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Ligation of a damaged internal iliac vein and suturing of a damaged common iliac artery

Damage to the common iliac vessels can occur with laparoscopy during the introduction of the trocar and cannula or when the lymph nodes are removed for cancer.

METHODOLOGY:

General steps for dressing and suturing

1

Most often, the right external iliac artery is damaged (as shown here), since most surgeons are better at owning and, accordingly, inject the trocar with the right hand. Below is shown damage to the hypogastric vein. Both lesions are accompanied by heavy bleeding.

2

The first thing any Hirurg should do is to close the damage to an artery or vein with a finger. Note the proximity of the right ureter and the right common iliac vessels.

Ligation of a damaged internal iliac vein

3

Each laparotomy instrument set has spongy pads. With their help, it is necessary to squeeze the vessel proximal and distal to the site of damage, be it, as shown, the internal hypogastric vein or the common iliac artery (see Fig. 5). Bleeding from the site of injury should be stopped. You cannot try to suture a large blood vessel with ongoing significant bleeding.

4

Ligation of a damaged vein can be more difficult than suturing a damaged artery. Ligation of the internal iliac vein may not have any consequences. The figure shows vascular clamps superimposed proximal and distal to the lesion site.
The vein is ligated with synthetic absorbable suture next to the clamps. Over time, collateral venous circulation will develop between the lower limb and the ligated internal iliac vein.

Suturing a damaged common iliac artery

5

Spongy pads can also be used to stop bleeding from a damaged common iliac artery. Damage to the arterial wall must be sutured. First you need to stop the bleeding. With ongoing bleeding, suturing may not be neat and accurate. Spongy pads, as a rule, are available in laparotomy sets, but special vascular instruments are not. The use of other, not special vascular, clamps (Kelly, Kocher, etc.) on large vessels is a gross mistake.

6

The figure shows the correct way to restore the common iliac artery. Vascular clamps are applied proximal and distal to the lesion site. After stopping the bleeding, a transverse suture is applied to the wound of the arterial wall with a synthetic non-absorbable monofilament thread 5/0 with an atraumatic needle. The suture material “Prolene” used for operations on the heart and vessels is usually released already on both sides with atraumatic needles. This allows you to impose a continuous seam that turns outward, and not screwed inward. An inwardly sutured seam can alter blood flow, contributing to thrombosis.
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Ligation of a damaged internal iliac vein and suturing of a damaged common iliac artery

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