arterial suture and anastomosis  

outlines

- size suitable for repair

- การลง incision

- เทคนิคการเย็บมีอะไรบ้าง

- การตั้งเข็มเย็บ vessel ทำอย่างไร

size suitable for repair

- 3-0 aorta

- 4-0 iliac artery

- 5-0 femoral artery

- 6-0 popliteal artery

- 7-0 tibial artery

 

การลง incision

- longitudinal incision

- transverse incision

** มักเลือก longitudinal incision > transverse incision เนื่องจากอะไร

- easier to close

- any thrombosis has less tendency to narrow the lumen

- easily be extended

- low risk of intimal dissection and flap formation

 

การตั้งเข็มเย็บ vessel ทำอย่างไร

- the needle should be directed 90 degree to the vessel wall. always include the intima, especially on the downstream side, to avoid dissection of the distal intimal edge.

 

เทคนิคการเย็บมีอะไรบ้าง

- simple suture

- closure with patch

- end-to-end anastomosis

- end-to-side anastomosis

simple suture

- the needle must pass through all layers of the arterial wall with every stich.

- maintain a firm, even tension on the suture line and optimal spacing and size of each bite.

closure with patch

- indication closure with patch

- กรณีที่เป็น small vessel

- กรณีที่เป็น large vessel

indication closure with patch

- vessel diameter < 4 mm

- loss of substance of the arterial wall

 

กรณีที่เป็น small vessel

- a patch of autologous vein

 

กรณีที่เป็น large vessel

- prosthetic material with an oval or rectangular patch จะดีกว่า elliptical patch with sharp points

end-to-end anastomosis

- มีเทคนิคอะไรบ้าง

มีเทคนิคอะไรบ้าง

- stay sutures

- interrupted sutures

- continuous sutures

- single-stich method

- inlay parachute technique

stay sutures

- two or three stay sutures are placed either at the anterior and posterior or at each side

interrupted sutures

- apply gentle traction to the stay sutures

- interrupted sutured was done

continuous sutures

- indication continuous suture

- closure of arteriotomy with a running suture

- suture at end-to-end anastomosis

indication continous suture

- artery is large (> 10 mm wide)

 

closure of arteriotomy with a running suture

 

suture at end-to-end anastomosis

- start at the two opposite and tied sutures than can be used to turn the vessel for access to all sides.

single stitch method

- indication single stitch method

indication single stitch method

- difficulty in rotating the vessels (large bifurcation)

 

- the sutures are inserted from within the lumen to complete the deep or posterior aspect and then continued across the anterior aspect to the starting point

inlay parachute technique

- indication inlay parachute technique

indication inlay parachute technique

- AAA repair

 

 

- the double ended suture is left untied in order ot allow a number of stitches to be placed on each side before the graft is pulled down onto the artery.

- needles should pass from graft to aorta.