End-vascular anastomosis

After a sharp cut or debridement, those with smaller arterial defects can be anastomosed directly. Vascular end-to-end anastomosis precautions: 1. The length of the stump separation should be appropriate. When the vascular suture is too short, it will cause failure. In end-to-end anastomosis, sometimes the upper and lower sections of the blood vessel must be properly separated and ligated, and some collaterals must be cut off, but the more important arteries such as femoral depth, circumflex or brachial depth cannot be severed. If the tension is still high, blood vessel transplantation is preferred to rebuild blood flow, and end-to-end anastomosis is not allowed. Vascular transplantation should not be too long, otherwise the blood vessels will bend and block the blood flow. At the same time, anastomosis must pay attention to make the longitudinal axis of blood vessels consistent, to avoid blood vessel twisting. 2. Suture pulling and ligation should be tight and appropriate, not too loose to avoid blood leakage; not too tight, so as not to cause anastomotic stenosis. 3. After loosening the blood vessel clamp, the blood flow in the distal segment can be restored, which is manifested by redness of the skin of the distal segment of the limb, filling of the subcutaneous veins, recovery of capillary fillings, palpable arteries, and good venous return. If the above phenomenon does not occur, or disappears after a period of time, check the anastomosis and its distal vessels for obstruction. Common causes include: ① imperfect anastomosis techniques that narrow or block the anastomosis; ② thrombosis; ③ vasospasm. Generally, first apply warm compresses with warm saline gauze. Procaine seals around the blood vessels, or wet compresses with 2.5% poppy tincture. If no significant effect is seen within a short period of time, it should not be observed and waited. The anastomotic suture should be removed in time to investigate; use a flat needle or plastic tube to insert into the lumen of the blood vessel to attract and rinse to clear the thrombus, and inject heparin saline or procaine solution. To relieve vasospasm. If the blood flow is still not smooth, there is vascular intimal injury, adventitia embedding or anastomotic stenosis, the anastomosis should be excised and re-anastomosis.

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