Familiarity and experience often makes the best assistants, but like most things you cannot become experienced without assisting first! There are general principles for any assistant when first assisting, which apply equally to Vascular Surgery. These include making yourself familiar with the anatomy of the area being operated on, reviewing the surgical procedure being performed, and becoming familiar with the different instruments that will be encountered in vascular surgery. Finally, it is useful to ask about the surgeon and his preferences prior to the operation.

As a surgical assistant it is usually polite to meet the patient before the operation. This is especially important if he or she will receive a bill from you, or on your behalf.

General principles

Open operations

The specialty of vascular surgery encompasses arterial and venous surgery, and some related operations such as amputations. This chapter deals mainly with arterial surgery, because it is in this type of surgery that the assistant needs special skills, which are seldom needed elsewhere. However these skills are also applicable to venous surgery.

There are several important steps that are common to most arterial operations. These are: exposure of the vessels, establishing ‘control’ of vessels; temporary occlusion of the vessels, and the therapeutic part of the operation, which may involve grafting, patching, or performing anastomoses. These steps, and the assistant's role in them, are described in more detail below.

Exposure

Most vascular procedures start by exposing the vessels required for the operation to be performed. During the operation, the surgeon must be able to stop blood flowing from ‘upstream or downstream’ to the operative site, whenever needed.