Temporary Intraluminal Vascular Shunts for Limb Revascularization in Traumatic Injury of the Extremities

摘要

Vascular injury with extremity ischemia continues to result in high amputation rates when it is associated with extensive soft tissue loss, skeletal injuries, or life-threatening injuries. The time between injury and revascularization is the most readily modified factor affecting outcome. Many reports indicate that the use of a temporary intraluminal vascular shunt improves outcomes from complex vascular injuries. Shunt use provides prompt restoration of limb circulation, allowing for evaluation and treatment of concomitant injuries, followed by definitive vascular repair. Published clinical studies from 1966 to September 1999 reporting on the use of temporary shunts for the surgical management of extremity vascular injury, as well as all studies evaluating shunt use in experimental animal models, were reviewed. Reported data on 67 patients with 84 shunted vascular injuries were analyzed. Thirty-five patients recovered full use of the involved limb (52%). There were five amputations (8%). Thirty five injuries involved the popliteal artery. Of these, there was only one amputation (overall rate of 3%). Reported amputation rates among patients with popliteal artery injury in whom temporary shunts are not used vary widely, ranging from 0 to 75% in comparable series. This difference in amputation rate between shunted and non-shunted popliteal injuries is statistically significant (p less than 0.01). Animal model studies demonstrated no significant difference in the use of heparin-bonded shunts vs. non-heparin bonded shunts in temporary limb reperfusion.