• Lily Tung, Jennifer Leonard, Ryan A Lawless, Alexis Cralley, Richard Betzold, Jason D Pasley, Kenji Inaba, Jennie S Kim, Dennis Y Kim, Kwang Kim, Bradley M Dennis, Michael C Smith, Margaret Moore, Christina Tran, Joshua P Hazelton, Atlee Melillo, Tejal S Brahmbhatt, Stephanie Talutis, Noelle N Saillant, Jae Moo Lee, and Mark J Seamon.
• Division of Traumatology, Surgical Critical Care and Emergency Surgery, Department of Surgery, University of Pennsylvania, Penn Presbyterian Medical Center, 51 North 39th Street, Medical Office Building Suite 120, 19104 Philadelphia, Pennsylvania, USA. Electronic address: lilyLtung@gmail.com.
• Injury. 2021 May 1; 52 (5): 1204-1209.

IntroductionWe sought to determine the impact of the indication for shunt placement on shunt-related outcomes after major arterial injuries. We hypothesized that a shunt placed for damage control indications would be associated with an increase in shunt-related complications including shunt dislodgement, thrombosis, or distal ischemia.Patients & MethodsA prospective, multicenter study (eleven level one US trauma centers) of all adult trauma patients undergoing temporary intravascular shunts (TIVS) after arterial injury was undertaken (January 2017-May 2019). Exclusion criteria included age <15years, shunt placement distal to popliteal/brachial arteries, isolated venous shunts, and death before shunt removal. Clinical variables were compared by indication and shunt-related complications. The primary endpoint was TIVS complications (thrombosis, migration, distal ischemia).ResultsThe 66 patients who underwent TIVS were primarily young (30years [IQR 22-36]) men (85%), severely injured (ISS 17 [10-25]) by penetrating mechanisms (59%), and had their shunts placed for damage control (41%). After a median SDT of 198min [89-622], 9% experienced shunt-related complications. Compared by shunt placement indication (damage control shunts [n=27] compared to non-damage control shunts [n=39]), there were no differences in gender, mechanism, extremity AIS, MESS score, fractures, or surgeon specialty between the two groups (all p>0.05). Patients with shunts placed for damage control indications had more severe injuries (ISS 23.5 compared to 13; SBP 100 compared to 129; GCS 11 compared to 15; lactate 11.5 compared to 3.6; all p<0.05), and had more frequent shunt complication predictors, but damage control shunts did not have significantly more TIVS complications (11.1% compared to 7.7%, p=0.658). Shunt complication patients were discharged home less often (33% vs 65%; p<0.05) but all survived.ConclusionShunts placed for damage control indications were not associated with shunt complications in this prospective, multicenter study.Copyright © 2021 Elsevier Ltd. All rights reserved.

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