12 Vascular surgery 12

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12 Vascular surgery

12.1 Neck – 150

12.1.1 Supine position – 150

12.2 Upper extremities – 152

12.3 Lower extremities – 154

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12

12.1

Neck

12.1.1

Supine position

. Figs. 12.1–12.4.

Indications

operations to vessels (glomus tumour).

Preparations

4 Arm positioning devices 4 Padded arm protection 4 Gel ring

Positioning

4 Standard operating table position 1, position 2 or universal operating table

4 Anaesthetic preparation and induction in supine position with 2 adapted arm positioning devices

4 Normal positioning of the operating table in the theatre

4 When positioning the patient, take appropriate measures to prevent decubitus at areas which are subjected to pressure

4 Possibly pad the shoulders with a flat padded cushion

4 Tilt the operating table in the Trendelenburg position, raise the back plate by 20–30°, lower the leg plates and the head section by hand

4 Position the head on a gel ring, possibly slightly turned to the side and reclined

4 Position both arms at the body with arm protection, forearm slings, clips or other positioning aids or the infusion arm in the supination position with max. 90° abduction on an arm positioning device

4 Apply the neutral electrode and connect to the HF surgery device

4 Arrange absorbent drapes or self-adhesive covers for preoperative skin disinfection

4 Position the operating lights 4 Patient warming system

Operation to the carotis: carotid patch, carotid shunt, carotid TEA; tumour

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. Fig. 12.1. Supine position with raised back plate and lowered head plate

. Fig. 12.2. Supine position with raised back plate, adapted connection bar, fastening piece and one-piece horseshoe-shaped headrest

. Fig. 12.4. The head is reclined and held in a stable position with a one-piece horseshoe-shaped headrest

. Fig. 12.3. The head is reclined and held in a stable position with a gel ring

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12

12.2

Upper extremities

12.2.1

Supine position

. Figs. 12.5, 12.6.

Indications

Embolectomies of the upper extremities; shunt placement, (Cimino shunt), shunt revisions; shunt connections, e.g. axillofemoral bypass.

Preparations

4 Arm positioning devices 4 Large arm table

Positioning

4 Crosswise positioning of the operating table top in the theatre

4 Remove the arm positioning device on the operating side and attach the large arm rest to the side rail of the back plate

4 Position the patient near to the edge of the table

4 Standard supine position, position the infusion arm on the arm positioning device

4 Apply the neutral electrode and connect to the HF surgery device 4 Arrange self-adhesive covers for preoperative skin disinfection 4 Position the operating lights

4 Patient warming system

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. Fig. 12.5. Supine position with arm in abduction. The back plate can be adjusted during the operation without jeopardising the stability of the large arm table

. Fig. 12.6. Arm positioning e.g. for shunt placement and shunt connections

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12

12.3

Lower extremities

12.3.1

Supine position

. Figs. 12.7–12.9.

Indications

aneurysms, e.g. abdominal aortic aneurysm, embolectomies to the lower extremities; prosthesis connections, e.g. axillofemoral bypass.

Preparations

4 Arm positioning devices Positioning

4 Normal positioning of the operating table in the theatre

4 Spread out and pad both arms on the arm positioning devices 4 Apply the neutral electrode and connect to the HF surgery device

4 Arrange absorbent drapes or self-adhesive covers for preoperative skin disinfection

4 Position the operating lights 4 Patient warming system

Angioplasty procedures, e.g. profundaplasty, patch graft; shunts, e.g. Y-shunt;

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. Fig. 12.7. Supine position for Y-shunt operation with arms in abduction

. Fig. 12.8. Maximum 90° abduction and supination position of the arms

. Fig. 12.9. Head positioned on a double wedge cushion