[Basic techniques in vascular surgery].
The procedure for vascular resection and reconstruction includes exposure of the diseased vessel, temporary interruption of blood flow, resection of the diseased segment, vascular repair or anastomosis and restoration of blood flow. Adequate exposure, including the healthy portions on both the afferent and efferent sides of the diseased segment, facilitates subsequent steps in the procedure. Since the temporary interruption of blood flow could lead to ischemic and reperfusion injuries, it is necessary to take measures to protect organs that receive blood flow from diseased vessels. The basic principles in vascular suturing are single sutures through all layers and intima-to-intima approximation. Continuous simple sutures are often used for vascular repair and anastomoses. In the case of anastomoses between small arteries, however, interrupted simple sutures are preferred to prevent stenosis. Twisting, stenosis, and overstretch at the point of anastomosis are errors that result in failure of vascular reconstruction. The methods for overcoming size differences between anastomosed vessels should be understood. Topical heparinization is easy and a useful method to prevent the production of thrombus. Systemic administration of anticoagulants is not always needed.
Ohtsuka
M
M
Department of General Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
Miyazaki
M
M
Ito
H
H
Kimura
F
F
Shimizu
H
H
Nakajima
N
N
D000714:Anastomosis, Surgical / Q000379:methods; D006801:Humans; D014656:Vascular Surgical Procedures / Q000379:methods*