[Temporary intravascular shunts for quick restoration of perfusion to the extremity with major vascular injury].

OBJECTIVE

To report clinical experience in the use of temporary intravascular shunts (TIVS) for quick restoration of perfusion to the extremity with major vascular injury.

METHODS

Between August 2009 and March 2011, TIVS was applied temporarily to restore blood perfusion to the extremity in 6 patients with major extremity vascular structure injury secondary to trauma (4 patients) or tumor resection (2 patients), who would received vascular transplantation and underwent long ischemia. The patterns of vascular shunts included external carotid artery-subclavian artery, axillary artery-axillary artery, axillary vein-subclavian vein, brachial artery-brachial artery, brachial vein-brachial vein, brachial artery-radial artery, femoral artery-popliteal artery, and popliteal artery-posterior tibial artery. After TIVS, extensive debridement, fracture fixation, or tumor excision was performed. Then the shunted tubes were removed, and the vessels were repaired definitely. Six vessels were repaired by transplanting the great saphenous veins; one vessel was anastomosed directly without tension; and one vessel was repaired by artificial vascular graft.

RESULTS

All shunted tubes were successfully established within 5 to 10 minutes (mean, 8.2 minutes). The duration of bypass ranged from 67 to 210 minutes. After establishment of TIVS, blood perfusion to the affected limb was improved. When shunted tubes were removed, thrombosis and partial obstruction occurred in one who accepted amputation, and the others kept patency. No loosening of tubes and haemorrhage occurred. At 2-15 months of follow-up, affected limbs had good blood supply.

CONCLUSION

TIVS is rapid and simple, which can quickly restore blood perfusion to the extremity with major vascular injury and shorten the ischemic time of the affected extremity.