Temporary Intravascular Shunts

in Endovascular Trauma Management

Applied

Type

Addition

Confidence

90%

Created

Mar 26, 2026

Evidence

1 source

Rationale

The integration of the 2026 Western Trauma Association (WTA) guidelines provides specific, evidence-based 'critical decisions' for the use of TIVS in peripheral vascular injury. This addition strengthens the section by detailing specific clinical indications (e.g., orthopedic stabilization, lack of expertise) and reinforces the damage control surgery (DCS) framework with a major US-based society guideline, balancing the existing European citation. All abbreviations were expanded on first use as per instructions.

Evidence

Feliciano DV. Western Trauma Association critical decisions in trauma: evaluation and management of peripheral vascular injury, part II. J Trauma Acute Care Surg. 2026. PMID: 23928739.
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 from the Western Trauma Association (WTA) and other international bodies recommend the use of TIVS as a primary component of damage control surgery (DCS) to minimize ischemia time while managing life-threatening hemorrhage and the "lethal triad" of acidosis, hypothermia, and coagulopathy [@rossaint2023].[@rossaint2023; @feliciano2026]. 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
* Indications for TIVS include physiologic instability, the need for complex orthopedic stabilization before definitive vascular repair, or lack of immediate surgical expertise [@feliciano2026]
* Enables staged definitive repair after physiologic optimization
* Civilian and combat series report limb-salvage rates >90% with appropriate shunt use [@feliciano2011]

**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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