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Basic Skills in Vascular Surgery

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7.Arterial Defect 2cm long,Do not do primary anastomosis (Interposition Graft) ... Interposition grafts have poorer long term results. ... – PowerPoint PPT presentation

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Title: Basic Skills in Vascular Surgery


1
Basic Skills in Vascular Surgery
  • Tim Brandys MD FRCSC

2
Objectives
  • Learn Basic Operative Skills involved with
  • management of unexpected vascular injuries
  • Proximal and Distal Control
  • Primary Vessel Repair
  • Patch Angioplasty
  • Primary Anastomosis
  • Decision making (Interposition Graft)
  • Vessel Ligation

3
Unexpected Bleeding
  • Do Not Panic
  • Communicate Early with anesthesia that you will
    have ongoing bleeding

4
ASK FOR WHAT YOU NEED
  • Group and cross match 6 units
  • FFP,CRYO,PLTs
  • Get appropriate sutures,clamps,retractors

5
Call for Help
  • Ask for help early rather than too late

6
Think FIRST AID
  • Apply direct pressure to the source of bleeding
    until you are ready to deal with it
  • More diffuse bleeding pack off the area with LAP
    pads

7
Change your Mind Set
  • Switch from elective procedure to Trauma
    protocols.
  • Extend incisions to get greater exposure.
  • Consider packing the patient and carrying out
    temporary closure if profound coagulopathy ensues.

8
Exposure,Exposure ,Exposure !
  • Do I need to extend the incision ?

9
Arterial Injury Basic Principles
  • 1.Proximal /Distal Control
  • 2.Avoid direct entry into hematoma
  • 3.HeparinSystemic,Local, or None
  • 4.Active Bleeding apply Direct pressure
  • 5.Debride damaged arterial wall
  • 6.Arterial defect gt 1/3 circumference,Do not do
    primary repair(Patch ,Resect Reanastomose,Interpos
    ition Graft)
  • 7.Arterial Defect gt2cm long,Do not do primary
    anastomosis (Interposition Graft)

10
Arterial Injury Continued
  • 7.Remember possibility of through and through
    injury.
  • 8.Suture Choice Non absorb. Monofilament
  • 9.Interposition graftavoid prosthetic in
    contaminated field,consider extra anatomic bypass
  • 10.Some arteries can be ligated (ext.
    carotid,int. iliac)

11
Dissection
12
Dissection
13
Prox./Distal Control
14
Proximal and Distal Control
15
Primary Repair
16
Primary Anastomosis
17
End to End Repair
18
Primary Anastomosis Pediatrics
19
Patch Repair
20
Patch Angioplasty Repair
21
Fish Mouth
22
Modified Fish Mouth
23
Triangulated
24
Interposition Graft Repair
25
Venous Injury
  • Avoid any repair that will narrow lumen by 50 or
    more
  • Interposition grafts have poorer long term
    results.
  • Vigorous dissection around veins and attempts to
    clamp can sometimes do more harm than good
  • Proximal and Distal control of Cava try sponge
    sticks
  • Some veins can be ligated without limb or life
    threatening consequences
  • Prep. Leg for vein harvest

26
Cava Repair
27
Today
  • Patch Angioplasty
  • End to end Fish mouth Anastomosis
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