Abstract
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.
Highlights
Each year approximately 41 million emergency department visits and 2.3 million hospital admissions are the result of trauma in the United States [1]
A review of the National Trauma Databank (NTDB) showed that the use of temporary intravascular shunts (TIVS) among civilians was most common in blunt trauma (251 of 395 shunted patients: 64%) mostly from motor vehicle collisions with concurrent orthopedic and soft tissue injuries occurring in 185 of the 251 patients (74%)
According to a query of the Navy and Marine Corps Combat Trauma Registry (NMCCTR), 100% of shunts were placed at Echelon II facilities whereas all the injuries received at Echelon III facilities were treated with definitive repair [10]
Summary
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 revealed similar favorable outcomes. 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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