To Ligate/To Not Ligate

Injury	Best Action
Infrarenal vena cava	Repair	Can Ligate
Suprarenal vena cava	Repair	Cannot Ligate- at least 50% mortality
Internal jugular vein	Repair	Can ligate unilaterally
Brachiocephalic vein	Repair	Can ligate unilaterally
Subclavian vein and artery	Repair	Can ligate
Superior vena cava	Repair	Can ligate in life-threatening situations
Carotid artery	Repair	Can ligate in life-threatening situations
Mesenteric veins	Ligate
Portal veins	Repair	Can ligate if isolated injury, but at least 50% mortality rate secondary to massive fluid sequestration in splanchnic vascular bed and bowel necrosis
Right renal vein	Repair	Cannot ligate- fewer collateral than left renal vein
Popliteal vein	Repair	Cannot ligate
Femoral vein	Repair	Can ligate
Lobar bile duct	Ligate
Celiac artery	Ligate
Left gastric artery	Ligate
Common/Proper hepatic arteries	Ligate	Especially if proximal to gastroduodenal branch
Right/Left hepatic arteries	Ligate	Especially if portal vein is intact
Splenic artery	Ligate	Short gastric a from left gastroepiploic
Iliac vein-common/ext	Ligate
Iliac artery- comm/ext	Repair
Femoral/Popliteal arteries	Repair
Tibial arteries	Repair	Can ligate but need to ensure patency of other leg arteries
Brachial artery	Repair	Can ligate if distal to profunda brachi branch since the elbow has a rich collateral of blood flow

Special Thanks

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To Ligate/To Not Ligate, Michigan Medicine, Dept of Surgery, “CC BY-NC 4.0”