Thoratec Vectra Manual Del Usuario página 6

Implantation Tips and Techniques
Due to the compliant nature of the Vectra, it will expand approximately 0.5cm once
exposed to normal arterial pressure. We recommend the following tips and techniques
during the implantation procedure in order to allow for graft expansion and reduce the
incidence of kinking. These are further detailed on the following pages 7 through 11.
• The graft features a longitudinal orientation line, and a dashed line and apex
marker to identify the more densely reinforced area, to facilitate proper graft
positioning. (Figure 4)
• When performing the anastomoses, trim the graft to a length approximately 0.5 to
1.0cm shorter than the length measured. Pull each end slightly taut when
performing anastomosis to vessel. The end of the graft should be beveled to
accommodate a smooth lie of the graft.
• When positioning and trimming the graft, avoid bending those areas of less dense
reinforcement, especially near the anastomotic ends. The non-reinforced segment
must be trimmed to allow for proper sizing of the graft.
• Liberally irrigate with saline the inside of the tunneler sheath to facilitate freely
pushing the graft through the sheath. (Figure 5)
For looped configurations:
• Use of a sterile surgical skin marker to demarcate the proposed graft layout on the
arm will facilitate final positioning of the graft.
• Use of the two-tunneler sheath technique facilitates movement of the graft for
proper positioning prior to removing the sheath. (Figures 6 – 11)
• Perform one horizontal incision at the volar site, distal to the intended loop position,
and dissect approximately 2cm of extra space in the subcutaneous pocket around
the apex of the looped portion of the graft to allow for free expansion of the graft
after establishing flow. (Figure 10)
• Use the apex marker to properly position the more densely reinforced portion (24-32
W.P.I./9.5-12.5 W.P.C.) of the graft at the loop apex. (Figure 9)
• We recommend a loop diameter of at least 3.5cm to minimize the incidence of
kinking in the loop region.
Tunneling
Because the graft can be damaged if pulled excessively, it is necessary to use a Vectra
VAG sheath tunneler with this graft. The tunneler is designed to permit graft place-
ment by gently pushing the graft through the tunneler sheath rather than pulling.
The Vectra VAG tunnelers (except for the full curve tunneler which can only be used-
with the 5mm) can be used with either the 5mm or 6mm Vectra VAG. Refer to the Vec-
tra Tunneler IFU.
Liberally irrigate the inside of the tunneler sheath as well as all surfaces of the graft
with a sterile solution of normal physiologic saline to facilitate slipping the graft
through the tunneler (also see "Precautions" statement #3).
Figure 4. Apex marker
Figure 5. Lubricating tunneler sheath
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Vectra Vascular Access Graft