TY - JOUR
T1 - Temporary intravascular shunts after civilian arterial injury
T2 - A prospective multicenter Eastern Association for the Surgery of Trauma study
AU - Tung, Lily
AU - Leonard, Jennifer
AU - Lawless, Ryan A.
AU - Cralley, Alexis
AU - Betzold, Richard
AU - Pasley, Jason D.
AU - Inaba, Kenji
AU - Kim, Jennie S.
AU - Kim, Dennis Y.
AU - Kim, Kwang
AU - Dennis, Bradley M.
AU - Smith, Michael C.
AU - Moore, Margaret
AU - Tran, Christina
AU - Hazelton, Joshua P.
AU - Melillo, Atlee
AU - Brahmbhatt, Tejal S.
AU - Talutis, Stephanie
AU - Saillant, Noelle N.
AU - Lee, Jae Moo
AU - Seamon, Mark J.
N1 - Publisher Copyright:
© 2021 Elsevier Ltd
PY - 2021/5
Y1 - 2021/5
N2 - 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.
AB - 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.
UR - https://www.scopus.com/pages/publications/85099347170
UR - https://www.scopus.com/pages/publications/85099347170#tab=citedBy
U2 - 10.1016/j.injury.2020.12.035
DO - 10.1016/j.injury.2020.12.035
M3 - Article
C2 - 33455811
AN - SCOPUS:85099347170
SN - 0020-1383
VL - 52
SP - 1204
EP - 1209
JO - Injury
JF - Injury
IS - 5
ER -