Artery reconstruction

Artery reconstruction

 * sutura (simple, with a venous or artificial patch – plastic surgery)
 * endarterectomy (open, semi-closed)
 * Direct replacement – for aneurysms
 * shortening – when breaking too long a blood vessel (kinking of the carotid artery)
 * implantation
 * embolectomy, thrombectomy – Fogarty catheterem
 * bridging (bypass)

Types of vascular replacements

 * 1) Biological (artery or vein) – autologous, allogeneic, xenogenic (bovine);
 * 2) * a. thoracica interna – artery of elastic type, resistant to aterosklerosis;
 * 3) artificial – knitted (polyester);
 * 4) * porous wall (must pre-precipitate);
 * 5) * well reachable, but often infected (Staphylococcus epidermidis);
 * 6) Woven
 * 7) cast (PTFE) – microporous wall
 * 8) Combined

Principles of operation

 * We prepare and suture the blood vessels subadventially and in the procedure we use fine atraumatic non-absorbable fibers (e.g. Prolene®;). Before reconstruction, administer heparin (1–2 mg/kg) and neutralise it with protamine (1.5 mg protamine / 1 mg heparinu) before restoring flow. The flow is then restored slowly from the periphery, we control the recovery and build any bleeding.

Postoperative complications

 * early – bleeding, occlusion, infection, thrombosis, peroperative peripheral embolisation, postperfusion syndrome (leaching of metabolites from previously ischemic tissues), compartment syndrome (sudden increase in tissue pressure in the compartment)
 * late – occlusion, pseudoaneurysm, right aneurysm

Three basic surgical methods of passage reconstruction are used – disobliteration, patch or bypass'.

Trombendarterectomy, deobliteration (TEA)

 * The thickened inner layer of the artery (intima and the part of the media on which the thrombus usually mounts) is removed.
 * Target – expand the lumen, get a smooth surface, adjust the transition from the deobliterated part to the untreated area.
 * Disadvantage:
 * 1) large thrombogenic surface;
 * 2) therefore, it is used for short obliterations with high flow – A. carotis, aorta, A. iliaca comm.
 * The main method is open TEA

Patch

 * expansion of the lumen by suturing a patch from an autologous vein or artificial material
 * can be combined with TEA

Related Articles

 * Coronary artery disease
 * Chronic ischemic disease of the lower extremities
 * Capping of large veins
 * Acute arterial occlusion