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    • Temporary vascular occlusion is a vital step in cardiothoracic surgeries to control blood flow and to ensure a clear operating field1. Since the beginning of this field, innovations in the development of vascular clamps have played a key role in minimising injuries and improving surgical results. 

     

    Temporary vascular occlusion in the history of cardiothoracic surgery

    The art of surgery has evolved considerably since its creation, with instruments that are increasingly efficient. Interest in vascular and cardiothoracic surgery has led to the need for more effective and less traumatic temporary vascular occlusion solutions2.  Good occlusion conditions will determine the precision and success of surgical interventions. Since 1850 and until the 2000s, pioneers in cardiothoracic surgery have worked on numerous developments and innovations in vascular clamping methods and instruments. Among them, the Doctors William Stewart Halsted, Clarence Crafoord, Michel E. DeBakey, Victor P. Satinski and Denton E. Cooley have made great contributions, and the clamps used today still carry their names2. Afterwards, many prominent cardiothoracic surgeons have become interested in vascular clamps and clips, always looking for more effective solutions that would allow clamping pressure to be adjusted while respecting the tissue as much as possible to avoid surgical trauma2. 

     

    The need for vascular occlusion at all stages of cardiothoracic procedures 

    Clamping is an essential surgical technique in cardiothoracic surgery. It is necessary to interrupt blood flow to a vessel or isolate an anatomical structure throughout the entirety of procedures3. Clamping controls or stops blood flow and provides a clear operating field for the surgeon4. Different types of cardiovascular clamps exist depending on the type of vessel that requires clamping, the occlusion capacity, the handling of the clamp, and its atraumatic features3, 4. The clamps can be used with soft inserts, which will make the clamping atraumatic, in order to prevent intimal lesions or haematomas on vessels4. With regard to the type of vessel clamped, arterial and peripheral venous clamping is distinguished from aortic and pulmonary clamping4.  Aortic clamping is necessary for many cardiac procedures. The endothelial, hemodynamic, and humoral effects of aortic clamping and unclamping have been widely studied.1 Transmural pressure exerted on the inner wall of the aorta is more than eight times greater than systemic pressure during clamping. For this reason, the development of vascular clamps and its application method are crucial in minimising endothelial lesions1. The procedures we use clamping for include coronary artery bypass surgeries, the repair or replacement of heart valves, lung transplants and thoracic tumour resections5.  

     

    Covered and uncovered clamps in open and minimally invasive cardiovascular surgeries 

    The difference between covered and uncovered clamps is in their design and impact on blood vessels6. Covered clamps feature silicone pads or coatings that reduce mechanical and traumatic damage to vessel walls, reducing the risk of endothelial damage and thrombosis. Uncovered clamps, on the other hand, which lack these coatings, can cause greater vascular trauma, increasing the risk of postoperative complications6. In open and minimally invasive surgery, the two types of clamps can be used, and the choice depends on the sensitivity of the vascular structure and the expected clamping time6. The DeBakey clamp significantly improved aortic clamping by developing clamping jaws to distribute pressure. Subsequent developments have adapted DeBakey jaws to minimally invasive surgery by adapting the length and inclination of the clamp1. The appropriate use of clamps according to the type of surgery and vessel condition is crucial to ensure optimal recovery and reduce complications6. 

     

    Peters Surgical, a wide range of products for temporary vascular occlusions.  

    Peters Surgical offer a wide range of solutions for temporary vascular occlusions, combining clamping quality (occlusal force, clamps of various straight, angled, and curved lengths) and atraumaticity, thanks to the different types of covers available.  They are specially designed and developed to adapt to different cardiac, vascular, and thoracic surgical procedures.

