Evaluation and Management of Peripheral
Annotation for Point M
Removal of temporary intraluminal shunts and insertion of vascular interposition grafts are appropriate after orthopedic fixation at the first operation in the hemodynamically stable patient who is normothermic and has no other major injuries requiring immediate diagnostic or therapeutic intervention. In contrast, the patient with previous near exsanguination and insertion of temporary intraluminal shunts is returned to the operating room when hemodynamically stable and normothermic. The longest dwell time for an arterial intraluminal shunt in a recent large civilian series was 52 hours,33 but there is on report of a patient with a 10-day dwell time in the right axillary artery.34 There has been a recent report of increased infections in PTFE grafts placed at a reoperation after a temporary intraluminal shunt has been removed.35 If these data are noted in other reports, it would be recommended that an extra-anatomic bypass or insertion of an autogenous saphenous vein graft be performed after the shunt is removed.