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FIGURE 69

Axillary Artery Anatomy

The axillary artery has six branches. The pectoralis major and pectoralis minor muscles, which cover the axilla, are not shown in this drawing.

FIGURE 70

Retroperitoneal Exposure of Iliac Artery

This is a lateral lower abdominal incision often used for kidney transplants, which allows for exposure of the retroperitoneal fossa at the bifurcation of the iliac artery. The common, external, and internal iliac arteries are visualized, with the accompanying iliac veins behind the arteries. Note that the ureter crosses anterior to the iliac artery where the iliac artery bifurcates.

FIGURE 71

Femoral Artery

This is the anatomy of the femoral nerve, artery, and vein, just distal to the inguinal ligament. These anatomical relationships are important to remember when inserting various lines and catheters. Note the arterial branches just proximal to the inguinal ligament. These can produce troublesome bleeding if inadvertently injured during dissection.

FIGURE 72

Temporary Intraluminal Vascular Shunt

A. Used in most major named vessels of the body, a temporary intravascular shunt is pictured here in the common femoral artery. This vascular damage control tactic provides oxygenated blood distal to a vascular injury, while other injuries are addressed or, if necessary, the patient is transferred for a higher level of care.

B. Using appropriately sized plastic tubing, that is, commercially available carotid shunts, the shunt is secured with encircling tapes.

FIGURE 73

Complex Reconstruction of the Femoral Artery

A. Drawing illustrating a complex injury to the femoral artery.

B. The area of injury is debrided, and the sides of the superficial femoral and profunda femoris arteries are sewn together to produce a large single orifice. Depending on the tension, an end-to-end anastomosis can be performed.

C. The artery may also be reconstructed using an interposition graft, here depicted with Dacron.

D. On occasion, a bridge of prosthetic material can be sutured to the proximal superficial femoral artery, with the foreshortened profunda femoris artery sutured end-to-side to a more distal location in the superficial femoral artery.

FIGURE 74

Sartorius Muscle Flap in the Groin

This depicts the anatomy of the sartorius muscle, with its accompanying arterial supply. A flap of the sartorius muscle is useful to cover nearby vessels and nerves.

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