Analysis of PROOVIT Registry Finds Temporary Intravascular Shunts Improve Early Limb Salvage After Extremity Vascular Injury

April 14, 2021—The Society for Vascular Surgery (SVS) announced that findings from the PROOVIT registry suggest that the use of temporary intravascular shunts (TIVSs) results in lower rates of amputation during the early phase of care and should be part of a more aggressive approach to restore perfusion in the most injured patients and ischemic limbs. The PROOVIT registry is a multicenter, retrospective study of prospective observational vascular injury treatment. Jeanette E. Polcz, MD, et al published the PROOVIT registry results in Journal of Vascular Surgery (2021;73:1304-1313).

As noted in the SVS announcement, the “time is tissue” concept suggests time to reperfusion is a critical factor in saving an extremity that has suffered trauma complicated by arterial injury. The objective of this study was to characterize the effect of using temporary intravascular shunts on early limb salvage and to determine the factors associated with amputation during the acute phase of extremity injury management.

In the study, the investigators compared the outcomes of patients with a vascular injury to the common, superficial, or deep femoral arteries, popliteal artery, axillary artery, and brachial artery entered into the PROOVIT registry between 2012 and 2018 from 24 trauma centers.

Comparing 78 patients treated with TIVSs versus 613 patients treated without TIVS, the investigators reported that the shunted patients were more severely injured (injury severity score, 19 vs 12; P = .002) and mangled (extremity score, 3.2 vs 3.0; P = .008).

After propensity matching the groups, the analysis revealed that patients without TIVSs were three times more likely to undergo amputation than shunted patients (odds ratio, 3.6; P = .026). Additionally, concomitant nerve and orthopedic injury were risk factors for amputation.

The investigators believe this is the first multicenter, matched cohort study to characterize early limb salvage as a function of temporary vascular shunt use in the setting of arterial injury, stated the SVS announcement.

“As a damage-control adjunct, the use of [TIVSs] can preserve the injured limb while the patient is resuscitated and other injuries are treated,” commented Dr. Polcz in the SVS press release. “Shunts can also be placed to reperfuse the limb while the patient is transferred to a higher level of care where the TIVS can be removed, and a formal vascular repair completed.

“The use of TIVSs as an alternative to ligation is best applied to resource-limited or damage-control situations in which neither the time nor the surgical expertise is available to perform vascular reconstruction. In contrast, in non–damage-control situations and scenarios that involve an isolated vascular injury managed by an experienced surgeon adept at vascular repair, it might be preferable to not use TIVSs and, instead, proceed directly to saphenous vein harvest and expedited interposition grafting."

A limitation of this study is that the PROOVIT registry lacks information on the outcomes of the patients in both cohorts beyond the < 2-week follow-up in this study, preventing analysis of the mid- and long-term viability of the treated extremities, advised the investigators in the SVS press release.