Temporary Intravascular Shunts After Civilian Arterial Injury: A Prospective Multicenter Eastern Association for the Surgery of Trauma Study
Introduction: 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. Patients & methods: 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). Results: 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. Conclusion: Shunts placed for damage control indications were not associated with shunt complications in this prospective, multicenter study.
Tung, Lily; Leonard, Jennifer; Lawless, Ryan A.; Cralley, Alexis; Betzold, Richard; Pasley, Jason D.; Inaba, Kenji; Kim, Jennie S.; Kim, Dennis Y.; Kim, Kwang; Dennis, Bradley M.; Smith, Michael C.; Moore, Margaret; Tran, Christina; Hazelton, Joshua P.; Melillo, Atlee; Brahmbhatt, Tejal S.; Talutis, Stephanie; Saillant, Noelle N.; Lee, Jae Moo; and Seamon, Mark J., "Temporary Intravascular Shunts After Civilian Arterial Injury: A Prospective Multicenter Eastern Association for the Surgery of Trauma Study" (2021). School of Medicine Faculty Publications. 380.