Temporäre intravasale shuntanlage (TIVS). Eine nützliche ergänzung im konzept der "vascular damage control surgery" peripherer gefäße der extremitäten

Background. The primary reconstruction of vascular injuries is not always possible. This is especially true for critical situations with a lack of expertise in vascular surgery and/or a necessary intensive care treatment of the lethal triad (i.e. hypovolemia, hypothermia and acidosis) in multiple traumatized patients. Nevertheless, even under such extreme conditions preservation of the extremities is given the highest priority. Material and methods. In this article the possibility of using temporary intravascular shunts (TIVS) for maintaining perfusion in an injured extremity as an adjunct in the vascular damage control surgery concept is described and evaluated based on a review of the literature. The question of the necessity for a fasciotomy is also examined, especially taking into account that this approach follows the dogma of primum non nocere. Results. Ligation or time-consuming reconstruction of vessels without a TIVS in primary care situations is associated with an unacceptably high mortality and secondary amputation rate. With the use of a TIVS and damage control surgery these rates can be substantially reduced. Conclusions. The TIVS is a technique which in time critical situations and/or a lack of vascular surgical expertise contributes to preservation of injured extremities.