    • Cygnet® clamps are flexible and reusable. They have multiple uses and can be used for aortic clamping. The rigid sheath is designed to allow it to be tunnelled and then precisely positioned. After closing the clamp, the extendible sheath can be retracted to make way for a flexible sheath that can be positioned outside the operating field, allowing easy remote handling, particularly during minimally invasive surgeries1. They are available in many types, straight or curved, and are compatible with Intrack® inserts.  
    • Intrack® clamps are used for the temporary occlusion of any artery type, vein, or prosthesis in peripheral vascular, cardiovascular and general surgery. They are available in more than 25 surgical clamp models in different shapes and lengths and are used exclusively with Intrack® inserts. The Intrack® clamp and insert combo is designed to provide effective occlusion of blood vessels, while minimizing vascular damage and fragmentation of atherosclerotic material.  Available in different lengths (33 mm, 66 mm, 86 mm), they adapt to different surgical needs, offering standard, conforming, double and ultra traction surfaces for maximum adaptability.  
    • Intrack® inserts are detachable, atraumatic, and single-use clamps, available in 4 designs, ensuring improved protection of vessels according to user requirements. They are compatible with flexible Cygnet® clamps and Intrack®  clamps. Suitable for the temporary occlusion of any type of artery, vein, or prosthesis requiring atraumatic external clamping, the flexibility of the clamp adapts to all straight/angled or curved shapes thanks to the detachable linear clamp attachment system. These innovative products provide safe and effective temporary vascular occlusion, meeting the demands for cardiovascular and peripheral vascular surgery. 

    SOURCES 

    1. Bates MJ, Chitwood WR Jr. Minimally invasive and robotic approaches to mitral valve surgery: Transthoracic aortic crossclamping is optimal. JTCVS Tech. 2021  Sep 22;10:84-88. doi: 10.1016/j.xjtc.2021.09.034. PMID: 34977709; PMCID:  PMC8691828.  
    2. Ailawadi G, Nagji AS, Jones DR. The legends behind cardiothoracic surgical instruments. Ann Thorac Surg. 2010 May;89(5):1693-700. doi:  10.1016/j.athoracsur.2009.11.019. PMID: 20417823. 
    3. Hickman GA, Mortensen JD. A comparative evaluation of vascular clamps.  Journal of Thoracic and Cardiovascular Surgery 1962 Nov;44,5.  
    4. Site de l’AORN (Association of periOperative Registered Nurses).  Cardiothoracic Instrumentation. Consulté sous le lien:  https://www.aorn.org/article/cardiothoracic-instrumentation le 19/07/2024 
    5. Perspectives in Cardiothoracic Surgery. Society for Cardiothoracic Surgery in Great Britain and Ireland. The SCTS Ionescu University – Volume I. Edited by Paul  Modi 
    6. Bunt TJ, Manship L, Moore W. Iatrogenic vascular injury during peripheral revascularization. J Vasc Surg. 1985 May;2(3):491-8. PMID: 3889383. 

    LEGAL MENTIONS  

    Intrack® clamp: Class Ir  

    INDICATIONS: 

    Surgical clamps are used with jaw inserts to occlude a blood vessel temporarily and may be used to clamp over indwelling catheters. Suitable for veins and arteries. 

    For Vascular 

    -Suitable for veins and arteries 

    -Performs efficiently on either diseased or normal vessels 

    -Provides occlusion of atherosclerotic vessels without excessive closing forces 

    -Minimizes intimal damage and fragmentation of atherosclerotic material 

    -Can be clamped over indwelling catheters For Gastro intestinal 

    -Replaces bulky, rubber shod clamps 

    -Cushion-design of inserts enables occlusion without crushing the bowel 

    Carefully read the instructions for use of the medical device before use. 

    Intrack® insert: Class IIa 

    INDICATIONS: 

    Surgical clamps are used with jaw inserts to occlude a blood vessel temporarily and may be used to  clamp over indwelling catheters. Suitable for veins and arteries. 

    For Vascular 

    -Suitable for veins and arteries 

    -Performs efficiently on either diseased or normal vessels 

    -Provides occlusion of atherosclerotic vessels without excessive closing forces 

    -Minimizes intimal damage and fragmentation of atherosclerotic material 

    -Can be clamped over indwelling catheters For Gastro intestinal 

    -Replaces bulky, rubber shod clamps 

    -Cushion-design of inserts enables occlusion without crushing the bowel 

    Carefully read the instructions for use of the medical device before use. 

    Cygnet® Flexible Clamp. 

    INDICATIONS: 

    The Cygnet® clamps are indicated for use in cardiovascular, peripheral vascular and general surgical  procedures. They are used for temporary occlusion of all types of arteries and veins, including aorta  clamping during mini-thoracotomy cardiac surgery. The Cygnet® clamps must exclusively be loaded  with single use Intrack® inserts prior to use. Medical device class Ir. Manufacturer: Vitalitec International  Inc. distributed by PETERS SURGICAL. Carefully read the instructions for use of the medical device before use.