ABSTRACT
My technique of shunt insertion will be described later. This drawing is intended to illustrate that in preparation for placement of a shunt it is essential that the Rummel tourniquet that will secure the shunt in place be at least 1 cm (hopefully farther) distal to the DeBakey cross-clamp. This entails dissection of a fair amount of CCA to obtain a good proximal location for placement of the cross clamp. The reason for this is that in order to avoid copious bleeding with placement of the shunt in the CCA, it is my preference to place the shunt down in the lumen of the vessel through the Rummel tourniquet loop until it abuts against the cross-clamp. The loop can then be securely snugged down around it before the cross-clamp is removed. When the cross-clamp is then removed, there is essentially no bleeding because the shunt has already been secured, but it is still possible to slide the shunt farther down the CCA as it slips quite nicely through the loop. In this way I have converted a procedure that formerly produced copious bleeding into an essentially bloodless task.
