Intraoperative measurement of javid shunt flow with transit-time ultrasound

Abstract

Transit-time ultrasound methods were used to measure blood flow in 37 patients undergoing carotid endarterectomy. Internal carotid flow before (ICF^bef) and after (ICF^aft) endarterectomy was measured with a 6 mm perivascular probe, and Javid shunt flow (SF) was measured with a clamp-on probe. For the entire group ICF^bef averaged 117±67 ml/min and ICF^aft was 173±67 ml/min. Shunt flow averaged 123±51 ml/min. The differences between ICF^bet and ICF^aft and between SF and ICF^aft were significant (ANOVA,p<0.01) but the difference between ICF^bef and SF was not. The relationship between ICF^bef and SF appeared to define two groups of patients. Those in whom SF was greater than ICF^bef (SF > ICF^bef) had more stenosis evident on preoperative arteriograms (64.7%±14.55% maximum single diameter stenosis) and a greater average increase in ICF (151%±159%) than those with SF ≤ ICF^bef (43.3%±20.9% stenosis and 34%±54% increase in ICF), suggesting that the relationship between SF and ICF^bef defines groups with different hemodynamic responses. The similarity between SF and ICF^bef indicates that Javid shunt flow offers adequate protection from cerebral ischemia. A practical benefit of the shunt clamp-on flow probe is the ability afforded to recognize shunt occlusions.