Rutherford's 055: Thoracic and Thoracoabdominal Vascular Exposure скачать в хорошем качестве

Rutherford's 055: Thoracic and Thoracoabdominal Vascular Exposure

#AorticSurgery #VascularAccess #MedianSternotomy #Thoracotomy #RetroperitonealAccess #TransperitonealAccess #RutherfordVascular #SurgicalExposure #AorticArch #DescendingAorta #AbdominalAorta Drawing from Rutherford’s Vascular Surgery 10th Edition, this video explores the diverse surgical approaches required to access different segments of the aorta, the body's main artery. Access methods vary based on the specific aortic section needing intervention for issues like aneurysms, blockages, or trauma. For the ascending aorta and aortic arch, the standard approach is a *median sternotomy**, involving a midline incision from the suprasternal notch to the xiphoid, splitting the sternum to directly expose the heart sac and aorta. A less invasive **mini-sternotomy* is also used for certain repairs. Careful dissection is needed to protect nerves like the vagus and recurrent laryngeal nerves. Accessing the distal arch and upper descending thoracic aorta may use a *trans-sternal bilateral thoracotomy* (clam shell), providing broad access but causing more pain and requiring longer ventilation. Alternatively, a *left posterolateral thoracotomy* is used, requiring single lung ventilation and specific side positioning. This approach involves dissecting chest wall muscles and entering the pleural space, protecting nerves like the phrenic nerve. For the complex descending thoracic and paravisceral aorta (thoracoabdominal), a combined *thoracoabdominal approach* is needed, often using a modified right lateral decubitus position. This involves a long incision across both the chest and abdomen, dividing the diaphragm, and accessing the retroperitoneal space to expose the aorta and visceral arteries. The abdominal aorta can be accessed via *retroperitoneal* or *transperitoneal* approaches. The retroperitoneal route avoids opening the main abdominal cavity, using a flank incision and peeling the peritoneum away. The transperitoneal route opens the abdomen directly, offering better visualisation of visceral artery origins, but requires significant organ mobilisation. Both abdominal approaches require careful dissection to identify and protect vital vessels and nerves near the aorta and iliac arteries. Each technique is chosen based on the specific anatomy involved and patient factors, highlighting the precision and complexity of aortic surgical exposure.