Chapter 108 Vascular Surgery Flashcards
What are the three layers of the vein/artery?
Tunica externa (fibroblasts + collagen)
- Tunica media* (smooth muscle)
- Tunica intima* (endothelial cells)
List 5 tissues where arteries are not found
- Nails
- Hair
- Epidermis
- Cornea
- Cartilage
Name a key step re vascular prep when performing anastomisis
Dissect adventitia (to avoid inadvertent inclusion in lumen)
Name the instruments
From left to right:
Diamond-jawed needle holder
DeBakey atraumatic forceps
Metzenbaum scissors
Potts scissors
Small and large right-angled forceps.
Name the instruments
From left to right:
Microvascular needle holders, without catch
Curved Vannas microvascular dissecting scissors
Straight adventitial scissors
Jeweler’s forceps
Curved and straight mosquito hemostats
Name the instruments
From left to right:
DeBakey atraumatic angled vascular clamp
DeBakey atraumatic tangential clamps
DeBakey-Satinsky atraumatic tangential clamp
Cooley atraumatic clamp
DeBakey atraumatic multipurpose curved clamp
Castaneda atraumatic neonatal clamp.
Name the instrument
Arteriotomy clamp
(open tip allows accurate assessment of depth of arteriotomy)
List 3 techniques for temporary vascular occlusion
Potts (double) loop, Rumel tourniquet, vascular clamp
What are the recommended suture sizes for the following vessel sizes (internal diameter):
- 4 - 6 mm
- 2 - 3 mm
- <2 mm
- 4 - 6 mm: 4/0 - 5/0
- 2 - 3 mm: 6/0
- <2 mm: 7/0 - 8/0
How are vascular grafts and patches categorized?
- Biologic
- Synthetic
- Textile (Dacron)
- Non-textile (PTFE)
What concoction do the chapter authors advise for local anticoagulation during vessel anastomosis?
Ice-cold solution of 2% lidocaine, heparin and 0.9% saline
What is the recommended dose of unfractionated heparin for systemic anti-coagulation for bypass?
What is the target ACT?
300U/kg unfractionated heparin, IV, before cannulation
ACT >480s (ref range 60 - 120)
When division is not possible, what technique is recommended to reduce the risk of re-cannalization?
Encircling ligature placed at each end of intervening vessel, and transfixing ligature between them.
List two advantages of a longitudinal venotomty/arteriotomy. And one disadvantage
Advantages
Can be extended for greater exposure
Can accomodate end-to-side anastomosis
Disadvantages
Luminal narrowing when closed
Below which size is transverse ventotomy/arteriotomy recommended (to reduced risk of luminal narrowing)
Transverse incision recommended in vessels <4mm
What is Kunlin’s technique.
Using double swaged suture, place mattress suture in each corner to create eversion.
What is recommended suture spacing for vascular surgery?
1mm apart and 1mm from cut edge
List 2 techniques for end-to-end anastomosis when mobility is limited
- Transluminal suturing of far half.
- Traingulation (suture corners spaced 120º apart to allow rotation)
The triangulation technique. Three corner sutures are placed 120 degrees apart (A). This allows for accurate circumferential suturing upon retraction of the vessel (B-D). A disparity in size between the two vessel ends may be accommodated among the three patterns.
Name one scenario for deliberate creation of AV fistula
Long-term venous access.
What is the optimal and acceptable angle of anastomosis for end-to-side vessel anastomosis
And same re ratio of length of recipient vessel opening vs donor vessel diameter
Angle of insertion
Optimal: 35-45º
Acceptable: 75º or more
Recipient opening:donor diameter
Optimal: 1:2
Acceptable: 1:1
What is the most common autologous vascular graft harvested?
What are the components of the solution it should be ‘stored’ in?
Jugular vein
100ml chilled 0.9% saline, 3ml heparin (1000U/ml), 0.2ml papaverine (30 mg/ml)
What material are guidewires made from
Stainless steel
What is the diameter and length range for balloons?
1.5 - 18mm diameter
2 - 10cm length
What are nitinol stents made of
Nickel + titanium
