By Prof. Dr. Michael Staudacher (auth.)
During the earlier 3 a long time, Vascular surgical procedure has emerged as a distinctiveness inside common surgical procedure. Fellowships are actually to be had to equip surgeons with really good abilities for coping with a number of vascular difficulties. Nev ertheless, the vascular surgical emergency, one of many maximum demanding situations in surgical administration, may well ensue unexpectedly and at a time and position distant from the hugely certified vascular physician or a really good heart the place advanced vascular remedy is regimen. The preliminary review and therapy needs to be undertaken through a basic health professional who determines the level, sever ity, and urgency of the matter handy, and expectantly will manage appro priate move to a really expert heart if the patient's allows. pressing difficulties, nonetheless, call for instant surgical interven tion by way of the overall doctor if any wish for salvage is to happen. it truly is during this set ting that this quantity provided via Professor Staudacher will be of counsel to the final health practitioner whose adventure during this form of emergency might be constrained. This concise, good illustrated quantity may still function a consultant to regulate the peripheral vascular emergency regarding both the arte rial or venous system.
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Additional info for Acute Peripheral Vascular Surgery
The c1amp should not be too sharply pointed, so as to avoid injury to the posterior wall of the vessels. It should always be introduced from the side of the artery tumed away from the accompanying vein, to avoid the danger of injuring the latter. Tying the vessels, which must always be carried out (it is a basic principle of vascular surgery, which also allows control of hemorrhaging) should be with thick, paraffin-coated silk thread or elastic rubber or plastic tubes (not with wick or umbilical cord twine).
It is recommended first to coat the tip ofthe Fogarty catheter with paraffin before introducing it into the vessel to allow easier sliding of the catheter past the thrombus. 24 10 /' 10 A 10 B 25 11-12 11 DeBakey's Atraumatic Vascular Clamp These angled, atraumatic, elastic clamps, according to DeBakey, are standard tools in vascular surgery. They are available in various sizes. The medium size (ca. 18 cm, top) is suitable for the common femoral artery, the smaller size (ca. 12 cm, bottom) for the popliteal artery, the brachial artery, the deep femoral artery.
We can also make 3/4 ofthe circumference ofthe patch operation with one end of the thread and one quarter with the other and thus fasten in the vicinity of a lateral holding thread. The holding threads that keep the arteriotomy retracted are removed after the entire suturing is ended. It is important always to have available doublereinforced monofilament thread. In our example of a plastic patch operation on a femoral vessel, a 5/0 suture material is best. @ The patch is completed. 38 2 @ 39 3 Basic Measures Before Finishing a Venous Patch Operation (or any Form of Vascular Anastomosis): IIFlushing" This proeedure serves to remove possible loeal thrombi above and below the clamps and to ventilate.