Multicenter Evaluation of Temporary Intravascular Shunt Usage in Vascular XXXX .

@entity1 @entity715 @entity1317 @entity130
BACKGROUND: The indications and outcomes associated with Temporary Intravascular Shunting (TIVS) for vascular @entity130 in the civilian sector are poorly understood. The objective of this study was to perform a contemporary multicenter review of TIVS usage and outcomes. METHODS: @entity1 sustaining vascular @entity130 , requiring TIVS insertion, (1/2005-12/2013) were retrospectively identified at seven Level I @entity130 centers. Clinical demographics, operative details and outcomes were abstracted. RESULTS: 213 (2.7%) injuries (94.8% arterial) requiring TIVS were identified in 7385 @entity1 with @entity1317 . Median age 27.0 years (range 4-89). 91.0% male, GCS 15.0 (IQR 4.0), ISS 16.0 (IQR 15.0), 26.0% were ISS>= 25 and 71.1% penetrating. The most common mechanism was GSW (62.7%) followed by AvP (11.4%) and MVC (6.5%). Shunts were placed for Damage Control in 63.4%, staged repair for combined orthopedic and @entity1317 in 36.1% and for insufficient surgeon skillset in 0.5%. The most common vessel shunted was the SFA (23.9%) followed by popliteal A (18.8%) and brachial A (13.2%). An argyle shunt (81.2%) was the most common conduit followed by Pruitt-Inahara (9.4%). Dwell time was <6h in 61.4%, 24h in 86.5%, 48h in 95.9% with only 4.1% remaining in place for >48h. 81.6% survived to definitive repair, 79.6% survived overall. Complications included shunt @entity715 (5.6%) and dislodgment (1.4%). There was no association between dwell time and shunt @entity715 . Use of a non-commercial shunt (chest tube/feeding tube) did not impact shunt @entity715 but was an independent risk factor for subsequent graft failure. The limb salvage rate was 96.3%. No deaths could be attributed to a shunt complication. CONCLUSIONS: In the largest civilian TIVS experience insertion to date, both damage control and staged orthopedic @entity1317 were common indications for shunting. With an acceptable complication burden and no associated mortality attributed to this technique, shunting should be considered a viable treatment option. LEVEL OF EVIDENCE: Level V, therapeutic.
