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Ebook Vascular surgery: Part 2

(BQ) Part 2 book “Vascular surgery” has contents: Techniques of open vascular surgery, abdominal aortic surgery, thoracic aortic surgery, infrainguinal revascularization, lower limb amputations, vascular surgery of head and arm, vascular trauma, venous surgery, and other contents. | Chapter 2 Techniques of open vascular surgery Exposure of the aorta  40 Exposure of iliac arteries  44 Exposure of the common femoral artery  46 Exposure of the popliteal artery  48 Exposure of calf and foot arteries  5 Exposure of the carotid artery  55 Exposure of the subclavian artery  57 Exposure of the axillary artery  59 Exposure of the brachial artery  6 Techniques for vascular anastomoses  62 Techniques for haemostasis  69 139 140 Chapter 2   Techniques of open vascular surgery Exposure of the aorta Transperitoneal approach Commonest approach. Allows inspection of peritoneal contents. Patient position Supine. Incision There are two alternative incisions.   Vertical midline from the xiphisternum to just above the symphisis pubis • Quick, good access to the aorta between the superior mesenteric artery (SMA) and iliac arteries. • The aorta can be controlled at the diaphragm, if necessary (mobilize the left lobe of the liver, and divide the right crus of the diaphragm), but access between here and the SMA difficult because of the pancreas, unless the spleen and pancreas mobilized completely over to the right. 2  Transverse just above/below the umbilicus • Less respiratory compromise post-operatively. • In tall, thin patients, access to the upper aorta and distal iliac vessels may be more difficult. Steps Full laparotomy in elective case. 2 Move the small bowel to the right of the abdomen to expose the duodenal–jejunal flexure. 3 Incise the retroperitoneum around the 4th part of the duodenum to mobilize it off the aorta. 4 Clear tissue from the anterior wall of the aorta at this level, and then dissect up in the same plane, until you reach the left renal vein crossing the aorta (do not mistake the inferior mesenteric vein for the renal vein—the former runs much more superficially and obliquely; the latter is closely applied to the aorta (see Fig. 2. )). This gives you a guide to the position of the renal arteries so that an infrarenal .