Vascular and Nerves L3 Flashcards
Explain the NVB ,supply of NVB , and principles of Formation of vascular sheeths , Projectional line
—NVB: its set if a main artery One or two accompanying veins , lymphatic nodes and artery , and they are surrounded by common fascial sheath and blood supply drain and nerve supply as a rule in the same region
-Supply of NVB :
1-Vasa vasorum
2-Vasa nervorum
2-Nervi Nervorum
2-Nerve Vasorum
— principals of formation of vascular fascial sheath
- its was descoverd by Pirgove
1-vascular sheath formed by muscular fasciea
2-Vascular sheath has a shape of trihedral prism ( triangular in transverse section
3-internal side of the prismatic sheath is connected with adjacent bone or joint capsule
—projectional line :
-its one of the important characteristics of the NVB , thats allow Sargon to manipulate on its own elements
-DF : its line that passes on the skin on the base of external landmarks , Corresponds to the Cours of NVB
explain the surgical Access to the vessels
-they are two types :
1-Direct : along the projectional lines
2-indirect : stepping back 1.2 cm from the projectional line , and its done in case id superficial or very deep location of NVB to avoid injury of the vessels
-Ex :
1- NVB of post region of the upper arm its very deep inside humarl muscular canal
Classification of surgical Intervention on the blood vessels
1-Surgeries at the vascular injuries
2-surgeries at the vascular Obstruction
3-Surgeries at the aneurism
4-Surgeries at the Anomalies of vessels development
5-Surgeries at Varicose vines
6-Surgeries at non vascular pathology
Common surgeries on Blood vessels
1-Ligation of the vessels alone its cours : application of ligature onto the exposed blood vessel to block the blood flow
2-Vascular suture : restoration of the intigerty of the vessel by suturing
3-Embolectomy : isolated extraction of the Embolus from the blood vessel
4-resection of the vessel : removal of the part of the vessel
5-Angioplasty : restoration of the blood vessel by means id replacement of its defect by Vascular transplant
6-Prosthatcs of vessel : replacement of the circular defect of blood vessel by vascular prosthesis
7-Vascular bypass : creation of collateral way of circulation in case of an obstruction of part at the large vessel
8-intervascular anastomoses: connection of two vessels with each other
Explain surgeries at vascular injuries bleeding ( haemorrhages) ,classification ,method of bleeding control , sites of Finger compression
—Classification: they are 3
1- according to srouce of bleeding , Arterial , Venous , arteriovenous , Capillary
2-According to the direction of blood escaping ( external or internal )
3-According to time of origin
3.1 primary immediately bleeding
3.2 secondary take time
—Method of bleeding control
1-Temporary:
1.1 Finger compression
1.2 tourniquet
1.3 Clamp to the bleeding vessel
2-Final ( Definitive )
2.1 Ligation of the vessel in the wound
2.2 ligation of the vessel with stitching
2.3 ligation of the vessel along its course
2.4 Cauterisation
2.5 Vascular suture
3- Final :
3.1 Mechanical ( ligation )
3.2 physical ( cautraztion )
3.3 chemical ( hydrogen peroxide )
3.4 biological ( hemostatic spong , omentum)
—site of finger compression
1-Common carotid Artery
2-Subclavian Ar
3-Maxillary ar
4-Superfascial temporal Ar
5-Brachail Ar
6-Axillary Ar
the goal of ligation of the vessel in the wound
-the goal : to close the lumen of the vessel at site of damage and its performed in emergency in cases if traumas
explain the goal and indication , stages , risk ,of The ligation of the vessel along its course
-the goal : its to reduce the blood flow in the damaged part of limb or organ , as well as to temporarily stop the blood circulation in case of large blood loss are expected
—indications :
1-impossible to ligation at the wound
2-risk of infection as resulted of manipulation in the wound
3-presences of traumatic aneurysm
4-Amputation
5- Risk of Erosive bleeding
—Stages : they are 4 stages
1-application of proximal ligature
2-Application of distal ligature
3-Application of a stitched ligature 1 cm distally from a proximal one
4-Dissection of the vessel between stitched and distal ligatures
—risk :
- its could cause a necrosis to the supplied organ or tissue
what are the ways if the collateral circulation
1-large pre-existing intervascular anastamosis ( Ex scapual ) they can provide blood even in case acute thrombosis
2-interamscular : inside the muscles
3-Periarterial arterial network ( such as elbow joint or knee joint )
4-Vasa vasorum
5-newly formed collaterals
explain Vascular suture , Requirements ,stages ,types
—Requirements:
1-Tightness
2-Durability ( strength )
3-Prevntation the narrowing of the lumen
4-Asipticty
5-Atrumatcity
6-prevention of Clot formation
—Stages :
1-Revision of the soft tissue , blood vessels, nerves , bones
2-mobilisation of the vessel
3-prepartion the end of the vessel for suturing
4-Suturing of the vessel
5-Control homeostasis and conductivity ( by removing the clamps and check if there is leaking or not )
—Types :
1-Lateral : applied if the length of the injury doesn’t exceed 1/3 of the artery circumference and dimter of the vessel is not less then 4 mm ,
(with partial wound )
2-Circular : applied if the injury exceed the 1/3 of the artery and the diameter of the vessel is less then 4 mm
( with complete break of the vessel )
what is the method to avoid the narrowing of the lumen ?
