A simple and rapid vascular anastomosis for emergency surgery: a technical case report
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A 22-year old male presented with a transected femoral artery following a gunshot wound. He underwent a successful primary repair following limited segmental resection of the injured segment. End-to-end anastomoses after resection of injured arteries include, but are not limited to, interrupted and continuous suturing with, or without "parachuting" of the graft and/or vessel. We offer a rapid and reliable repair using a conceptually and operationally simple technique. Major advantages include: 1) the operating system is always oriented towards the surgeon, 2) the posterior row of sutures is placed as both ends are readily visualized, avoiding the need for potentially obscuring traction stitches, and 3) flushing is easily performed prior to completing the anterior suture row.
KeywordsGunshot Wound Vascular Anastomosis Vascular Clamp Injured Artery Visible Lumen
End-to-end anastomoses after resection of injured arteries were described in the United States as early as 1897, however it was not until the later stages of World War II, and then the Korean War that they became an acceptable solution for the management of acute vascular injuries [1, 2, 3, 4]. Although Carrel and Guthrie are credited with describing an end-to-end anastomosis using triangulation with 3 equidistant sutures , other techniques have since been published . These include, but are not limited to, interrupted and continuous suturing with, or without "parachuting" of the graft and/or vessel . A simple and rapid method for end-to-end anastomosis after limited segmental resection of an injured femoral artery is described in this report.
A 22-year old, otherwise healthy, male presented following a single gunshot wound to the left groin. On examination, the patient was hemodynamically stable, but had no palpable lower extremity pulses on the injured side (dorsalis pedis or posterior tibial). The ankle-brachial index confirmed an arterial injury (<0.9). On immediate exploration, a transacted superficial left femoral artery was identified. Following debridement of the contused ends of the vessel, as well as moderate mobilization, a primary repair was completed using the technique described. The patient was discharged home on post-operative day 3 with normal extremity function.
Discussion of technique
As with most vascular anastomoses, a synthetic, nonabsorbable monofilament suture on an atraumatic needle (6-0 polypropylene) was employed. Basic principles of vascular repair were followed. These included debridement of contused or lacerated vessel, proper orientation, and an absence of tension on the anastomosis. We did not require an autalogous graft (reversed saphenous vein).
Although techniques of vascular anastomosis after trauma are numerous in type and form, most surgeons will default to the one associated with the greatest comfort and ease. This report offers a rapid and reliable repair using a conceptually and operationally simple technique. Its methodology is appropriate for all repairs, including cases mandating the insertion of vascular conduit. We have employed this technique for the past 15 years in nearly all patients with vascular injuries, regardless of the site and size of the vessel. This has included vessels of the neck, torso, upper and lower extremities. There have been no obvious complications associated with its use. Major advantages include: 1) the operating system is always oriented towards the surgeon, 2) the posterior row of sutures is placed as both ends are readily visualized, avoiding the need for potentially obscuring traction stitches, and 3) flushing is easily performed prior to completing the anterior suture row.
Written informed consent was obtained from the injured patient for publication of this case report. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
Thank-you to Alex Derienko for the creation of all figures.
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