Journal article
Temporary intravascular shunts after civilian arterial injury: A prospective multicenter Eastern Association for the Surgery of Trauma study
Injury, Vol.52(5), pp.1204-1209
01 May 2021
PMID: 33455811
Abstract
•Temporary intravascular shunts (TIVS) placed for damage control indications had longer shunt dwell times but not shunt-related complications.•Prolonged shunt dwell time in 66 adult trauma patients after arterial injury did not lead to shunt-related complications (7.1% vs 12.5%).•Shunt dwell time should be determined by a patient's overall clinical condition rather than concern for shunt-related complications.
We sought to determine the impact of the indication for shunt placement on shunt-related outcomes after major arterial injuries. We hypothesized that a shunt placed for damage control indications would be associated with an increase in shunt-related complications including shunt dislodgement, thrombosis, or distal ischemia.
A prospective, multicenter study (eleven level one US trauma centers) of all adult trauma patients undergoing temporary intravascular shunts (TIVS) after arterial injury was undertaken (January 2017-May 2019). Exclusion criteria included age <15years, shunt placement distal to popliteal/brachial arteries, isolated venous shunts, and death before shunt removal. Clinical variables were compared by indication and shunt-related complications. The primary endpoint was TIVS complications (thrombosis, migration, distal ischemia).
The 66 patients who underwent TIVS were primarily young (30years [IQR 22-36]) men (85%), severely injured (ISS 17 [10-25]) by penetrating mechanisms (59%), and had their shunts placed for damage control (41%). After a median SDT of 198min [89-622], 9% experienced shunt-related complications. Compared by shunt placement indication (damage control shunts [n=27] compared to non-damage control shunts [n=39]), there were no differences in gender, mechanism, extremity AIS, MESS score, fractures, or surgeon specialty between the two groups (all p>0.05). Patients with shunts placed for damage control indications had more severe injuries (ISS 23.5 compared to 13; SBP 100 compared to 129; GCS 11 compared to 15; lactate 11.5 compared to 3.6; all p<0.05), and had more frequent shunt complication predictors, but damage control shunts did not have significantly more TIVS complications (11.1% compared to 7.7%, p=0.658). Shunt complication patients were discharged home less often (33% vs 65%; p<0.05) but all survived.
Shunts placed for damage control indications were not associated with shunt complications in this prospective, multicenter study.
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Details
- Title
- Temporary intravascular shunts after civilian arterial injury: A prospective multicenter Eastern Association for the Surgery of Trauma study
- Creators
- Lily Tung - University of PennsylvaniaJennifer Leonard - University of PennsylvaniaRyan A Lawless - Denver Health Medical CenterAlexis Cralley - Denver Health Medical CenterRichard Betzold - University of Maryland, BaltimoreJason D Pasley - University of Maryland Medical SystemKenji Inaba - University of Southern CaliforniaJennie S Kim - Los Angeles Medical CenterDennis Y Kim - Ronald Reagan UCLA Medical CenterKwang Kim - UCLA Medical CenterBradley M Dennis - Vanderbilt University Medical CenterMichael C Smith - Vanderbilt University Medical CenterMargaret Moore - Louisiana State University Health Sciences Center New OrleansChristina Tran - Tulane UniversityJoshua P Hazelton - Cooper University HospitalAtlee Melillo - Cooper University HospitalTejal S Brahmbhatt - Boston Medical CenterStephanie Talutis - Boston Medical CenterNoelle N. Saillant - Massachusetts General HospitalJae Moo Lee - Massachusetts General HospitalMark J Seamon - University of Pennsylvania
- Publication Details
- Injury, Vol.52(5), pp.1204-1209
- Publisher
- Elsevier Ltd
- Number of pages
- 6
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Surgery
- Web of Science ID
- WOS:000647170200017
- Scopus ID
- 2-s2.0-85099347170
- Other Identifier
- 991022056903904721