The Use of Temporary Vascular Shunts as a Damage Control Adjunct in the Management of Wartime Vascular Injury
Abstract
Historically wartime surgical experience has lead to advances in the treatment of traumatic vascular injury. Past military conflicts have provided lessons on vascular trauma that have been applied to civilian and military surgical practice. From routine injury ligation in World Wars I and II, to the principles of rapid air evacuation and in theater repair of arterial and venous injuries in Korea and Vietnam, limb salvage has steadily improved. Military operations in support of Operation Iraqi Freedom (OIF) represent the first mature military conflict since Vietnam to allow assessment of contemporary practices such as vascular shunts in the management of wartime vascular injuries. Eger et al. in 1971 were among the first to report the use of temporary vascular shunts to treat combat related vascular injuries listing six benefits of this surgical adjunct. Since this publication, understanding of the usefulness of shunts has come from case reports and small series mostly from civilian centers. This experience supports the early exploration of the injured vessel(s) and use of shunts in certain cases as part of an overall strategy in the management of vascular injury. This strategy also includes thrombectomy, administration of heparin to the injured vessel and fasciotomy of the injured extremity. Shunts in the arterial position allow for perfusion of the extremity during transport or fixation of associated orthopedic injuries. For injury patterns involving an artery and vein, shunts placed in the venous position provide drainage and decrease venous hypertension that can compound tissue ischemia and bleeding. Despite this experience, the role of temporary vascular shunts in a present-day military vascular registry has not been reported and the frequency, pattern of use, safety, and efficacy remain unknown.
Document Details
- Document Type
- Technical Report
- Publication Date
- Jul 01, 2006
- Accession Number
- ADA480281
Entities
People
- David L. Smith
- Donal H. Jenkins
- Jonathan L. Eliason
- Michael A. Peck
- Todd E Rasmussen
- W. D. Clouse