Arterial Reconstruction

Types of interventions on arteries

 * sutura (plain, with venous or artificial patch - plastics)
 * endarterectomy (open, semi-closed)
 * direct replacement - for aneurysms
 * shortening - when a too long vessel is kinked (kinking of the carotid artery)
 * iimplantation
 * embolectomy, thrombectomy - Fogarty catheterem
 * bridging (bypass)

Types of vascular replacements

 * 1) Biological (artery or vein) - autologous, allogeneic, xenogeneic (bovine);
 * 2) *a. thoracica interna – artery of elastic type, resistant to atherosclerosis;
 * 3) artificial - knitted (polyester);
 * 4) *porous wall (must be precipitated);
 * 5) *easy to reach but often infected (Staphylococcus epidermidis);
 * 6) woven
 * 7) cast (PTFE) - microporous wall
 * 8) combined

Principles of operation

 * The vessels are prepared and sutured subadventitially and fine, atraumatic, non-absorbable fibres (např. Prolene&reg;)are used as a rule. We administer heparin (1–2 mg/kg) before reconstruction and neutralize it with protamine (1,5 mg protaminu / 1 mg heparinu)before restoring flow. Flow is then slowly restored from the periphery, and we control the restoration and stop any bleeding.

Postoperative complications
Three basic surgical methods of passage reconstruction are used - desobliteration, patch or bypass.
 * early - bleeding, closure, infection, thrombosis, peripheral embolization, postperfusion syndrom (leaching of metabolites from previously ischemic tissues), compartment syndrom (sudden increase in tissue pressure in the compartment)
 * late - closure, pseudoaneurysm, right aneurysm

Thrombendarterectomy, disobliteration (TEA)

 * The thickened inner layer of the artery (the intima and the part of the media on which the thrombus usually sits) is removed.
 * The aim - to widen the lumen, to obtain a smooth area, to modify the transition from the disobliterated part to the untreated area.
 * Disadvantage:
 * Large thrombogenic surface;
 * therefore used in short obliterations with high flow - a. carotis, aorta, a. iliaca comm.
 * The main method is open TEA.

Patch

 * widening of the lumen by sewing a patch made of autologous vein or artificial material
 * can be combined with TEA

Related erticles

 * Ischemic heart disease
 * Chronic ischaemic disease of the lower limbs
 * Large vein occlusions
 * Akute arterial occlusions

Source

 * Categories:Surgery Categories:Cardiology