title: Temporary vascular shunting in vascular trauma: a 10-year review from a civilian trauma centre.
abstract: BACKGROUND
  Temporary intravascular shunts (TIVSs) can replace immediate definitive repair as a damage control procedure in vascular trauma. We evaluated their use in an urban trauma centre with a high incidence of penetrating trauma.
  
  
  METHODS
  A retrospective chart review of all patients treated with a TIVS in a single centre between January 2000 and December 2009.
  
  
  RESULTS
  Thirty-five TIVSs were placed during the study period: 22 were part of a damage control procedure, 7 were inserted at a peripheral hospital without vascular surgical expertise prior to transfer, and 6 were used during fixation of a lower limb fracture with an associated vascular injury. There were 7 amputations and 5 deaths, 4 of the TIVSs thrombosed, and a further 3 dislodged or migrated. Twenty-five patients underwent definitive repair with an interposition graft, 1 primary anastomosis was achieved, and 1 extra-anatomical bypass was performed. Five patients with non-viable limbs had the vessel ligated.
  
  
  CONCLUSIONS
  A TIVS in the damage control setting is both life- and limb-saving. These shunts can be inserted safely in a facility without access to a surgeon with vascular surgery experience if there is uncontrollable bleeding or the delay to definitive vascular surgery is likely to be more than 6 hours. A definitive procedure should be performed within 24 hours.
authors.affiliation: Faculty of Health Sciences, University of Cape Town, South Africa. cleooliver@yahoo.com
authors.forename: J C
authors.initials: JC
authors.lastname: Oliver
authors.forename: H
authors.initials: H
authors.lastname: Gill
authors.forename: A J
authors.initials: AJ
authors.lastname: Nicol
authors.forename: S
authors.initials: S
authors.lastname: Edu
authors.forename: P H
authors.initials: PH
authors.lastname: Navsaria
mesh_terms: D000328:Adult; D001807:Blood Vessel Prosthesis / Q000009:adverse effects; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D006470:Hemorrhage / Q000517:prevention & control; D006801:Humans; D007511:Ischemia / Q000517:prevention & control*; D035002:Lower Extremity / Q000098:blood supply*; D012189:Retrospective Studies; D013997:Time Factors; D014193:Trauma Centers; D034941:Upper Extremity / Q000098:blood supply*; D057772:Vascular System Injuries / Q000601:surgery*; D014950:Wounds, Penetrating / Q000601:surgery; D055815:Young Adult