The Use of Temporary Vascular Shunts as a Damage Control Adjunct in the Management of Wartime Vascular Injury

Rasmussen, Todd E.; Clouse, W. Darrin; Jenkins, Donald H.; Peck, Michael A.; Eliason, Jonathan L.; Smith, David L.

doi:10.1097/01.ta.0000220668.84405.17

Cited by 310 publications

(151 citation statements)

References 14 publications

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“…This experience supports the early detection of the injured vessel(s) and use of shunts in certain cases as part of an overall strategy in the management of vascular injury. 2,3 Early results of in-theater repair are comparable with contemporary civilian reports and have greatly improved from the Vietnam era. Rapid evacuation and damage control maneuvers, such as temporary shunting and early fasciotomy, assist in timely definitive repair and appear effective.…”

supporting

confidence: 69%

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Management of high-risk popliteal vascular blunt trauma: clinical experience with 62 cases

Pourzand

Fakhri²,

Azhough³

et al. 2010

VHRM

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Patients and methods:A retrospective analysis was conducted of prospectively collected data from Tabriz Medical Trauma Center. Our aim was to perform surgical revascularization as soon as the arterial injury was recognized. The mechanism of injury was blunt in the entire cohort of patients, and all of them had bone fractures about the knee. The treatment of arterial injury included vein graft interposition in 39 (63%), primary anastomosis in 20 (32.3%), and lateral repair in 3 (4.8%) patients. The patients were divided into 2 study groups: limb salvage group (group 1) and amputation group (group 2). Subgroup analysis consisted of univariate analysis comparing the 2 groups and multivariate analysis examining the factors associated negatively and positively with the primary endpoint, limb salvage. Results: In the entire cohort of patients, 60 patients (97%) were male and 2 were female (3%); the mean age was 34.1 years (16-49 years). The overall amputation rate in this study was 37.1% (23 amputations). Significant (P , 0.05) independent factors associated negatively with limb salvage were combined tibia and fibula fracture, concomitant artery and vein injury, ligation of venous injury, and lack of backflow after Fogarty catheter thrombectomy, while repair of popliteal artery and vein injury, when present, was associated with improved early limb salvage. For 40 patients, we adopt a liberal attitude toward open 4-compartment fasciotomy through both medially and laterally placed incisions. Conclusion: Expeditious recognition of vascular injury, transport to repair, and repair of associated venous injury when possible are necessary to optimize limb salvage. The importance of a high level of suspicion and low threshold for timely amputation has been emphasized when limb salvage was deemed impossible to prevent life-threatening complication. Delays in surgery, extensive soft tissue defect, compound tibia-fibula fracture, and other factors are associated with high amputation rate following popliteal artery injury.

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supporting

confidence: 69%

“…For injury patterns involving an artery and vein, shunts placed in the venous position provide drainage and decrease venous hypertension that can compound tissue ischemia and bleeding. 3 Despite the reported utility of this technique, none of the patients in this series were managed with use of temporary vascular shunts.…”

mentioning

confidence: 99%

Management of high-risk popliteal vascular blunt trauma: clinical experience with 62 cases

Pourzand

Fakhri²,

Azhough³

et al. 2010

VHRM

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“…Furthermore, the use of DCS principles has shortened the operating time in recent war conflicts. The use of temporary vascular shunts as a damage control adjunct in Iraq was reported by Rasmussen et al (18). They described the need of vascular shunts as am ethod for stabilizing and transporting patients in situations with alarge number of injured patients.…”

