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duplicated, or posted to a publicly accessible website, in whole or in part.

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CHAPTER 23

Peripheral Vascular Surgery

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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

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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

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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

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Objectives (cont’d.)– Assess any specific variations related to the

preoperative, intraoperative, and postoperative care of the patient undergoing peripheral vascular surgery

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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Diagnostic Procedures and Tests• Diagnostic procedures and tests for the

evaluation of peripheral vascular disease – Plethysmography– Doppler probe – Phleborheography – Computed axial tomography– Angiography

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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

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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

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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

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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)

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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