Temporary vascular shunts

Definition

A temporary vascular shunt is defined as an intraluminal plastic conduit for the temporary maintenance of arterial inflow/venous outflow.

Historical perspective

Alexis Carrel (1873–1944), winner of the 1912 Nobel Prize in Physiology or Medicine, first described the insertion of a glass tube coated with paraffin into the abdominal aorta of a dog in 1911. Silver tubes as vascular shunts/conduits were used by the French surgeon Professor Theodore Tuffier (1857–1929) during World War I. A comprehensive description of silver tubes lined by paraffin as temporary vascular shunts by George H. Makins, a former president of the Royal College of Surgeons (Eng.), is available in his post–World War I textbook entitled On Gunshot Injuries to the Blood-Vessels . Founded on Experience Gained in France During the Great War, 1914–1918. The hope was that arterial collaterals would open as the shunt gradually occluded over 4 to 10 days.

American surgeons used plastic shunts/conduits in World War II with the same philosophy. In civilian life in 1950, Clatworthy and Varco described the use of a “small bore polythene shunt to prevent mechanical shock after prolonged cross-clamping of the thoracic aorta.” Two extraordinary laboratory and clinical reports on the use of “polythene shunts” in both trauma and elective vascular surgery were then published by Creighton A. Hardin in 1952.

The use of shunts over the past 50 years was stimulated by the report by Eger, Golcman, Goldstein, and Hirsch from Beer-Seba, Israel, in 1971. The authors constructed their own shunts in two military casualties from “regular polyethylene tubing of adequate size and length.” Of interest, they placed a three-way adapter in the middle of the tubing and commented that the rubber cap on the adapter allowed for the “injection of heparin.” Since the report by Eger et al, there has been a continuing series of publications on the use of temporary vascular shunts in both civilian and military centers.