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This document provides an overview of basics of vascular surgery including principles of vascular closure and suturing vessels, types of suturing and arteriotomies, end-to-end and end-to-side anastomoses, treatment of chronically blocked arteries through endarterectomy, excision and grafting or bypass grafting, and terminologies used in vascular surgery such as conduits, types of clamping, and revascularization.
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Vascular techniques
This document provides instructions for various vascular anastomosis techniques:
1) It describes basic principles such as minimal incisions, careful tissue handling, and proximal and distal vessel control.
2) Transverse arteriotomy and embolectomy are explained, involving making an incision, inserting a stay suture, and closing with interrupted sutures.
3) Longitudinal arteriotomy and patch closure involves using a vein patch graft sutured with an everting technique or wrapped around the vessel edge.
4) End-to-end and end-to-side anastomoses are demonstrated, with placement of pursestring or spatulated sutures to approximate the vessels.
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The principles of vascular repair with sutures were established in the first decade of the 20th century by Alexis Carrel, who in 1912 was awarded the Nobel Prize for medicine for his work .Since then, technical refinements of suture materials have made possible surgical reconstruction of most arteries from the root of the aorta to microvascular anastomosis or repair of the smallest vessels, e.g., digital arteries or those on the surface of the brain.
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This document discusses vascular injuries, their causes, signs, investigations, and principles of management. It focuses on surgical repair techniques including preparing the limb, assessing and trimming the injured vessel, thrombectomy, and using a reverse saphenous vein graft or direct approximation when possible. It also addresses venous injuries, combined vascular and skeletal trauma, and the role of primary amputation in extensive crush injuries. The overall aim is to resuscitate the patient, repair the injury as soon as possible with or without fasciotomy or external fixation, provide post-operative monitoring, and enable rehabilitation.
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This document provides an overview of topics that will be covered in a vascular surgery lecture series. It discusses various vascular conditions including occlusive arterial disease, aortic aneurysms, carotid disease, varicose veins, occlusive venous disease, lymphedema, visceral arterial occlusion, peripheral aneurysms, arterial trauma, diabetic foot disease, and hyperhidrosis. The lectures will cover the history, physical exam, differential diagnosis, and presentation of these conditions. Specific topics to be addressed include leg ulcers, peripheral arterial occlusive disease, aortic aneurysms, carotid disease, varicose veins, and the diabetic foot. The lectures will also discuss clinical skills for vascular surgeons such as history taking, physical examination, differential diagnosis
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Aortic repair ppt
This document describes procedures for aortic valve replacement and repair. It discusses excising the native aortic valve and implanting a prosthetic valve using sutures placed around the annulus. For small annuli, the aortic root can be enlarged using techniques like the Nicks-Nunez or Konno-Rastan methods which involve patching the aortic wall. The document also outlines techniques for reconstructing valves, including patching leaflet perforations or tears.
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2) Transverse arteriotomy and embolectomy are explained, involving making an incision, inserting a stay suture, and closing with interrupted sutures.
3) Longitudinal arteriotomy and patch closure involves using a vein patch graft sutured with an everting technique or wrapped around the vessel edge.
4) End-to-end and end-to-side anastomoses are demonstrated, with placement of pursestring or spatulated sutures to approximate the vessels.
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2. Factors such as aneurysm size greater than 5.5cm, shape, wall thickness, and presence of thrombus impact the risk of rupture. Open or endovascular repair options are discussed based on risk factors. Endovascular repair has lower short-term mortality but higher reintervention rates.
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This document describes procedures for aortic valve replacement and repair. It discusses excising the native aortic valve and implanting a prosthetic valve using sutures placed around the annulus. For small annuli, the aortic root can be enlarged using techniques like the Nicks-Nunez or Konno-Rastan methods which involve patching the aortic wall. The document also outlines techniques for reconstructing valves, including patching leaflet perforations or tears.
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This document discusses angiography and angioplasty procedures. It explains that angiography uses imaging techniques to visualize blood vessels, while angioplasty widens narrowed vessels. The document outlines different types of each procedure and describes how they are performed. It also discusses stents, which are used to prop open vessels after angioplasty and discusses advantages and disadvantages of various stent materials.
