“…Two multicenter reviews were unable to demonstrate an association with systemic anticoagulation with a reduced incidence of shunt thrombosis. 7,28 However, the four patients in one of those studies that developed limb ischemia or thrombosis did not receive anticoagulation during shunt dwell time. 28 Shunt dislodgement is a rare complication that providers should strive to avoid.…”
Section: Discussionmentioning
confidence: 99%
“…7,28 However, the four patients in one of those studies that developed limb ischemia or thrombosis did not receive anticoagulation during shunt dwell time. 28 Shunt dislodgement is a rare complication that providers should strive to avoid. In a single-center, retrospective review, there were two (8%) reported dislodgments of shunts with one resulting in catastrophic bleeding.…”
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.
“…Two multicenter reviews were unable to demonstrate an association with systemic anticoagulation with a reduced incidence of shunt thrombosis. 7,28 However, the four patients in one of those studies that developed limb ischemia or thrombosis did not receive anticoagulation during shunt dwell time. 28 Shunt dislodgement is a rare complication that providers should strive to avoid.…”
Section: Discussionmentioning
confidence: 99%
“…7,28 However, the four patients in one of those studies that developed limb ischemia or thrombosis did not receive anticoagulation during shunt dwell time. 28 Shunt dislodgement is a rare complication that providers should strive to avoid. In a single-center, retrospective review, there were two (8%) reported dislodgments of shunts with one resulting in catastrophic bleeding.…”
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.
“…The swine were randomized to a thrombin infusion of 5000 U/h vs 10,000 U/h as determined by prior experience with thrombin infusions and reported applications of thrombin in swine. 7 , 8 , 11 Fig 2 Experimental setup and preparation. A, Schematic representation of the experimental setup showing left-to-right blood flow, with a proximal flow probe, a cannulated circumflex iliac artery with a size 18 angiocatheter for thrombin infusion, and Argyle shunt placement through the external ( Ext. )…”
Section: Methodsmentioning
confidence: 99%
“…Furthermore, the mechanism of TIVS failure has not yet been clearly defined, and neither the duration nor the type of TIVS have been proved to be associated with the thrombosis rate or timing. 6 , 8 Overall, TIVS failure has been thought to multifactorial and likely related to reduced runoff resulting from capillary bed thrombosis, which slows TIVS blood transit and thrombosis. To determine the factors leading to shunt failure and to develop an early warning system that could prompt intervention, such as an earlier return to the operating room or medical management (eg, heparin or blood pressure titration), and to avoid complete shunt failure, a reproducible and clinically relevant model of intrinsic TIVS failure is required.…”
mentioning
confidence: 99%
“… 9 , 10 , 11 The reliability that the external iliac artery will be ≥6 mm if the pig weighs ≤50 kg has been shown to >90% 11 and thus represents a model for human size brachial to superficial femoral arteries, common anatomic locations for TIVS placement. 1 , 6 , 7 , 8 , 12 …”
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