By Roger M. Greenhalgh (Eds.)
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Extra resources for Vascular Surgical Techniques, 1st Edition
Should this prove difficult or impossible, a short interposition tube graft can be used (c). Direct reconstruction of intrathoracic great vessels 33a, b & c In the presence of segmental or extensive occlusion of the LCCA (a), a bifurcation aorto-innominate-carotid artery bypass graft appears to be the most convenient technique in the majority of cases (b). However it cannot be used when the LCCA is much smaller than the innominate artery. In these rare cases, a large aorto-innominate artery bypass graft is inserted, with a smaller prosthetic tube graft being attached at its left lateral aspect in order to revascularize the left carotid bifurcation (c).
A less acceptable alternative is to coagulate these branches with a bipolar coagulator. 12 A superficial segment of the artery is excised with a microscissors, taking care to lift the superficial wall away from the deep wall and not to cut away more than half the wall of the vessel in the ellipse. Alternatively the artery may be incised longitudinally over the exposed surface with a razor-blade fragment or a diamond knife. 13 The incision may be enlarged with microscissors, to a length approximately three times the diameter of the artery.
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