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Angiogram
An angiogram is an imaging test that uses x-rays and dye to map the blood vessels. A catheter is inserted into an artery and threaded to the targeted blood vessels where dye is injected to make blockages visible on x-rays. Angiograms are performed to detect blockages in arteries of the heart, brain, legs, and other organs to help diagnose and plan treatment for conditions like heart disease. While it provides detailed images of blood vessels, risks include bleeding or reaction to the dye where the catheter is inserted.
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Improving patient comfort by reducing pain is one of the concerns of a cardiac surgeon. Making the procedure less invasive is one of the ways bys which surgeons aim to achieve this.
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1) Aortoiliac occlusive disease is caused by atherosclerosis and impairs blood flow to the lower body, causing symptoms ranging from claudication to gangrene.
2) Surgical options for revascularization include aortoiliac endarterectomy, iliofemoral bypass, and aortofemoral bypass.
3) Aortoiliac endarterectomy involves exposing the aorta and iliac arteries through a transperitoneal incision, performing a longitudinal arteriotomy, and removing the atherosclerotic plaque. Short graft interposition may be needed if the vessel wall is too thin.
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Thoracic aortic aneurysm occurs when a portion of the aorta in the chest weakens and bulges out. It can take on a fusiform or saccular shape. There are three main types based on location in the ascending aorta, aortic arch, or descending aorta. Symptoms vary depending on location but may include chest, back, or neck pain as well as difficulty swallowing or shortness of breath. Causes also differ based on location such as cystic medial degeneration in the ascending aorta or atherosclerosis in the descending aorta. Prevention focuses on lifestyle factors like not smoking, exercising, and a healthy diet.
Basics of Hand Surgery
This document provides an overview of hand surgery basics including physical exam and anatomy, common injuries and conditions such as lacerations, fractures, arthritis, and carpal tunnel syndrome. Treatment approaches are discussed for various conditions including suturing of lacerations, splinting of fractures, surgical excision of ganglions, and carpal tunnel release surgery. Emerging treatments like platelet-rich plasma injections are also mentioned.
Aortic aneurysms and dissection 2016
Update on current management of aortic aneurysms with special emphasis on descending aortic aneurysms.
Anaesthetic managent of Bariatric surgery
This document discusses anesthesia considerations for bariatric surgery. It defines obesity and lists common comorbidities like diabetes and hypertension. Bariatric surgery procedures aim to induce weight loss and resolve medical conditions. Risks include respiratory complications from reduced lung capacity and obesity hypoventilation syndrome. Preoperative evaluation assesses the airway, cardiovascular and pulmonary systems, sleep apnea risk, and use of weight loss medications. Polysomnography is used to diagnose sleep apnea severity.
Anesthesia for Lower limb revascularization
This document discusses anaesthesia considerations for lower limb revascularization procedures. It begins with an introduction to peripheral artery disease and classifications. Causes, common sites, and presentations of acute and chronic limb ischemia are described. Preoperative assessment includes cardiovascular and pulmonary evaluation. Risk stratification guidelines are provided. Optimal perioperative management focuses on hemodynamic stability, temperature control, hydration and pain management. Both regional and general anesthesia techniques are reviewed. Postoperative monitoring and analgesia are also discussed.
Emergency vascular surgery_a_practical_guide
Here are the key points from the medical history:
- Mechanism of injury provides clues to potential vascular injury
- In penetrating injuries, details on external bleeding are important - amount, color, duration
- For blunt injuries, assess neurological symptoms - transient ischemic attack, stroke, amaurosis fugax
- Evaluate mental status and check for focal neurological changes, including any alterations during transport
peripheral vascular disease
Peripheral vascular disease refers to narrowing of blood vessels outside the heart and brain, often affecting legs. It has many causes including atherosclerosis, aneurysms, arterial injuries or clots. Diagnosis involves tests like ankle-brachial indexes, duplex ultrasound, CT or MR angiography. Treatment depends on symptoms and location but may include risk factor modification, medications, angioplasty, stenting or surgery.
