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.
Presentation describing surgical technique and principles of anastomosis, factors for good healing in the post operative phase, risk factors for leak and the role of staplers in modern day surgical practice, advantages over hand sewn anastomosis.
Lecture on principles of bowel anastomosis delivered during Advanced Suturing Workshop 2018 - which was attended by junior doctors learning to perform bowel anastomosis on a bench setting. Encompasses basic sciences, classification, principles and tips on performing bowel anastomosis.
Presentation describing surgical technique and principles of anastomosis, factors for good healing in the post operative phase, risk factors for leak and the role of staplers in modern day surgical practice, advantages over hand sewn anastomosis.
Lecture on principles of bowel anastomosis delivered during Advanced Suturing Workshop 2018 - which was attended by junior doctors learning to perform bowel anastomosis on a bench setting. Encompasses basic sciences, classification, principles and tips on performing bowel anastomosis.
Component seperation technique for the repair of very large ventral hernias nikhilameerchetty
Includes all the ventral hernia repairs with the loss of domain and the various methods of component separation technique with their success rate for their repair ,few videos showing the methods of repair in addition to the latest techniques of repair .
OPEN RIGHT HEMICOLECTOMY- STEP BY STEP OPERATIVE SURGERY
#surgicaleducator #operativesurgery #openrighthemicolectomy #usmle #babysurgeon #surgicaltutor
Subscription Link: http://youtube.com/c/surgicaleducator...
Surgical Educator Android App link: https://play.google.com/store/apps/de...
Dear viewers,
• Greetings from “Surgical Educator”
• Because of the popular demand by viewers of the YouTube channel “Surgical Educator”, I have decided to create and upload videos on common surgeries.
• In this video today, I have discussed Open Right Hemicolectomy .
• However, these videos are not real surgeries but the theoretical aspect of operative surgery like going through an atlas of operative surgery.
• Along with these videos, I recommend you to watch real operative surgery videos as well and I will give a link for each surgery in the end of the video as end-cards, which I think will be very useful.
• This will give a very good opportunity for the surgical trainees to mentally rehearse various surgical steps in a sequential manner prior to actual surgery. You can watch all my teaching videos in the following link:
• youtube.com/c/surgicaleducator
• Thank you for watching the videos.
Whipple's procedure - Indications, Steps, ComplicationsVikas V
Whipple's Procedure - Explaining the History of Whipple's Procedure, Indications, Contraindications, Step wise detailed procedure, Complications, Perioperative Management.
The Presentation Includes Detailed Step wise approach to the procedure assisted with Pictorial Representation of The steps
OPEN INGUINAL HERNIA REPAIR- OPERATIVE SURGERY
#surgicaleducator #operativesurgery #openinguinalherniarepair #usmle #babysurgeon #surgicaltutor
Dear viewers,
• Greetings from “Surgical Educator”
• Because of the popular demand by viewers of the YouTube channel “Surgical Educator”, I have decided to create and upload videos on common surgeries.
• I have already uploaded videos on open and Laparoscopic Appendicectomy, Thyroidectomy, Modified Radical Mastectomy and open and
Laparoscopic Cholecystectomy
• In this video today, I have discussed Open Inguinal Hernia Repair.
• However, these videos are not real surgeries but the theoretical aspect of operative surgery like going through an atlas of operative surgery.
• Along with these videos, I recommend you to watch real operative surgery videos as well and I will give a link for each surgery in the end of the video as end-cards, which I think will be very useful.
• This will give a very good opportunity for the surgical trainees to mentally rehearse various surgical steps in a sequential manner prior to actual surgery. You can watch the video in the following links:
• surgicaleducator.blogspot.com
• youtube.com/c/surgicaleducator
• Thank you for watching the videos.
Component seperation technique for the repair of very large ventral hernias nikhilameerchetty
Includes all the ventral hernia repairs with the loss of domain and the various methods of component separation technique with their success rate for their repair ,few videos showing the methods of repair in addition to the latest techniques of repair .
OPEN RIGHT HEMICOLECTOMY- STEP BY STEP OPERATIVE SURGERY
#surgicaleducator #operativesurgery #openrighthemicolectomy #usmle #babysurgeon #surgicaltutor
Subscription Link: http://youtube.com/c/surgicaleducator...
Surgical Educator Android App link: https://play.google.com/store/apps/de...
