heart123
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do i have anything else 36830
thanks ya'll
Attention was then turned to the groin crease: the pulse was marked and a transverse incision over it was made, slightly medial: dissection down to the femoral artery and vein was made: both are surrounded by thick scar tissue ; the vein is thick but patent: both artery and vein are dissected circumferentially and vessel loops are placed for control. A loop was marked on the skin of the thigh over the tuneler ; the tuneler was introduced in the venous aspect of the loop ( medial) from the mid thigh ( small 3 cm incision) towards the incision in the crease. The patient was given heparin intravenously. Vascular clamps were used to obtain control of the vein and a 6 mm longitudinal venotomy was then made with a 11 blade. Stay sutures were placed. The veno-graft anastomosis was then performed with 6-0 prolene, in a continuous running manner. At the completion the vein was back and forward flushed, and the sutures were tied. The graft was then flushed from its end in the mid thigh , the venous anastomosis was checked for any bleeding ( diffuse oozing) .Attention was then directed to the artery: the graft wa sthen tuneled through the arterial limb of the tunel; a similar longitudinal arteriotomy was made : the artery is severely disease, with plaque and a stent in the very proximal aspect of the SFA- the arteriotomy was made proximal to the stent; . The graft was transected in an oblique fashion to avoid mismatch . An anastomosis was then created in an usual fashion between the graft and the artery using 6-0 prolene, continuous; backbleeding from the artery side and then forward bleeding from the graft were made before the knots were tied. The vein had a good thrill after the anastomoses were completed. A JP was placed, as there is diffuse oozing from all walls.
thanks ya'll
Attention was then turned to the groin crease: the pulse was marked and a transverse incision over it was made, slightly medial: dissection down to the femoral artery and vein was made: both are surrounded by thick scar tissue ; the vein is thick but patent: both artery and vein are dissected circumferentially and vessel loops are placed for control. A loop was marked on the skin of the thigh over the tuneler ; the tuneler was introduced in the venous aspect of the loop ( medial) from the mid thigh ( small 3 cm incision) towards the incision in the crease. The patient was given heparin intravenously. Vascular clamps were used to obtain control of the vein and a 6 mm longitudinal venotomy was then made with a 11 blade. Stay sutures were placed. The veno-graft anastomosis was then performed with 6-0 prolene, in a continuous running manner. At the completion the vein was back and forward flushed, and the sutures were tied. The graft was then flushed from its end in the mid thigh , the venous anastomosis was checked for any bleeding ( diffuse oozing) .Attention was then directed to the artery: the graft wa sthen tuneled through the arterial limb of the tunel; a similar longitudinal arteriotomy was made : the artery is severely disease, with plaque and a stent in the very proximal aspect of the SFA- the arteriotomy was made proximal to the stent; . The graft was transected in an oblique fashion to avoid mismatch . An anastomosis was then created in an usual fashion between the graft and the artery using 6-0 prolene, continuous; backbleeding from the artery side and then forward bleeding from the graft were made before the knots were tied. The vein had a good thrill after the anastomoses were completed. A JP was placed, as there is diffuse oozing from all walls.