Peripheral Vascular Surgery ST 240 OBJECTIVES Locate and identify related anatomy Understand and explain blood pressure Learn related terminology Discuss and learn related surgical procedures Arteries and Veins Layers of veins and arteries differ in thickness Veins have valves Arteries and Veins Systemic, Pulmonary, Renal and Portal Blood Circuits Arteries Blood Pressure The force that blood exerts against the internal walls of blood vessels Adults have ~5L Resistance is the hindrance of blood flow within the cardiovascular system Venous blood pressure is lower than arterial Skeletal Muscle Moves Venous Blood Venous Valves Arterial System 3 major arteries emerge from the aortic arch Brachiocephalic Left common carotid Left subclavian Arterial Embolism Emboli may be blood clots, air, fat, or even portions of a tumor When surgery is not an option, anticoagulants may be used For surgical intervention, an incision is made into the artery and the thromboembolitic material is removed using a Fogarty catheter Insertion of Fogarty Catherter In situ Saphenous Vein Anastomosis Bypass Grafting and Endarterectomy The saphenous is left in place and the ends are used for anastomosis Autogenous saphenous vein is the material of choice Dacron grafts not used in below-knee popliteal bypasses because the graft kinks Aneurysms of the Abdominal Aorta Generally fusiform May rupture into peritoneal cavity, but more commonly into retroperitoneal space Mortality sharply increases once rupture has occurred Planned Incision Sites for repair of an Aortic Aneurysm Normal Aorta Saccular Aneurysm Fusiform Aneurysm Dissecting Aneurysm Clamps that may be used Debakey Occlusion clamp Debakey Vascular Clamp AAA Lambert-KayLambert-Kay Lambert-Kay Vascular Clamp AAA Clamps that may be used Debakey Peripheral Vascular clamp Glover Bulldog Peripheral vascular clamp Lambert-KayLambert-Kay Debakey Patent ductus/ peripheral Vascular clamp Abdominal Aortic Aneurysm Repaired 6cm or greater Bifurcated Aortic Graft Dacron: Tubular Vascular Graft (Straight Graft) Bifurcated Vascular Graft For a Friable Aorta: pledgets may be used to reinforce anastomosis Teflon-coated Pledget: Ready for Use Incorporated into the Anastomosis Lumbar Vessels Over sewn Popliteal Artery-Saphenous Vein Anastomosis Femoropopliteal Bypass An arteriotomy is performed on the femoral artery and the saphenous vein is anastomosed The popliteal artery is anastomosed with the distal end of the saphenous vein Femorofemoral Bypass or Cross-Femoral Bypass: Occlusion/Primary Incision Secondary Incision and Creation of the Tunnel Graft Positioned and Blood Flow Restored to the Left Lower Extremity Axillofemoral Bypass Carotid Endarterectomy Clamps and Shunt in Place Questions???