Successful atrial caval shunting in the management of retrohepatic venous injuries

Area of Science:

• Trauma Surgery
• Vascular Surgery
• Hepatobiliary Surgery

Background:

• Liver injuries can cause severe hemorrhage, particularly from perihepatic venous disruptions.
• Controlling venous hemorrhage during laparotomy for liver trauma presents significant surgical challenges.

Purpose of the Study:

• To evaluate the efficacy of atrial caval shunts in managing hemorrhage from liver venous injuries.
• To identify common errors in shunt placement and develop improvements in technique and device design.

Main Methods:

• Retrospective analysis of 519 patients undergoing laparotomy for liver injuries over 3 years.
• Focused review of 9 patients requiring atrial caval catheter insertion for perihepatic venous hemorrhage.
• Development of a modified atrial caval catheter and simplified insertion technique.

Main Results:

• Nine patients (2%) required atrial caval shunts for perihepatic venous hemorrhage.
• Shunt insertion successfully controlled hemorrhage in 3 cases, facilitating surgical repair.
• Analysis identified common errors in placement, leading to technique and device modification.

Conclusions:

• Atrial caval shunting is a viable option for controlling life-threatening hemorrhage from liver venous injuries.
• Refined techniques and a modified catheter improve the safety and efficacy of this intervention.
• Experience gained can guide future management of complex liver trauma involving venous injury.