Chapter 59 - Open surgical techniques

Question 1

Debakey-bahnson aortic aneurysm clamp

Answer 1

FIGURE 59.1

Question 2

Fogarty aortic clamp

Answer 2

FIGURE 59.2

Question 3

Lambert-Kay aortic clamp

Answer 3

FIGURE 59.3

Question 4

Wylie hypogastric clamp

Answer 4

FIGURE 59.4

Question 5

Debakey peripheral vascular clamp

Answer 5

FIGURE 59.5

Question 6

Henly subclavian clamp

Answer 6

FIGURE 59.6

Question 7

Lamole-Strong aortic clamp

Answer 7

FIGURE 59.7

Question 8

Satinsky clamp

Answer 8

FIGURE 59.8

Question 9

Cooley pediatric clamp

Answer 9

FIGURE 59.9

Question 10

Needle holder types

Answer 10

1) Castroviejo 2) Ryder 3) Mayo-Hegar

Question 11

Scissor types

Answer 11

1) Metzenbaum 2) Church 3) Potts 4) Stevens tenotomy 5) Castroviejo

Question 12

Abdominal retractor systems

Answer 12

1) Omni-tract retractor 2) Bookwalter retractor

Question 13

Ethicon needle types

Answer 13

Small (Calcified tibial): CC Small (tibial, internal carotid): BV-1 Small (tibial): BV Medium (CCA, fem, pop): C-1 Large (CIA): RB-1 Large (Aorta): V7 Large (posterior wall aorta): MH

Question 14

Typical anticoagulation dose

Answer 14

75-100 Units/kg

Question 15

Typical ACT

Answer 15

> 250 seconds

Question 16

Ways to control vessel flow

Answer 16

1) clamp 2) balloon occlusion 3) vessel loops 4) pneumatic tourniquet 5) rumel touriniquet 6) internal vessel occluders

Question 17

Thromboembolectomy catheter types

Answer 17

1) embolectomy 2) adherent clot catheter (spiral shape) 3) graft thrombectomy catheter (double helix ring stripper)

Question 18

Fogarty catheter size and uses

Answer 18

2F = pedal/hand 3F = tibial 4F = SFA, EIA 5F = EIA, CIA 6F/7F = aorta

Question 19

Sizes of over-the-wire thrombectomy catheters

Answer 19

3, 4, 5.5, 6, 7F

Question 20

Method of directing thrombectomy cathether down a branch point

Answer 20

1) visual direction 2) balloon occlusion of the other 3) guide catheter 4) over the wire

Question 21

Size of artery that’s not appropriate for longitudinal primary closure

Answer 21

< 5mm

Question 22

Arteriotomy length for end-to-side bypass

Answer 22

1.2 - 2 times graft diameter

Question 23

U-stitch at the apex and heel problems

Answer 23

can narrow lumen in small vessels

Question 24

Miller cuff key points

Answer 24

1) oval venous cuff used 2) significant turbulance

Question 25

Taylor patch key points

Answer 25

1) long arteriotomy 2) U shaped slit 1 cm long on the graft with minimal angulation 3) heel of graft sutured onto proximal arteriotomy with suture line on each side 4) cut anterior surface 2 cm 5) vein patch the rest 1) need long vein 2) graft still touching distal arterial anast thereby disadvantage 3) three suture line possible narrowing

Question 26

Saint Mary’s boot key points

Answer 26

1) like miller cuff and taylor patch combined 2) harder to construct 1) vein patch start at apex 2) sew it on along one wall only before coming back to itself 3) excise excess cuff

Question 27

Distal anastomotic AV fistual construction

Answer 27

Sew the artery and coinciding vein back wall together place the graft on both