Vascular anastomoses презентация

An anastomosis is the connection of two normally divergent structures. It refers especially to connections between blood vessels

Types of vascular anastomoses
«End-to-End»
«Side to side»
«Side to end»

«End-to-End»

1 — Carrel's suture with three fixing threads
2— Morozova's suture with two fixing threads
3 — Suture of Blalock and Polyantsev

Littman’s suture (1954) — apply П-shaped sutures with nodes located on the one side.
F. Brian; M. Jaboulay [1896] apply П-shaped sutures with nodes located on the different sides.

The Method Of Payr
Donetsky ring

Solovyov suture: suture is used for uniting vessels with different diameters. Central end of blood vessel is turned inside out and introduced into peripheral
end. Then sutures are put on blood vessels.
J.В. Murphy’s suture

End to side

Arteriotomy

heel-and-toe

Side to side

arteriovenous fistula

Cardiac Artery Bypass Graft

If the vessel wall is calcined
If the vessel wall is loose
1 variant- you must sew from inside to outside
2 variant – press on the wall with forceps against a place of puncture
Fixing suture with teflon strip

Ways to make anastomosis for vessels with different diameters
Cutting vessel with smaller diameter at the angle
Method of Dobrovolskaya

Mistakes
Loose sutures
«Sandglass»
Rupture of vessel’s wall

Prevention of gas embolism
The first always remove clip from the distal part. The blood retrogradly will fill the vessel, air’ll escape through holes in the anastomosis. Surgeon have to tie threads after opening the distal clamp. Only then is possible remove the proximal clamp and restore blood flow.

Requirements for suture material and instruments
Minimal harm for tissues
Needles only atraumatic
Wide working parts to reduce the specific pressure on the fabric;
Г-the shaped form of the transition of the handle into the working part, which does not complicate the overview of the bottom of the operating wound;
the possibility of using elastic sleeves on the working parts to prevent excessive compression of the vascular wall
Minimal bleeding through the hole made by the needle
No thrombosis on the suture material
Non-absorbable filament: polypropylene, polytetrafluoroethylene
The vessels of different diameters are suturing with different suture material: aorta 2/0-3/0, coronary arteries 7/0-8/0

Suture material
Polypropylene (main suture material)
Polydioxanone (pediatric vascular surgery)
Gore-Tex
(in anastomosis between the vessel and the prosthesis)