Aortic aneurys mppt
An aortic aneurysm is a dilation of the aorta wall at a weak point. The most common type is abdominal aortic aneurysm, which affects older males. Risk factors include atherosclerosis and smoking. Small aneurysms are monitored while larger aneurysms require surgery to replace the damaged segment. Aortic dissection occurs when blood tears the inner aortic layers, creating a false passageway. It is a medical emergency often presenting with severe chest pain and requires treatment to reduce blood pressure and prevent rupture. Both conditions carry risk of fatal hemorrhage and require lifelong monitoring.
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The document provides an overview of internal jugular vein cannulation including relevant anatomy, anatomical variations, landmarks, approaches, techniques, ultrasound guidance, indications, contraindications, positioning, and potential complications. Key points include the internal jugular vein draining into the brachiocephalic vein and carrying venous blood from the head and neck. The central approach between the sternocleidomastoid muscle heads is most common for cannulation. Ultrasound guidance allows real-time visualization and reduces risks. Potential early complications include arterial puncture, pneumothorax, and bleeding.
Coronary angiography
Coronary angiography remains the gold standard for detecting coronary artery disease. The technique was first performed in 1958 by Dr. Mason Sones at the Cleveland Clinic. Coronary angiography allows visualization of the coronary arteries, branches, and anomalies to precisely locate lesions. It provides information needed for coronary interventions. The procedure involves accessing the femoral or radial artery and advancing a catheter into the heart to inject contrast dye and image the arteries. It can detect blockages but has limitations like vessel overlap that may obscure lesions. Complications are rare but can include artery damage, embolism, or arrhythmias.
coronaryangiographymadhu-151130170912-lva1-app6892 (1).pdf
Coronary angiography remains the gold standard for detecting coronary artery disease. The technique was first performed in 1958 by Dr. Mason Sones at the Cleveland Clinic. Coronary angiography allows visualization of the coronary arteries, branches, and anomalies to precisely locate lesions. It remains an important diagnostic tool used to evaluate patients with suspected coronary artery disease. The procedure involves accessing the femoral artery and advancing a catheter into the heart to inject contrast and obtain images of the coronary arteries under fluoroscopy. Precise technique and monitoring are required to minimize risks of potential complications.
Hyoid bone
The hyoid bone is a U-shaped bone located in the neck superior to the larynx. It has a body and paired greater and lesser horns. It develops from cartilage and ossifies from multiple centers between ages 16-30 years. Muscles of the oral cavity, pharynx, and larynx attach to the hyoid bone. Fractures can occur due to strangulation or blows to the neck. Inward or lateral fractures displace the fragments medially, while outward fractures displace them laterally. CT scan is the best way to diagnose hyoid fractures which are important in cases of hanging or strangulation.
ANATOMY OF THE Hyoid bone
The hyoid bone is a U-shaped bone located in the neck superior to the larynx. It has a body and paired greater and lesser horns. It develops from cartilage and ossifies from multiple centers, fusing fully between ages 40-60 years. Younger hyoids are more mobile and flexible while older hyoids calcify and become brittle. The hyoid attaches to various muscles and ligaments in the neck. Hyoid fractures can occur from strangulation or blows to the neck and are categorized by the direction of displacement of fragments. X-rays and CT scans are most accurate for diagnosing hyoid fractures which are important in medicolegal cases involving neck injuries.
Types of aortic arch and navigation of difficult arches
This document discusses types of aortic arch anatomy and navigation techniques for difficult aortic arches. It begins by describing the normal anatomy of the aortic arch and its variants that can develop due to variations in embryonic development. It then discusses different challenging arch types and techniques for navigating them, including use of simple curve vs complex curve catheters and reforms. Key complications of arch catheterization like plaque disruption and dissection are also reviewed. Overall, recognition of arch anatomy is important for endovascular procedures, and complex arches may require cervical access or arch angiography for safe navigation.
