Temporary vascular shunt for damage control of extremity vascular injury: A toolbox for trauma surgeons

Hornez, E.; Boddaert, Guillaume; Ngabou, U.D.; Aguir, Sonia; Baudoin, Y.; Mocellin, N.; Bonnet, Stéphane

doi:10.1016/j.jviscsurg.2015.09.005

Cited by 58 publications

(47 citation statements)

References 31 publications

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“…The vascular injury becomes a priority, like in our patient needing control of bleeding from pelvis with preperitoneal packing [10]. In situations where the patient is undergoing damage control surgery, there is not enough time to perform an official vascular repair; thus hemostasis and revascularization become primarily dependent on damage control techniques, and temporary vascular shunts (TVS) for control of the vessel bleed is used [11]. Tourniquets or vascular clamps help to control proximal vessel bleeding initially [10].…”

Section: Discussionmentioning

confidence: 99%

“…A TVS of the appropriate size is chosen and flushed with heparinized saline. It is crucial that the diameter of the TVS closely approximates that of the artery because, with size mismatch, the risk of rupture and hemorrhage is there [11]. The ability to temporize ongoing hemorrhage via proximal occlusion offers a distinct advantage for the rapid management of extremity injuries.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Vascular Shunt for Small Vessel Trauma in a Polytrauma Patient

Gupta

Burgos

Azar

et al. 2020

Cureus

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A 15-year-old male patient presented with multiple gunshot injuries. The patient underwent emergency lifesaving exploratory laparotomy and subsequently needed repair of his left upper limb ulnar artery injury. A shunt helped restore blood flow to the hand in a setting of damage control surgery in an exsanguinating patient with an ulnar artery injury having a massive disruption. After resuscitation, the patient underwent definitive repair of the artery using a vein interposition graft.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Vascular Shunt for Small Vessel Trauma in a Polytrauma Patient

Gupta

Burgos

Azar

et al. 2020

Cureus

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“…Intraoperative use of anticoagulation is associated with lower-limb loss without any significant bleeding complications [35]. Although regional hepsal solution is used, perioperative use is not well demonstrated [36]. In a study of 1,524 patients, it was noted that there is no role of anticoagulation to prevent thrombosis although there is no significant bleeding risk as well [37].…”

Section: Anticoagulation In Perioperative Periodmentioning

confidence: 99%

The Utility of Therapeutic Anticoagulation in the Perioperative Period in Patients Presenting in Emergency Surgical Department With Extremity Vascular Injuries

Masood

Danawar

Mekaiel

et al. 2020

Cureus

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Extremity vascular trauma is a challenging surgical emergency in both civilian population and combat environment. It requires vigilant diagnosis and prompt treatment to minimize limb loss and mortality. A multidisciplinary team approach is required to deal with shock states, concomitant abdominal injuries, head injuries, and fractures with significant tissue loss and psychological stress. Anticoagulation is frequently used during traumatic vascular repair to avoid repair site thrombosis, postoperative deep venous thrombosis, and pulmonary embolism (PE). In this review article, we are going to search about how frequent is the use of anticoagulation in terms of limb salvage rates, and mortality rates or side effects of anticoagulation in terms of risk of bleeding episodes, and the need for future prospective studies. Extremity vascular trauma is managed by a variety of methods including open repairs, endovascular repairs, and nonoperative management. Most of the literature demonstrates the use of systemic or regional anticoagulation in the management of vascular injuries with the improvement in limb salvage rates and reduced morbidities but confounding factors lead to variable results. Some studies show an increased risk of bleeding in trauma patients with the use of anticoagulants in trauma settings without any significant effect on repair site thrombosis. More comprehensive studies and randomized controlled trials are needed to confirm the importance of perioperative anticoagulation while avoiding the confounding factors in terms of injury severity scores, ischemia time, demographics of patients, modes of injury, comorbidities, grades of shock, concomitant injuries that need anticoagulation like venous injuries or intracranial injuries that are contraindications to the use of anticoagulation, type of anticoagulation and expertise available as well as the experience level of the operating surgeon. Literature also reveals the use of new oral anticoagulants (e.g., dabigatran) to be associated with lesser bleeding episodes when compared to warfarin, so in future, we can check the feasibility of these agents to reduce the bleeding episodes and at the same time improve the limb salvage rates.

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“…One study reported ligating all venous injuries (25). There is evidence, however, that vein shunting and repair is associated with lower incidences of compartment syndromes, fasciotomies and amputations (26, 27). Shunt diameter is another critical consideration; oversizing causes intimal injury while undersizing might cause shunt dislodgement.…”

Section: Evidence In Favor Of Shunt Usementioning

confidence: 99%

“…Shunt dwell time has not been associated with thrombosis; 86.5% of shunts were removed at 24 h in one study, while the mean “dwell” time was 24 h in another (3, 18). Current shunt configuration is in a straight position (vs. looped) inserted to a depth of 2 cm into the injured vessel (8, 26). …”

Section: Evidence In Favor Of Shunt Usementioning

confidence: 99%

Vascular Shunts in Civilian Trauma

et al. 2017

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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.

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Temporary vascular shunt for damage control of extremity vascular injury: A toolbox for trauma surgeons

Cited by 58 publications

References 31 publications

Vascular Shunt for Small Vessel Trauma in a Polytrauma Patient

Vascular Shunt for Small Vessel Trauma in a Polytrauma Patient

The Utility of Therapeutic Anticoagulation in the Perioperative Period in Patients Presenting in Emergency Surgical Department With Extremity Vascular Injuries

Vascular Shunts in Civilian Trauma

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