Time course study on the use of temporary intravascular shunts as a damage control adjunct in a superior mesenteric artery injury model

Temporary intravascular shunts (TIVS) are now widely used in vessels injuries. Little information concerned how long TIVS can safely maintain patency for in the setting of damage control surgery (DCS). We compared four different shunt-indwelling times in previous established superior mesenteric artery (SMA) injury models and aimed to find out the safest duration in the setting of DCS.

SMA was clamped and completely transected while pigs were hemorrhaged. TIVS was inserted to the proximal and distal end of the transected SMA to restore blood flow. Twenty-four animals were resuscitated and randomized into four groups: group A (shunt for 3 hours), group B (shunt for 6 hours), group C (shunt for 9 hours), and group D (shunt for 12 hours). Angiography and duplex ultrasonography were periodically used to detect the patency of TIVS. Systemic hemodynamic parameters were recorded hourly, and intestine was collected at the end of the experiment.

Shunts in groups A and B maintained patency in all the six animals (100%) compared with only 50% (3 of 6) in group C and 0% (0 of 6) in group D. Intestine necrosis developed in all shunt-occluded animals, whereas reversible intestine ischemia-reperfusion injuries were found if shunts remained patency at the end of the experiment.

Our study suggests that TIVS can be used as an important DCS adjunct to maintain patency safely for 6 hours in SMA injury model.