CHAPTER 23

2. CHAPTER 23 Peripheral Vascular Surgery

3. Objectives • After studying this chapter, you will be able to: • Recognize the relevant anatomy of the peripheral vascular system • Summarize the pathology that prompts surgical intervention of the peripheral vascular system and the related terminology • Determine any special preoperative peripheral vascular diagnostic procedures

4. Objectives (cont’d.) • Determine any special preoperative preparation procedures • Indicate the names and uses of peripheral vascular instruments and supplies • Indicate the names and uses of special equipment • Determine the intraoperative preparations of the patient undergoing the peripheral vascular procedures

5. Objectives (cont’d.) • Summarize the surgical steps of the peripheral vascular procedures • Interpret the purpose and expected outcomes of the peripheral vascular procedures • Recognize the immediate postoperative care and possible complications of the peripheral vascular procedures

6. Objectives (cont’d.) • Assess any specific variations related to the preoperative, intraoperative, and postoperative care of the patient undergoing peripheral vascular surgery

7. Peripheral Vascular Surgical Anatomy • Peripheral vascular system • Closed system of blood vessels • Transports blood away from the heart to the body’s tissues, and then back to the heart • Blood vessels • Arterial blood: blood transported away from the heart to body tissues • Refer to Figures 23-1 and 23-2

8. Peripheral Vascular Surgical Anatomy (cont’d.) • Structure of the artery and the vein • Layers of artery walls • Tunica adventitia • Tunica media • Tunica intima • Layer of arterioles • Simple squamous epithelium • Epithelial layer of capillaries • Very thin and contains openings or pores where two adjacent epithelial cells overlap

9. Peripheral Vascular Surgical Anatomy (cont’d.) • Veins • Composed of the same three layers as arteries • Equipped with flap-like valves made of thin layers of tunica intima that close if blood begins to back up in a vein • Refer to Figures 23-3, 23-4, and 23-5

10. Peripheral Vascular Surgical Anatomy (cont’d.) • The arterial system • Aorta • Largest artery in the body • Coronary arteries • Directly supply myocardium with oxygenated blood • Arteries that emerge from the aortic arch • Brachiocephalic artery • Left common carotid artery • Left subclavian artery

11. Peripheral Vascular Surgical Anatomy (cont’d.) • Branches of the descending aorta supplying the thoracic wall • Superior phrenic arteries and posterior intercostal arteries • Branches supplying the viscera of the thorax • Bronchial, pericardial, mediastinal, and esophageal arteries • Common hepatic artery branches • Hepatic artery proper, gastroduodenal artery, and right gastric artery

12. Peripheral Vascular Surgical Anatomy (cont’d.) • Splenic artery branches • Left gastroepiploic artery, pancreatic artery, and polar arteries • Additional arteries • Gastric • Inferior phrenic • Superior mesenteric and suprarenal • Renal and gonadal • Inferior mesenteric • Lumbar and middle sacral

13. Peripheral Vascular Surgical Anatomy (cont’d.) • Additional arteries (cont’d.) • Abdominal aorta • Internal and external iliac • Femoral • Right and left subclavian • Carotid • Brachiocephalic • Superficial temporal • Maxillary

14. Peripheral Vascular Surgical Anatomy (cont’d.) • The venous system • Dural sinuses • Blood channels that receive blood from the cerebral, ophthalmic, cerebellar, and meningeal veins of the brain • Veins of the brain • Superior cerebral vein, inferior and medial veins, the great cerebral vein of Galen, and superior and inferior ophthalmic veins

15. Peripheral Vascular Surgical Anatomy (cont’d.) • Right and left internal jugular veins • Receive blood from numerous sinuses and veins within the brain • Right and left vertebral veins • Drain deep structures of the neck • Cephalic and basilic veins • Drain superficial tissues of the upper extremities • Tributaries of brachiocephalic and azygos veins • Drain abdominal and thoracic walls

16. Peripheral Vascular Surgical Anatomy (cont’d.) • Bacteria present in the portal vein • Filtered by phagocytic action of Kupffer cells within the hepatic sinusoids • Veins of the lower extremities • Superficial group • Deep group

17. Peripheral Vascular Surgery • Peripheral vessel procedures • Often performed on patients with advanced atherosclerosis that affects the extremities, abdominal and thoracic viscera, and the brain • Outcome of each peripheral vascular procedure depends on ability of OR personnel to function as a team

18. Diagnostic Procedures and Tests • Diagnostic procedures and tests for the evaluation of peripheral vascular disease • Plethysmography • Doppler probe • Phleborheography • Computed axial tomography • Angiography

19. Instrumentation, Supplies, and Equipment • Instrumentation • Peripheral vascular procedures: vascular set with instruments that are proper size and fit • Typical peripheral vascular instrument set: refer to Table 23-1

20. Instrumentation, Supplies, and Equipment (cont’d.) • Supplies • General supplies used for most vascular procedures • Refer to text • Biologic and synthetic grafts • Used to bypass an occlusion or reconstruct a vessel • Refer to Figures 23-8 and 23-9

21. Peripheral Vascular Surgical Procedures • Include: • Angioscopy • Peripheral vessel angioplasty • Insertion of double-lumen Groshong venous catheter • Embolectomy • Carotid endarterectomy • Abdominal aortic aneurysm with graft • Aortofemoral bypass

22. Peripheral Vascular Surgical Procedures (cont’d.) • Unilateral femoropopliteal bypass • Arteriovenous fistula and shunt • Inferior vena cava filter placement–jugular vein access • Vein ligation and stripping (unilateral)

23. Summary • This chapter reviewed: • Anatomy of the peripheral vascular system • The pathology that prompts surgical intervention of the peripheral vascular system • Peripheral vascular diagnostic procedures • Peripheral vascular instruments and supplies • Peripheral vascular surgical procedures