TEMPORARY INTRAVASCULAR SHUNTS FOR QUICK RESTORATION OF PERFUSION TO THE EXTREMITYWITH MAJOR VASCULAR INJURY_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHU Qingtang , ZHENG Canbin , QI Jian , GU Liqiang , FU Guo , QIN Bengang , WANGDong , LI Ping , LI Zhiyong , XIANG Jianping , LIU Xiaolin.

Department of Microsurgery and Orthopaedic Trauma, the First AffiliatedHospital of Sun Yat-sen University, Guangzhou Guangdong, 510080, P.R.China.;

Corresponding author：

Keywords：

Temporary intravascular shunts; Revascularization; Limb trauma; Tumor

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【Abstract】 Objective To report cl inical 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 definitly. 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.

Citation： ZHU Qingtang,ZHENG Canbin,QI Jian,GU Liqiang,FU Guo,QIN Bengang,WANGDong,LI Ping,LI Zhiyong,XIANG Jianping,LIU Xiaolin.. TEMPORARY INTRAVASCULAR SHUNTS FOR QUICK RESTORATION OF PERFUSION TO THE EXTREMITYWITH MAJOR VASCULAR INJURY. Chinese Journal of Reparative and Reconstructive Surgery, 2012, 26(2): 231-234. doi: Copy

1.	Blaisdell FW. The pathophysiology of skeletal muscle ischemia and the reperfusion syndrome: a review. Cardiovasc Surg, 2002, 10(6): 620-630.
2.	罗庚, 郭现辉, 李燕山, 等. 显微外科技术修复四肢主干血管损伤的疗效分析. 中华显微外科杂志, 2011, 34(1): 66-67.
3.	Davidovic LB, Cinara IS, Ille T, et al. Civil and war peripheral arterial trauma: review of risk factors associated with limb loss. Vascular, 2005, 13(3): 141-147.
4.	郑灿镔, 朱庆棠, 顾立强, 等. 四肢主要动脉钝性损伤延误修复的原因分析. 中华创伤骨科杂志, 2011, 13(4): 392-394.
5.	McHenry TP, Holcomb JB, Aoki N, et al. Fractures with major vascular injuries from gunshot wounds: implications of surgical sequence. J Trauma, 2002, 53(4): 717-721.
6.	Eger M, Golcman L, Goldstein A, et al. The use of a temporary shunt in the management of arterial vascular injuries. Surg Gynecol Obstet, 1971, 132(1): 67-70.
7.	Borut LT, Acosta CJ, Tadlock LC, et al. The use of temporary vascular shunts in military extremity wounds: a preliminary outcome analysis with 2-year follow-up. J Trauma, 2010, 69(1): 174-178.
8.	Ball CG, Feliciano DV. Damage control techniques for common and external iliac artery injuries: have temporary intravascular shunts replaced the need for ligation? J Trauma, 2010, 68(5): 1117-1120.
9.	Hancock H, Rasmussen TE, Walker AJ, et al. History of temporary intravascular shunts in the management of vascular injury. J Vasc Surg, 2010, 52(5): 1405-1409.
10.	Sriussadaporn S, Pak-art R. Temporary intravascular shunt in complex extremity vascular injuries. J Trauma, 2002, 52(6): 1129-1133.
11.	Choudry R, Schmieder F, Blebea J, et al. Temporary femoral artery bifurcation shunting following penetrating trauma. J Vasc Surg, 2009, 49(3): 779-781.
12.	Taller J, Kamdar JP, Greene JA, et al. Temporary vascular shunts as initial treatment of proximal extremity vascular injuries during combat operations: the new standard of care at Echelon II facilities? J Trauma, 2008, 65(3): 595-603.
13.	孙如泉, 刘泽, 张远林, 等. 动脉临时性桥接技术在四肢骨折合并血管损伤中的应用. 中华创伤杂志, 2004, 20(9): 566-567.
14.	Hossny A. Blunt popliteal artery injury with complete lower limb ischemia: is routine use of temporary intraluminal arterial shunt justified? J Vasc Surg, 2004, 40(1): 61-66.
15.	Ding W, Wu X, Li J. Temporary intravascular shunts used as a damage control surgery adjunct in complex vascular injury: collective review. Injury, 2008, 39(9): 970-977.
16.	张泽峰, 徐振海, 姚继方, 等. 心血管外科技术在肿瘤切除术中的应用. 山东医药, 2005, 45(33): 32.
17.	Hemming AW, Reed AI, Fujita S. Ex vivo extended left hepatectomy with caval preservation, temporary portacaval shunt, and reconstruction of the right hepatic vein outflow using a reversed portal vein bifurcation graft. J Hepatobiliary Pancreat Surg, 2006, 13(6): 525-529.
18.	Granchi T, Schmittling Z, Vasquez J, et al. Prolonged use of intraluminal arterial shunts without systemic anticoagulation. Am J Surg, 2000, 180(6): 493-497.
19.	郑灿镔, 朱庆棠, 秦本刚, 等. 简便快速重建损伤肢体血供一例报告. 中华创伤骨科杂志, 2011, 13(5): 497-498.
20.	Nalbandian MM, Maldonado TS, Cushman J, et al. Successful limb reperfusion using prolonged intravascular shunting in a case of an unstable trauma patient-a case report. Vasc Endovascular Surg, 2004, 38(4): 375-379.

