Vascular anastomoses

1. Vascular anastomoses

Dashdamirova Nargiz 304 A
Hamitov Firat 403 Б

2.

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

3.

4. Types of vascular anastomoses

«End-to-End»
«Side to end»
«Side to side»

5. «End-to-End»

6.

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

7.

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.

8.

Donetsky ring
The Method Of Payr

9.

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

10.

11. End to side

12. Arteriotomy

13.

heel-and-toe

14.

15.

16. Side to side

17. arteriovenous fistula

18. Cardiac Artery Bypass Graft

Cardiac Artery Bypass Graft

19.

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

20. Ways to make anastomosis for vessels with different diameters

Cutting vessel with smaller
diameter at the angle
Method of Dobrovolskaya

21. Mistakes

Loose sutures
«Sandglass»
Rupture of vessel’s wall

22. 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.

23. Requirements for suture material and instruments

1. 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
2. Minimal bleeding through the hole made
by the needle
3. No thrombosis on the suture material
4. Non-absorbable filament: polypropylene,
polytetrafluoroethylene
5. The vessels of different diameters are
suturing with different suture material:
aorta 2/0-3/0, coronary arteries 7/0-8/0

24. Suture material

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

25.

26. Thank you for attention