Dear viewers,
• Greetings from “Surgical Educator”
• Because of the popular demand by viewers of the YouTube channel “Surgical Educator”, I have decided to create and upload videos on common surgeries.
• In this video today, I have discussed Open Right Hemicolectomy .
• However, these videos are not real surgeries but the theoretical aspect of operative surgery like going through an atlas of operative surgery.
• Along with these videos, I recommend you to watch real operative surgery videos as well and I will give a link for each surgery in the end of the video as end-cards, which I think will be very useful.
• This will give a very good opportunity for the surgical trainees to mentally rehearse various surgical steps in a sequential manner prior to actual surgery. You can watch all my teaching videos in the following link:
• youtube.com/c/surgicaleducator
• Thank you for watching the videos.
Whipple's procedure - Indications, Steps, ComplicationsVikas V
Whipple's Procedure - Explaining the History of Whipple's Procedure, Indications, Contraindications, Step wise detailed procedure, Complications, Perioperative Management.
The Presentation Includes Detailed Step wise approach to the procedure assisted with Pictorial Representation of The steps
OPEN INGUINAL HERNIA REPAIR- OPERATIVE SURGERY
#surgicaleducator #operativesurgery #openinguinalherniarepair #usmle #babysurgeon #surgicaltutor
Dear viewers,
• Greetings from “Surgical Educator”
• Because of the popular demand by viewers of the YouTube channel “Surgical Educator”, I have decided to create and upload videos on common surgeries.
• I have already uploaded videos on open and Laparoscopic Appendicectomy, Thyroidectomy, Modified Radical Mastectomy and open and
Laparoscopic Cholecystectomy
• In this video today, I have discussed Open Inguinal Hernia Repair.
• However, these videos are not real surgeries but the theoretical aspect of operative surgery like going through an atlas of operative surgery.
• Along with these videos, I recommend you to watch real operative surgery videos as well and I will give a link for each surgery in the end of the video as end-cards, which I think will be very useful.
• This will give a very good opportunity for the surgical trainees to mentally rehearse various surgical steps in a sequential manner prior to actual surgery. You can watch the video in the following links:
• surgicaleducator.blogspot.com
• youtube.com/c/surgicaleducator
• Thank you for watching the videos.
Resection and reconstruction of the SVC is still considered a surgical challenge.
However, with the appropriate indications and surgical technique a clear benefit has been documented in a selected group of patients. This lengthy power point presentation addresses the elective and emergency surgical procedures which can be done on the SVC. The viewer is expected to appreciate the technical challenges of SVC surgery and the ways how to overcome them.....
By the end of the module, you will be able to:
Define Arterio Venous Fistula and Arterio Venous Graft
Identify Complications and Management
Familiarise and use the Pre Needling Cannulation Tool
The Transradial technique is the true minimally invasive "Drive-through" approach to perform percutaneous coronary and peripheral angiograms and interventions.
Vascular anastomosis
Arteriovenous anastomosis
Bowel anastomosis
Ileocolic anastomosis
Risks of ileocolic anastomosis
Recovery after ileocolic anastomosis surgery
Colorectal anastomosis
How is colorectal anastomosis done?
Risks of colorectal anastomosis
Recovery after colorectal anastomosis surgery
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
1. Principles of Vascular
Anastomosis
By
Professor
Abdulsalam Y Taha
School of Medicine/ University of Sulaimaniyah/ Region of
Kurdistan/Iraq
https://sulaimaniu.academia.edu/AbdulsalamTaha
2. Introduction
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.
Fine sutures on atraumatic needles are best for arterial
anastomosis.
Silk was used for many years, but it has now been replaced by
synthetic fibers, which are less traumatic to the vessel walls.
Prof. A Y Taha: Principles of
15/10/14 2
vascular anastomosis
3. History
1899 – Dorfler advocated use of all layers of vessels
in repair
1907 – (Carrel) “The Surgery of Blood Vessels” (JH
Hospital Bull.)
1st replantation of canine limbs
1st esophageal-intestinal interposition
1959 – (Seidenberg) human esophageal-intestinal
interposition
1960 – (Jacobson/Suarez) operating microscope
introduced (1 mm vessels)
1966 – (Antia/Buch) fasciocutaneous transfer
1972 – (McLean/Buncke) omental flap to scalp
Prof. A Y Taha: Principles of
15/10/14 3
vascular anastomosis
4. a. Pass a right angle clamp gently through the soft tissue
directly on the dorsal aspect of the artery and direct it
away from the larger veins to avoid iatrogenic injuries.
