Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_3660_Библиотеки_им_академика_М_И_Перельмана

When all fragments have been removed from the arterial bed, the repair begins in the distal ICA. A single anchor bite is placed distal to the apex of the arteriotomy and secured with a surgeon’s knot followed by nine more throws. Tiny bites are then taken in continuous, non-locking fashion approximately 1 mm back from the arte­riotomy edge and approximately 1–2 mm apart. It is extremely important that the ICA portion of the repair be done with ne bites, and some authors advocate the use of the microscope for this purpose. I believe the repair can be satisfactorily performed under magnied (×3.5) loupe vision, and the experienced surgeon is not likely to encounter inadvertent stenosis. Deep or large bites in the ICA repair may create an area of focal stenosis that would be thrombogenic. As can be seen in this gure, the suture line is brought down to the region of the carotid bulb where the lumen becomes much wider. At this point, somewhat larger bites may be taken. A second suture line is begun in the CCA where a broad, deep bite is taken just proximal to the crotch of the arteriotomy and likewise continuous, non-locking sutures are brought up until the rst suture line is met. When the two sutures meet and can be tied together at the center of the incision, the artery is prepared for nal closure.