A temporary arteriovenous shunt (Scribner) in the management of traumatic venous injuries of the lower extremity

Abstract

The use of a temporary arteriovenous shunt distal to the repair of a traumatic venous injury of the lower extremity in eight patients is reported. Three patients sustained injury to the superficial femoral vein, three had common femoral vein injuries, one had a through-and-through injury of common iliac vein, and one had a popliteal venous injury. Seven patients had associated arterial injuries. Venous repairs included four vein patches, two end-to-end anastomoses, a single venography, and one autogenous vein interposition graft. At the end of each operation, a distal A-V shunt utilizing the posterior tibial artery and vein was constructed. In two patients the shunt clotted within hours after insertion and could not be reopened. In the remaining six patients, the temporary A-V shunt was left in place an average of 10 days (range, 3-15). Followup venograms obtained 2 to 15 days postoperatively revealed patent venous repairs in all patients whose shunt remained functional for 72 hours or more. Noninvasive Doppler studies were obtained in four patients 3 to 8 months post repair and revealed no evidence of deep venous obstruction. No patient with a functioning distal A-V shunt had significant limb edema following repair. This technique appears to improve patency rates of venous repairs and has several distinct advantages over previously described A-V anastomotic fistulas.