Vascular surgery Flashcards
What are the three layers of the arterial wall?
Tunica adventitia: collagen and fibroblasts.
Tunica media: smooth muscle.
Tunica interna: endothelial cells.
The venous wall is composed of the same layers but is much thinner.
Name the following instruments.
Name the following instruments.
Name the following instruments.
Name the following instruments.
Name the following materials.
What type of suture is preferred for aterial and venous closure?
Arterial: monofilament (greater strength and durability).
Venous: multifilament passed through mineral or bone wax (excellent knot holding and ease of handling).
What are the two types of prosthetic grafts used in vascular surgery?
Textile (Dacron) and nontextile (PTFE). Textile grafts have largely been replaced by nontextile grafts due to their thrombogenicity and infectivity.
The adventitial surface of the artery is marked by what characteristic pattern?
Vaso vasorum
List some methods of temporary vessel occlusion.
Vascular clamps, Potts loops or single loops of suture, tape or Silastic, or Rumel tourniquets.
In addition, Codman and Cooley clamps or curved Satinsky clamps can be applied parallel to the course of the vessel.
Is local or systemic anticoagulation preferred in small animals undergoing vascular surgery?
Local. A solution of 2% lidocaine, heparin, and 0.9% saline is effective.
In what size vessel should a transverse rather than longitudinal arteriotomy or venotomy be performed?
<4mm, to prevent loss of luminal diameter with closure.
What are three methods of vascular end-to-end anastomosis closure?
- Simple closure.
- Oblique anastomosis.
- Triangulating (particularly useful in instances of limited vessel mobility).
Images page 2099-2101 in Tobias.
Why should excessive adventitia be dissected free the cut end of vessels when performing closure of resection and anastomoses?
Inclusion of excessive adventitia will narrow the lumen of the vessel and potentially cause obstruction.
What is the ideal angle of end-to-side vascular anastomoses?
30-45 degrees to minimize turbulence of the blood flow.
When performing end-to-side vascular anastomosis how large should the incision be in the recipient vessel be?
Ideally twice as large as the diameter of the donor vessel or prosthetic graft (2:1).
What instrument is shown?
In addition to standard surgical instruments, what instruments might be required for endovascular surgery?
Various sizes and types of needles, trocars, catheters, guide wires, dilating sheaths (3-4 Fr), vascular sheaths (5-6 Fr) and introducers, stents, and balloons.
What are the two classifications of intravascular stent?
Self-expanding: cannot be overexpanded beyond their intended diameter. Can be reconstrainable (stainless steel, braided stents), or non-reconstrainable. Stainless steel braided stents exhibit considerable foreshortening compared to newer generation stents made of nitinol.
Balloon expandable: can be expanded beyond their original diameter, but are prone to dislodgement from the balloon and catheter onto which they are mounted (best not used in tortuous vessels or areas with significant motion).
What device is depicted?
What veins can be used for central venous catheter placement?
Jugular, or the medial and lateral saphenous veins with the peripherally inserted central catheter (PICC) technique.
For CVP monitoring catheter should be just cranial to the right atrium.
What are subcutaneous central venous access ports used for?
Requirements for serial sedation or anesthesia (wound management, radiation), serial blood sampling, serial or long term administration of medications (antimicrobials, chemotherapy).
Port is implanted in the subcutaneous space of the neck and connects to the jugular vein.
What are complications associated with subcutaneous central venous access ports?
Local swelling, bruising, redness, hematoma, fistula formation, infection, pain.
Most are self-limiting and resolve within 7 days.
What are some types of embolotherapy devices?
Liquid (lipiodol, cyanoacrylate), particulate (polyvinyl alcohol), solid or mechanical (metallic coils) occlusion devices.
