Temporary intravascular shunts: when are we really using them according to the NTDB?
Temporary intravascular shunts (TIVS) are synthetic intraluminal conduits that maintain arterial and/or venous blood flow. This technique can be used for: 1) replantation; 2) open extremity fractures with extensive soft tissue and arterial injuries; or 3) damage control (extremity/truncal). The literature defining TIVS is composed exclusively of small case series (primarily penetrating injuries). Our goal was to identify the injured population who actually undergoes TIVS using the National Trauma Data Bank (2001 to 2005). TIVS were placed in 395 patients (mean Injury Severity Score = 26; initial hemodynamic instability = 24%; mean based deficit = -7.2; mortality = 14%). Blunt mechanisms caused 64 per cent (251 of 395) of cases. Penetrating injuries were primarily gunshot wounds (97%). Concurrent severe extremity fractures and/or soft tissue defects were present in 185 (74%) blunt-injured patients. Only six of 111 centers performing TIVS used this technique five or more times. Only three centers used TIVS more than 10 times. The volume of TIVS use was similar across the study period (P > 0.05). TIVS is primarily used in blunt motor vehicle collision trauma with concurrent severe extremity fractures and soft tissue injuries. This provides distal perfusion while surgeons assess/fixate the limb. TIVS are placed relatively uncommonly by a large number of trauma centers with a few hospitals using them much more frequently for penetrating injuries.
Ball
Chad G
CG
Department of Surgery, Emory School of Medicine, Grady Memorial Hospital, Atlanta, Georgia 30303, USA. ball.chad@gmail.com
Kirkpatrick
Andrew W
AW
Rajani
Ravi R
RR
Wyrzykowski
Amy D
AD
Dente
Christopher J
CJ
Vercruysse
Gary A
GA
Mcbeth
Paul
P
Nicholas
Jeffrey M
JM
Salomone
Jeffrey P
JP
Rozycki
Grace S
GS
Feliciano
David V
DV
D000328:Adult; D001134:Arm Injuries / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D001807:Blood Vessel Prosthesis / Q000706:statistics & numerical data*; D019917:Blood Vessel Prosthesis Implantation / Q000706:statistics & numerical data*; D005260:Female; D006489:Hemostatic Techniques / Q000295:instrumentation* / Q000706:statistics & numerical data; D006801:Humans; D015601:Injury Severity Score; D007869:Leg Injuries / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D008297:Male; D018579:Patient Selection; D012042:Registries; D014481:United States / Q000453:epidemiology