we use method called hypertanos forming triangle between the end - end
explain the suturing method of Alexis carrel
- its consist of 2 Phases :
1- application of 3 interrupted sutures to connect the end of the vessel
2-Application of continous sutures between 1st and 2nd , 2nd and 3rd , 3rd and 1st
list examples of Types of Vascular sutures
1-Simple separate nodal suture
2-inverted separate U-Shaped suture
3-End to end arterial anastomoses by dorrance
4-End to side anastamosis
5- Barashot Technique 
explain the Surgeries at the vascular obstruction , Classification , methods
—Classification:
1-Exovascular : aims to eliminate the pathology out of vessels ( Such as tumor)
2-Endovascular : aimed to eliminate stenosis in the vessel lumen ( balloon , angioplasty )
3-Reconstructive surgery
—methods :
1-Direct Thromboctomy : its direct we use clamp at the beginning and at the end , then we dossecate the wall of the vessel get the thrombotic out and we stitch it again
2-Loop thrombocetomy : less trumatic
3- Fogarty catheter : less traumatic
4-stent retriever thromboctomy : usually done in the brain thrombosis
5-Aspiration thromboctomy
6-Thrombendareterectomy
explain the Thrombendareterectomy
— the essence of the operation : is to remove the thickened intima along with the atherosclerotic plaque and the blood clot which is formed above it in the narrowing zone of artery
Explain Bypass surgery , Goal , Possible Bypass surgeries
-the Goal : is to creat an additional path for blood flow to bypass an existing obstacle with help of Autovein or prosthesis
—Possible surgeries:
1-Coronary Arteries : narrowing of the coronary arteries bypass grafting has become widespread
2-Abdominal Aorta : narrowing of abdominal aorta and iliac arteries = Aortic -Femoral bypass surgery
3-Femoral : Femoral - popliteal bypass surgery is performed
explain Angioplasty , DF , methods
-Df : its restoration of the potency of the vessel or its integrity with possible use of Auto , homo , synthetic graft
—methods:
1-Balloon angioplasty : restoring the patency of the narrowed or fully obliterated vessels by introduction a special balloon into the zone and inflating it in the lumen of the vessel
2-Stent : a special mesh tube that creates a frame for the lumen of the vessel and does not give it to contract
what is the classification of transplantation
1-Autotransplantion : is transplantation of organs , tissue from one part of the body to another in the same person
- there is 2 type of Autotransplnation:
1.1 Autovenous transplantation : form from superfascial veins ( such as saohenous vein , external jugular vein )
autoveouns graft should be reversed so that the venous valves do not interfere with blood flow
1.2 Autoarterial transplantation : used fro reimplantion of the fingers of the hand and for Coronary-Mammary bypass
2-Allotransplantion , its transplantation form same species but not genetically identical
3-Xenotransplantation: is the transplantation from a species to another type of species ( Ex animals )
Explain Surgeries at aneurysm , DF,Classification,
—DF: its a permanent abnormal blood filled dilation of a blood vessel
—Classification:
1-True Aneurysm: its dilation of the vessel wall bounded by all 3 layers of vascular wall ( layers :
1-outer most Adventita
2-media
3-Intima
2-false aneurysm: is a dilation of the vessel bounded only by tunica adventitia
3-Dissecting aneurysm: is a hematoma that accumulates in tumica media and separates tunica intima from tunica media duo to rupture of tunica intima
explain the surgical treatment if aneurysm, Goal , methods
-Goal : the goal of aneurysm treatment is to isolate aneurysm from the circulation while ensuring patency of parent artery and perforator branches
—Methods :
1-Ligature method : are aimed to creat thrombosis at the aneurysm sac
-Ex of such surgeries:
1.1 Antyllus : which is clamp of distal and proximal part and desscets the sac and put a clothes to form clot , Complications : Gangrene , compression of nerve
1.2 Philigrius : which is ligation of all afferent and efferent vessel and extirpation of the aneurysm , Complications: postoperative bleeding
2-Reconstructive : save or restore patency of the vessel while exclude aneurysm from blood flow
-Ex : Matas method : which is open the aneurysm and stitch the wall of the vessel
3-Obliterating method : are aimd to creat a condition for the fusion of the walls of aneurysm sac with an opportunity of reclanaztion
explain surgeries at Varicose vines of lower limb , methods
1-Crossectomy : ligation and resection of greater saphenous vein and all of its tributaries in subcutaneous fatty tissue at the level of sapheno-femoral junction
2-Madelung surgery : removal of greater saphenous vein along the thigh through long approach from upper 1/3 of the thigh to medial condyle of femur
- or along the leg from medial condyleto the medial malleolus
3-Narat surgery: removal of greater saphenous vein through numerous short incision
4-Babcock surgery ( vein stripping ) :
removal if greater saphenous vein along the thigh or leg by means of vein-striping
5-Kocket surgery : its ligation of the communicant veins ( superfascial and deep ) the ligation above the superfascial fasicea
6- Linton surgery: its subfasical ligation of communicating veins , the ligation below superfascial fasicea
explain the surgeries at non-vascular pathology
- its done in case of non vascular pathology such as Bengin tumer , mayoma in the uterus it have good blood supply to , we do this type of surgery reduce the blood flow into this pathology which this process called :
-Embolisation : blockage of the vessel with special substance and devices ( such as liquid sclerosants , plastic particles , spirals ) its done through approach in the femoral Artery then reach common iliac artery then to internal iliac artery then to Uterine Artery , then we look for the branch who perticulary supply this myoma and perform embolaztion
