maraprpreview1982

25

Co.n:lationolthc:Aona

SurJicaiTechnique

Surgical Technique Subclavian Artery Patch Angioplasty A left posterolateral thoracotomy is made throuah the third or fourth interspace. The pleura is incised over the aorta, and the incision carried up the subclavian artery . Retraction of the medial pleural ftap carries the vagus and recurrent laryngeal nerve medially. The ductus , distal aorta, area of coarctation, left subclavian artery, and arch up to the left carotid artery are dissected (Fig. 12·2). A heavy silk tie is passed around the ductus. The branches of the subclavian artery are tied, with tyina of the vertebral artery to prevent subsequent development of a subclavian steal sy ndrome . The ductus is lip ted. A vascular clamp is placed across the aortic arch between the left carotid artery and the left subclavian artery. Another clamp is placed distal to the coarctation. Heparin is not used. The distal subclavian artery is liaated and divided. A lateral incision is made in the aorta below the coarctation (Fia. 12-3) and carried through the area of coarctation into the subclavian artery (Figs. 12·4, 12-S). If present, any marked internal ridae of coarctation is excised. A suture is placed through the end of the subclavian artery and the distal portion of the aortic incision in order to align the

Figure 12·3

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63

D ESIGN COUNCIL

Design by Byron Ferris.

1967 version of international travelers ' symbols now in use at the Portland International Airport .

Examples of the airport signage.

Right: moving announcement for the architectural firm unfolds to spell out the name of the Zimmer Gunsul Frasca Partnership. On the back are the addresses and dates of the six previous locations of the 40-year-old firm before their 1981 move to the Sherlock Building, "Our new Sherlock home."

Cover and pages from ZGF brochure.

70

Communication Arts March / April 1982

I

If only may grow: firmer, simpler.... quieter, warmer.

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c.ned oubt..t•,._ We lwvt o:nnwd c..d\11 C'Ontrol ol opn«tn(( Dpmlft. 10 tNt riwy .n ~ly lown lod.y ttwn they wnt five ~MI o130 Wt twvc .. mphf.ed W.l)'l oldolnathinp.tndi'WinmadrllltolourC'OfrlpUtftSfwrout~ntchora.toltwtour peop&e,Nvtlhlhmetowort~vdy«ilnprov•. . wtYictto~And

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75

CA DESIGN /PRODUCTION

One of the 11-inch proportioning wheels that we constructed for CA. This one is an old veteran that was retired several years ago and now hangs as a wall decoration but it still functions with accuracy.

We thought the coloration was more interesting than our clean , new ones.

The pattern of our templates that are made as film positives.

Right: example of a layout made with a 2H mechanical pencil on vellum.

84

Communication Arts March / April 1982