title: Multicenter evaluation of temporary intravascular shunt use in vascular trauma.
abstract: BACKGROUND
  The indications and outcomes associated with temporary intravascular shunting (TIVS) for vascular trauma in the civilian sector are poorly understood. The objective of this study was to perform a contemporary multicenter review of TIVS use and outcomes.
  
  
  METHODS
  Patients sustaining vascular trauma, requiring TIVS insertion (January 2005 to December 2013), were retrospectively identified at seven Level I trauma centers. Clinical demographics, operative details, and outcomes were abstracted.
  
  
  RESULTS
  A total of 213 injuries (2.7%; 94.8% arterial) requiring TIVS were identified in 7,385 patients with vascular injuries. Median age was 27.0 years (range, 4-89 years), 91.0% were male, Glasgow Coma Scale (GCS) score was 15.0 (interquartile range, 4.0), Injury Severity Score (ISS) was 16.0 (interquartile range, 15.0), 26.0% had an ISS of 25 or greater, and 71.1% had penetrating injuries. The most common mechanism was gunshot wound (62.7%), followed by auto versus pedestrian (11.4%) and motor vehicle collision (6.5%). Shunts were placed for damage control in 63.4%, staged repair for combined orthopedic and vascular injuries in 36.1%, and for insufficient surgeon skill set in 0.5%. The most common vessel shunted was the superficial femoral artery (23.9%), followed by popliteal artery (18.8%) and brachial artery (13.2%). An argyle shunt (81.2%) was the most common conduit, followed by Pruitt-Inahara (9.4%). Dwell time was less than 6 hours in 61.4%, 24 hours in 86.5%, 48 hours in 95.9%, with only 4.1% remaining in place for more than 48 hours. Of the patients, 81.6% survived to definitive repair, and 79.6% survived overall. Complications included shunt thrombosis (5.6%) and dislodgment (1.4%). There was no association between dwell time and shunt thrombosis. The use of a noncommercial shunt (chest tube/feeding tube) did not impact shunt thrombosis but was an independent risk factor for subsequent graft failure. The limb salvage rate was 96.3%. No deaths could be attributed to a shunt complication.
  
  
  CONCLUSIONS
  In the largest civilian TIVS experience insertion to date, both damage control and staged orthopedic vascular injuries were common indications for shunting. With an acceptable complication burden and no associated mortality attributed to this technique, shunting should be considered a viable treatment option.
  
  
  METHODS
  Therapeutic study, level V.
authors.affiliation: From the Los Angeles County + University of Southern California Medical Center (K.I., H.A., D.D.), Los Angeles, California; University of Pennsylvania Medical School (M.J.S., J.A.M., J.C.), Pennsylvania, Philadelphia; Tulane University School of Medicine (J.D., R.S.), New Orleans, Louisiana; Denver Health (C.J.F., F.M.P., E.E.M), University of Colorado, Denver, Colorado; University of Arizona Medical School (B.J., A.A.H.), Tucson, Arizona; University of Texas Health Sciences Center in Houston (J.A.H., R.A.L.), Houston; and San Antonio Military Medical Center (S.R.H.), San Antonio, Texas.
authors.forename: Kenji
authors.initials: K
authors.lastname: Inaba
authors.forename: Hande
authors.initials: H
authors.lastname: Aksoy
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Seamon
authors.forename: Joshua A
authors.initials: JA
authors.lastname: Marks
authors.forename: Juan
authors.initials: J
authors.lastname: Duchesne
authors.forename: Rebecca
authors.initials: R
authors.lastname: Schroll
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Fox
authors.forename: Fredric M
authors.initials: FM
authors.lastname: Pieracci
authors.forename: Ernest E
authors.initials: EE
authors.lastname: Moore
authors.forename: Bellal
authors.initials: B
authors.lastname: Joseph
authors.forename: Ansab A
authors.initials: AA
authors.lastname: Haider
authors.forename: John A
authors.initials: JA
authors.lastname: Harvin
authors.forename: Ryan A
authors.initials: RA
authors.lastname: Lawless
authors.forename: Jeremy
authors.initials: J
authors.lastname: Cannon
authors.forename: Seth R
authors.initials: SR
authors.lastname: Holland
authors.forename: Demetrios
authors.initials: D
authors.lastname: Demetriades
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001916:Brachial Artery / Q000293:injuries / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005121:Extremities / Q000098:blood supply; D005260:Female; D005263:Femoral Artery / Q000293:injuries / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D015601:Injury Severity Score; D023821:Limb Salvage / Q000379:methods; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma; D011150:Popliteal Artery / Q000293:injuries / Q000601:surgery*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods*; D057772:Vascular System Injuries / Q000601:surgery*; D014948:Wounds, Gunshot; D014950:Wounds, Penetrating / Q000601:surgery*; D055815:Young Adult