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CASE 32: Molmenti Tourniquet for Heavily Calcified Vessels

Santiago J Miyara; Alexia McCann-Molmenti; Sara Guevara; Anshul Vemuri; Kambhampathy Krishnasastry; Ernesto P Molmenti

  • 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 112-118
An illustration shows 2 rounded cross sections of an artery that is to be occluded. The label corresponding to the cross-section on the left reads, blood vessel to be occluded. Both the cross sections show atherosclerotic plaque within the artery. The text reads, a sponge (shown in green) is placed within the tourniquet overlying the non-calcified area of the arterial wall. The sponge (or other soft objects such as gel or silicone) conforms to the shape of the vessel, occluding its lumen by pushing on the wall. This can potentially minimize the injury to the plaque. The tourniquet around the blood vessel is labeled in the second cross-section.
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FIGURE 112-119

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

An intra-operative shows a tourniquet placed around the blood vessel and a sponge in the adjacent area.
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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.

An intra-operative shows an occlusion procedure. Two arrows highlight a tightened tourniquet and the sponge placed close to it.
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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.

An intra-operative shows an occlusion procedure. A tightened tourniquet, additional clamps, and a sponge were placed close to the occlusion site.
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