Introduction

Patch angioplasty is used to repair a partial disruption of a vessel wall or longitudinal incision, where simple suture would result in narrowing of the vessel. The arteriotomy below was made in the common femoral artery as part of a procedure to remove clot from the external iliac artery.

Technique

The patch may be constructed from a piece of vein, artery or synthetic material. The artery should be trimmed and the patch cut to the appropriate size. The ends should be rounded, to aboid narrowing at the apices.

A double-ended, non-absorbable monofilament suture is used for the repair. The needle is passed from inside of the artery to outside, through all layers of the wall, to avoid creating an intimal flap.

Starting at one end, pass the each needle through the patch and through the artery and secure with a knot on the outside of the artery.

Suturing is continued around the artery, starting at the far wall, the needle passing outside-in on the graft and inside-out on the artery. An assistant follows, keeping appropriate tension on the suture line.

Minimal handling of the artery, and especially the intima, will reduce the risk of late thrombosis.

Sutures are placed in a clock-face pattern at the apices of the repair. Once around the apex, the second needle should be used to finish the first apex. This insures that sutures are appropriately placed at the ends of the patch.

Before closing the inflow and outflow are released to remove any clot, and the artery flushed with heparinised saline.

The suture is then tied on one side of the repair, away from the apices.

trauma.org (7:12) December 2002