vascular shunt -Argyle =  Pruit Inahara and = Le-Maitre - base deficit - bicarbonate

1. https://cbc.org.br/wp-content/uploads/2013/07/112012JT.pdf 
2. Of the 99 TIVS used, 

1. 61 (62%) were Argyle shunts (C.R.
   Bard, Billerica, MA), 
1. maximum - the 14 Fr. Argyle shunt which was employed 30 times in 22 patients (30%) with 18 arterial (60%) and 12 venous (40%) injuries.
2. The most frequent injured vessel in which a 14 Fr. Argyle shunt was used was the superficial femoral artery (SFA) (30%). Other vessels which accommodated this
   shunt were the popliteal artery (POA) (n 7), popliteal vein (POV) (n 7), and superficial femoral vein (SFV) (n 5)  (Table 2).
2. 16 (16%) were small caliber chest tubes, and 
3. 20 (20%) were Pruitt-Inahara (P-I) shunts (LeMaitre Vascular,
   Burlington, MA). 
1. Twenty 9 Fr. P-I shunts were employed in 18 patients (27%) with 19 arterial (19%) and 1 venous (1%) injury (Table 3). 
2. This type of TIVS most commonly accommodated the SFA (n 7), followed closely by the POA (n 6). 
3. The only thrombosed TIVS which lead to amputation was a 9 Fr. P-I
   shunt in the brachial artery of a 56-year-old man with a mangled upper extremity
4. In addition, one 5 Fr. pediatric feeding tube and 
5. one 16 gauge angiocatheter were used.
6. Over the years, many different types of shunts have been used for temporary revascularization. 
7. Shunts may be classified as “in-line” or “looped” shunts. 
1. The most common TIVS used in our institution were the “in-line” Argyle shunts and small caliber CTs (Fig. 2). These are technically very simple and quick to place and, therefore, very practical in damage control settings. CTs, most commonly used in veins in this series, were used when 14 Fr. Argyle shunts were not large enough to accommodate the vessel. 
2. Other “in-line” shunts available are the 
1. Javid shunt (C.R. Bard, Billerica, MA) and 
1. Javid shunts have cone-shaped bulbs on the ends, and special
   forceps or Rumel tourniquets can be used to secure the shunt
   to the vessel (Fig. 3)
2. the Sundt shunt (Integra Neurosciences, Plainsboro, NJ).
   . All “in-line” shunts can be secured in place with soft rubber vessel loops or heavy silk ties. P-I and some Sundt shunts exist in the “looped” configuration
3. P-I shunts have intraluminal occluding balloons at the
   ends to support them in the vessel with ports at the center for
   balloon inflation, angiography, and infusion of heparin or a
   vasodilator (Fig. 5).
4.  In addition, a variety of other conduits have been used as shunts.
1. such as 
2. polyvinylchloride endotracheal suction catheters, 
3. sterile nasogastric tubes, 
4. simple polyethylene intravenous and extension tubes, 
5. and pediatric feeding tubes. Along with 
6. a 5 Fr. pediatric feeding tube in a 2-year old’s brachial artery, 
7. a 16 gauge angiocatheter was used successfully in a young male’s PT artery in this series.
   
   
3. https://tsaco.bmj.com/content/2/1/e000110   
   Pitfalls in the management of peripheral vascular injuries  -  David V Feliciano
   
   Over the past 65+ years, most civilian peripheral vascular injuries have been managed by trauma surgeons with training or experience in vascular repair or ligation. This is appropriate as the in-hospital trauma team is immediately available, and there are often other injuries present in the victim.
   
   The pitfall to avoid during evaluation of the patient in the emergency center is a missed diagnosis. In the patient without ‘hard’ signs of a peripheral vascular injury, a careful history (bleeding), physical examination including measurement of ankle–brachial (ABI) or brachial–brachial index and liberal use of CT arteriography depending on an ABI <0.9 should essentially make the diagnosis if an arterial injury is present.
   
   At operation, one pitfall is to limit skin preparation and draping, thereby eliminating the option of removing the greater saphenous vein if needed as a conduit from either the groin or ankle of an uninjured lower extremity. Another pitfall is to make a full longitudinal incision directly over a large pulsatile hematoma. Rather, separate shorter longitudinal incisions should be made to obtain proximal and distal vascular control before entering the hematoma. The failure to recognize patients who should be managed initially with insertion of a temporary intraluminal shunt is a major pitfall as well. Not following time-proven and results-proven ‘fine techniques’ of operative repair is another major pitfall. Such techniques include the following: use of small angioaccess vascular clamps or silastic vessel loops; passage of proximal and distal Fogarty catheters; administration of regional or systemic heparin during complex repairs; an open anastomosis technique; and completion arteriography after a complex arterial repair in a lower extremity.
   
   Avoiding pitfalls should allow for success in peripheral vascular repair, particularly since most patients are young with non-diseased vessels.
   
   
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4. base deficit and bicarbonate levels predict mortality in ICU 
1. serum HCO₃ level of 22 mEq/L, which equals a BD of 0, and 
2. a serum HCO₃ level of 18 mEq/L, which equates to a BD of 5.
1. anion gap used to estimate bicarbonate  
2. BD base deficit = 21.5 − (0.79 × HCO₃).
1. depends on pH. -  pCo2 and also - Hb level