Temporary intravascular shunts after civilian arterial injury: A prospective multicenter Eastern Association for the Surgery of Trauma study

Lily Tung; Jennifer Leonard; Ryan A Lawless; Alexis Cralley; Richard Betzold; Jason D Pasley; Kenji Inaba; Jennie S Kim; Dennis Y Kim; Kwang Kim; Bradley M Dennis; Michael C Smith; Margaret Moore; Christina Tran; Joshua P Hazelton; Atlee Melillo; Tejal S Brahmbhatt; Stephanie Talutis; Noelle N Saillant; Jae Moo Lee; Mark J Seamon

doi:10.1016/j.injury.2020.12.035

Temporary intravascular shunts after civilian arterial injury: A prospective multicenter Eastern Association for the Surgery of Trauma study

Injury. 2021 May;52(5):1204-1209. doi: 10.1016/j.injury.2020.12.035. Epub 2021 Jan 3.

Authors

Lily Tung¹, Jennifer Leonard², Ryan A Lawless³, Alexis Cralley⁴, Richard Betzold⁵, Jason D Pasley⁶, Kenji Inaba⁷, Jennie S Kim⁸, Dennis Y Kim⁹, Kwang Kim¹⁰, Bradley M Dennis¹¹, Michael C Smith¹², Margaret Moore¹³, Christina Tran¹⁴, Joshua P Hazelton¹⁵, Atlee Melillo¹⁶, Tejal S Brahmbhatt¹⁷, Stephanie Talutis¹⁸, Noelle N Saillant¹⁹, Jae Moo Lee²⁰, Mark J Seamon²¹

Affiliations

¹ Division of Traumatology, Surgical Critical Care and Emergency Surgery, Department of Surgery, University of Pennsylvania, Penn Presbyterian Medical Center, 51 North 39th Street, Medical Office Building Suite 120, 19104 Philadelphia, Pennsylvania, USA. Electronic address: lilyLtung@gmail.com.
² Division of Traumatology, Surgical Critical Care and Emergency Surgery, Department of Surgery, University of Pennsylvania, Penn Presbyterian Medical Center, 51 North 39th Street, Medical Office Building Suite 120, 19104 Philadelphia, Pennsylvania, USA. Electronic address: jennleonard1027@gmail.com.
³ Department of Surgery, Denver Health Medical Center, University of Colorado, 777 Bannock Street MC 0206, 80204 Denver, Colorado, USA. Electronic address: ryan.lawlessmd@gmail.com.
⁴ Department of Surgery, Denver Health Medical Center, University of Colorado, 777 Bannock Street MC 0206, 80204 Denver, Colorado, USA. Electronic address: alexis.cralley2@dhha.org.
⁵ Department of Surgery, R Adams Cowley Shock Trauma Medical Center, University of Maryland Medical System, 22 S Greene Street, 21201 Baltimore, Maryland, USA. Electronic address: Richard.Betzold@umm.edu.
⁶ Department of Surgery, R Adams Cowley Shock Trauma Medical Center, University of Maryland Medical System, 22 S Greene Street, 21201 Baltimore, Maryland, USA. Electronic address: jpasley999@gmail.com.
⁷ Division of Trauma, Acute Care Surgery, Surgical Critical Care, Department of Surgery, Los Angeles County and University of Southern California Medical Center, 2051 Marengo Street, IPT, C5L100, 90033 Los Angeles, California, USA. Electronic address: kenji.inaba@med.usc.edu.
⁸ Division of Trauma, Acute Care Surgery, Surgical Critical Care, Department of Surgery, Los Angeles County and University of Southern California Medical Center, 2051 Marengo Street, IPT, C5L100, 90033 Los Angeles, California, USA. Electronic address: jenniesomangkim@gmail.com.
⁹ Department of Surgery, Harbor-UCLA Medical Center, 1000 W Carson Street, Torrance, California, 90502, USA. Electronic address: dennisyongkim@gmail.com.
¹⁰ Department of Surgery, Harbor-UCLA Medical Center, 1000 W Carson Street, Torrance, California, 90502, USA. Electronic address: KwangKim@mednet.ucla.edu.
¹¹ Division of Trauma and Surgical Critical Care, Department of Surgery, Vanderbilt University Medical Center, 1211 21st Avenue South, 404 Medical Arts Building, 37212 Nashville, Tennessee, USA. Electronic address: bradley.m.dennis@vanderbilt.edu.
¹² Division of Trauma and Surgical Critical Care, Department of Surgery, Vanderbilt University Medical Center, 1211 21st Avenue South, 404 Medical Arts Building, 37212 Nashville, Tennessee, USA. Electronic address: michael.c.smith@vumc.org.
¹³ Department of Surgery, Louisiana State University School of Medicine, 1542 Tulane Avenue 7th Floor, 70112 New Orleans, Louisiana, USA. Electronic address: mmoo19@lsuhsc.edu.
¹⁴ Tulane University School of Medicine, 131 South Robertson Avenue 15th Floor, New Orleans, Louisiana, 70112, USA. Electronic address: christinaktran17@gmail.com.
¹⁵ Division of Trauma, Department of Surgery, Cooper University Hospital, #411, Camden, New Jersey 08103, USA. Electronic address: jhazelton@pennstatehealth.psu.edu.
¹⁶ Division of Trauma, Department of Surgery, Cooper University Hospital, #411, Camden, New Jersey 08103, USA. Electronic address: melillo-atlee@cooperhealth.edu.
¹⁷ Department of Surgery, Boston Medical Center, 840 Harrison Ave, Dowling 2 South, Suite 2509, 02118 Boston, Massachusetts, USA. Electronic address: Tejal.Brahmbhatt@bmc.org.
¹⁸ Department of Surgery, Boston Medical Center, 840 Harrison Ave, Dowling 2 South, Suite 2509, 02118 Boston, Massachusetts, USA. Electronic address: stephanie.talutis@bmc.org.
¹⁹ Division of Trauma, Emergency Surgery and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge Street, Suite 810, Boston, 02114 Massachusetts, USA. Electronic address: nsaillant@mgh.harvard.edu.
²⁰ Division of Trauma, Emergency Surgery and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge Street, Suite 810, Boston, 02114 Massachusetts, USA. Electronic address: leejmoo94@gmail.com.
²¹ Division of Traumatology, Surgical Critical Care and Emergency Surgery, Department of Surgery, University of Pennsylvania, Penn Presbyterian Medical Center, 51 North 39th Street, Medical Office Building Suite 120, 19104 Philadelphia, Pennsylvania, USA. Electronic address: mark.seamon@uphs.upenn.edu.

PMID: 33455811
DOI: 10.1016/j.injury.2020.12.035

Abstract

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.

Keywords: Complications; Damage control; Temporary intravascular shunts; Trauma.

Publication types

Multicenter Study

MeSH terms

Adolescent
Humans
Male
Popliteal Artery
Prospective Studies
Retrospective Studies
Trauma Centers
Vascular Surgical Procedures
Vascular System Injuries* / surgery