vascular techniques
TRANSCRIPT
Vascular
Strasbourg, February 2001
• Basic principles• Transverse arteriotomy, embolectomy & closure • Longitudinal arteriotomy & patch closure• End to end anastomosis• End-side anastomosis
Basic Principles
Strasbourg, February 2001
Basic Principles
• Incision placement• Minimal incisions• Anatomical approach
– preoperative assessment
• Tissue handling• Careful dissection• Proximal & distal control• Anticoagulation• Precision of technique• Checking
Incisions & tissue handling
Anatomypreoperative assessment
Dissection
Control
Transverse arteriotomy& embolectomy
Strasbourg, February 2001
Transverse arteriotomy
Hold vessel firmly
Embolectomy
stay
Place double ended stay in distal edge
Rule 1
Rule 2
Rule 3
Vascular suturing
Closure (safe)
• Place all sutures
• Interrupted double ended
• Tie from corners
Closure (safe)
Closure (large vessel)
Continuous suture = risk of narrowingLarge vessels only
Longitudinal arteriotomy& patch
Strasbourg, February 2001
Longitudinal arteriotomy
Vein patch 1
Vein patch 2
Everting suture
Trim tip
Suture back from toe
Alternative:suture around the toe finish on the “near side”
Alternative
End to end anastomosis
Strasbourg, February 2001
End to end (Carrel)
Large vessel
Pursestring
Small vessel
Suture placement
Suture placement
Suture placement
Closure
Spatulated
Heel to toe
Continuous suture
End to end – caution!
End to side anastomosis
Strasbourg, February 2001
End to side
Spatulate vein
Heel suture
Toe suture
Alternative
Avoid narrowing artery (toe)
Strasbourg, February 2001
Laparoscopic appendicectomy
Strasbourg, February 2001
Port placement
Mobilise appendix
Mesoappendix
Mesoappendix
EndoGIA
Removal of appendix
