Vascular Surgery

Question 1

Indications in smalls

Answer 1

Experimental

therapeutic

• Cardiac!! e.g PDA
• Removal of adrenal tumour= adrenelectomy would require veinotomy of the vena cava
• kidney transplant

Question 2

Instrument used in vascular surgery

Answer 2

Frazier suction cup

Bipolar electrocautery

Needle hoders:Castroviejo and Mayo-Hegar

Scissors: Potts vascular and Metzenbaum

Forceps: DeBakey

Vessel clamp: Satinsky

Dissector: Mixter- angled and very fine tip

Additional: rumel tourniquet= sling with rubber tube

Latex tape is used to grab and reflect the vessel

Question 3

Suture material

Answer 3

Always a taper needle!!

1. Polypropylene (prolene/surgilene)

Polymerized polyolefin

NON-ABS, synth

monofilament

Thrombophobic (no thrombocytes adhere to the surface

Very low: chance of FB reactio, drainage

low knot security

**this is the preferred, and the sutures and penetrative

Question 4

Suture material

Answer 4

2. Nylon monofilament (Ethilon, dermalon, Nurolon)

NON ABS, SYNTH

Monofilament

Low: FB reaction and drainage

moderate knot security

Question 5

Prerequisites/ conditions prior to surgery

Answer 5

Anticoag protocol must be in place!

Local: 2% lidocaine at 4degrees– spasmolysis+heparin (anticoag)+0.9% NaCl

Systemic: Non-fractionated heparin- causes activated coag time to incr, give 100-300 IU bwkg IV

Low Mr weight heparin= exoxaparin! can antagonise with protamin-sulphate

Question 6

Surgical opening and closing

Answer 6

When clamping the vessels: Satinsky and DeBakey

Opening: number 11 blade and then potts vessel scissors

longit: vessel diameter greater or equal to 4mm
transv: vessel diameter <4mm

Closing: flush the lumen with the local anticoag cocktail

Single layer of simple continuous

Maybe reinforce with inteerrupted!

Question 7

Vascular anastomosis

Answer 7

End-to-end: 2 or 3 point technique! the sutures are used to turn the vessels

or end to side