TIVS versus Non-TIVS management of limb vascular injury in limb salvage: systematic review and meta-analysis.

Abstract

Background: To compare the postoperative complications between temporary intravascular shunts (TIVS) and non-TIVS management in limb salvage surgery for severe limb trauma, and to provide reference for clinical decision making.

Methods: The literature on postoperative complications of limb salvage with and without TIVS was searched in PubMed, Cochrane Library, Embase and MEDLINE from January 2000 to December 2023. References were screened and extracted according to inclusion and exclusion criteria, and meta-analysis was performed using RevMan5.4 software.

Results: 8 studies were included, including 1375 cases, 329 of which used TIVS and 1046 of which did not. Compared with no TIVS group, TIVS group was associated with a lower rate of amputation (OR = 0.48, 95%CI: [0.29, 0.82], P = 0.007) and less limb ischemic time (SMD = -0.96, 95%CI: [-1.17, -0.74], P < 0.00001), the incidence of thrombosis (OR = 1.48, 95%CI: [0.46, 4.78], P = 0.51), fasciotomy (OR = 0.84, 95%CI: [0.30, 2.36], P = 0.75) and infection (OR = 0.88, 95%CI: [0.35, 2.19], P = 0.78) were not statistically significant.

Conclusion: Compared with no TIVS group, TIVS group may reduce amputation rate and limb ischemia time, prospective multi-centre studies are needed for further evaluation.