The use of temporary intravascular shunting to improve resource utilization is safe and effective for penetrating peripheral vascular trauma.

Abstract

Temporary Intravascular Shunting (TIVS) is well described in peripheral vascular trauma, typically for orthopedic fixation or damage control. Due to a high volume of penetrating trauma, our urban Level 1 trauma center began utilizing TIVS frequently to minimize resource constraints. Our hypothesis is that TIVS is not inferior to immediate repair. Penetrating peripheral arterial injuries were identified from the institutional trauma registry from 5/2018-8/2024. Patients were categorized as having undergone immediate repair (ImR) vs delayed repair (DR), following TIVS placement. The DR group was further divided into resource utilization (DR-RU) and damage control (DR-DC) subgroups. DR-RU included patients receiving < 6 units of packed red blood cells intraoperatively, with a final intraoperative lactate < 5.0 mmol/L, and no other body cavity explored. DR-DC included shunted patients not meeting these criteria. The DR-RU subgroup was compared to both ImR and DR-DC using univariable tests. Of 228 patients included, 118 were in the ImR group, 47 in the DR-RU subgroup, and 63 in the DR-DC subgroup. Trauma surgeons performed 76% of the ImR, 99% of the TIVS and 97% of the definitive repairs in the DR group. Median shunt dwell time was 12.9 h (IQR 9.7-17.7) in the DR-RU group. When comparing ImR to DR-RU respectively, there was no statistically significant difference detected in vascular complications requiring reoperation (22% vs 13%, p = 0.206), compartment syndrome (8% vs 2%, p = 0.332), amputation (3% vs 0%, p = 0.726) or mortality (1% vs 0%, p = 1.000). TIVS to improve resource utilization is safe for penetrating peripheral arterial injuries when both shunting and definitive repair are performed by trauma surgeons.