title: The use of temporary vascular shunts as a damage control adjunct in the management of wartime vascular injury.
abstract: BACKGROUND
  While the use of vascular shunts as a damage control adjunct has been described in series from civilian institutions no contemporary military experience has been reported. The objective of this study is to examine patterns of use and effectiveness of temporary vascular shunts in the contemporary management of wartime vascular injury.
  
  
  METHODS
  From September 1, 2004 to August 31, 2005, 2,473 combat injuries were treated at the central echelon III surgical facility in Iraq. Vascular injuries were entered into a registry and reviewed. Location of shunts was divided into proximal and distal, and shunt patency, complications and limb viability were examined.
  
  
  RESULTS
  There were 126 extremity vascular injuries treated. Fifty-three (42%) had been operated on at forward locations and 30 of 53 (57%) had temporary shunts in place upon arrival to our facility. The patency for shunts in proximal vascular injuries was 86% (n = 22) compared with 12% (n = 8) for distal shunts (p < 0.05). All shunts placed in proximal venous injuries were patent (n = 4). Systemic heparin was not used and there were no shunt complications. All shunted injuries were reconstructed with vein in theater and early viability for extremities in which shunts were used was 92%.
  
  
  CONCLUSIONS
  Temporary vascular shunts are common in the management of wartime vascular injury. Shunts in proximal injuries including veins have high patency rates compared with those placed in distal injuries. This vascular adjunct represents a safe and effective damage control technique and is preferable to attempted reconstruction in austere conditions.
authors.affiliation: 332nd EMDG/Air Force Theater Hospital, Balad Air Base Iraq, APO AE. Todd.Rasmussen@lackland.af.mil
authors.forename: Todd E
authors.initials: TE
authors.lastname: Rasmussen
authors.forename: W Darrin
authors.initials: WD
authors.lastname: Clouse
authors.forename: Donald H
authors.initials: DH
authors.lastname: Jenkins
authors.forename: Michael A
authors.initials: MA
authors.lastname: Peck
authors.forename: Jonathan L
authors.initials: JL
authors.lastname: Eliason
authors.forename: David L
authors.initials: DL
authors.lastname: Smith
mesh_terms: D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D001808:Blood Vessels / Q000293:injuries*; D004630:Emergencies; D005121:Extremities / Q000098:blood supply*; D006801:Humans; D007493:Iraq; D008889:Military Personnel; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States