Carotid in neck , eca, ima &
The document summarizes the anatomy of arteries in the neck and head region. It describes the branches and course of the common carotid artery, external carotid artery, internal carotid artery, and their major branches including the maxillary artery, lingual artery, facial artery, occipital artery, and ophthalmic artery. It provides details on ligations and surgical approaches for various arteries. Key anatomical structures and landmarks are highlighted.
Digital Subtraction Neuroangiography: What a Resident Should Know
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Central Line in Anesthesia
This document discusses central line placement, including:
1) It provides a brief history of central line development and discusses their increasing common use today.
2) Major uses of central lines include access for volume infusion, determination of cardiovascular function, and nutrition.
3) Potential complications include mechanical issues like arterial puncture or cannulation in 5-19% of cases, and infectious complications in 5-26% of cases.
Percutaneous Coronary Intervention
Percutaneous coronary intervention (PCI) is a non-surgical procedure used to treat narrowed coronary arteries of the heart. During PCI, a catheter is inserted through the groin or arm and threaded to the blocked artery. A deflated balloon at the catheter's tip is inflated to flatten the plaque against the artery wall. In some cases, a stent is placed to keep the artery open. PCI aims to restore blood flow, relieve chest pain, and reduce the risk of heart attack. Patients typically recover within a day but are advised to limit activity for 1-2 weeks.
Autopsy internal examination, Forensic Medicine, Post-mortem Examination
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Principles of amputation
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autopsyinternalexamination-140427110739-phpapp02 - Copy.pptx
The document provides details on the process and procedures followed during an internal autopsy examination. It involves making incisions on the body, systematically inspecting and examining the organs in cavities, weighing and measuring organs, and checking for any pathology. The specific steps described include examining the head, brain, spinal cord, thorax, heart, lungs, and abdomen. Organs are incised and sectioned to thoroughly inspect for any injuries, diseases, or abnormalities. Standard techniques are described for removal of organs and the order they are examined according to established autopsy procedures.
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This document provides an overview of neck dissection procedures, including:
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- Generic steps for all neck dissections including incision, exposure, and lymph node removal.
- Detailed descriptions of performing a radical neck dissection, focusing on three areas of special attention: the lower end of the internal jugular vein, the junction of the clavicle and trapezius muscle, and the upper end of the internal jugular vein.
Radiographic anatomy and views of c spine
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CAG final.pptx
Coronary angiography is a diagnostic procedure that uses x-ray imaging and dye to visualize the coronary arteries and detect blockages. The technique was first performed in 1958 and involves inserting a catheter into the arteries and injecting dye so that blockages are highlighted on x-ray images. It remains the gold standard for detecting clinically significant coronary artery disease. Potential complications include bleeding, infection, and reactions to the dye, but it provides information on the location and severity of blockages when clinically suspected coronary artery disease needs to be diagnosed or bypass grafts evaluated. Careful patient preparation and monitoring during and after the procedure are important to minimize risks.
Aortic dissection
Aortic dissection is a life-threatening condition where the inner layer of the aorta tears, allowing blood to flow between the layers. It is classified as type A if the ascending aorta is involved and type B if it is isolated to the descending aorta. Type A requires emergency surgery while type B can often be treated medically or with TEVAR. Complications include malperfusion, rupture, and aortic expansion which may require intervention. Imaging plays a key role in diagnosis and management. Treatment aims to seal the entry tear, relieve malperfusion, and prevent further complications through control of blood pressure and heart rate.
Central venous catheterisation
Central venous catheters are inserted into central veins to deliver fluids, medications, or monitor central venous pressure. The three main sites for central venous catheter placement are the internal jugular, subclavian, and femoral veins. Potential complications include hemorrhage, pneumothorax, and guidewire entanglement. Care must be taken to inspect guidewires and hold them securely during insertion and removal to avoid complications.
