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with death occurring even before the bleeding area is localized. Surgically, the area is difficult to access as it is largely covered by the liver. In 1968 Schrock et al. reported on the first use of the ACS. They devised this approach after observing that above the renal veins only the right adrenal
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A 1988 review by Burch et al. analyzed their experience with the ACS looking at 31 patients. 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 74% the vena cava
76:—can be inserted. The stent is secured with tourniquets. Problems during surgery involve uncontrollable bleeding and technical problems in placing the shunt in a timely fashion. Six patients survived (about 20%).
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Pachter et al. devised a transhepatic approach to access the inferior vena cava. Another approach may be the placement of a balloon-caval shunt introduced from the
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such as an injury to the local vena cava. Injuries to the inferior vena cava are challenging, those behind the liver being the most difficult to repair.
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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
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Pilcher DB, Harman PK, Moore EE, et al. (Nov 1977). "Retrohepatic vena cava balloon shunt introduced via the sapheno-femoral junction".
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Pachter HL, Spencer FC, Hofstetter SL, et al. (May 1986). "The management of juxtahepatic venous injuries without an atriocaval shunt".
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Buckmann et al. indicate that injury to the juxtahepatic veins may not necessarily require surgery if the hematoma is contained.
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Schrock T; Blaisdell FW; Mathewson C., Jr (May 1968). "Management of blunt trauma to the liver and hepatic veins".
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Buckman RF, Pathak AS, Badellino MM, Bradley KM (Dec 2001). "Injuries of the inferior vena cava".
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vein, the hepatic veins, and the inferior phrenic veins enter the inferior vena cava.
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110:"Use of an Atriocaval Stunt in a Trauma Patient: First Reported Case in Hawai'i"
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39:. It is used during the repair of larger juxtahepatic (next to the
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is necessary to find the atrium so that the stent—usually a 36
156:Burch JM, Feliciano DV, Mattox KL (May 1988).
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64:was directly involved. In addition to the
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158:"The atriocaval shunt. Facts and fiction"
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108:Clark JJ, Steinemann S, Lau JM (2010).
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219:10.1001/archsurg.1968.01330230006002
68:to access the retrohepatic space, a
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281:10.1097/00005373-197711000-00003
174:10.1097/00000658-198805000-00010
1:
316:10.1016/s0039-6109(01)80016-5
344:Emergency medical procedures
20:(ACS) is an intraoperative
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114:Hawai'i Medical Journal
51:Procedure and results
304:Surg Clin North Am
37:inferior vena cava
74:French chest tube
57:hemorrhagic shock
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18:atriocaval shunt
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310:(6): 1431–47.
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275:(11): 837–41.
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213:(5): 698–704.
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88:in the groin.
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248:(5): 569–75.
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168:(5): 555–68.
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86:femoral vein
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80:Alternatives
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27:between the
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120:(2): 47–8.
70:thoracotomy
43:) vascular
207:Arch. Surg
95:References
66:laparotomy
162:Ann. Surg
338:Category
324:11766184
269:J Trauma
136:20358727
45:injuries
35:and the
22:surgical
254:3518106
242:Surgery
227:5647544
192:3377566
183:1493506
127:3104635
31:of the
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29:atrium
41:liver
33:heart
25:shunt
320:PMID
285:PMID
250:PMID
223:PMID
188:PMID
132:PMID
312:doi
277:doi
215:doi
178:PMC
170:doi
166:207
122:PMC
16:An
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