Mayo Set-up
– 10 blade for skin (not shown)
– 15 blade for endarterectomy (not shown)(most Dr. will probably use an 11 blade)
– Straight Mayo (Suture scissors)
– Metz for dissecting tissue close to nerves & vessels
– Straight Potts to cut vascular sutures (may be used to dissect the plaque
– Large Angled Potts used to enlarge incision into the artery
– Diamond Forceps used while suturing artery
– DeBakey Forceps used for general dissection
– Weitlander Retractor
– Thyroid Retractor (not shown)
– Army / Navy Retractor for visualization of the superior part of the incision
– Hartman Snaps w/ suture booties on them (Rubber Shods) placed on one end of the vascular suture to keep tension on it while the Dr sutures with the other half
– Snaps to secure vessel loops & noodles (neither shown) that are put around the artery & branches to occlude these vessels during the endarterectomy
– Baby Mixters (Right Angles) used to dissect down to & around the artery & branches
– Needle Holders for closing
– Javid Clamps used to hold the Javid Shunt in place during the endarterectomy
– Carotid Clamp (Karychner), this clamp is used to occlude the proximal end of the Carotid Artery (Internal Carotid)
– Large 45° Vascular Clamp (45° Angled DeBakey). This clamp is used to occlude the distal end of the Carotid Artery (External Carotid)
Back Table set-up
Under the pan I place my small items
From Left to Right
– Vascular Dilators
– Heparin Needle
– Dissector
– Nerve Hook
– Wescott Scissors
– Cassie Needle Holders
All the way to the right are the Dr.’s own instruments (just duplicates of dissector, nerve hook, & cassie needle holder)
A close up of the:
– Carotid Clamp for Internal Carotid Occlusion
– 45° Angled Clamp for External Carotid Occlusion
Both of these medications are good to have on the field for just in case situations
– 3cc of 1% Lidocaine Plain for injection into the artery if the pt. becomes bradycardic due to. carotid manipulation
– 2cc (60mg) Papaverine for injection in & around the vessels to dilate them & relieve spasm
Heparinized Saline for Vascular irrigation in 20cc syringe w/ Olive Tip (some Drs. use angiocaths)
Set-up of the Javid shunt
Attach Heparin Saline Syringe to the larger end of the shunt, flush the shunt, then clamp the shunt with a straight vascular clamp
There can be NO AIR / BUBBLES in the syringe & Shunt. Air in the shunt could result in giving the patient a stroke NO AIR….NO BUBBLES
Close up of the Javid Shunt Clamps
– External Javid Clamp on the Left
– Internal Javid Clamp on the Right
Example of how the clamps fit on the shunt
– Dissector used to dissect plaque off the artery wall
– Nerve Hook used to help fix mis-thrown sutures
Diamond Forceps used when suturing vessel
Close up of the tips of the Diamond Forceps
French (Left) Girard (Right) Forceps. These are used the same as the Diamond Forceps
