A Decade's Experience With Temporary Intravascular Shunts at a Civilian Level I Trauma Center

J Trauma. 2008 Aug;65(2):316-24; discussion 324-6. doi: 10.1097/TA.0b013e31817e5132.

Abstract

Background: A 10-year review of temporary intravascular shunts (TIVS) at a regional trauma center.

Methods: Retrospective chart review of all patients treated with temporary intravascular shunts from January 1, 1997 to January 1, 2007.

Results: Seven hundred eighty-six patients were treated for vascular injuries. Sixty-seven (9%) had a total of 101 (72 arterial, 29 venous) TIVS placed to facilitate damage control or to allow for reconstruction of Gustilo IIIc fractures or limb replantation. Seven patients who, on trauma day 0, died or had an extremity which was deemed unsalvageable were excluded. Of 60 patients who met inclusion criteria, seven died from TBI (3%), MOF (3%), sepsis (2%), deceleration of care (2%), and loss of airway (2%), which was deemed preventable.

Conclusions: TIVS have a shunt thrombosis rate of 5%, amputation rate of 18%, overall survival of 88%, and combination limb/patient survival rate of 73%. TIVS have an established role primarily in patients requiring either "damage control" for exsanguination or temporary vascular conduits during stabilization of Gustilo IIIc fractures. Truncal injuries are associated with the highest mortality likely due to accompanying multisystem trauma.

MeSH terms

  • Adult
  • Amputation / statistics & numerical data
  • Balloon Occlusion
  • Brachial Artery / surgery
  • Critical Illness
  • Extremities / blood supply*
  • Fasciotomy
  • Female
  • Femoral Artery / surgery
  • Fractures, Open / complications*
  • Humans
  • Ischemia / prevention & control*
  • Leg / blood supply
  • Limb Salvage / methods*
  • Male
  • Multiple Trauma / surgery*
  • Popliteal Artery / surgery
  • Retrospective Studies
  • Vascular Patency
  • Vascular Surgical Procedures / methods*
  • Wounds, Gunshot / surgery
  • Wounds, Nonpenetrating / surgery