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. 2023 Nov 24:10:1302976.
doi: 10.3389/fsurg.2023.1302976. eCollection 2023.

Temporary intravascular shunts and limb salvage in civilian vascular trauma

Ombretta Martinelli  1 , Francesca Miceli  1 , Simone Cuozzo  1 , Francesco Giosuè Irace  1 , Stefano Avenia  1 , Immacolata Iannone  2 , Ilaria Clementi  2 , Paolo Sapienza  2 , Maria Irene Bellini  2
Affiliations

Temporary intravascular shunts and limb salvage in civilian vascular trauma

Ombretta Martinelli et al. Front Surg. .

Abstract

Background: Temporary intravascular shunts (TIVS) may allow quick revascularization and distal reperfusion, reducing the ischemic time (IT) when an arterial injury occurs. Furthermore, TIVS temporarily restore peripheral perfusion during the treatment of concomitant life-threatening injuries or when patients require evacuation to a higher level of care. Notwithstanding, there are still disputes regarding the use of TIVS, in view of the paucity of evidence in terms of potential benefits and with regard to the anticoagulation during the procedure. The present study aimed to assess TIVS impact, safety, and timing on limb salvage in complex civilian vascular traumas.

Patients and methods: Data were retrieved from the prospective database of our department, which included all patients hospitalized with a vascular injury of the extremities between January 2006 and December 2022. Patients undergoing TIVS during vascular injury management were included in group A, and those who could not postpone immediate care for TIVS insertion were included in group B (control group). Data concerning the times required for extremity revascularization or other surgical procedures such as orthopedic interventions and the time of limb ischemia were compared between the two groups. A comparison of the postoperative course between the two groups was also performed.

Results: A total of 53 patients were included: group A (TIVS insertion, n = 31) and group B (control, n = 22). Revascularization time significantly differed (p = 0.002) between the two groups, which is lower in group A (4.17 ± 2.37 h vs. 5.81 ± 1.26 h). TIVS positively affected the probability of limb salvage (p = 0.02). At multivariate analysis, the factors independently associated with limb salvage were TIVS usage, the necessity of hyperbaric oxygen therapy, and the total IT. In group A, there were three deaths and one major amputation, and in group B, there were two deaths and four major amputations.

Conclusions: The use of TIVS minimizes revascularization time and improves limb salvage probability. A multidisciplinary approach is recommended, and correct surgical timing is key to ensure the best outcome.

Keywords: amputation; limb salvage; trauma; vascular injury; vascular shunt.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The handling editor GI declared a shared affiliation with the authors at the time of review. The authors declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision.

Figures

Figure 1
Figure 1
Kaplan Meier for limb rescue probability by total ischemic time in TIVS and non-TIVS groups. Log Rank 0.014.
Figure 2
Figure 2
Kaplan Meier for limb rescue probability by hours prior to revascularization in TIVS and non-TIVS groups. Log Rank 0.02.
See this image and copyright information in PMC

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