Section: Introductionmentioning

confidence: 99%

Multiple Small Bowel Ligation Compared to Conventional Primary Repair after Abdominal Gunshot Wound with Haemorrhagic Shock

et al. 2009

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Aims: the aim of this study was to evaluate the effects of early rapid control of multiple bowel perforations on cardiovascular function in combined abdominal missile trauma and haemorrhagic shock compared with conventional surgery.Methods: eighteen anesthetised pigs were injured with a standardised abdominal missile trauma. the animals were bled to a mean arterial pressure of 50 mm hg for 30 minutes, after which they were resuscitated and had laparotomy.t hey were divided into conventional surgery group (n=9) with primary resection and anastomosis of bowel injuries and early rapid multiple bowel ligation group (n =9). repeated measurement analysis of variance was used for analysis.Results: there was profound hypotension, reduced cardiac output, increased vascular resistance and lactic acidaemia in both groups. lactic acidaemia persisted longer in the early rapid multiple bowel ligation group. there were no significant differences in mean arterial pressure, cardiac output ,stroke volume or systemic vascular resistance between the groups. the mean operation time was significantly shorter in the early rapid multiple bowel ligation group (13.3 (1.5) (seM) minutes, compared with 116.4 (1.74) (seM) minutes in the conventional surgery group, p =<0.001).Conclusions: damage control principles have shortened the operating time in our model but did not improve the cardiovascular function and caused more lactic acidaemia than conventional repair.

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“…Since these reports, DCS has become the standard of care for the most severely injured patients. It has been widely applied not only for abdominal trauma but also for thoracic [84], vascular [85], pelvic [86], and extremity injuries [87,88]. DCS has led to better outcomes in severely hemorrhagic patients [89].…”

Section: Adverse Effects Of Dcsmentioning

confidence: 99%

Damage control resuscitation: a practical approach for severely hemorrhagic patients and its effects on trauma surgery

Mizobata

2017

j intensive care

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Coagulopathy observed in trauma patients was thought to be a resuscitation-associated phenomenon. The replacement of lost and consumed coagulation factors was the mainstay in the resuscitation of hemorrhagic shock for many decades. Twenty years ago, damage control surgery (DCS) was implemented to challenge the coagulopathy of trauma. It consists of three steps: abbreviated surgery to control the hemorrhage and contamination, resuscitation in the intensive care unit (ICU), and planned re-operation with definitive surgery. The resuscitation strategy of DCS focused on the rapid reversal of acidosis and prevention of hypothermia through the first two steps. However, direct treatment of coagulopathy was not emphasized in DCS. Recently, better understanding of the pathophysiology of coagulopathy in trauma patients has led to the logical opinion that we should directly address this coagulopathy during major trauma resuscitation. Damage control resuscitation (DCR), the strategic approach to the trauma patient who presents in extremis, consists of balanced resuscitation, hemostatic resuscitation, and prevention of acidosis, hypothermia, and hypocalcemia. In balanced resuscitation, fluid administration is restricted and hypotension is allowed until definitive hemostatic measures begin. The administration of blood products consisting of fresh frozen plasma, packed red blood cells, and platelets, the ratio of which resembles whole blood, is recommended early in the resuscitation. DCR strategy is now the most beneficial measure available to address trauma-induced coagulopathy, and it can change the treatment strategy of trauma patients. DCS is now incorporated as a component of DCR. DCR as a structured intervention begins immediately after rapid initial assessment in the emergency room and progresses through the operating theater into the ICU in combination with DCS. By starting from ground zero with the performance of DCS, DCR allows the trauma surgeon to correct the coagulopathy of trauma. The effect of the reversal of coagulopathy in massively hemorrhagic patients may change the operative strategy with DCS.

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The Use of Temporary Vascular Shunts as a Damage Control Adjunct in the Management of Wartime Vascular Injury

Cited by 310 publications

References 14 publications

Management of high-risk popliteal vascular blunt trauma: clinical experience with 62 cases

Management of high-risk popliteal vascular blunt trauma: clinical experience with 62 cases

Multiple Small Bowel Ligation Compared to Conventional Primary Repair after Abdominal Gunshot Wound with Haemorrhagic Shock

Damage control resuscitation: a practical approach for severely hemorrhagic patients and its effects on trauma surgery

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