1. Peripheral Vascular Surgery ST 240

2. OBJECTIVES  Locate and identify related anatomy  Understand and explain blood pressure  Learn related terminology  Discuss and learn related surgical procedures

3. Arteries and Veins

4.  Layers of veins and arteries differ in thickness  Veins have valves

5. Arteries and Veins

6. Systemic, Pulmonary, Renal and Portal Blood Circuits

7. Arteries

8. Blood Pressure  The force that blood exerts against the internal walls of blood vessels  Adults have ~5L  Resistance is the hindrance of blood flow within the cardiovascular system  Venous blood pressure is lower than arterial

9. Skeletal Muscle Moves Venous Blood

10. Venous Valves

11. Arterial System  3 major arteries emerge from the aortic arch  Brachiocephalic  Left common carotid  Left subclavian

12. Arterial Embolism  Emboli may be blood clots, air, fat, or even portions of a tumor  When surgery is not an option, anticoagulants may be used  For surgical intervention, an incision is made into the artery and the thromboembolitic material is removed using a Fogarty catheter

13. Insertion of Fogarty Catherter

14. In situ Saphenous Vein Anastomosis

15. Bypass Grafting and Endarterectomy  The saphenous is left in place and the ends are used for anastomosis  Autogenous saphenous vein is the material of choice  Dacron grafts not used in below-knee popliteal bypasses because the graft kinks

16. Aneurysms of the Abdominal Aorta  Generally fusiform  May rupture into peritoneal cavity, but more commonly into retroperitoneal space  Mortality sharply increases once rupture has occurred

17. Planned Incision Sites for repair of an Aortic Aneurysm

18. Normal Aorta

19. Saccular Aneurysm

20. Fusiform Aneurysm

21. Dissecting Aneurysm

22. Clamps that may be used Debakey Occlusion clamp Debakey Vascular Clamp AAA Lambert-KayLambert-Kay Lambert-Kay Vascular Clamp AAA

23. Clamps that may be used Debakey Peripheral Vascular clamp Glover Bulldog Peripheral vascular clamp Lambert-KayLambert-Kay Debakey Patent ductus/ peripheral Vascular clamp

24. Abdominal Aortic Aneurysm Repaired 6cm or greater

25. Bifurcated Aortic Graft

26. Dacron: Tubular Vascular Graft (Straight Graft)

27. Bifurcated Vascular Graft

28. For a Friable Aorta: pledgets may be used to reinforce anastomosis

29. Teflon-coated Pledget: Ready for Use

30. Incorporated into the Anastomosis

31. Lumbar Vessels Over sewn

32. Popliteal Artery-Saphenous Vein Anastomosis

33. Femoropopliteal Bypass  An arteriotomy is performed on the femoral artery and the saphenous vein is anastomosed  The popliteal artery is anastomosed with the distal end of the saphenous vein

34. Femorofemoral Bypass or Cross-Femoral Bypass: Occlusion/Primary Incision

35. Secondary Incision and Creation of the Tunnel

36. Graft Positioned and Blood Flow Restored to the Left Lower Extremity

37. Axillofemoral Bypass

38. Carotid Endarterectomy

42. Clamps and Shunt in Place

43. Questions???