A decade's experience with temporary intravascular shunts at a civilian level I trauma center.
BACKGROUND
A 10-year review of temporary intravascular shunts (TIVS) at a regional trauma center.


METHODS
Retrospective chart review of all patients treated with temporary intravascular shunts from January 1, 1997 to January 1, 2007.


RESULTS
Seven hundred eighty-six patients were treated for vascular injuries. Sixty-seven (9%) had a total of 101 (72 arterial, 29 venous) TIVS placed to facilitate damage control or to allow for reconstruction of Gustilo IIIc fractures or limb replantation. Seven patients who, on trauma day 0, died or had an extremity which was deemed unsalvageable were excluded. Of 60 patients who met inclusion criteria, seven died from TBI (3%), MOF (3%), sepsis (2%), deceleration of care (2%), and loss of airway (2%), which was deemed preventable.


CONCLUSIONS
TIVS have a shunt thrombosis rate of 5%, amputation rate of 18%, overall survival of 88%, and combination limb/patient survival rate of 73%. TIVS have an established role primarily in patients requiring either "damage control" for exsanguination or temporary vascular conduits during stabilization of Gustilo IIIc fractures. Truncal injuries are associated with the highest mortality likely due to accompanying multisystem trauma.
Subramanian
Anuradha
A
Department of Surgery, Baylor College of Medicine, Houston, Texas 77030, USA. asubrama@bmc.edu
Vercruysse
Gary
G
Dente
Christopher
C
Wyrzykowski
Amy
A
King
Erin
E
Feliciano
David V
DV
D000328:Adult; D000671:Amputation, Surgical / Q000706:statistics & numerical data; D021721:Balloon Occlusion; D001916:Brachial Artery / Q000601:surgery; D016638:Critical Illness; D005121:Extremities / Q000098:blood supply*; D000071938:Fasciotomy; D005260:Female; D005263:Femoral Artery / Q000601:surgery; D005597:Fractures, Open / Q000150:complications*; D006801:Humans; D007511:Ischemia / Q000517:prevention & control*; D007866:Leg / Q000098:blood supply; D023821:Limb Salvage / Q000379:methods*; D008297:Male; D009104:Multiple Trauma / Q000601:surgery*; D011150:Popliteal Artery / Q000601:surgery; D012189:Retrospective Studies; D014654:Vascular Patency; D014656:Vascular Surgical Procedures / Q000379:methods*; D014948:Wounds, Gunshot / Q000601:surgery; D014949:Wounds, Nonpenetrating / Q000601:surgery