Basics of Vascular Surgery

Soumya Ranjan ParidaSum Nursing College

Chronically Blocked Artery

Principles of Vascular Closureheart is a (bent) vessel !!

•Full thickness •Angle to center• ‘inside out’ on artery•Posterior Anterior / Distal Proximal•Sutures Under vision •Avoid narrowing

endothelium is an ‘organ’ not a passive membrane

Principles of suturing a vessel

Suture angle to center

Calcified Vessel : Needle ‘Inside - Out’

Needle puncture Occupied by strand Needle hole bleed

When you pass a suture through a tissue,

Suture passed

Suture pulled

Suture

Cut through

Types of suturing

Simple continuous Simple interrupted

Mattress longitudinal/ vertical interrupted

Mattress Transverse interrupted

1. Jump2. Bite3. Dog ear4. Lips5. Fall

Jargons

ARTERIOTOMY

Transverse

Longitudinal

longitudinal Arteriotomy

Direct closure

Patch closure

Transverse arteriotomy

Beveling, back cutting , Toe , Heel,

End to End Anastomosis

End to Side Anastomosis

End to Side Anastomosissteps

•Site chosen , artery clamped – opened•Shunt inserted•Graft length decided, graft clamped- cut -

beveled•Suture decided•Graft held away, heel sutures taken•Graft lowered, sutures tightened•Suturing continued on one/ either side•Sutures loosened – shunt removed – tied•Clamp released , bleeding checked

Types of anastomosis A: end to side B: side to side C: sequential

side to side anastomosisTypes A: longitudinal

B: transverse ( diamond)

Treatment Chronically Blocked Artery:Endarterectomy

B: Excision & Grafting C: Bypass grafting

Treatment Chronically Blocked Artery:

PEDICLED GRAFT1: parent artery2: pedicle3: branch ( conduit/ graft)

FREE GRAFT

Hood

Back cut

Lie of a graft

Types of Clamping

Blalock Loop

artery

Terminologies•Harvesting•Composite graft• In Situ•Prosthesis• Inside out / out side in•Follow •Tunnel•Fall

CONDUITS

ARTERIAL

VENOU S

AU TOL OG OU SH O M O L O G O U S

H E TE R O L O G O U S

N A TU R A L

K N ITTE DW O V E N

S O L ID B L O W N

S Y N TH E TIC C O M P O S ITE

C O N D U IT

Terminologies

•Total Arterial Revascularisation•Complete Revascularisation• ‘Culprit Vessel’