Vascular

Surgery
Concept :
Suite & Tie
Bedah Vaskular

yang
 Definition of Vascular Surgery

Vascular surgery encompasses the diagnosis and

comprehensive, longitudinal management of
disorders of the arterial, venous, and lymphatic
systems, exclusive of the intracranial and coronary
arteries

Vascular Surgery Board of the American Board of Surgery

 Ahli Bedah Vaskular
Suite and duty
• vascular surgeons should possess the advanced knowledge and skills to
provide comprehensive care to patients with vascular disease.
• All elements of clinical evaluation; non-invasive testing including
plethysmography, duplex ultrasonography, magnetic resonance imaging, CT
scans, angiography, and other diagnostic tests utilized in the diagnosis of
vascular disease.
• Comprehensive management of vascular disease to include screening and
surveillance, medical management, drug therapy, risk factor management,
wound management including amputations, and other adjunctive procedures.
• Indications and techniques relating to open and endovascular treatment of
vascular disorders to include the entire spectrum of interventions used to treat
vascular disorders including occlusive, aneurysmal, inflammatory disease,
trauma, and neurovascular compressive syndromes involving the arteries and
veins of the body (excluding the intracranial and coronary arteries).  This
includes the aorta and its branches, the arteries of the neck, pelvis and upper
and lower extremities, and the venous system.
• The critical care of the vascular surgery patient.
 Procedural Skills (Surgical DOPS) and
Procedure Based Assessments (PBAs).
Aortic aneurysm Upper Limb
 Elective open repair tube graft  Brachial artery embolectomy
 Elective open repair bifurcated graft
 Endovascular repair Re-do Vascular Surgery
 Ruptured aneurysm repair  Removal of infected graft

Carotid endarterectomy Varicose vein surgery

 Sapheno-femoral and sapheno-popliteal ligation.
Infra-inguinal bypass  Endovenous LSV and SSV ablation
 Above knee run-off  Foam injection sclerotherapy
 Below knee popliteal run off
 Calf vessel run off Vascular access
 Popliteal artery exclusion bypass  AV fistula at wrist, upper arm
 Revision of failed AV fistula
Emergency Lower Limb
 Femoral Embolectomy
Vascular Surgery Curriculum, ISCP the Royal College of
 4 compartment fasciotomy Surgeons of UK and Ireland, Aproved by GMC, 2018
 Repair of false femoral artery aneurysm
Technical skills in patient assessment and treatment

a. Generic Vascular Ultrasound Skills

i. B mode ultrasound, spectral Doppler and colour duplex
ii. aortic ultrasound
iii. ultrasound guided vascular access
b. Generic Endovascular Skills
i. the safe use of guidewires, sheaths and catheters
ii. the exchange principle
iii. available intervention options
iv. cannulation for access
v. guidewire manipulation
vi. angiography
vii. angioplasty
c. Generic Open Vascular Surgery Skills
i. patch angioplasty
ii. end to side anastomosis
iii. proximal aortic anastomosis
 Generic Open Vascular Surgery Skills

i. patch angioplasty
ii. end to side anastomosis
iii. proximal aortic anastomosis
1. Arteriotomi melintang
2. Arteriotomi longitudinal
3. Jahitan kontinyu vaskular
patch angioplasty
patch angioplasty
Pitfall
end to side anastomosis
end to side anastomosis
end to side anastomosis
memakai graft vaskular
 End to End anastomosis

Tehnik anastomosis dengan benang polypropylene 7–0 atau 8–0

untuk anastomosis end-to-end

David V Feliciano Trauma Surg Acute Care Open 2017

 End to End anastomosis

Usahakan untuk ARTERI

jahitan dari DALAM-ke-LUAR
Sisi
Vena
 untuk mencegah disekasi
atau intima.
protesa
Setelah 1/3 dari end-to-end anastomosis selesai, tarik kedua ujung benang sampai rapat
kedua permukaannya sambil klem didekatkan satu sama lain.

David V Feliciano Trauma Surg Acute Care Open 2017;2:e000110

Lanjutkan penjahitan bagian anterior dan biarkan kedua ujung terakhir tetap kendor untuk
melakukan flushing darah menjamin aliran yang lancar .

David V Feliciano Trauma Surg Acute Care Open 2017;2:e000110

Tehnik alternatif untuk anastomosis End-To-End :
1. Bisa mulai dengan mengikat kedua ujung
2. Lanjut jahitan kontinyu
3. Anastomosis selesai  ikatan asa dikedua ujung
4. Melebarkan tepi anastomosis : irisan longitudinal
5. Lanjut jahitan kontinyu tanpa mengikat kedua ujung
Side to side anastomosis
Castroviejo
Needle holder
Anjuran : ikat semua cabang, jangan diathermi
Vascular
clips
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