The indications for shunting after vascular injury include damage control for patients in extremis, the presence of associated fractures requiring fixation, the need for transportation to specialized centers for definitive reconstruction, or injury occurrence in an austere environment with limited resources.

There are a number of commercially available vascular shunts. Improvised shunts can be constructed out of any plastic tubing that has the adequate diameter to match the corresponding vessel, such as chest tubes, intravenous tubing, and feeding tubes. Improvised shunts must be rigid enough that when they are tied into position, the sutures do not collapse the lumen of the shunt.

When selecting the shunt size for temporary bypass, the largest size of shunt that fits into the injured vessel without forcing it into place should be selected. This will maximize distal blood flow.

Commercially made shunts should not be trimmed. The edges of commercially made shunts are smooth and designed to avoid trauma to the intima of the artery.

Improvised shunts should be left long, with redundant length in both the proximal and distal vessel. This will reduce the risk of inadvertent shunt dislodgement.

The maximum length of time that a vascular shunt can remain in situ is unknown. It is important to perform definitive repair as soon as the patient’s physiology and other circumstances allow. Most shunts remain patent for 24–48 hours. The patency of the shunt is confirmed by the presence of a distal palpable pulse or dopplerable signal.

For extremity vascular injuries, a peripheral vascular instrument tray is sufficient. This should include vessel loops, a variety of types and sizes of vascular clamps (Bulldogs, Satinsky’s, etc.), DeBakey and Gerald forceps, an olive tip syringe, heparinized saline, a variety of sizes of Fogarty catheters, vascular shunts of different sizes, and 0-silk ties.

For central vascular injuries, such as aortic injuries, thoracotomy or laparotomy sets are required to allow for proper exposure of the injury. The instruments required for these shunts are the same as for the extremity injuries.

A sterile extremity tourniquet and sterile Doppler probe should be available.