Abstract
Temporary intravascular shunts are inserted in 3% to 10% of patients with major vascular injuries. The major indications are “damage control” in a patient with near-exsanguination or multiple injuries and physiologic exhaustion or in one with a Gustilo IIIC open fracture of an extremity. A variety of commercially available straight or tapered arterial shunts up to 17-French are available, while larger thoracostomy tubes are used for large peripheral or truncal veins. Keys to maintaining patency of shunts beyond the first operation include the following: (1) early insertion of the shunt that will fit the artery; (2) insertion of a shunt in an adjunct injured major vein rather than ligation; and (3) prophylactic distal fasciotomy versus serial measurements of compartment pressures in the distal extremity.
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