extreme revascularization techniques “limb-saving procedures” distal bypasses including bypass...
TRANSCRIPT
EXTREME REVASCULARIZATION TECHNIQUESEXTREME REVASCULARIZATION TECHNIQUES
““LIMB-SAVING PROCEDURES”LIMB-SAVING PROCEDURES”
DISTAL BYPASSES including BYPASS at FOOT LEVELDISTAL BYPASSES including BYPASS at FOOT LEVEL
with “with “in situin situ” saphenous vein graft” saphenous vein graft
CRITICAL LIMB ISCHEMIAREST PAIN and GANGRENE
BYPASS on the DISTAL POSTERIORTIBIAL ARTERY
with “in situ” saphenous graft
AMPUTATION AVOIDEDAMPUTATION AVOIDED
Posterior tibial artery
Saphenous vein
BYPASS on the DORSALIS PEDIS ARTERYBYPASS on the DORSALIS PEDIS ARTERY
with “with “in situin situ” saphenous graft” saphenous graft
Venous graft
Dorsalis pedis artery
Early result afterEarly result afteramputation of the big toeamputation of the big toe
Preoperative aspectPreoperative aspect
CEREBRAL CEREBRAL
REVASCULARIZATIONREVASCULARIZATION
CAROTID ARTERIESCAROTID ARTERIES
VERTEBRAL ARTEREISVERTEBRAL ARTEREIS
SUBCLAVIAN ARTERIESSUBCLAVIAN ARTERIES
CAROTID ENDARTERECTOMY
Removal of the atherosclerotic plaque
Angioplasty with synthetic patch
SIMULTANEOUS BILATERAL CAROTID ENDARTERECTOMYSIMULTANEOUS BILATERAL CAROTID ENDARTERECTOMY
under CERVICAL PLEXUS BLOCK (in the awake patient)under CERVICAL PLEXUS BLOCK (in the awake patient)
LITERATURE REVIEW:
TOTAL NUMBER OF AUTHORITIES 11
TOTAL NUMBER OF CASES PUBLISHED 235
PERSONAL EXPERIENCE (Horia MURESIAN) 70 cases
OTHER CENTERS IN ROMANIA 0
RIGHT BIFURCATION LEFT BIFURCATIONINTRAOPERATIVE ASPECT
SINGLECERVICALINCISION
SIMULTANEOUSSIMULTANEOUSBILATERALBILATERALCAROTIDCAROTID
ENDARTERECTOMYENDARTERECTOMY
VERTEBRAL ARTERY SURGERYVERTEBRAL ARTERY SURGERY
VERTEBRAL ARTERY RE-IMPLANTATION
CAROTID-to-VERTEBRAL BYPASS
BYPASS on the SUBOCCIPITAL VERTEBRAL ARTERY (V3)
PERSONAL EXPERIENCE (Horia MURESIAN) 14 CASES
OTHER CENTERS IN ROMANIA 0
ANGIOPLASTY of the CAROTID BIFURCATION
BYPASS BYPASS CAROTID ARTERY – to – SUBOCCIPITAL VERTEBRAL CAROTID ARTERY – to – SUBOCCIPITAL VERTEBRAL
with saphenous graftwith saphenous graft
CCACCAICAICA
XIIXII
XIXI
JugularJugular
COMPLEX CEREBROVASCULAR REVASCULARIZATIONSCOMPLEX CEREBROVASCULAR REVASCULARIZATIONS
ASCENDING AORTA – to – BILATERAL CAROTID BYPASS
ASCENDING AORTA –to – CAROTID and SUBCLAVIAN BYPASS
ASCENDING AORTA – to - BILATERAL CAROTID and SUBCLAVIAN BYPASS
PERSONAL EXPERIENCE (Horia MURESIAN) 7 CASES
OTHER CENTERS IN ROMANIA 0
ASCENDING AORTA – to - BILATERAL CAROTID ARTERY BYPASS
PARTIAL CLAMPINGof the AORTA
on beating heart
COMPLEX OPERATIONSCOMPLEX OPERATIONS
andand
EXTREME REVASCULARIZATIONSEXTREME REVASCULARIZATIONS
ASCENDING AORTA – to – RIGHT CAROTID and SUBCLAVIAN ASCENDING AORTA – to – RIGHT CAROTID and SUBCLAVIAN
ARTERY BYPASS ARTERY BYPASS
plus CORONARY ARTERY BYPASS on beating heart (OPCAB)plus CORONARY ARTERY BYPASS on beating heart (OPCAB)
Right carotid artery.
Right subclavian artery
Ascending Ascending aortaaorta
Venous graftVenous graft
Coronary bypassCoronary bypass(OPCAB)(OPCAB)
ASCENDING AORTA – to – RIGHT CAROTID and SUBCLAVIAN ASCENDING AORTA – to – RIGHT CAROTID and SUBCLAVIAN
ARTERY BYPASS ARTERY BYPASS
plus CORONARY ARTERY BYPASS on beating heart (OPCAB)plus CORONARY ARTERY BYPASS on beating heart (OPCAB)
Coronary bypass graft
Aorta – to – carotid and subclavian artery bypass
ASCENDING AORTA – to – RIGHT CAROTID and SUBCLAVIAN ASCENDING AORTA – to – RIGHT CAROTID and SUBCLAVIAN
ARTERY BYPASS ARTERY BYPASS
plus CORONARY ARTERY BYPASS on beating heart (OPCAB)plus CORONARY ARTERY BYPASS on beating heart (OPCAB)
ASCENDING AROTA – to- RIGHT CAROTID and SUBCLAVIAN ARTERYASCENDING AROTA – to- RIGHT CAROTID and SUBCLAVIAN ARTERY
and to the LEFT DEEP FEMORAL ARTERY BYPASS (trifurcated graft)and to the LEFT DEEP FEMORAL ARTERY BYPASS (trifurcated graft)
SIMULTANEOUS BILATERAL CAROTID ENDARTERECTOMYSIMULTANEOUS BILATERAL CAROTID ENDARTERECTOMY
RE-IMPLANTATION of the LEFT VERTEBRAL ARTERY into the LEFT RE-IMPLANTATION of the LEFT VERTEBRAL ARTERY into the LEFT
CAROTIDCAROTID
COMPLEX OPERATIONSCOMPLEX OPERATIONS
andand
EXTREME REVASCULARIZATIONSEXTREME REVASCULARIZATIONS
Endarterectomyof the
left carotidarteryand
patch angioplasty
Re-implantationof the
left vertebral arteryinto the left carotid
Endarterectomy
of theright carotid
arteryand bypass
Ascending aorta-to-rightcarotid and subclavian
arteries bypass
Ascending aorta-to-deep femoral arterybypass
COMPLETION ANGIOGRAMCOMPLETION ANGIOGRAM
ICAICA ICAICA
PROSTHETICGRAFT
PROSTHETICGRAFT RE-IMPLANTED
LEFT VERTEBRAL
ARTERY
RE-IMPLANTEDLEFT
VERTEBRALARTERY
PATCH on the
left carotid bifurcation
RIGHTSUBCLAVIAN
ARTERY
GRAFTGRAFTININ
EXTRAPERITONEALEXTRAPERITONEALLOCATIONLOCATION
THE DISTAL ANASTOMOSISTHE DISTAL ANASTOMOSISON THE DEEP FEMORAL ALRTERYON THE DEEP FEMORAL ALRTERY
(LEFT SIDE)(LEFT SIDE)
COMPLETION ANGIOGRAMCOMPLETION ANGIOGRAM
GRAFTGRAFTININ
EXTRAPERITONEALEXTRAPERITONEALLOCATIONLOCATION
