Early Versus Delayed Restoration of Flow With Temporary Vascular Shunt Reduces Circulating Markers of Injury in a Porcine Model

Abstract

This study provides physiologic insight into the benefit of shunts in a model of extremity ischemia. Early shunting protects the extremity from further ischemic insult and reduces circulating markers of tissue injury. Additionally, the presence of a shunt does not increase the Ischemic Injury Index and patency is maintained in the absence of heparinization.

The impact of ischemic intervals on neuromuscular recovery in a porcine (Sus scrofa) survival model of extremity vascular injury

“…21 In that study, restoration of flow with a temporary vascular shunt before 3 hours of ischemia was associated with reduced tissue and circulating markers of muscle injury. Indeed, a recent clinical study documented the negative impact of iliac vessel ligation in humans.…”

Surgical Damage Control and Temporary Vascular Shunts

“…As 30 Gifford and colleagues confirmed similar findings demonstrating consistent 18-hour patency of the Sundt shunt without full anticoagulation. 31 Additionally, most clinical series in the military and civilian settings show that temporary vascular shunts remain patent and effective without systemic doses of heparin. Most of these reports acknowledge the selective use of systemic heparin in rare instances of isolated vascular injury with some compelling factor such as initial shunt thrombosis or a documented heavy clot burden in the distal circulation.…”

Imaging Assessment of Gunshot Wounds

“…A minimum velocity of 59.4-61.0 m/s is necessary for a bullet to breach its cortex. 79,80 The clinical and radiographic appearance of the entrance hole is usually a punched out round-to-oval shape with a sharp beveled edge. In contrast, the exit site typically has an excavated, conelike appearance with a variable amount of combinations.…”