Diseases of the thoracic aorta
This document summarizes various diseases of the thoracic aorta including normal variations, aneurysms, dissections, and other conditions. It describes the pathogenesis, risk factors, imaging appearance and features that help differentiate various thoracic aortic diseases including atherosclerotic aneurysms, mycotic aneurysms, traumatic aortic injuries, acute aortic syndromes like dissections and intramural hematomas, and penetrating atherosclerotic ulcers. Treatment options are mentioned for different conditions based on location and severity of the disease.
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anatomical review of internal jugular vein cannulation.pptx
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Digital Subtraction Neuroangiography: What a Resident Should Know
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Lesson plan on Glomerulonephitis
it is a term used to refers to several kidney disease (both kidney) characterized by inflammation either of the glomeruli or of the small blood vessels in the kidney. but not all the disease necessarily have an inflammatory component.
It occurs due to repeated episodes of acute nephritic syndrome, nephrosclerosis and hyperlipidemia.
Process and steps of curriculum development
A curriculum Plan is the advance arrangement of learning opportunities for a particular population of learners.
Curriculum guide is a written curriculum.
Curriculum Planning is the process whereby the arrangement of curriculum plans or learning opportunities are created.
Master plan, course plan, unit plan
Master rotation plan is the overall plan of rotation of all students in a particular educational institution, showing the placement of the students belonging to total programme (4 years in B.Sc.(N) and 3 years in GNM) includes both theory and practice denoting the study block, partial block, placement of student in clinical blocks, team nursing, examinations, vacation, co-curricular activities etc.
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Curriculum Evaluation is the process of collecting data on a programme to determine its value or worth with the aim of deciding whether to adopt, reject, or revise the programme.
Equivalency of courses transcripts, credit system
Indian citizens possessing foreign nursing qualification are examined individually & after examination the syllabi and conformation from concerned foreign authorities, the nurses are granted approval for registration in India with the recommendation of equivalence committee under Section 11(2)(a) INC Act. 1947.
Curriculum models, typees, framework
A model is a three-dimensional representation of a person or thing or of a proposed structure, typically on a smaller scale than the original:"a model of St. Paul's Cathedral“
A Model is a pattern of something to be made or reproduced and means of transferring a relationship `or process from its real (actual) setting to one which it can be more conveniently studied.
Curriculum development process
Curriculum development is a process in which participants at many levels make decisions about the purposes of learning, teaching- learning situation.
It is the process of gathering, setting, selecting, balancing and synthesizing relevant information from many sources in order to design the goals of curriculum.
Curriculum development cycle
Let’s examine what happens in each step of the curriculum development/revision cycle. This cycle is a dynamic system that helps each school re-vitalize and replenish what is taught to its students.
Curriculum determinants
Determinants of curriculum are the factors that affect the process of assessing needs, formulating objectives and developing instructional opportunities and evaluations.
Formulation of philoophy, objecives.........
The term philosophy is derived from the Greek word Philein meaning to love, to strive after or search for and from the word Sophia which means wisdom.
Therefore, Philosophy is the search for wisdom by philosophers.
Concept of curriculum
The document discusses the concept of curriculum, defining it as the totality of a student's learning experiences, both inside and outside of the classroom, and describes the traditional subject-centered curriculum and more modern competency-based and experience-based models. It also outlines the main components of a curriculum, including its objectives, content, instructional methods, and evaluation processes.
Distraction
This very short document does not provide enough contextual information to generate an informative summary. It contains only the word "DISTRACTION" repeated twice but no other details.
Corono
current outbreak of novel coronavirus (2019-nCoV) that was first reported from Wuhan, China, on 31 December 2019.
Perception
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Somatoform disorder and its management
The somatoform disorders are a group of psychological disorders in which a patient experiences physical symptoms that are inconsistent with or cannot be fully explained by any underlying general medical or neurologic condition. Medically unexplained physical symptoms account for as many as 50% of new medical outpatient visits. [1] Physical symptoms or painful complaints of unknown etiology are fairly common in pediatric populations. [2] Many healthy young children express emotional distress in terms of physical pain, such as stomachaches or headaches, but these complaints are usually transient and do not effect the child's overall functioning. The somatoform disorders represent the severe end of a continuum of somatic symptoms.
