Temporary Intravascular Shunt in Complex Vascular Injury

Hemorrhage remains a leading cause of death in both civilian and military traumatic patients. Vascular injuries, which literally threaten both life and limb, have always constituted a serious problem in the surgical management of traumatic conditions. In military operations, medical care is often delivered in an austere and dangerous environment with limited availability of resources. In World War I, when vascular surgical skills had not been popularized, ligation of vascular injuries was an expedient and useful option, with a resultant amputation rate as high as 72.5 % [1]. Of the 2,471 arterial injuries studied during World War II by DeBakey and Simeone [2], proximal ligation was used, with an amputation rate of 48.9 %. Advances in the surgical physiology, techniques, and armamentarium by the end of World War II led to a shift of emphasis from primary control of the hemorrhage to efforts aimed at preserving the viability and function of the extremities. During the Korean conflict, Hughes [3] reported that the amputation rate in a series of 269 patients decreased to 13 %, although popliteal artery injury resulted in a 38 % amputation rate. This figure was not significantly better in the Vietnam War, although the amputation rate for popliteal artery injury had decreased to 29.5 % [4].