%0 Journal Article
%T A simple and rapid vascular anastomosis for emergency surgery: a technical case report
%A Chad G Ball
%A David V Feliciano
%J World Journal of Emergency Surgery
%D 2009
%I BioMed Central
%R 10.1186/1749-7922-4-30
%X End-to-end anastomoses after resection of injured arteries were described in the United States as early as 1897, however it was not until the later stages of World War II, and then the Korean War that they became an acceptable solution for the management of acute vascular injuries [1-4]. Although Carrel and Guthrie are credited with describing an end-to-end anastomosis using triangulation with 3 equidistant sutures [5], other techniques have since been published [6]. These include, but are not limited to, interrupted and continuous suturing with, or without "parachuting" of the graft and/or vessel [6]. A simple and rapid method for end-to-end anastomosis after limited segmental resection of an injured femoral artery is described in this report.A 22-year old, otherwise healthy, male presented following a single gunshot wound to the left groin. On examination, the patient was hemodynamically stable, but had no palpable lower extremity pulses on the injured side (dorsalis pedis or posterior tibial). The ankle-brachial index confirmed an arterial injury (<0.9). On immediate exploration, a transacted superficial left femoral artery was identified. Following debridement of the contused ends of the vessel, as well as moderate mobilization, a primary repair was completed using the technique described. The patient was discharged home on post-operative day 3 with normal extremity function.As with most vascular anastomoses, a synthetic, nonabsorbable monofilament suture on an atraumatic needle (6-0 polypropylene) was employed. Basic principles of vascular repair were followed. These included debridement of contused or lacerated vessel, proper orientation, and an absence of tension on the anastomosis. We did not require an autalogous graft (reversed saphenous vein).This technique of vascular anastomosis requires a double-armed polypropylene suture placed in a continuous fashion with perpendicular bites located 1 mm from the vessel edge and 1 mm apart. The anastomosis begins at
%U http://www.wjes.org/content/4/1/30