Vascular Shunts in Civilian Trauma

Abstract

Experience with temporary intravascular shunts (TIVS) for vessel injury comes from the military sector and while the indications might be clear in geographically isolated and under resourced war zones, this may be an uncommon scenario in civilian trauma. Data supporting TIVS use in civilian trauma have been extrapolated from the military literature where it demonstrated improved life and limb salvage. Few non-comparative studies from the civilian literature have also revealed similar favorable outcomes. Still, TIVS placement in civilian vascular injuries is uncommon and by some debatable given the absence of clear indications for placement, the potential for TIVS-related complications, the widespread resources for immediate and definitive vascular repair, and the need for curtailing costs and optimizing resources. This article reviews the current evidence and the role of TIVS in contemporary civilian trauma management.

Keywords: civilian trauma; extremity trauma; military trauma; vascular injury; vascular shunts; vascular surgical procedures; vascular trauma.

Figure 1

Popliteal artery and vein transection secondary to a motor vehicle collision. (A) 12 and 14 French Argyle shunts placed in the popliteal artery and vein, respectively. (B) Vascular reconstruction of tibial artery and vein using a Great Saphenous Vein interposition graft; Tibial nerve reconstructed with artificial synthetic tubulization.

Figure 2

Brachial artery transection secondary to an electric saw injury. (A) 12 French Pruitt-Inahara Shunt placed in the Left Brachial artery. (B) Vascular reconstruction of artery using a Great Saphenous Vein interposition graft.