1. Blaisdell FW. The pathophysiology of skeletal muscle ischemia and the reperfusion syndrome: a review. Cardiovasc Surg, 2002, 10(6): 620-630.
2. 罗庚, 郭现辉, 李燕山, 等. 显微外科技术修复四肢主干血管损伤的疗效分析. 中华显微外科杂志, 2011, 34(1): 66-67.
3. Davidovic LB, Cinara IS, Ille T, et al. Civil and war peripheral arterial trauma: review of risk factors associated with limb loss. Vascular, 2005, 13(3): 141-147.
4. 郑灿镔, 朱庆棠, 顾立强, 等. 四肢主要动脉钝性损伤延误修复的原因分析. 中华创伤骨科杂志, 2011, 13(4): 392-394.
5. McHenry TP, Holcomb JB, Aoki N, et al. Fractures with major vascular injuries from gunshot wounds: implications of surgical sequence. J Trauma, 2002, 53(4): 717-721.
6. Eger M, Golcman L, Goldstein A, et al. The use of a temporary shunt in the management of arterial vascular injuries. Surg Gynecol Obstet, 1971, 132(1): 67-70.
7. Borut LT, Acosta CJ, Tadlock LC, et al. The use of temporary vascular shunts in military extremity wounds: a preliminary outcome analysis with 2-year follow-up. J Trauma, 2010, 69(1): 174-178.
8. Ball CG, Feliciano DV. Damage control techniques for common and external iliac artery injuries: have temporary intravascular shunts replaced the need for ligation? J Trauma, 2010, 68(5): 1117-1120.
9. Hancock H, Rasmussen TE, Walker AJ, et al. History of temporary intravascular shunts in the management of vascular injury. J Vasc Surg, 2010, 52(5): 1405-1409.
10. Sriussadaporn S, Pak-art R. Temporary intravascular shunt in complex extremity vascular injuries. J Trauma, 2002, 52(6): 1129-1133.
11. Choudry R, Schmieder F, Blebea J, et al. Temporary femoral artery bifurcation shunting following penetrating trauma. J Vasc Surg, 2009, 49(3): 779-781.
12. Taller J, Kamdar JP, Greene JA, et al. Temporary vascular shunts as initial treatment of proximal extremity vascular injuries during combat operations: the new standard of care at Echelon II facilities? J Trauma, 2008, 65(3): 595-603.
13. 孙如泉, 刘泽, 张远林, 等. 动脉临时性桥接技术在四肢骨折合并血管损伤中的应用. 中华创伤杂志, 2004, 20(9): 566-567.
14. Hossny A. Blunt popliteal artery injury with complete lower limb ischemia: is routine use of temporary intraluminal arterial shunt justified? J Vasc Surg, 2004, 40(1): 61-66.
15. Ding W, Wu X, Li J. Temporary intravascular shunts used as a damage control surgery adjunct in complex vascular injury: collective review. Injury, 2008, 39(9): 970-977.
16. 张泽峰, 徐振海, 姚继方, 等. 心血管外科技术在肿瘤切除术中的应用. 山东医药, 2005, 45(33): 32.
17. Hemming AW, Reed AI, Fujita S. Ex vivo extended left hepatectomy with caval preservation, temporary portacaval shunt, and reconstruction of the right hepatic vein outflow using a reversed portal vein bifurcation graft. J Hepatobiliary Pancreat Surg, 2006, 13(6): 525-529.
18. Granchi T, Schmittling Z, Vasquez J, et al. Prolonged use of intraluminal arterial shunts without systemic anticoagulation. Am J Surg, 2000, 180(6): 493-497.
19. 郑灿镔, 朱庆棠, 秦本刚, 等. 简便快速重建损伤肢体血供一例报告. 中华创伤骨科杂志, 2011, 13(5): 497-498.
20. Nalbandian MM, Maldonado TS, Cushman J, et al. Successful limb reperfusion using prolonged intravascular shunting in a case of an unstable trauma patient-a case report. Vasc Endovascular Surg, 2004, 38(4): 375-379.

Chinese Journal of Reparative and Reconstructive Surgery

TEMPORARY INTRAVASCULAR SHUNTS FOR QUICK RESTORATION OF PERFUSION TO THE EXTREMITYWITH MAJOR VASCULAR INJURY

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