Central venous injuries of the subclavian-jugular and innominate-caval confluences

Injuries to the central venous system can result from penetrating trauma or iatrogenic causes. Injuries to major venous confluences can be particularl y problematic, because the clavicle and sternum seriously limit exposure of the injury site. We report our institution's experience with central venou s injuries of the subclavian-jugular and innominate-caval venous confluence s. Significant injuries of the subclavian-jugular venous confluence frequen tly result from penetrating trauma, while injuries to the innominate-caval confluence are usually catheter-related. Median sternotomy provides adequat e exposure of the innominate-caval confluence while exposure of the subclav ian-jugular venous confluence requires extension of the median sternotomy i ncision into the neck and resection of the clavicle. The literature is revi ewed.