17 - Surgical Damage Control and Temporary Vascular Shunts

Abstract

The past 30 years has witnessed a fundamental change in the approach to the multiply-injured patient. With increasing enthusiasm for the dogma of damage control surgery, surgical strategies to quickly stabilize a severely injured patient have focused on methods of vascular control and on cessation of hemorrhage—the latter often meaning a default to vascular ligation if simple, quick repairs are not feasible. Use of a temporary vascular shunt to expeditiously restore perfusion in the setting of a significant axial vessel injury, however, has now become an accepted alternative to ligation. While vascular shunts are not novel concepts, their use has become greatly encouraged by experience afforded by the wars in Afghanistan and Iraq. Promising outcomes in the management of complex extremity vascular injury have also been echoed in the civilian literature where the necessity of shunt use is driven by the damage control imperative rather than the need to transport patients to a higher level of care. Some surgeons have expanded use of these adjuncts to the management of truncal vascular injuries where ligation often carries significant morbidity and mortality in an already-threatened patient. As such, the intraluminal vascular shunt is a valuable concept that provides surgeons with a much-needed solution to the perpetual dilemma of whether to repair or to ligate a major vascular injury.