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Temporary arterial shunts in damage control: Experience and outcomes.
Sarah Mathew1, Brian P Smith, Jeremy W Cannon
1From the Division of Traumatology, Surgical Critical Care and Emergency Surgery, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
The Journal of Trauma and Acute Care Surgery
|December 29, 2016
Summary
Prolonged arterial shunt dwell times exceeding six hours are linked to increased complications in major arterial injury patients. Limiting shunt duration may reduce adverse outcomes.
Area of Science:
- Vascular Surgery
- Trauma Management
- Patient Outcomes
Background:
- Arterial shunting is crucial for hemorrhage control and flow restoration.
- Optimal duration for arterial shunt placement remains debated.
- This study investigates the impact of prolonged shunt dwell times on adverse outcomes.
Purpose of the Study:
- To determine if prolonged arterial shunt dwell times (>6 hours) correlate with adverse outcomes after major arterial injury.
- To identify potential complications associated with extended shunt use.
Main Methods:
- Retrospective review of patients with arterial shunts post-traumatic injury (2005-2013).
- Exclusion of non-survivors prior to shunt removal.
- Definition of shunt complications: dislodgement, thrombosis, distal ischemia.
- Comparison of clinical parameters between patients with shunt dwell times <6 hours and >6 hours.
Main Results:
- A total of 42 patients underwent arterial shunting; 35 survived until shunt removal.
- Five patients (14.3%) developed shunt complications.
- No complications occurred in patients with shunt dwell times <6 hours (0/19).
- Significant shunt complications (31.3%) were observed in patients with dwell times >6 hours (5/16, p=0.05).
Conclusions:
- Limiting arterial shunt dwell times to less than 6 hours may decrease the incidence of adverse outcomes.
- This civilian study suggests a potential threshold for shunt duration to improve patient safety.
