Temporary Vascular Shunts as Initial Treatment of Proximal Extremity Vascular Injuries During Combat Operations: The New Standard of Care at Echelon II Facilities?

Abstract

Complex combat injuries to proximal extremity vessels should be routinely shunted at forward-deployed Echelon II facilities as part of the resuscitative, damage control process.

Advances in damage control resuscitation and surgery: implications on the organization of future military field forces

“…Vascular damage control involves a truncated approach of early and rapid revascularization, most often with an interpostion shunt. 56,57 Early external fixation offers the added advantage of providing skeletal stability to protect temporary vascular shunts or definitive repairs. 58,59 Extremity damage control also involves débridement of grossly contaminated tissues and the liberal use of fasciotomies.…”

Femoral and Above-Knee Popliteal Injuries

“…, and the authors meticulously documented the time from shunt placement to casualty presentation at the level 3 surgical facilities in Baghdad or Balad, Iraq. These authors also validated the earlier experience of a US Navy forward surgical unit and concluded that complex combat injuries to proximal extremity vessels should be routinely shunted at forward-deployed Echelon II facilities as part of the resuscitative, damage control process [ 15 ].…”

Surgical Damage Control and Temporary Vascular Shunts

“…While flow rates are lower than their arterial counterparts, the patency of venous shunts is comparable. [21][22][23] Successful use of vascular shunts in venous injuries has also been reported the civilian sector as Parry and colleagues have described 18 cases either to allow for orthopedic fixation or to control hemorrhage during a damage control operation. All venous shunts in their series were patent on reexploration at a mean 22 hours dwell time.…”

“…21 The favorable experience with the use of vascular shunts in this initial report was corroborated by subsequent series provided by other combat surgical teams. [22][23][24] Figures 17-2, A-C detail a case example in which a midsubclavian injury was initially treated at a forward surgical location with the insertion of an intraluminal shunt and subsequently was repaired with interposition graft at a higher level of care. Gifford and colleagues provided one of the only studies to characterize longer-term extremity outcomes following the use of temporary vascular shunts.…”