Surgery through the eyes of a teenager - Day 1

This week I am in Bucharest and I have the incredible opportunity to sit next to a vascular surgeon at the Institute of Emergency for Cardiovascular Diseases "Prof Dr C.C. Iliescu" and to watch closely all his activity. I am going to go from the shift reports to the visits paid to the patients, to individual consultations and even surgical interventions, all that for which purpose? Well, I really take into consideration following medicine in university and this experience would eventually show me if I am suited for this kind of job or not.

Day 1: A brachiobasilic fistula

First thing in the morning, we went to the medical shift report. The point of the meeting was exchanging essential patient care information with other medical and nursing staff, including eventual complications and surgical procedures applied on different patients.

After the report was over, we went into a cabinet in order to consult two cases, one of which would have been operated by the surgeon that I follow. The whole point of the operation was to create a way the man could undertake dialysis treatment. The intervention was supposed to bring together the brachial artery and the basilic vein, in a process called brachiobasilic anastomosis, thus creating what is known as a fistula, an unnatural bond between an artery and a vein, usually present as a hereditary malformation, but here representing the result of the whole surgical procedure.

The reason why the artery and the vein are bonded together is quite simple. Veins are superficial blood vessels, while arteries are more profound. Unfortunately, by their nature, veins transport the blood slowly, whereas the same blood flows much faster in arteries. But for a dialysis machine to work, it must be connected to a superficial blood vessel with a significant flow speed of the blood. A vein is good because it is superficial, but it must be attached to an artery due to the high blood speed necessity.

The connection was made between the basilic vein (marked on the image) and the red artery crossing nearby.

The operation could have been made even between the brachial artery and the cephalic vein, which is generally accepted as a better solution, but not in this case due to an edema that was present on the man's arm.

The operation itself consisted in three major parts: finding the vessels, bonding them and suturing the wound. When trying to find the two vessels through the layers of conjunctive tissue, we also ran across the medial nerve, an essential structure that we were ought to leave intact. When found, both the basilic and brachial artery were pinched with so called bulldog clamps, metal devices that did not let to pass the blood when applied onto the blood vessels. The bonding was realized with a hair thin thread of polypropylene. The secret of connecting the two vessels together consisted in knowing how to sew them so as not to let blood pass through. When the linking of the two was realized, the blood circulation was reopened, and the flesh sutured back into place. All in all it took approximately two hours, and it went very well, with no complications.

For me, it was an extremely interesting first operation ever to assist and also a very interesting day. See you tomorrow with another surgical story!