FIGURE 48 Small Vascular Anastomoses

A. A triangulated end-to-end vascular anastomoses, a technique initially described by Alexis Carrel

B. Three temporary stay sutures may be tied as each section of the anastomosis is completed. Some surgeons prefer an interrupted anastomosis (not shown)

FIGURE 49 Deliberate Division of the Right Common Iliac Artery

A. Exposure of an injury to the right common iliac vein is very difficult. Deliberate division of the right common iliac artery between vascular clamps facilitates exposure and repair of underlying venous injury (right common iliac vein, iliac vein)

B. Following venous control, the right common iliac artery is simply re-anastomosed

FIGURE 50 Temporary Vascular Shunt

A. Used in most major named vessels of the body, a temporary intravascular shunt is pictured here in the common femoral artery. This vascular damage control tactic provides oxygenated blood distal to a vascular injury, while other injuries are addressed or, if necessary, the patient is transferred for a higher level of care

B. Using appropriately sized plastic tubing, that is, commercially available carotid shunts, the shunt is secured with encircling tapes

FIGURE 51 Complex Femoral Artery Reconstruction

A. Drawing illustrating a complex injury to the femoral artery

B. Medial and lateral incisions are made in both the profunda femoris and superficial femoral arteries. Suturing these sides together produces a larger opening, which can, at times, be primarily sutured to the distal common femoral artery

C. The artery may also be reconstructed using an interposition graft, here depicted with Dacron

D.

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