chapter 23
DESCRIPTION
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 PresentationTRANSCRIPT
©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. 1©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. 2©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.
CHAPTER 23
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. 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
©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. 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
©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. 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
©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. 6
Objectives (cont’d.)– 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. 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
©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. 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
©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. 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
©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. 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
©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. 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
©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. 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
©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. 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
©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. 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
©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. 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
©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. 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
©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. 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
©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. 18
Diagnostic Procedures and Tests• Diagnostic procedures and tests for the
evaluation of peripheral vascular disease – Plethysmography– Doppler probe – Phleborheography – Computed axial tomography– Angiography
©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. 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
©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. 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
©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. 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
©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. 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)
©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. 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