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  • In instances where the recipient vessels are calcified almost circumferentially, we have observed that placing a tourniquet with a sponge (or another soft adaptable object such as gel or silicone) at the site with no calcifications allows for a less traumatic occlusion.

  • As shown in the diagrams and operative pictures, the sponge (or other soft object) adapts to the internal contour of the vessel. Although this modified tourniquet may not always be completely occlusive, any additional clamps that may be placed do not need to be tightened as much, decreasing the incidence of potential complications such as occlusion, dissection, and distal embolization.

FIGURE 112-119

Once the tourniquet (green arrow) is around the vessel, a sponge (yellow arrow) is placed overlying the area with no plaque.

FIGURE 112-120

The tourniquet (green arrow) is tightened, causing the sponge (yellow arrow) to further occlude the vessel by applying pressure over the non-calcified wall.

FIGURE 112-121

Additional clamps (or tourniquets) can be placed (if necessary) to achieve full occlusion of the vessel. In such instances, they should be tightened only enough to do so.

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