Injury to the vena cava adjacent to the liver and/or connected hepatic veins leads to often fatal bleeding.
Patients may be admitted already in hemorrhagic shock with death occurring even before the bleeding area is localized.
[2] They indicated that “few technical maneuvers in surgery (are) as dramatic or desperate as the use of the atriocaval shunt ...” Ninety percent of the patients were admitted in shock.
In addition to the laparotomy to access the retrohepatic space, a thoracotomy is necessary to find the atrium so that the stent—usually a 36 French chest tube—can be inserted.
[5] Buckmann et al. indicate that injury to the juxtahepatic veins may not necessarily require surgery if the hematoma is contained.