General Surgery

Vascular trauma is associated with a high mortality rate, approaching 50 % in some series of iliac vessel injuries,[1] and when it is combined with a delay of over 6 hours to surgical reperfusion of a limb, amputation is often necessary.[2] Many of the innovations in the management of vascular injuries have arisen from experience obtained through care of wartime injuries. During World War I and II injured vessels were mainly ligated, with a high amputation rate. In the Korean and Vietnam conflicts, vascular repair and vein grafts were commonly used. Use of a temporary intravascular shunt (TIVS) was first described in the military as early as 1919. Its role became more prominent during the conflicts in Northern Ireland for fractures with associated vascular injuries[3] and in the Gulf since 1991, both in the setting of a physiologically unstable patient requiring a damage control procedure, and in the patient with an acutely ischaemic limb in a forwarding hospital where there may be no time for extensive surgical procedures, or expertise or equipment for formal vascular repair.[4] Since the developments in the Gulf War, use of TIVSs has also been advocated in the civilian trauma patient.[5] There are, however, only case reports and small case series in the literature describing their use. The aim of this study was to evaluate the use of TIVSs in an urban trauma centre with a high incidence of penetrating trauma, and outcome in patients so treated