Atrial caval shunting in blunt hepatic vascular injury.

Of 51 patients with major blunt hepatic trauma treated at a Level I trauma center, 29 patients (56.8%) survived. Nine of the 51 patients required insertion of the atrial caval shunt, as indicated by uncontrollable hemorrhage due to disruption of the perihepatic veins. Eight of these nine patients sustained injury to the hepatic veins or the retrohepatic vena cava. Of the eight patients with hepatic vascular injury, four (50.0%) were long-term survivors. In hepatic trauma patients with suspected hepatic vascular injury, aggressive use of the shunt can control hemorrhage before the onset of coagulopathy or hypothermia.