Comparison of Internal Shunts during Carotid Endarterectomy under Routine Shunting Policy

Abstract

We compared patients who underwent carotid endarterectomy (CEA) using two-way and three-way internal shunts and discussed which shunt was more appropriate and effective for surgeons. Eighty-two patients (mean 69.5 ± 6.1 years old, mean degrees of stenosis 79.6 ± 10.4%) who had undergone CEA by our routine shunting policy were examined concerning the difference of Sundt and Pruitt-Inahara (P-I) shunts in clinical use. Carotid clamping time for the P-I shunt was over 2 minutes longer than that by Sundt in either split or conventional continuous arteriotomy (p < 0.001). The proportions of cases with multiple trials of either arteriotomy or insertion of a shunt tube, cases detected more than one high-intensity spot on diffusion-weighted images of magnetic resonance imaging after CEA, and cases detected postoperative intimal flaps detected by multi-detector CT angiography showed no significant differences between the two shunt groups. The two-way Sundt shunt was quicker than the three-way P-I shunt in placement with no remarkable problems. Split arteriotomy was not useful in shortening the placement time for either Sundt or P-I shunt tubes, compared with continuous arteriotomy. A simple two-way shunt with easy handling like the Sundt shunt would be also appropriate to choose in selective shunting under the unfamiliarity of treating shunts.

Vascular Shunt for Small Vessel Trauma in a Polytrauma Patient

“…Shunt tubes are of two categories: two-way and three-way types. The former includes Sundt, Javid, and Argyle shunts, and the latter Pruitt-Inahara, Brener, and Furui shunt [ 14 ]. Some commercial arterial shunts are too large for the distal brachial artery and ulnar arteries; thus, an appropriately sized shunt uses balances between maintaining patency and preventing an unwanted intimal injury [ 15 ].…”