Evaluation and Management of Peripheral
Annotation for Point J
The first step in limb salvage in the patient with a mangled extremity or near exsanguination is to restore arterial inflow and, if needed, venous outflow by the insertion of temporary intraluminal shunts.33 In addition to intravenous tubing, a number of commercially available carotid artery-type shunts are available, and a rigid 14 Fr size has been the most commonly inserted in recent years.33 While the Pruitt-Inahara shunt is only 8 Fr in size, the added T-piece will allow for infusion of vasodilators or anticoagulants. The patency of an intraluminal arterial shunt is confirmed by the presence of palpable pulses or Doppler signals at the ankle or wrist. Thoracostomy tubes in the 16 Fr to 24 Fr size range are used as shunts in large peripheral veins such as the popliteal or femoral.