Utilization of shunting

Abstract

An alternative to ligation and bridge to formal vascular reconstruction is use of a temporary vascular shunt. These flexible, cylindrical plastic tubes provide a quick and technically basic means to restore flow across certain patterns of vascular injury. Recognition of the need to improve quality and not just statistical limb salvage following extremity vascular injury has led to a broader acceptance and use of temporary vascular shunts. The future of this adjunct appears to be bright and will likely include the development of trauma-specific vascular injury shunts able to be recognized and used routinely by general and acute care surgeons for both extremity and mesenteric injuries. Shunts of the future may have larger internal diameters better suited to perfuse a limb and include infusion ports to allow for delivery of therapeutics able to mitigate ischemic injury. Trauma-specific shunts with a side-port lumen may also allow for performance of arteriography and infusion of an anticoagulant to prevent shunt thrombosis or thromboembolism. In this context scenarios of extended shunt dwell times could be envisioned, allowing for stabilization of contaminated soft tissue wounds prior to shunt removal and vascular reconstruction. Just as temporary intraluminal devices for vascular trauma evolved a century ago, it is quite likely that innovation in their design, delivery, and clinical use will continue to expand in near and midterm.