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Arterial disorders
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
In the acute situation, the presentation is usually with a thrombosed aneurysm and an ischaemic foot; popliteal aneurysms very rarely rupture. Surgery is often unsuccessful because the distal vessels are thrombosed and difficult to clear. Attempts should be made with a Fogarty catheter and intra-arterial thrombolysis. The limb loss rate is high (50%).
Management of penetrating extracranial carotid and vertebral artery trauma
Published in Sachinder Singh Hans, Alexander D Shepard, Mitchell R Weaver, Paul G Bove, Graham W Long, Endovascular and Open Vascular Reconstruction, 2017
For V1 injuries, transection of the clavicular head of the SCM and anterior scalene muscle (ASM) may be necessary. Care should be taken to avoid injury to the phrenic nerve that lies on the ASM. Branches of the thyrocervical trunk are divided to gain access to the vertebral artery and the subclavian vertebral junction. Proximal control may require median sternotomy to expose the SCA. A small Fogarty catheter is a useful adjunct to obtain temporary control. The vertebral artery is then clipped above and below the injury.
Applied Surgical Anatomy
Published in Tjun Tang, Elizabeth O'Riordan, Stewart Walsh, Cracking the Intercollegiate General Surgery FRCS Viva, 2020
Vishal G Shelat, Andrew Clayton Lee, Julian Wong, Karen Randhawa, CJ Shukla, Choon Sheong Seow, Tjun Tang
There is a large haematoma behind the patient's knee that is pulsatile. How would you approach repairing the popliteal artery?The injury is likely to be confined to the popliteal fossa and should be approached posteriorly with the patient placed in a prone position.Mark out the great and small saphenous vein for potential conduit use using an ultrasound scan before set upS-shaped incision is made over the popliteal fossa, with the inferior portion over the small saphenous vein. If adequate, SSV excised from the superficial location at the mid-calf level to its deeper sub-fascial location in the upper calf. Venous branches are ligated with fine vicryl sutures, and the vein is gently hydro dilated and prepared as a reverse venous conduit.The proximal popliteal artery above the stabbing is located by palpation and controlled high in the popliteal fossa as it exits the adductor canal.The artery is followed distally, being careful to avoid adherent and crossing veins so that distal control below the knife can be obtained.There may well be multiple geniculate branches to control during the dissection. After adequate heparinisation, the popliteal artery is clamped above and below the knife. The knife is removed, and the extent of injury assessed.Depending on the extent of the injury, the artery can be patched, segment excised, and primarily anastomosed if enough length or if not used, the SSV can be used as an interposition conduit.The inflow and outflow of the artery should be checked and an embolectomy.Fogarty catheter should be passed to make sure no clots have formed in situ.
Surgical and non-surgical approaches in the management of lower limb post-thrombotic syndrome
Published in Expert Review of Cardiovascular Therapy, 2021
M Machin, S Salim, M Tan, S Onida, AH Davies, J Shalhoub
Surgical thrombectomy has fallen out of practice with the advancement in catheter-directed therapies, with numbers at rock-bottom in the UK since the early 2000s with as few as 26–45 procedures performed annually [15]; it is likely that even these few open thrombectomy procedures are not exclusively related to primary DVT and include cases for restoring flow within venous bypass grafts. Although no longer routinely practiced, some centers in Europe still undertake surgical thrombectomy; hence, it will be briefly mentioned here. The usual technique is to perform a surgical cut down to the common femoral vein as a minimum, with addition of access to the crural veins such as the posterior tibial vein if required [24]. If there is involvement of the inferior vena cava, a proximal filter is usually placed to avoid pulmonary embolization during thrombectomy. Intra-operative venography is used to visualize the obstruction and aid passage of the Fogarty catheter. The catheter is passed to a cephalad point prior to balloon inflation and thrombectomy undertaken. Intra-operative injection thrombolysis and stenting procedures can also be undertaken as an adjunct to open surgical thrombectomy. A surgical arteriovenous fistula can be created at the femoral vessels to improve venous patency.
Ascending aortic thrombus with multiple emboli associated with COVID-19
Published in Baylor University Medical Center Proceedings, 2021
Portia Schmidt, Javier Vasquez, Bryce Gagliano, Alastair J. Moore, Charles S. Roberts
The morning after admission, the patient developed severe right upper extremity pain with no palpable pulse. A repeat CTA of chest, abdomen, pelvis, and the right upper extremity revealed a large mobile thrombus in the ascending aorta and occlusion of the distal right brachial artery (Figure 1b, 1c). He also had an incidental finding of a renal infarct. A hypercoagulable workup was negative, including Factor V Leiden, lupus anticoagulant, and anti-cardiolipin antibody. Full anticoagulation with heparin was initiated, and he underwent an open thrombectomy of the ascending aorta on cardiopulmonary bypass. A transverse aortotomy was made and a 5 cm fibrin thrombus was found attached to the wall of the greater curve in the mid-ascending aorta (Figure 2). The thrombus was removed and the aortotomy was closed in two layers. A right brachial and radial artery cutdown was then performed with thrombectomy using a Fogarty catheter. Reperfusion of the right upper extremity was confirmed with a palpable radial pulse.
Intra-Aortic Balloon Occlusion Decreases Blood Loss During Open Reduction and Internal Fixation for Delayed Acetabular Fractures: A Retrospective Study of 43 Patients
Published in Journal of Investigative Surgery, 2020
Lingzhi Kong, Yaling Yu, Fujian Li, Haomin Cui
Reduction and fixation in the traditional way were performed on the patients in the control group, and balloon occlusion was carried out in the patients who had severely displaced acetabular fractures with reduction difficulty or unmanageable bleeding during surgery (Figure 1). After anesthesia, a 2-cm long longitudinal incision was performed to expose the femoral artery in the inguinal region after sterilization. Five minutes after systemic heparinization, a Fogarty catheter was inserted into the femoral artery, about 20 cm deep (Figure 2). It was confirmed that the balloon was distal to the renal artery and proximal to abdominal aortic bifurcation using the C-arm (Figure 3). The balloon catheter was carefully fixed. Then, the balloon was fixed with contrast medium to pre-occlude the abdominal aorta and the amount (about 8–10 mL) was recorded. Occlusion was confirmed when the contralateral femoral artery pulse disappeared. When it was difficult to control hemorrhage and perform reduction and fixation after fracture exposure, the balloon catheter was gradually filled with the same amount of contrast medium again. The occlusion duration should not exceed 60 minutes. If necessary, a second occlusion may be performed, but there should be an interval of 10–15 minutes.