Multicenter evaluation of temporary intravascular shunt use in vascular trauma

Abstract

Therapeutic study, level V.

Vascular Shunts in Civilian Trauma

“…A query of the NTDB over a 5-year period revealed that only 6 centers used more than 5 shunts during this period; only 3 used more than 10 (6). The diverse nature of this population was highlighted when the NTDB revealed that 64% of vascular injuries were blunt traumas in contrast to earlier and recent studies indicating a 62–71% incidence of penetrating injuries (3, 18). This variability showcases the inherent selection bias with single center studies depending on the regional characteristics of an institution.…”

“…A recent analysis of the NTDB demonstrated that 74% of vascular shunts are placed in “blunt traumas associated with extensive orthopedic and/or soft tissue injury” compared to 1% in military registries (6, 16). The incidence of shunt use in civilian vascular trauma is also lower and ranges between 3 and 9% (3, 18). A query of the NTDB over a 5-year period revealed that only 6 centers used more than 5 shunts during this period; only 3 used more than 10 (6).…”

“…The largest and most recent multicenter study revealed that shunts are infrequently used for vascular injuries with only 213 TIVS placed across 9 years (2.7% of vascular injuries) (18). Two-thirds of the shunts were placed for damage control with the remaining one-third for combined orthopedic-vascular injuries.…”

“…The elevated mortality rate among shunted injuries in the study (20.4%) was due to truncal injuries constituting 25% of the study population; none of the deaths was attributed to shunt use. The amputation rate was 3.5% with half of them due to soft tissue injuries, while the other half was due to graft complications; none of the amputations was attributed to shunt use (18). …”

“…Shunts were more commonly used in extremity (65–94%) and arterial (70–100%) injuries compared to truncal and venous injuries, respectively (3, 18). The most commonly shunted extremity vessels were the superficial femoral artery (25%) followed by the popliteal artery (19%) (3, 18).…”