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Apr 29, 2013Article Details
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Temporary vascular shunting in vascular trauma: A 10-year review from a civilian trauma centre
Abstract
Background. Temporary intravascular shunts (TIVSs) can replace immediate definitive repair as a damage control procedure in vascular
trauma. We evaluated their use in an urban trauma centre with a high incidence of penetrating trauma.
Method. A retrospective chart review of all patients treated with a TIVS in a single centre between January 2000 and December 2009.
Results. Thirty-five TIVSs were placed during the study period: 22 were part of a damage control procedure, 7 were inserted at a peripheral
hospital without vascular surgical expertise prior to transfer, and 6 were used during fixation of a lower limb fracture with an associated
vascular injury. There were 7 amputations and 5 deaths, 4 of the TIVSs thrombosed, and a further 3 dislodged or migrated. Twenty-five
patients underwent definitive repair with an interposition graft, 1 primary anastomosis was achieved, and 1 extra-anatomical bypass was
performed. Five patients with non-viable limbs had the vessel ligated.
Conclusions. A TIVS in the damage control setting is both life- and limb-saving. These shunts can be inserted safely in a facility without access to a surgeon with vascular surgery experience if there is uncontrollable bleeding or the delay to definitive vascular surgery is likely to be more than 6 hours. A definitive procedure should be performed within 24 hours.
trauma. We evaluated their use in an urban trauma centre with a high incidence of penetrating trauma.
Method. A retrospective chart review of all patients treated with a TIVS in a single centre between January 2000 and December 2009.
Results. Thirty-five TIVSs were placed during the study period: 22 were part of a damage control procedure, 7 were inserted at a peripheral
hospital without vascular surgical expertise prior to transfer, and 6 were used during fixation of a lower limb fracture with an associated
vascular injury. There were 7 amputations and 5 deaths, 4 of the TIVSs thrombosed, and a further 3 dislodged or migrated. Twenty-five
patients underwent definitive repair with an interposition graft, 1 primary anastomosis was achieved, and 1 extra-anatomical bypass was
performed. Five patients with non-viable limbs had the vessel ligated.
Conclusions. A TIVS in the damage control setting is both life- and limb-saving. These shunts can be inserted safely in a facility without access to a surgeon with vascular surgery experience if there is uncontrollable bleeding or the delay to definitive vascular surgery is likely to be more than 6 hours. A definitive procedure should be performed within 24 hours.
