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Comment on routine shunting
Eur J VascSurg 7 (SupplementA), 2 (1993)
Comment on Routine Shunting We have used most of the modalities of cerebral protection mentioned in this symposium, and are well aware of all the data. We finally settled on general anaesthesia and routine shunting for all carotid endarterectomies, using a No. 8 or No. 10 Fr straight plastic catheter about 9cm long. We have had no technical problems and only one instance in which the shunt clotted in about 3000 operations done over the last 25 years by our group. In a personal series of 707 operations, operative mortality was 0.42%, mostly cardiac, the incidence of severe deficits was 0.56% and that of mild deficits 1%, a total of 1.56%. The advantages of a shunt are: simple, quick,
0950-821X/93/0A0002+01 $08.00/0© 1993Grune & StrattonLtd.
safe, always available, effective, allows for no-haste surgery, which is especially important when training residents and fellows, and acts as a stent for closure. This is of special importance in complicated lesions and when patch angioplasty is required. The majority of the practicing clinical vascular surgeons present at meetings in the U.S. use a shunt routinely. Finally, in the U.S.A. the legal implications of shunting versus non-shunting are very important. The disadvantages of the shunt are in practice minimal.
Jesse E. Thompson, Dallas, Texas, U.S.A.
Comment on Routine Shunting We have used most of the modalities of cerebral protection mentioned in this symposium, and are well aware of all the data. We finally settled on general anaesthesia and routine shunting for all carotid endarterectomies, using a No. 8 or No. 10 Fr straight plastic catheter about 9cm long. We have had no technical problems and only one instance in which the shunt clotted in about 3000 operations done over the last 25 years by our group. In a personal series of 707 operations, operative mortality was 0.42%, mostly cardiac, the incidence of severe deficits was 0.56% and that of mild deficits 1%, a total of 1.56%. The advantages of a shunt are: simple, quick,
0950-821X/93/0A0002+01 $08.00/0© 1993Grune & StrattonLtd.
safe, always available, effective, allows for no-haste surgery, which is especially important when training residents and fellows, and acts as a stent for closure. This is of special importance in complicated lesions and when patch angioplasty is required. The majority of the practicing clinical vascular surgeons present at meetings in the U.S. use a shunt routinely. Finally, in the U.S.A. the legal implications of shunting versus non-shunting are very important. The disadvantages of the shunt are in practice minimal.
Jesse E. Thompson, Dallas, Texas, U.S.A.