The Use of lntraluminal Intravascular Balloon Occlusive Shunts in

Vascular Surgery

Joseph Hodge, MD, Spartanburg, South Carolina

Intraluminal intravascular occlusive shunt tubes were previously utilized primarily to prevent cerebral ischemia. Since DeBakey et al [I] first popularized this method, polyethylene, polyvinyl, and Silastic@ tubes have been used. Javid [2] developed a soft tube that could be introduced into the common carotid artery with a smaller end projecting into the internal carotid artery held with appropriate clamps, thereby avoiding injury to the vessels. The Javid shunt has been widely used in carrying out thromboendarter- ectomy [3;. The shunt described herein can be used to prevent cerebral or extremity ischemia by allowing perfusion to continue during carotid artery surgery, repair of arteriovenous fistulas, and traumatic lac- erations of vessels.

Material and Methods

The shunts (Figures 1 and 2) are 3 and 4 mm vinyl tubes consisting of a central silicon-treated tube through which blood flows. Two T tubes are attached to the central portion of the shunt, and upon intro- ducing normal saline into the T tube through a valve pilot balloon assembly, balloon cuffs at each end of the tube are inflated, thereby occluding blood flow at the site of the operative field. However, perfusion is continued through the central lumen of the tube. (Figure 3.)

Technic

Prior to arteriotomy, the inflatable balloons are tested by the introduction of air into the balloon as- sembly. (Figure 1.) The T tube on the right inflates the balloon on the left, and the left T tube inflates the balloon on the right. The shunts are immersed in heparinized solution prior to introduction into the vessel. After exposure of the vessels involved, en-

Repfint requests should be addressed to Joseph Ho+e, MD, l-lodge Building, 856 North Church Street, Spartanburg, South Carolina 29303.

circling tapes are passed proximal and distal to the arteriotomy site. After arteriotomy, the occlusive balloon shunt is introduced into the proximal and distal ends of the vessels, and normal saline is in- troduced into the T tubes. Upon completion of ca- rotid endarterectomy or peripheral vascular proce- dures, the vessel is irrigated with heparinized solu- tion, and closure of the arteriotomy is begun at the distal end up to the emergence of the base of the

Figure 1. Description of intravascular balloon assembly with inflatable cuffs.

Figure 2. Demonstration of the inflatable balloon cuffs of the occlusive shunt.

278 The American Journal of Surgery

Balloon Occlusive Shunts

Figure 3. lnfraluminal shunt to prevent cerebral ischemia.

lower T tube. Then closure of the proximal end of the vessel is carried down to the upper T tube with ap- propriate Dacron@ or polyethylene sutures. The shunt is removed by withdrawing saline from each tube, and bleeding is temporarily controlled by either en- circling tapes or a small atraumatic arterial clamp, until final closure of the incision is completed with interrupted sutures.

Summary

Intravascular shunts are primarily utilized to prevent cerebral &hernia during carotid artery surgery. However, an intraluminal intravascular balloon occlusive shunt tube is described which may

be used to perfuse extremities during bypass proce- dures, repair of arteriovenous fistulas, and traumatic lacerations of sizable arteries and veins.

Acknowledgment: The shunts were supplied by National Catheter Corporation, Hook Road, Argyle, New York 12809.

References

1. DeBakey ME, Crawford ES, Cooley DA, Morris DC: Surgical considerations of occlusive disease of innominate, carotid, subclavian and vertebral arteries. Ann Surg 149: 690, 1959.

2. Javid H: Can surgery prevent stroke? Appraisal of progress in surgical therapy. Surgery 59: 1147, 1966.

3. Julian DC, Dye WS, Javid H, Hunter JA: Ulcerative lesions of the carotid artery bifurcation. Arch Surg 86: 803. 1963.

Volume 137, February 1979 279