Noiuni de

chirurgie vascular
Anastomoze vasculare
SSCR - Basic Surgical Skills, editia 56, Bucuresti
Istoria chirurgiei vasculare
Rzboiul din Troia 500 . Hr.
Istoria chirurgiei vasculare
Arter Ven ... 300 .Hr
Istoria chirurgiei vasculare
Ligaturarea vaselor ... 150 d. Hr
Ambroise Par
 Prezent i obiective:
1. De ce anastomoze vasculare?
2. Instrumente
3. Principii de baz
Expunere

Control hemodinamic

Arteriotomia si pregtirea grefei

Anastomoza

Declampare i reperfuzare

4. Tipuri de anastomoze
Patologiile vasculare
- perete
- lumen
 Principiile anastomozelor vasculare
1. Condiii de ASEPSIE i ANTISEPSIE
2. Condiii HEMODINAMICE controlate
3. Instrumentar potrivit ATRAUMATIC
4. Refacerea continuitii intimale EVERSANT
5. Pstrarea permeabilitii lumenului -
NESTENOZANTE si NETROMBOZANTE
6. S rmn VIABILE

SSCR - Basic Surgical Skills, editia 56, Bucuresti

Instrumentarul din chirurgia
vascular

SSCR - Basic Surgical Skills, editia 56, Bucuresti

 Pense
de prehensiune
Pense
de prehensiune
Pense Generale
Clip vascular
Dieffenbach
(Bulldog)
Pens Cooley
 Pens
Cooley-Satinsky
Portacul
Castroviejo
Tietoare

SSCR - Basic Surgical Skills, editia 56, Bucuresti

Tietoare

SSCR - Basic Surgical Skills, editia 56, Bucuresti

Microchirurgie
1. Foarfec dreapt ( micro)
2. Foarfec curb ( micro)
3. Portac Castoviejo
4. Deprttor
5. Mner lam ( micro)
6. Pens Adson ( micro)
7. Pens Gerald curb
8. Pens Gerald dreapt
9. Pens DeBacky
 Materiale de sutur

Dublu armate
Monofilament
Sintetice
Lent resorbabil
Vrf rotund
Grosimea firului variaz n funcie de grosimea
peretelui, nu a lumenului
SSCR - Basic Surgical Skills, editia 56, Bucuresti
 Proteze
Sintetice:
Poliester = Dacron

Politetraflouretilen =

Gore-tex

Biologice:
Vena omonim

Artera sau vena de la

cadavru (tratat)
Pericard bovin

SSCR - Basic Surgical Skills, editia 56, Bucuresti

 Types of vascular anastomoses
1. End-to-end anastomosis
2. End-to-side anastomosis
3. Side-to-side anastomosis
4. Enlarging patch angioplasty

SSCR - Basic Surgical Skills, editia 56, Bucuresti

Exposure and Dissection

The periadventitial adipose

tissue is dissected on a
minimum area required, not
more than 1 cm.

To prevent periadventitial fibrosis,

procaine + saline solution is
administered.

SSCR - Basic Surgical Skills, editia 56, Bucuresti

 Bleeding control

Clamping
Ligation
Dabbing

Clamping may be longitudinal or transverse:

Longitudinal - partially maintains blood flow in large vessels while controlling

the bleeding in the damaged area.

Transverse - completely stops blood flow and it is done both downstream and
upstream of the incision.

SSCR - Basic Surgical Skills, editia 56, Bucuresti

 Bleeding control
Atherosclerotic plaques are usually located on the posterior
wall of the artery. The clamp should be placed horizontally to
avoid fissure and fragmentation of the plaque.

SSCR - Basic Surgical Skills, editia 56, Bucuresti

 Arteriotomy

Longitudinal Transverse

SSCR - Basic Surgical Skills, editia 56, Bucuresti

End-to-end anastomosis

1. Stay sutures placement

2. Anterior wall suturing
3. Exposure of the back
wall
4. Posterior wall suturing

SSCR - Basic Surgical Skills, editia 56, Bucuresti

End-to-end anastomosis

SSCR - Basic Surgical Skills, editia 56, Bucuresti

 Anastomoza termino-terminala

Cnd trebuie s anastomozm termino-terminal dou

vase de dimensiuni diferite, vasul mic va fi incizat i
marginile sale aranjate pentru a se potrivi vasului mai
mare, care trebuie tiat oblic pentru a evita ncovoierea.

SSCR - Basic Surgical Skills, editia 56, Bucuresti

Anastomoza termino-lateral

SSCR - Basic Surgical Skills, editia 56, Bucuresti

Anastomoza termino-laterala

SSCR - Basic Surgical Skills, editia 56, Bucuresti

Anastomoza latero-lateral

Utilizata in:
Sunt porto-cav in hipertensiunea
portala
Fistula arterio-venoasa radiocefalica
pentru hemodializa cronica

SSCR - Basic Surgical Skills, editia 56, Bucuresti

Angioplastia cu patch

SSCR - Basic Surgical Skills, editia 56, Bucuresti

 Prevenirea trombozei
Heparinoterapie

Vasul se va manevra fr a atinge endoteliul cu pensa

Firele nu se vor aeza haotic

Acul va trece din prima prin perete

SSCR - Basic Surgical Skills, editia 56, Bucuresti

 Greeli tehnice
Sfierea peretelui

Spaii libere la nivelul anastomozei

ngustarea lumenului

Prinderea n sutur a ambilor perei vasculari i

incluziunea adventicei
SSCR - Basic Surgical Skills, editia 56, Bucuresti
a. Repararea cu sutur n X a
unei artere puncionate
b. Suturi simple discontinue ntr-o
leziune transversal sau
arteriotomie
c. Dac artera are dimetrul
>10mm, leziunea poate fi
reparat printr-o sutur continu
d. nchiderea unei arteriotomii
longitudinale cu o sutur
continu
 Alternative

Cateter Fogarty

SSCR - Basic Surgical Skills, editia 56, Bucuresti

 Bibliografie

Tehnici chirurgicale suport de curs Societatea Studenteasca de

Chirurgie din Romania, Editura Universitara Carol Davila, Bucuresti
2013

Basic Surgical Techniques by R. M. Kirk, 6th edition published by

Elsevier

Ball and Feliciano World Journal of Emergency Surgery 2009

http://www.ecu.edu/cs-dhs/surgery/upload/Skills-lab-Vascular-surgery-
one.pdf

http://www.ecu.edu/cs-dhs/surgery/upload/Skills-lab-Vascular-
surgery-two.pdf

SSCR - Basic Surgical Skills, editia 56, Bucuresti

 V mulumesc !

SSCR - Basic Surgical Skills, editia 56, Bucuresti