Effect of temporary vascular shunting as a previous intervention on lower extremity arterial injury: Single center experiences in the Syrian Civil War

BACKGROUND: The goal of this retrospective study was to clarify the effect of using temporary vascular shunt (TVS) as a previous intervention.
METHODS: A total of 96 cases with war-related lower extremity arterial injury and surgically treated between October 2013 and March 2016 were included in the study. The patients were divided into two groups: those in which TVS was performed as a previous intervention on admission (TVS group, n=24) and those in which compression, tourniquet, and ligation/clampage were performed as a previous intervention on admission (non-TVS group, n=72).
RESULTS: In comparing injury pattern, there was no difference between the two groups. In addition, mean hematocrit level, mean systolic blood pressure, the incidence of concomitant vein injury, nerve injury, soft tissue damage, and bone injury were similar in both groups. The overall amputation rate was 19%. There were a total of 18 amputations, with 1 (4%) in the TVS group and 17 (24%) in the non-TVS group. The difference on amputation rate was statistically significant. The mean values of the mangled extremity severity score (MESS) were 6.45 in the TVS group and 7.44 in the non-TVS group. The overall mean MESS was 7.1. The duration of ischemia (DoI) was 4.84±1.84 h in the TVS group and 5.95±1.92 h in the non-TVS group. These differences in MESS and DoI were statistically significant.
CONCLUSION: We think that it may be beneficial for patients to consider a TVS to reduce DoI and gain time for surgical revascularization. As a result, the present study demonstrates that the use of TVS may successfully serve as a bridge between initial injury and definitive repair with a reduction in amputation rates.

Alt ekstremite arteriyel yaralanmalarýnda ilk müdahalede geçici vasküler þant uygulamasýnýn etkileri: Suriye iç savaþýnda tek merkez deneyimleri

AMAÇ: Bu geriye dönük çalýþmanýn amacý, ateþli silah yaralanmalarýnda ilk müdahelede geçici vasküler þant (GVÞ) uygulamasýnýn etkilerini irdelemektir.
GEREÇ VE YÖNTEM: Ekim 2013 ve Mart 2016 tarihleri arasýnda ateþli silah yaralanmasý nedeniyle ameliyat edilen 96 hasta çalýþmaya alýndý. Hastalar; ilk giriþim olarak GVÞ uygulanan hastalar (GVÞ grubu, n=24) ve ilk giriþim olarak kompresyon, turnike ve ligasyon/klempaj uygulanan hastalar (GVÞ yapýlmayan grup, n=72) olmak üzere iki gruba ayrýldý.
BULGULAR: Yaralanma mekanizmasý karþýlaþtýrýldýðýnda, her iki grup arasýnda fark yoktu. Ayný þekilde ortalama hematokrit seviyesi, ortalama sistolik kan basýncý, eþlik eden ven ile sinir ve yumuþak doku ve kemik yaralanmalarý her iki grupta benzerdi. Tüm ampütasyon oraný %19 idi. Biri GVÞ grubunda, 17’si diðer GVÞ yapýlmayan hasta grubunda olmak üzere toplam ampütasyon sayýsý 18 idi. Ortalama travmaya uðramýþ ekstremite skoru (MESS) GVÞ grubunda 6.45 iken GVÞ yapýlmayan grupta 7.44 idi. Ýskemi süresi GVÞ grupta 4.84±1.84 saat iken GVÞ yapýlmayan grupta 5.95±1.92 saat idi. MESS ve iskemi süresindeki farklýlýk istatistiksel olarak anlamlý deðerlendirildi.
TARTIÞMA: Geçici vasküler þant kullanýmýnýn iskemi süresini kýsaltmak ve cerrahi revaskülarizayon için zaman kazandýrmasý bakýmýndan hastalar için faydalý olabileceðini düþünmekteyiz. Sonuç olarak, bu çalýþma GVÞ kullanýmýnýn yaralanma baþlangýcýndan nihai cerrahi onarýmýna kadar baþarýlý bir köprü görevi gördüðünü ve ampütasyon oranýný azalttýðýný göstermektedir.