Systematic review of temporary intravascular shunt use in military and civilian extremity trauma

Abstract

BACKGROUND:The use of temporary intravascular shunts (TIVS) in the setting of military and civilian trauma has grown in recent years, predominantly because of the mounting evidence of improved limb outcomes. We sought to characterize the use and outcomes of TIVS in trauma through a systematic review of military and civilian literature. METHODS:The MEDLINE, EBSCO, EMBASE, and Cochrane databases were searched for studies on TIVS use in military and civilian trauma settings published between January 2000 and March 2021. Reports lacking systematic data collection along with those with insufficient TIVS descriptive and outcome data were excluded. Data regarding the characteristics and outcomes of TIVS were assessed and collective syntheses of military and civilian data performed. RESULTS:Twenty-one reports were included, 14 from civilian trauma centers or databases and 7 from military field data or databases (total of 1,380 shunts in 1,280 patients). Sixteen were retrospective cohort studies, and four were prospective. Five studies had an unshunted comparison group. Shunts were predominantly used in the lower extremity and most commonly for damage control indications. Dwell times were infrequently reported and were not consistently linked to shunt thrombosis or other complications. Anticoagulation during shunting was sparsely reported and inconsistently applied. Shunted limbs had higher injury severity than unshunted limbs but similar salvage rates. CONCLUSION:Temporary intravascular shunts are effective for expeditious restoration of perfusion in severely injured limbs and likely contribute to limb salvage. There is a paucity of comparative TIVS data in the literature and no consistently applied reporting standards, so controversies regarding TIVS use remain.

Temporary arterial shunts in combat patient with vascular injuries to extremities wounded in Russian-Ukrainian war: A case report

“…Therefore, damage control surgery should include temporary arterial shunting in case of a major vessel gunshot injury [16] . It is worth also to mention, that data from systemic reviews also supported temporary arterial shunting for both civil and combat gunshot wounds within 6 h after the injury to prevent critical ischemia [17] . In this case we reported fasciotomy on the Level IV of medical care, but this procedure was not performed on Level II.…”

Twenty-minute harvesting of flow-through type vastus lateralis muscle flap significantly reduces the need for a temporary intravascular shunt in the treatment of severe upper extremity trauma in civilian patients

“…[6,7] The benefits of temporary reperfusion using a TIVS to improve ischemia as quickly as possible and avoid amputation has been reported in a number of cases. [1,2,8,9] Since the placement of an indwelling TIVS is a temporary procedure, subsequent bypass with the great saphenous vein is necessary. With regard to the time required to harvest the great saphenous vein, which is frequently used in such bypass procedures, the average harvest time was reported to be 23 minutes (23.680 ± 56.57 minutes).…”

Anterior Tibial to Dorsalis Pedis Bypass to Manage Acute Ischemia Attributed to Pilon Fracture

“…13,14 Admittedly, there is a lack of comparative data in the literature regaring the use of temporal intravascular shunt and no consistency in applied reporting standards, retaining controversies regarding the efficacy of these shunts. 15 Polcz et al 16 conducted recently the first multicenter, matched-cohort study to characterize early limb salvage as a function of temporal intravascular shunt in the setting of extremity vascular injury and documented lower rates of amputation during the early phase of care. Generally, it is our practice to use a Pruitt-Inahara shunt (LeMaitre Vascular Inc, Burlington, MA, USA) to bridge the popliteal artery above and below the knee in combined orthopedic and vascular lesions to restore perfusion temporarily prior to orthopedic interventions (Figure 4).…”