of these two patients died three days postoperatively from multiple organ system failure. The final patient survived, and was subsequently discharged from the hospital without complications. Major juxtahepatic venous injuries are highly lethal. An atrial caval shunt will permit the salvage of some patients in whom other methods are not possible or not effective.