The 1st SUDAVAS Vascular Anastomosis Workshop at 06-02-23 was a complete success!  great initiative from Sudanese Association of Vascular Surgeons. Khartoum, Sudan.

19 juniors, senior in surgical training and Consultant general surgery from 16 Hospital around of Sudan honed their skills and deepened their understanding of the different techniques of vascular anastomosis at the hands of expertise vascular surgeons from 11 hospital around world, without a doubt it was an unforgettable experience.

54 years old male, Over last 2 – 3 weeks he developed on his left foot change in his temperature coolness, rest pain and blue discolouration on his left 5th toe, was admitted from A&E without evidence of bilateral femoral pulses.

He is active smoker, 10 – 15 cigarette per day; Asthma; Osteoarthritis; CVA Stroke; Right Frontal lobe infarct; 60% Left ICA stenosis; Long history 10 year ago of  back pain with several infiltration on his Sacro-iliac joint; Severe lumbar vertebral canal stenosis with caudal equina compression; Long history of bilateral lower limb intermittent claudication around 200 yards.

Surgical Technique:

The procedure was carried out in a full equipped operation suite under general and regional anesthesia - spine.

The patient was positioned on a bean-bag device with the left shoulder rotated superiorly and to the right by 45° and the left pelvis angled slightly. The operating table was fully broken head down to increase the space between the costal margin and iliac crest. We used a right Rob incision begun at lateral edge of the rectus abdominis approximately 2 cm below at umbilicus and it extended curvilinearly toward the superior margin of the 11^th, 12th rib.

The latissimus dorsi, intercostal, external oblique, internal oblique, and transversalis muscles are divided using electrocautery. The peritoneum was then reflected medially off Gerota's fascia exposing the retro-peritoneum, the dissection proceeds medially and anterior to the psoas muscle and ureter.

A tunnel for the right branch graft is created, gentle dissection,  from the right common femoral artery and from the right common iliac artery, with the index or middle finger of each hand following the anterior surface of the iliac artery, avoiding venous injuries, intestine and ureter,

Post - Operator:

Extubated immediately after surgery, hemodynamic stability without need for catecholamine therapy, recovery observation for 4 hours,  transferred to ward, discharge 5 days after.

In 1963, Rob was the first to give a detailed description of the antero-lateral retroperitoneal approach. In 1980, Williams et al. described the extended retroperitoneal approach, which allows a better exposure not only of the infrarenal but also the pararenal and even suprarenal aorta.

Charles Granville Rob MC FRCS (4 May 1913 in Weybridge, England.  – 26 July 2001 NY) was a British surgeon.

Rob C. Extraperitoneal approach to the abdominal aorta. Surgery 1963;53:87-89.; Shumacker HB. Midline exposure of the abdominal aorta and iliac arteries. Surg Gynecol Obstet 1972;135:791-792.

George Melville Williams, M.D. (1930 China in Soochow, China - August 26, 2020, of complications of novel coronavirus disease-19 infection in Stuart, Florida) was an US surgeon.

Williams GM, Ricotta J, Zinner M, et al. The extended retroperitoneal approach for treatment of extensive atherosclerosis of the aorta and renal vessels. Surgery 1980; 88:846-855.

54 years old, male, Ex-smoker, Type II Diabetes, CKD stage 3, CVA stroke disease, Hypertension, previous left trans-metatarsal amputation.

Surgical Technique:

With initial failed percutaneous angioplasty, distal peroneal artery as target arterial path (TAP) with a diameter of 2.68 mm and arterial duplex scan dorsal pedal and plantar artery monophasic.

An indirect revascularization was performed,  Femoral to peroneal distal bypass via lateral with partial fibula resection , with non reversed great saphenous vein graft in-situ until knee and spliced reversed trans-located great saphenous vein to distal peroneal artery via lateral approach.

Lateral approach with partial fibula resection to improve exposure to the distal peroneal artery was described in 1974 by Dardik et al.

Dardik H, Dardick I, Veith FJ. Exposure of the tibial-peroneal arteries by a single lateral approach. Surgery 1974;75:377-83

Cumberland Infirmary, committed to continuing education, playing an important role in training in the next generation of vascular surgeons, improving technical performance in vascular anastomosis techniques.
We wait for you!

Course Director: Mr Manfred Ramirez
Course Co-Director: Mr Luis A. Navarro Garzon

The course will consist of a theoretical and practical part. It's main objective is to provide knowledge and training in different vascular anastomosis techniques.

Aimed for : Core Trainees, ST4

The assistant must learn the basic principles of anastomosis techniques, suture material; graft material; suture technique such as: interrupt, continue, anchor, parachute and tie.

In addition there will be 45 minutes of practical activity for each of the anastomosis such as from one end to the other, from one end to the other; from side to side and in addition to the patch angioplasty technique, all under the guidance of expert senior consulting vascular surgeons.

It is an essential course for those who are starting their first vascular surgery experiences.

Course Director: Mr Luis A. Navarro Garzon

This was the 1st course of "Vascular Scrub Nurse, Step by Step in Vascular Surgery", in the UK.

It is an intensive one-day course, whose main objective is to provide training skills and knowledge in the beautiful art of Vascular Surgery.

Aimed at: Junior scrub nurses in training and Senior scrub nurses interested in vascular.

The course consists of a theoretical part where the assistant must learn the basic principles in both Vascular and Endovascular surgery, they will finish this course knowing the usual and modern terminology, the instruments mostly used in Vascular and the important role of the Scrub Nurse in Vascular Surgery.

It also consists of a practical activity in a simulated theatre with models, where the three most relevant procedures in vascular surgery, CEA, AAA open repair and lower limb Bypass will be taught; explained step by step under the guidance of experts Consultant Vascular Surgeons and Vascular Scrub Nurses.

It is an essential course for those who want to be a "Vascular Scrub Nurse".

Course Director: Mr Luis A. Navarro Garzon
Course Co-Director: Mr Kevin Conway

It is an intensive one-day course, whose main objective is to provide knowledge, vascular anastomosis techniques and training skills in the fine art of Vascular Surgery.

Aimed for: ST 3-4; CT 2-3-4; Transplant Surgery Fellow; Clinical Research Fellow; Junior Vascular Surgical Care Practitioner.

The course consists of a theoretical part where the assistant must learn the basic principles in vascular surgery; basic principles in vascular anastomosis techniques; suture technique types such as: interrupted, continue, anchor, parachute and tie; the technique of patch angioplasty; and to know the most used instruments in vascular surgery.

It also consists of 1 hour of practical activity for each anastomosis on models and on the table, then after a presentation video, the participants will perform the different anastomosis techniques such as end-to-end, end-to-side and from side to side; in addition to the patch angioplasty technique, all under the guidance of expert senior Consultant Vascular Surgeons.

It is an essential course for those who are starting their first vascular surgery experiences.