Caution! Avoid accidental penetration of the dorsal wall of
the artery. b. Gently lift the artery with the vessel-loop to
achieve tension in the tissues, thus facilitating the
dissection.
Prof. A Y Taha: Principles of
15/10/14 4
vascular anastomosis
5. Different methods for controlling bleeding are demonstrated.
From left to right: doubly applied vessel loop, bulldog
( small metallic vascular clamp), balloon catheter,
loop of ligature, vascular clamp).
Prof. A Y Taha: Principles of
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vascular anastomosis
6. √ ᵡ
Prof. A Y Taha: Principles of
15/10/14 6
vascular anastomosis
7. Prof. A Y Taha: Principles of
15/10/14 7
vascular anastomosis
9. Prof. A Y Taha: Principles of
15/10/14 9
vascular anastomosis
10. Prof. A Y Taha: Principles of
15/10/14 10
vascular anastomosis
11. Prof. A Y Taha: Principles of
15/10/14 11
vascular anastomosis
12. Simple suture
Prof. A Y Taha: Principles of
15/10/14 12
vascular anastomosis
13. Kunlin suture
● If an endarterectomy has been performed,
there is a risk of intimal flap dissection at
the downstream edge. To eleminate this
risk, sutures are inserted to secure the
intima. The needle passes from outside to
inside through an endarterectomized part
of the wall and back from inside to outside
through the atheroma to be finally tied on
the outside.
Prof. A Y Taha: Principles of
15/10/14 13
vascular anastomosis
14. Prof. A Y Taha: Principles of
15/10/14 14
vascular anastomosis
16. End to end anastomosis: stay
sutures
Prof. A Y Taha: Principles of
15/10/14 16
vascular anastomosis
17. End to end anastomosis:
interrupted suture
Prof. A Y Taha: Principles of
15/10/14 17
vascular anastomosis
18. End to end anastomosis:
continuous suture
Prof. A Y Taha: Principles of
15/10/14 18
vascular anastomosis
19. When two vessels with different
diameters are being sutured
end to end, the smaller has to
be slit open and the edges
trimmed to fit the larger one,
which must be cut somewhat
obliquely to avoid kinking.
Prof. A Y Taha: Principles of
15/10/14 19
vascular anastomosis
20. Prof. A Y Taha: Principles of
15/10/14 20
vascular anastomosis
21. End to end anastomosis:
single-stitch method
● Used when there is
a difficulty in rotating the
vessels, for example at
a large bifurcation.
● Commensing on the side
nearest the operater, 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.
● Alternatively, a double ended
suture may be commensed
at the midpoint posteriorly and
each side completed in turn.
Prof. A Y Taha: Principles of
15/10/14 21
vascular anastomosis
22. End to end anastomosis: inlay
technique
● Used for AAA repair.
● Double ended horizontal mattress
suture in the middle of the graft.
● Needles should pass from graft to
aorta
● Take large bites incorporating all
layers.
Prof. A Y Taha: Principles of
15/10/14 22
vascular anastomosis
23. Inlay parachute technique
● The double ended
suture is left untied
in order to allow
a number of stitches
to be placed on each
side before the graft
is pulled down onto
the artery.
Prof. A Y Taha: Principles of
15/10/14 23
vascular anastomosis
24. Buttressing sutures
● Sutures may be buttressed
with Dacron pieces when
the wall of the artery is
friable and may cut out
causing hemorrhage.
Prof. A Y Taha: Principles of
15/10/14 24
vascular anastomosis
25. End to side anastomosis: four
quadrant technique
Prof. A Y Taha: Principles of
15/10/14 25
vascular anastomosis
26. End to side anastomosis:
parachute technique
Prof. A Y Taha: Principles of
15/10/14 26
vascular anastomosis
27. Prof. A Y Taha: Principles of
15/10/14 27
vascular anastomosis
28. How to make a venous patch?
Prof. A Y Taha: Principles of
15/10/14 28
vascular anastomosis
29. Spiral graft technique
Spiral graft
technique to create a
graft of large
diameter for
replacing vein
segments. A
saphenous vein is
cut longituidinally
and sutured in a
spiral fashion over
plastic tubing used
as a stent.