Somatization in children consists of the persistent experience and complaints of somatic distress that cannot be fully explained by a medical diagnosis. They can be represented by a wide spectrum of severity, ranging from mild self-limited symptoms, such as stomachache and headache, to chronic disabling symptoms, such as seizures and paralysis. These psychological disorders are often difficult to approach and complex to understand. It is important to note that these symptoms are not intentionally produced or under voluntary control.
In somatoform disorders, somatic symptoms become the focus of children and their families. They generally interfere with school, home life, and peer relationships. These youngsters are more likely to be considered sickly or health impaired by parents and caretakers, to be absent from school, and to perform poorly in academics. Somatization is often associated temporarily with psychosocial stress and can persist even after the acute stressor has resolved, resulting in the belief by the child and his or her family that the correct medical diagnosis has not yet been found. Thus, patients and families may continue to seek repeated medical treatment after being informed that no acute physical illness has been found and that the symptoms cannot be fully explained by a general medical condition. When somatization occurs in the context of a physical illness, it is identified by symptoms that go beyond the expected pathophysiology of the physical illness.
Recurrent complaints often present as diagnostic and treatment dilemmas to the primary care practitioner (PCP) who is trying to make sense of these symptoms. The PCP may feel poorly prepared and/or may have little time to assess or treat the somatic concerns. While the more disabling somatic complaints are more likely to be referred to a mental health professional, these youngsters presenting with these disabling physical symptoms bridge both medical and psychological domains and present a puzzling quandary for professionals from either field if working with them alone. [3] The nature of these symptoms requires an integrated medical and psychiatric treatment approach to successfully decrease the impairment caused by these disorders.
Schizophrenia and Other Psychotic Disorders
Schizophrenia is a mental disorder that usually appears in late adolescence or early adulthood. Characterized by delusions, hallucinations, and other cognitive difficulties, schizophrenia can often be a lifelong struggle. In this article, we will cover the causes, symptoms, and treatment of schizophrenia
Ocd
Amiya Ranjan Behera is an 18-year-old male student who was admitted to the hospital with a diagnosis of obsessive compulsive disorder. He reports symptoms of palpitations, breathlessness, repetitive behaviors like hand washing for 15 minutes and checking things an even number of times. On examination, he appears anxious but is oriented with intact cognition. He reports obsessions about contamination and compulsions to perform behaviors in an even manner. The document outlines his history, mental status exam, physical exam and provides context on obsessive compulsive disorder including potential etiological factors and definitions.
Opioid withdrawl
The patient is a 32-year-old male who has been abusing opioids for 11 years. He has a history of withdrawal symptoms when attempting to stop using heroin in the past. A mental status examination found slurred speech, auditory hallucinations, and problems with attention, but intact cognition, judgment, and insight overall. The patient reports taking heroin to relieve withdrawal symptoms and feelings of depression.
Case study on conduct disorder
- The 15-year-old male patient was admitted to the hospital with a diagnosis of conduct disorder. He exhibits aggressive behavior, lack of interest in school, stealing, and lying. He has a history of violent outbursts and was previously admitted for psychiatric treatment. His family experiences marital conflict which is thought to contribute to his condition. He is being treated with mood stabilizers and antipsychotic medication, as well as family and individual psychotherapy.
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This Dissertation explores the particular circumstances of Mirzapur, a region located in the
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centuries, evolving its structure over time and space. In the present era, these changes have
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providing crucial environmental data for scientific, resource management, policy purposes, and
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Accurate understanding of land use and cover is imperative for the development planning
of any area. Consequently, a wide range of professionals, including earth system scientists, land
and water managers, and urban planners, are interested in obtaining data on land use and cover
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cover support policymakers and scientists in making well-informed decisions, as alterations in
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Event Link:- https://meetups.mulesoft.com/events/details/mulesoft-mysore-presents-mule-event-processing-models/
Agenda
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For Upcoming Meetups Join Mysore Meetup Group - https://meetups.mulesoft.com/mysore/YouTube:- youtube.com/@mulesoftmysore
Mysore WhatsApp group:- https://chat.whatsapp.com/EhqtHtCC75vCAX7gaO842N
Speaker:-
Shivani Yasaswi - https://www.linkedin.com/in/shivaniyasaswi/
Organizers:-
Shubham Chaurasia - https://www.linkedin.com/in/shubhamchaurasia1/
Giridhar Meka - https://www.linkedin.com/in/giridharmeka
Priya Shaw - https://www.linkedin.com/in/priya-shaw
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Syllabus
Chapter-1
Introduction to objective, scope and outcome the subject
Chapter 2
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Chapter 3
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Levelling: Instrument used Object of levelling, Methods of levelling in brief, and Contour maps.
