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. 1

2. 2 CHAPTER 23 Peripheral Vascular Surgery

3. ©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

4. ©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

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. 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

6. ©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

7. ©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

8. ©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

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. 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

10. ©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

11. ©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

12. ©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

13. ©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

14. ©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

15. ©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

16. ©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

17. ©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

18. ©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

19. ©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

20. ©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

21. ©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

22. ©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)

23. ©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