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

Anuradha, S; Vercruysse, Gary; Dente, Christopher J.; Wyrzykowski, Amy D.; King, Erin R.; Feliciano, David V.

doi:10.1097/ta.0b013e31817e5132

Cited by 135 publications

(110 citation statements)

References 17 publications

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“…This experience supports the early detection of the injured vessel(s) and use of shunts in certain cases as part of an overall strategy in the management of vascular injury. 2,3 Early results of in-theater repair are comparable with contemporary civilian reports and have greatly improved from the Vietnam era. Rapid evacuation and damage control maneuvers, such as temporary shunting and early fasciotomy, assist in timely definitive repair and appear effective.…”

supporting

confidence: 70%

Management of high-risk popliteal vascular blunt trauma: clinical experience with 62 cases

Pourzand

Fakhri²,

Azhough³

et al. 2010

VHRM

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Patients and methods:A retrospective analysis was conducted of prospectively collected data from Tabriz Medical Trauma Center. Our aim was to perform surgical revascularization as soon as the arterial injury was recognized. The mechanism of injury was blunt in the entire cohort of patients, and all of them had bone fractures about the knee. The treatment of arterial injury included vein graft interposition in 39 (63%), primary anastomosis in 20 (32.3%), and lateral repair in 3 (4.8%) patients. The patients were divided into 2 study groups: limb salvage group (group 1) and amputation group (group 2). Subgroup analysis consisted of univariate analysis comparing the 2 groups and multivariate analysis examining the factors associated negatively and positively with the primary endpoint, limb salvage. Results: In the entire cohort of patients, 60 patients (97%) were male and 2 were female (3%); the mean age was 34.1 years (16-49 years). The overall amputation rate in this study was 37.1% (23 amputations). Significant (P , 0.05) independent factors associated negatively with limb salvage were combined tibia and fibula fracture, concomitant artery and vein injury, ligation of venous injury, and lack of backflow after Fogarty catheter thrombectomy, while repair of popliteal artery and vein injury, when present, was associated with improved early limb salvage. For 40 patients, we adopt a liberal attitude toward open 4-compartment fasciotomy through both medially and laterally placed incisions. Conclusion: Expeditious recognition of vascular injury, transport to repair, and repair of associated venous injury when possible are necessary to optimize limb salvage. The importance of a high level of suspicion and low threshold for timely amputation has been emphasized when limb salvage was deemed impossible to prevent life-threatening complication. Delays in surgery, extensive soft tissue defect, compound tibia-fibula fracture, and other factors are associated with high amputation rate following popliteal artery injury.

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supporting

confidence: 70%

Management of high-risk popliteal vascular blunt trauma: clinical experience with 62 cases

Pourzand

Fakhri²,

Azhough³

et al. 2010

VHRM

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“…Interim solutions (such as primary shunt placement to stabilize perfusion, fracture stabilization, and later definitive vascular reconstruction, or providing a damage control framework until physiological recompensation after severe trauma) are also under discussion [82,110,119,122,125,129,146,183]. In cases of complex trauma when there is a high probability of vascular injury, primary vascular revision should be performed, with immediate vascular reconstruction if needed [196].…”

Section: Explanationmentioning

confidence: 99%

“…This is about securing the basic vital functions directly associated with survival. In established standards of trauma care, the ''A'' for airway and ''B'' for breathing are given the highest priority and thus, are S38 particularly important for both pre-hospital and early hospital management [4,131,183]. One problem with evaluating the evidence available is that information cannot be directly referred to the German rescue and emergency physician system, due to the divergent organization of emergency rescue services internationally and the resulting differences in experience and routines used to secure the airway.…”

Section: Airway Management Ventilation and Emergency Anesthesiamentioning

confidence: 99%

Level 3 guideline on the treatment of patients with severe/multiple injuries

Bouillon¹,

Pieper²,

Flohé³

et al. 2018

Eur J Trauma Emerg Surg

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“…There are no studies that have compared the effectiveness of these shunts to one another in the setting of trauma, and any one or more may be used for vascular trauma even at the same institution. 26 Nevertheless, extrapolation from translational …”

Section: Insertion Techniquementioning

confidence: 98%