Chapter 4
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Chapter 5
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Chapter 6
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Water Pollution: Water Quality standards, Introduction to Treatment & Disposal of Waste Water. Reuse and Saving of Water, Rain Water Harvesting. Solid Waste Management: Classification of Solid Waste, Collection, Transportation and Disposal of Solid. Recycling of Solid Waste: Energy Recovery, Sanitary Landfill, On-Site Sanitation. Air & Noise Pollution: Primary and Secondary air pollutants, Harmful effects of Air Pollution, Control of Air Pollution. . Noise Pollution Harmful Effects of noise pollution, control of noise pollution, Global warming & Climate Change, Ozone depletion, Greenhouse effect
Text Books:
1. Palancharmy, Basic Civil Engineering, McGraw Hill publishers.
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Date: May 29, 2024
Tags: Information Security, ISO/IEC 27001, ISO/IEC 42001, Artificial Intelligence, GDPR
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3 print version nurses basics of vascular surgery Open heart surgery
- 1. Basics of Vascular Surgery Soumya Ranjan Parida Sum Nursing College
- 3. Principles of Vascular Closure heart is a (bent) vessel !! • Full thickness • Angle to center • ‘inside out’ on artery • Posterior → Anterior / Distal → Proximal • Sutures Under vision • Avoid narrowing endothelium is an ‘organ’ not a passive membrane
- 4. Principles of suturing a vessel
- 5. Suture angle to center
- 6. Calcified Vessel : Needle ‘Inside - Out’
- 7. Needle puncture Occupied by strand Needle hole bleed When you pass a suture through a tissue,
- 9. Types of suturing Simple continuous Simple interrupted
- 11. 1. Jump 2. Bite 3. Dog ear 4. Lips 5. Fall Jargons
- 13. longitudinal Arteriotomy Direct closure Patch closure Transverse arteriotomy
- 14. Beveling, back cutting , Toe , Heel,
- 16. End to Side Anastomosis
- 17. End to Side Anastomosis steps • Site chosen , artery clamped – opened • Shunt inserted • Graft length decided, graft clamped- cut - beveled • Suture decided • Graft held away, heel sutures taken • Graft lowered, sutures tightened • Suturing continued on one/ either side • Sutures loosened – shunt removed – tied • Clamp released , bleeding checked
- 18. Types of anastomosis A: end to side B: side to side C: sequential
- 19. side to side anastomosis Types A: longitudinal B: transverse ( diamond)
- 20. Treatment Chronically Blocked Artery: Endarterectomy
- 21. B: Excision & Grafting C: Bypass grafting Treatment Chronically Blocked Artery:
- 22. PEDICLED GRAFT 1: parent artery 2: pedicle 3: branch ( conduit/ graft) FREE GRAFT
- 23. Hood Back cut
- 24. Lie of a graft
- 27. Terminologies • Harvesting • Composite graft • In Situ • Prosthesis • Inside out / out side in • Follow • Tunnel • Fall
- 28. CONDUITS A R T E R I A L V E N O U S A U T O L O G O U S H O M O L O G O U S H E T E R O L O G O U S N A T U R A L K N I T T E D W O V E N S O L I D B L O W N S Y N T H E T I C C O M P O S I T E C O N D U I T
- 29. Terminologies • Total Arterial Revascularisation • Complete Revascularisation • ‘Culprit Vessel’