Temporary Intravascular Shunts
Type
ReinforcementConfidence
78%
Created
Mar 28, 2026
Evidence
1 source
Rationale
The article is the sixth edition of the European guideline on major bleeding and coagulopathy following trauma, which directly supports the existing statement about international guidelines recommending TIVS within DCS to address the lethal triad. The existing text already cites Rossaint R, et al, which likely refers to an earlier edition or the same guideline under a slightly different key; adding Rossaint R et al as the explicitly suggested key for this sixth edition ensures the most current European guidance is cited. No substantive content changes are needed — a citation-only addition is appropriate. The relevance score of 49/100 and 'needs-human-review' flag reflect that the guideline covers TIVS only indirectly within its broader DCS recommendations, so confidence is moderate.
Evidence
Content Changes
<!-- type: treatment --> 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-e; @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]].