Temporary arterial shunts in damage control: Experience and outcomes.

Background: Arterial shunting is a well-described method to control hemorrhage and rapidly re-establish flow, but optimal shunt dwell times remain controversial. We hypothesized that prolonged shunt dwell times of >6 hours are related to adverse outcomes after major arterial injury. Methods: A review (2005-2013) of all patients with arterial shunts placed after traumatic injury at our urban Level-I trauma center was undertaken. Patients who expired prior to shunt removal (n=7) were excluded. Shunt complications were defined as dislodgement, thrombosis and distal ischemia. Patients were compared on the basis of shunt complications with respect to clinical parameters. Results: The 42 patients who underwent arterial shunting after major vascular injury were primarily young (median 26 years, [IQR 22-31]) males (97.6%), severely injured (ISS 17.5 [14-29], shunted vessel AIS 4 [3-4]) by gunshot (85.7%) requiring neck/torso (33.3%), upper (19.1%) or lower (47.6%) extremity shunts. Thirty-five patients survived until shunt removal and 5/35 (14.3%) developed shunt complications. Demographics and clinical characteristics were compared between those with shunt dwell times 6 hours (n=16). While patients appeared to have a greater injury burden overall in the >6 hours group, there were no statistical differences between groups with respect to age, gender, initial SBP or hemodynamics during the shunt dwell period, use of vasopressors, AIS of the shunted vessel, ISS or outcomes including limb amputation or mortality. No patients (0/19) with shunt dwell times 6 hours developed shunt complications (p=0.05). Conclusions: In this civilian series, 14% of patients with arterial shunts developed shunt complications. Our data suggests that limiting shunt dwell times to

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