Temporary Intravascular Shunts

in Endovascular Trauma Management

Applied

Type

Addition

Confidence

90%

Created

Mar 20, 2026

Evidence

1 source

Rationale

The integration of the 2023 European guideline (Rossaint et al.) provides high-level evidence and a modern standard of care for the use of TIVS in the context of damage control surgery. This addition bridges the gap between general vascular trauma management and the specific physiological goals of resuscitation and coagulopathy management mentioned in the section. Abbreviations (DCS) were expanded on first use as per instructions.

Evidence

Rossaint R, Afshari A, Bouillon B, et al. The European guideline on management of major bleeding and coagulopathy following trauma: sixth edition. Crit Care. 2023;27(1):80. Published 2023 Mar 1. PMID: 36859355.
Verified source
PubMedDOI

Content Changes

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Temporary intravascular shunts (TIVS) are used in extremity vascular trauma to restore perfusion during resuscitation and orthopedic stabilization [@feliciano2011]. Current guidelines recommend the use of TIVS as a primary component of damage control surgery (DCS) to minimize ischemia time while managing life-threatening hemorrhage and coagulopathy [@rossaint2023]. In the endovascular trauma management (EVTM) context, TIVS can be combined with endovascular techniques such as resuscitative endovascular balloon occlusion of the aorta (REBOA) [@trauma2016-endovascular] to achieve proximal hemorrhage control while maintaining distal limb perfusion.

**Key considerations in EVTM:**
* Shunt placement may follow REBOA deployment to allow deflation while preserving limb perfusion
* Enables staged definitive repair after physiologic optimization
* Civilian and combat series report limb-salvage rates >90% with appropriate shunt use

**For comprehensive TIVS protocols** including indications, shunt selection, fixation techniques, anticoagulation, dwell times, and outcomes data, see [[Vascular Trauma|Ch. 15]].
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