Evaluation and Management of Peripheral
Annotation for Point D
An injury to a peripheral artery or vein that does not result in complete transection and in which there is minimal loss of tissue can be repaired, depending on luminal diameter, with an interrupted or continuous technique using 6-0 or 7-0 polypropylene suture. No matter which technique is used, the last one or two interrupted sutures are left untied, or the last several loops of a continuous suture are left loose until proximal and distal flushing is performed. With an arterial repair, the proximal clamp is then reapplied, and distal backflow flushes air out under the repair as the last knot is tied. Excessive tension should be avoided when tying the last knot to avoid constricting the anastomosis. When repairing a vein, the proximal clamp (toward the heart) is left off to evacuate intraluminal air.