Introduction
Injuries to the juxtahepatic inferior vena cava (IVC) are rare and often fatal. Limited successful uses of the atriocaval shunt as a damage control maneuver have been reported, and the prolonged use of the shunt outside the OR remains unreported. This case presentation describes the use of an atriocaval shunt in a patient with complex liver, pancreatic head, duodenal, and juxtahepatic IVC injuries, highlighting the novelty of its prolonged use.

Case Presentation
A 29-year-old man with multiple midepigastric gunshot wounds presented with confusion, diaphoresis, and inability to lie flat. PE showed HR146, BP146/117, RR37, and an additional penetrating wound on his back. A midline laparotomy revealed extensive injuries, including a juxtarenal IVC injury and a large right renal vein laceration. To avoid bilateral kidney loss, an atriocaval shunt was placed as a temporary measure, remaining in place for several hours until the patient’s condition improved. Following rewarming and resuscitation, the patient underwent IVC repair.

Working Diagnosis
The patient presented with multiple gunshot wounds, resulting in injuries involving the liver, pancreas, duodenum, and juxtahepatic IVC. The working diagnosis included traumatic coagulopathy, hypothermia, acidosis, and potential loss of renal function.

Outcome
The atriocaval shunt provided temporary blood flow diversion, facilitating resuscitation and stabilization. After embolization and rewarming, the IVC injury was repaired, resulting in approximately 70% narrowing. The patient underwent additional procedures for pancreaticoduodenectomy and stenting of the IVC stenosis. Anticoagulation therapy was administered, and the patient was discharged after a 37-day hospitalization.

Discussion
Injuries to the IVC, especially in the suprarenal and retrohepatic regions, are challenging and often fatal. Direct vascular control, ligation, or endovascular interventions are other employed strategies. The atriocaval shunt is an alternative in situations where conventional vascular control techniques are unlikely to succeed.

Conclusion
This case highlights the successful utilization of an atriocaval shunt as a temporizing measure in a complex trauma patient with juxtahepatic IVC injury. The novelty lies in the prolonged use of the shunt beyond the initial operation, allowing for further resuscitation and subsequent repair. More extensive case reporting is required to evaluate this approach’s efficacy and long-term outcomes in similar cases.

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