Temporary intravascular shunts after civilian arterial injury: A prospective multicenter Eastern Association for the Surgery of Trauma study |
| |
| Affiliation: | 1. 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;2. Department of Surgery, Denver Health Medical Center, University of Colorado, 777 Bannock Street MC 0206, 80204 Denver, Colorado, USA;3. Department of Surgery, R Adams Cowley Shock Trauma Medical Center, University of Maryland Medical System, 22 S Greene Street, 21201 Baltimore, Maryland, USA;4. Division of Trauma, Acute Care Surgery, Surgical Critical Care, Department of Surgery, Los Angeles County and University of Southern California Medical Center, 2051 Marengo Street, IPT, C5L100, 90033 Los Angeles, California, USA;5. Department of Surgery, Harbor-UCLA Medical Center, 1000 W Carson Street, Torrance, California, 90502, USA;6. Division of Trauma and Surgical Critical Care, Department of Surgery, Vanderbilt University Medical Center, 1211 21st Avenue South, 404 Medical Arts Building, 37212 Nashville, Tennessee, USA;7. Department of Surgery, Louisiana State University School of Medicine, 1542 Tulane Avenue 7th Floor, 70112 New Orleans, Louisiana, USA;8. Tulane University School of Medicine, 131 South Robertson Avenue 15th Floor, New Orleans, Louisiana, 70112, USA;9. Division of Trauma, Department of Surgery, Cooper University Hospital, #411, Camden, New Jersey 08103, USA;10. Department of Surgery, Boston Medical Center, 840 Harrison Ave, Dowling 2 South, Suite 2509, 02118 Boston, Massachusetts, USA;11. Division of Trauma, Emergency Surgery and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge Street, Suite 810, Boston, 02114 Massachusetts, USA;1. Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, NC, USA;2. Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi;1. OhioHealth/Doctors Hospital, Department of Orthopedics, Columbus, OH 43228, United States;2. OhioHealth Orthopedic Trauma and Reconstructive Surgeons, Grant Medical Center, Columbus, OH 43215, United States;1. Experimental Surgery and Simulation Center, Division of Gastrointestinal Surgery, Pontificia Universidad Católica de Chile, Chile;2. Trauma Surgery and Emergency Medicine Department, Hospital Dr. Sótero del Río, Chile;1. Department of Surgery; School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana, University Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana;2. Standford Children''s Health, Palo Alto, California, USA;3. Department of Surgery; School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana;4. Department of Medicine; School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana, Emergency Medicine Directorate, Komfo Anokye Teaching Hospital, Kumasi, Ghana;5. Department of Surgery; School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana;6. Department of Surgery, University of Washington, Seattle, WA, USA, Global Injury Control Section, Harborview Injury Prevention and Research Center;1. University of Manchester, Faculty of Biology, Medicine and Health, School of Medical Sciences, Division of Cardiovascular Sciences, Oxford Road, Manchester, M13 9PL;2. Centre for Urgent and Emergency Care Research, School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK;3. Institute of Population Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London;4. School of Health and Related Research (ScHARR), The University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA;5. Hull York Medical School, University of York, Heslington, York, YO10 5DD |
| |
| Abstract: | 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. |
| |
| Keywords: | |
| 本文献已被 ScienceDirect 等数据库收录！ |
|
