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CHAPTER 23. Peripheral Vascular Surgery. 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 - PowerPoint PPT Presentation

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2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part.2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. #1CHAPTER 23Peripheral Vascular Surgery2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part.2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. #ObjectivesAfter studying this chapter, you will be able to:Recognize the relevant anatomy of the peripheral vascular systemSummarize the pathology that prompts surgical intervention of the peripheral vascular system and the related terminologyDetermine any special preoperative peripheral vascular diagnostic procedures2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. #Objectives (contd.)Determine any special preoperative preparation proceduresIndicate the names and uses of peripheral vascular instruments and suppliesIndicate the names and uses of special equipmentDetermine the intraoperative preparations of the patient undergoing the peripheral vascular procedures2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. #Objectives (contd.)Summarize the surgical steps of the peripheral vascular proceduresInterpret the purpose and expected outcomes of the peripheral vascular proceduresRecognize the immediate postoperative care and possible complications of the peripheral vascular procedures

2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. #Objectives (contd.)Assess any specific variations related to the preoperative, intraoperative, and postoperative care of the patient undergoing peripheral vascular surgery

2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. #Peripheral Vascular Surgical AnatomyPeripheral vascular system Closed system of blood vessels Transports blood away from the heart to the bodys tissues, and then back to the heartBlood vesselsArterial blood: blood transported away from the heart to body tissuesRefer to Figures 23-1 and 23-22014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. #7Peripheral Vascular Surgical Anatomy (contd.)Structure of the artery and the veinLayers of artery wallsTunica 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 overlap2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. #8Peripheral Vascular Surgical Anatomy (contd.)Veins Composed of the same three layers as arteriesEquipped with flap-like valves made of thin layers of tunica intima that close if blood begins to back up in a veinRefer to Figures 23-3, 23-4, and 23-5

2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. #9Peripheral Vascular Surgical Anatomy (contd.)The arterial systemAortaLargest artery in the bodyCoronary arteries Directly supply myocardium with oxygenated bloodArteries that emerge from the aortic archBrachiocephalic arteryLeft common carotid arteryLeft subclavian artery2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. #10Peripheral Vascular Surgical Anatomy (contd.)Branches of the descending aorta supplying the thoracic wall Superior phrenic arteries and posterior intercostal arteriesBranches supplying the viscera of the thoraxBronchial, pericardial, mediastinal, and esophageal arteriesCommon hepatic artery branchesHepatic artery proper, gastroduodenal artery, and right gastric artery2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. #11Peripheral Vascular Surgical Anatomy (contd.)Splenic artery branchesLeft gastroepiploic artery, pancreatic artery, and polar arteriesAdditional arteriesGastric Inferior phrenicSuperior mesenteric and suprarenalRenal and gonadalInferior mesentericLumbar and middle sacral

2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. #12Peripheral Vascular Surgical Anatomy (contd.)Additional arteries (contd.)Abdominal aortaInternal and external iliacFemoral Right and left subclavianCarotidBrachiocephalicSuperficial temporalMaxillary2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. #13Peripheral Vascular Surgical Anatomy (contd.)The venous systemDural sinuses Blood channels that receive blood from the cerebral, ophthalmic, cerebellar, and meningeal veins of the brainVeins of the brain Superior cerebral vein, inferior and medial veins, the great cerebral vein of Galen, and superior and inferior ophthalmic veins2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. #14Peripheral Vascular Surgical Anatomy (contd.)Right and left internal jugular veinsReceive blood from numerous sinuses and veins within the brain Right and left vertebral veins Drain deep structures of the neckCephalic and basilic veinsDrain superficial tissues of the upper extremities Tributaries of brachiocephalic and azygos veinsDrain abdominal and thoracic walls 2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. #15Peripheral Vascular Surgical Anatomy (contd.)Bacteria present in the portal vein Filtered by phagocytic action of Kupffer cells within the hepatic sinusoidsVeins of the lower extremities Superficial group Deep group2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. #16Peripheral Vascular SurgeryPeripheral vessel procedures Often performed on patients with advanced atherosclerosis that affects the extremities, abdominal and thoracic viscera, and the brainOutcome of each peripheral vascular procedure depends on ability of OR personnel to function as a team2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. #17Diagnostic Procedures and TestsDiagnostic procedures and tests for the evaluation of peripheral vascular disease PlethysmographyDoppler probe Phleborheography Computed axial tomographyAngiography2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. #18Instrumentation, Supplies, and EquipmentInstrumentationPeripheral vascular procedures: vascular set with instruments that are proper size and fitTypical peripheral vascular instrument set: refer to Table 23-12014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. #19Instrumentation, Supplies, and Equipment (contd.)SuppliesGeneral supplies used for most vascular proceduresRefer to textBiologic and synthetic graftsUsed to bypass an occlusion or reconstruct a vessel Refer to Figures 23-8 and 23-92014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. #20Peripheral Vascular Surgical Procedures Include:AngioscopyPeripheral vessel angioplastyInsertion of double-lumen Groshong venous catheterEmbolectomyCarotid endarterectomyAbdominal aortic aneurysm with graftAortofemoral bypass2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. #21Peripheral Vascular Surgical Procedures (contd.) Unilateral femoropopliteal bypassArteriovenous fistula and shuntInferior vena cava filter placementjugular vein accessVein ligation and stripping (unilateral)

2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. #22SummaryThis chapter reviewed:Anatomy of the peripheral vascular systemThe pathology that prompts surgical intervention of the peripheral vascular system Peripheral vascular diagnostic proceduresPeripheral vascular instruments and suppliesPeripheral vascular surgical procedures2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website