Page 395 - Libro 2

PART 6 • MISCELLANEOUS
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Intraoperative Duplex Sonography
Steven A. Leers
OBJECTIVES
List the types of vascular reconstructions where intraoperative ultrasound is helpful
Describe the setup and preparation of the ultrasound equipment and transducer for use during an operative procedure
Define the duplex ultrasound criteria applied to intraoperative data
KEY TERMS
endarterectomy | infrainguinal reconstruction | intraoperative | sterile technique
GLOSSARY
autologous/autogenous self-produced or from the same organism; in the case of a bypass, using the patient’s own tissue (e.g., saphenous vein)
endarterectomy removal of plaque, intima, and part of the media of an artery to restore normal flow through the diseased segment
infrainguinal below the inguinal level; in the case of a bypass, procedures done from the groin down (outflow procedures)
prosthetic a device replacing an absent or dam- aged part; in the case of a bypass, a man-made
Vascular surgery is unique in its requirement for in- traoperative documentation of the technical success of revascularizations. In most surgical specialties, vi- sual inspection and palpation are adequate to dem- onstrate this, but the meticulous nature of vascular surgery and the devastating result of technical errors demand more from the vascular surgeon. For de- cades, the necessity of documenting technical results has been acknowledged by vascular surgeons. Not only in lower extremity bypass but also in carotid
tube used for the bypass procedure; (e.g., Dacron and polytetrafluoroethylene [PTFE])
revascularization restoration of blood flow to an organ or area by way of bypass, endarterectomy, or angioplasty and stenting
sterile technique means by which a surgical field is isolated from nonsterile or contaminated materials
surveillance keeping a watch over; in the case of revascularizations, it suggests periodically moni- toring patency and functioning by some means
visceral Pertaining to the viscera; in this case, the intestines or kidneys
endarterectomy, this has led to the suggestion of rou- tine angiography at the completion of the procedure, before closing the wound, and leaving the operating room. Color duplex scanning is the natural extension of this routine, avoiding contrast exposure and offer- ing the advantage of anatomic and physiologic infor- mation not provided by angiography. This chapter will review current applications of duplex scanning in the operating room and the results of such an approach.
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