Name of the Procedure:

Shunt; central, with prosthetic graft
Common names: Central Shunt, Central Venous Shunt, Arteriovenous Shunt with Prosthetic Graft

Summary

A central shunt with a prosthetic graft is a surgical procedure that creates a direct connection between an artery and a vein using a synthetic tube (graft). This helps to improve blood flow in patients where normal blood circulation is limited due to blocked or narrowed blood vessels.

Purpose

This procedure is typically used to manage conditions where the blood vessels are blocked or narrowed, such as severe peripheral artery disease or dialysis access complications. The goal is to create a new pathway for blood flow to bypass the blocked or damaged vessels, ensuring adequate blood supply to vital organs and tissues.

Indications

• Severe peripheral artery disease
• Complications from hemodialysis access (e.g., thrombosis, occlusions)
• Poor blood flow resulting in tissue damage or non-healing wounds

Preparation

• Fasting for at least 6-8 hours before the procedure
• Adjustment or cessation of certain medications, especially blood thinners
• Pre-procedure blood tests and imaging studies such as ultrasound or angiography to map out the blood vessels

Procedure Description

1. Anesthesia: General or local anesthesia is administered, depending on the location and complexity.
2. Incision: A surgical incision is made near the site where the shunt will be placed.
3. Vessel Preparation: The artery and vein are exposed, and any necessary vessel repair or preparation is done.
4. Graft Placement: A synthetic graft is tunneled between the artery and vein, then sewn (anastomosed) into place.
5. Flow Check: Blood flow through the new shunt is checked to ensure it is functioning correctly.
6. Closure: The incision is closed with stitches or staples, and the site is bandaged.

Duration

The procedure generally takes about 1 to 3 hours, depending on the complexity of the vascular anatomy and the patient's condition.

Setting

Performed in a hospital operating room or a specialized surgical center.

Personnel

• Vascular Surgeon
• Anesthesiologist
• Operating Room Nurses
• Surgical Technicians

Risks and Complications

• Infection at the incision or graft site
• Bleeding or hematoma formation
• Blood clots that may travel to other parts of the body
• Graft malfunction or occlusion
• Reaction to anesthesia
• Reduced blood flow to the limb or organ involved

Benefits

• Improved blood flow to the affected area
• Alleviation of symptoms such as pain and non-healing wounds
• Increased access for dialysis in patients with previous access complications

Recovery

• Post-operative monitoring in the hospital for a few hours to a day
• Pain management with prescribed medications
• Keeping the incision site clean and dry
• Follow-up appointments to monitor graft function and overall recovery
• Restrictions on physical activity for several weeks to allow proper healing

Alternatives

• Medication management for blood vessel conditions
• Endovascular procedures like angioplasty or stenting
• Other surgical options such as autologous vessel grafts (using the patient's own veins or arteries)

Patient Experience

• Patients may experience discomfort and pain at the incision site, managed with pain medication.
• Some swelling and bruising are common.
• Follow-up includes regular check-ups and imaging tests to ensure the graft remains functional and check for complications.

Pain and discomfort levels vary by patient, but most report significant improvement in symptoms within a few weeks post-surgery.