Temporary intraluminal shunts: resolution of a management dilemma in complex vascular injuries

Complex vascular injuries of the extremities in which acute arterial insufficiency is combined with severe or prolonged shock, extended periods of ischemia, or associated fractures or soft-tissue injuries have unacceptably high limb loss rates, frequently because the allowable warm ischemia time for skeletal muscle is exceeded before adequate revascularization. In a 1-year period, ten patients with complex vascular injuries identified at our metropolitan trauma center underwent routine introduction of temporary plastic intravascular shunts at the site of vessel disruption, thus permitting immediate limb revascularization. This rapid reperfusion permitted appropriate attention to be directed toward skeletal fixation, soft-tissue debridement, and other procedures without the urgency usually associated with the presence of acute limb ischemia. Following various local and distant orthopedic or general surgical procedures, arterial and venous continuity were uneventfully re-established. This experience suggests that the routine use of plastic intraluminal shunts in complex vascular injuries of the extremities has the distinct potential of reducing the excess morbidity from prolonged acute arterial insufficiency noted in such injuries.