Chapter 108: Vascular Surgery Flashcards
What are the three layers of blood vessels and how do they differ in arteries and vein?
- Tunica externa/adventitia - Connective tissue fibroblasts and collagen. This layer needs to be removed from the cut ends for vessel reconstruction
- Tunica media - Smooth muscle cells and elastic tissue
- Tunica intima - Endothelial cells
The tunica media of a vein is thinner than that of an artery
What veins carry oxygenated blood?
Where are the only venous sinuses located?
- Pulmonary veins and umbilical vein
- In the skull
Name the instruments pictured from left to right:
- Diamond-jawed needle holder
- DeBakey atraumatic forceps
- Metzenbaum scissors
- Potts scissors
- Small and large right-angled forceps
Name the instruments pictured from left to right:
- Microvascular needle holders, without catch
- Curved Vannas microvascular dissecting scissors
- Straight adventitial scissors
- Jeweler’s forceps
- Curved and straight mosquito hemostats
What suture types are recommended in vascular surgery?
What size suture for vessels with internal diameter of:
4-6mm?
2-3mm?
Less than 2mm?
Nylon or polypropylene for arteries
Braided multifilament passed through mineral oil or bone wax for veins
Vessels with internal diameter of
4-6mm: 4-0/5-0
2-3mm: 6-0
Less than 2mm: 7-0/8-0
What is the most common biological vascular graft in veterinary patients?
Jugular vein
What is the characteristic pattern on a perfused artery called?
Vaso vasorum (you can also see a nice white line to show you where to cut)
What are the main options for anticoagulation in vascular surgery?
Unfractionated heparin
Enoxaparin
What are the options for incision orientation for venotomy/arteriotomy?
Longitudinal
Transverse (recommended in vessels under 4mm diameter)
What are three ways to perform vascular anastomosis?
End-to-end (and oblique end to end)
End-to-side
Side-to-side
What is Kunlin’s technique?
Placing a horizontal mattress suture during vascular anastomosis to produce mild eversion and improve intima approximation
What are the three layers (tunics) of artery walls?
Tunica externa (adventitia) - Connective tissue, should be dissected away during reconstruction
Tunica media - elastic tissue and smooth muscle
Tunica intima - endothelium, fragile! Damage -> clotting cascade!
Arteries are generally smaller than the parent artery that gave rise to them, except for where?
At the bifurcation/branch the combined diameter exceeds the parent vessel diameter.
What are the three layers (tunics) of veins?
What is a valve made of?
Tunica externa (adventitia) - Connective tissue, should be dissected away during reconstruction
Tunica media - smooth muscle *no elastics - will not contract
Tunica intima - endothelium, fragile! Damage -> clotting cascade!
Valves are infoldings of tunica intima that prevent backflow
