{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,19]],"date-time":"2025-09-19T08:30:35Z","timestamp":1758270635309,"version":"3.44.0"},"reference-count":11,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2020,6,17]],"date-time":"2020-06-17T00:00:00Z","timestamp":1592352000000},"content-version":"unspecified","delay-in-days":16,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Trauma Surg Acute Care Open"],"published-print":{"date-parts":[[2020,6]]},"abstract":"<jats:p>This is a case report of a patient who sustained a stab wound to the right axilla with injuries to the right axillary artery and vein. The patient had near-exsanguination in the field and no recordable blood pressure upon admission to the trauma center. Resuscitation was performed with endotracheal intubation, a left anterolateral resuscitative thoracotomy with cross-clamping of the descending thoracic aorta, and the rapid infusion of crystalloid solutions and packed red cells. In the operating room, the third portion of the right axillary artery and the adjacent right axillary vein were found to be transected. As part of a \u2018damage control\u2019 procedure, the ends of the right axillary vein were ligated. A 14 French intra-arterial shunt was inserted into the transected ends of the right axillary artery to restore the flow to the right upper extremity. The patient\u2019s postoperative course was complicated by a coagulopathy, adult respiratory distress syndrome (ARDS), and anuria. The coagulopathy and anuria resolved within the first 48\u2009hours, but the patient\u2019s ARDS was slow to resolve. On the 10th postinjury day, the patient was returned to the operating room for a definitive repair of the right axillary artery. After the intra-arterial shunt was removed, a reversed greater saphenous vein graft was inserted between the ends of the right axillary artery in a medial intermuscular (extra-anatomic) tunnel. The patient made an uneventful recovery and was discharged home on the 16th postinjury day.<\/jats:p>\n               <jats:p>The following principles of advanced trauma care were part of the management of this patient: (1) occasional need for resuscitative thoracotomy with cross-clamping of the descending thoracic aorta in a patient without a thoracic injury; (2) \u2018damage control\u2019 operation with ligation of the right axillary vein and placement of a temporary intra-arterial shunt to restore the flow to the right upper extremity; and (3) vascular reconstruction with an extra-anatomic bypass in a previously contaminated field.<\/jats:p>","DOI":"10.1136\/tsaco-2020-000486","type":"journal-article","created":{"date-parts":[[2020,6,18]],"date-time":"2020-06-18T06:13:32Z","timestamp":1592460812000},"page":"e000486","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Long-term intra-arterial shunt"],"prefix":"10.1136","volume":"5","author":[{"given":"David V","family":"Feliciano","sequence":"first","affiliation":[{"name":"Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2020,6,17]]},"reference":[{"key":"2025082410405238000_5.1.e000486.1","doi-asserted-by":"publisher","DOI":"10.1136\/tsaco-2019-000376"},{"key":"2025082410405238000_5.1.e000486.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2019.04.024"},{"key":"2025082410405238000_5.1.e000486.3","unstructured":"Agur AMR , Dailey AF . Grant\u2019s Atlas of Anatomy. 14th edn. Philadelphia, Pa: Lippincott Williams & Wilkins, 2016."},{"key":"2025082410405238000_5.1.e000486.4","doi-asserted-by":"crossref","first-page":"1405","DOI":"10.1016\/j.jvs.2010.04.060","article-title":"History of temporary intravascular shunts in the management of vascular injury","volume":"52","author":"Hancock","year":"2010","journal-title":"J Vasc Surg"},{"key":"2025082410405238000_5.1.e000486.5","doi-asserted-by":"crossref","first-page":"553","DOI":"10.1007\/s00068-011-0171-9","article-title":"Temporary vascular shunts","volume":"39","author":"Feliciano","year":"2013","journal-title":"Eur J Trauma Emerg Surg"},{"key":"2025082410405238000_5.1.e000486.6","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0b013e31817e5132"},{"key":"2025082410405238000_5.1.e000486.7","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9610(00)00508-0"},{"key":"2025082410405238000_5.1.e000486.8","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1097\/01.ta.0000220668.84405.17","article-title":"The use of temporary vascular shunts as a damage control adjunct in the management of wartime vascular injury","volume":"61","author":"Rasmussen","year":"2006","journal-title":"J Trauma"},{"key":"2025082410405238000_5.1.e000486.9","doi-asserted-by":"publisher","DOI":"10.1097\/01.TA.0000087807.44105.AE"},{"key":"2025082410405238000_5.1.e000486.10","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1097\/TA.0000000000000949","article-title":"Multicenter evaluation of temporary intravascular shunt use in vascular trauma","volume":"80","author":"Inaba","year":"2016","journal-title":"J Trauma Acute Care Surg"},{"key":"2025082410405238000_5.1.e000486.11","doi-asserted-by":"crossref","first-page":"506","DOI":"10.1016\/0002-9610(89)90180-3","article-title":"Extraanatomic bypass for peripheral arterial injuries","volume":"158","author":"Feliciano","year":"1989","journal-title":"Am J Surg"}],"container-title":["Trauma Surgery &amp; Acute Care Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/tsaco-2020-000486","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,24]],"date-time":"2025-08-24T17:41:04Z","timestamp":1756057264000},"score":1,"resource":{"primary":{"URL":"https:\/\/tsaco.bmj.com\/lookup\/doi\/10.1136\/tsaco-2020-000486"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,6]]},"references-count":11,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2020,6,17]]},"published-print":{"date-parts":[[2020,6]]}},"alternative-id":["10.1136\/tsaco-2020-000486"],"URL":"https:\/\/doi.org\/10.1136\/tsaco-2020-000486","relation":{},"ISSN":["2397-5776"],"issn-type":[{"type":"electronic","value":"2397-5776"}],"subject":[],"published":{"date-parts":[[2020,6]]}}}