Injuries of hepatic veins and retrohepatic vena cava.

Three cases of hepatic vein and retrohepatic inferior vena caval injuries are reported, and the literature is reviewed. Our experience, coupled with a critical review of the literature reveals that successful vascular isolation of the relatively inaccessible retrohepatic vena cava and/or hepatic veins is the key to optimal surgical management of major injuries to these structures. The various shunt techniques have been outlined with special emphasis made to the midline sternotomy incision as the incision of choice. This incision not only gives optimal exposure to the injured site, but also allows easy atrial-caval cannulation. If cross-clamping of the abdominal aorta is necessary, it can be easily done via a median sternotomy.