Prof. A Y Taha: Principles of
15/10/14 29
vascular anastomosis
30. Prof. A Y Taha: Principles of
15/10/14 30
vascular anastomosis
32. Microvascular surgical technique
Trim adventitia
2-3mm
Gentle handling (no full-thickness)
Trim free edge, if needed
Dissect vessels from
surrounding tissues
Irrigate and dilate
Heparinized saline
Mechanical dilation (1 ½
times normal –paralyses
smooth muscle)
Chemical dilation, if
necessary
Suturing
Prof. A Y Taha: Principles of
15/10/14 32
vascular anastomosis
33. Microvascular suture
technique
3 guide sutures (120
degrees apart)
Perpendicular piercing
Entry point 2x thickness of
vessel from cut end
Equal bites on either side
Microforceps in lumen vs.
retracting adventitia
Pull needle through in
circular motion
Surgeon’s knot with guide
sutures, simple for others
Avoid backwalling—2
bites/irrigation
Prof. A Y Taha: Principles of
15/10/14 33
vascular anastomosis
34. 3 suture technique
Prof. A Y Taha: Principles of
15/10/14 34
vascular anastomosis
36. Mechanical anastomosis
Devices
Clips
Coupler
Laser
Results
Increased efficiency and
speed, use in difficult areas
Patency rates at least equal
to hand-sewn (Shindo, et al
1996, De Lorenzi, et al 2002)
Can be used for end-to-end
or end-to-side (DeLacure, et
al 1999)
Poorer outcome with arterial
anastomosis—20-25%
failure (Shindo, et al 1996,
Ahn, et al 1994)
Prof. A Y Taha: Principles of
15/10/14 36
vascular anastomosis
37. Microvascular Hints & Helps
Use background to help
visualize suture
Demagnetize instruments, if
needed
May reclamp vessels for
repair after 15 minutes of
flow
Reclamp both arterial and
venous vessels when
revising venous anastomosis
Support your hands and hold
instruments like a pencil
Prof. A Y Taha: Principles of
15/10/14 37
vascular anastomosis
38. Mechanical flap monitoring
Doppler
External
Implanted
Buried flaps
80-100% salvage
(Disa J, et
al 1999)
Color flow
Other
Prof. A Y Taha: Principles of
15/10/14 38
vascular anastomosis
39. Complications of Vascular
Anastomosis
Badr Aljabri MD, FRCSC
Associate Professor and Consultant
Vascular Surgeon, KKUH
40. Anastomotic bleeding
Needle hole bleeding.
- more common with PTFE grafts.
- Rx: Local haemostatic agents.
Reverse systemic heparin
effect.
Prof. A Y Taha: Principles of
15/10/14 40
vascular anastomosis
41. Anastomotic bleeding
Suture line bleeding.
- Rx: Simple or U-shaped suture at
the defect.
tying should be with non-
Pulsetile flow.
Prof. A Y Taha: Principles of
15/10/14 41
vascular anastomosis
42. Anastomotic Psudoaneurysm
Disruption of the suture line at the
anastomosis result in walled off extra-luminal
circulation of the blood.
Prof. A Y Taha: Principles of
15/10/14 42
vascular anastomosis
44. Prof. A Y Taha: Principles of
15/10/14 44
vascular anastomosis
45. Prof. A Y Taha: Principles of
15/10/14 45
vascular anastomosis
46. Prof. A Y Taha: Principles of
15/10/14 46
vascular anastomosis
47. Prof. A Y Taha: Principles of
15/10/14 47
vascular anastomosis
48. Anastomotic stenosis
Early : Technical.
1-18 months: Intimal hyperplasia.
> 18 months: Progression of
atherosclerosis.
Prof. A Y Taha: Principles of
15/10/14 48
vascular anastomosis
49. Prof. A Y Taha: Principles of
15/10/14 49
vascular anastomosis
50. Prof. A Y Taha: Principles of
15/10/14 50
vascular anastomosis
51. Prof. A Y Taha: Principles of
15/10/14 51
vascular anastomosis
52. Graft thrombosis
Early
1. Technical (kink, missed valve, AV fistula,
intimal flap)
2. Poor choice of inflow or outflow sites.
3. Insufficient runoff.
4. Ongoing or progression of soft tissue
infection
5. Low circulatory volume.
6. Hypercoagulable state.
Intermediate
Intimal Hyperplasia
(1 month -18 months)
Late
1. Progression of Atherosclerosis.
2. Degenerative lesions in the graft
Prof. A Y Taha: Principles of
15/10/14 52
vascular anastomosis