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| 24 | ENDOSCOPIC VESSEL HARVESTING | MAQUET Medical Systems USA |
VASOVIEW 7 | Training Manual | English | v1
Copyright MAQUET Gmbh
inciSiOn and TOurniQuET dEplOyMEnT
Making the incision
Create a 2 – 3 cm longitudinal incision over the radial artery
from the wrist crease proximally. (As a point of orientation, the
elbow area will be referred to as proximal and the wrist area
will be referred to as distal.) (Figure 35)
initial dissection under direct Vision
Under direct vision, dissect through the lateral muscular
fascia to identify the radial artery and venae comitantes.
(Figure 36)
Tourniquet deployment
In procedures using a tourniquet, wrap arm tightly with an
Esmark bandage from the fingers to the elbow. Inflate the
tourniquet to 75 – 100 mmHg over systolic blood pressure,
not exceeding 250 mmHg total. Remove the Esmark bandage.
Extend the forearm, placing a rolled towel under wrist. Note
the time of tourniquet deployment. Generally tourniquet time
is kept under one hour.
EndOScOpic diSSEcTiOn
The radial artery is dissected as a pedicle with the
accompanying venae comitantes, to minimize contact
with, and potential spasm of the radial artery. Advance the
endoscope over the anterior surface of the radial artery, about
4 cm’s, to allow insertion of the BTT. Insert the BTT into the
incision. Attach the CO
2
insufflation tubing to the clear flexible
CO
2
Insufflation Port on the BTT and begin CO
2
insufflation
at 10 – 12 mmHg and a flow rate of 3 – 5 L/min. If desired
pressure is not obtained in the tunnel, the slip tip syringe
provided can be used to inflate the balloon on the BTT. Inflate
the balloon with the minimal amount of air needed to create
an adequate seal (0 – 25 cc’s of air).
(Notice that you do not achieve the same sized tunnel that
you see during saphenous vein harvesting, which is in part
due to the fascia constraining the tunnel. Later in the proce-
dure, the fascia will be released, opening the tunnel.)
Figure 35 Figure 36