Surgical connection between blood vessels or other tubular or hollow structures such as loops of intestine is called anastomosis. reduction – the movement or realignment of a body part to its normal position. e.g. Reduction of a broken nose involves the physical manipulation of the bone or cartilage from their displaced state back to their original position to restore normal airflow and aesthetics. ligation – tying off blood vessels, ducts, or "tubes". grafts – may be severed pieces of tissue cut from the same (or different) body or flaps of tissue still partly connected to the body but resewn for rearranging or restructuring of the area of the body in question. Although grafting is often used in cosmetic surgery, it is also used in other surgery. Grafts may be taken from one area of the persons body and inserted to another area of the body. An example is bypass surgery, where clogged blood vessels are bypassed with a graft from another part of the body. Alternatively, grafts may be from other persons, cadavers, or animals. insertion of prosthetic parts when needed. Pins or screws to set and hold bones may be used. Sections of bone may be replaced with prosthetic rods or other parts. Sometimes a plate is inserted to replace a damaged area of skull. Artificial hip replacement has become more common. Heart pacemakers or valves may be inserted. Many other types of prostheses are used.
Pathophysiology
The changes in hypertensive retinopathy result from damage and adaptive changes in the arterial and arteriolar circulation in response to the high blood pressure. Diagnosis
Fundoscopy and patients history. Differential Diagnoses
Several other diseases can result in retinopathy that can be confused with hypertensive retinopathy. These include diabetic retinopathy, retinopathy due to autoimmune disease, anemia, radiation retinopathy, and central retinal vein occlusion. Keith Wagener Barker (KWB) Grades
Grade 1
Vascular Attenuation
Grade 2
As grade 1 + Irregularly located, tight constrictions – Known as "AV nicking" or "AV nipping" – Saluss sign
Grade 3
As grade 2 + Retinal edema, cotton wool spots and flame-hemorrhages "Copper Wiring" + Bonnets Sign + Gunns Sign
Grade 4
As grade 3 + optic disc edema + macular star "Silver Wiring"There is an association between the grade of retinopathy and mortality. In a classic study in 1939 Keith and colleagues described the prognosis of people with differing severity of retinopathy. They showed 70% of those with grade 1 retinopathy were alive after 3 years whereas only 6% of those with grade 4 survived. The most widely used modern classification system bears their name. The role of retinopathy grading in risk stratification is debated, but it has been proposed that  individuals with signs of hypertensive retinopathy signs, especially retinal hemorrhages, microaneurysms and cotton-wool spots, should be assessed carefully. Management
A major aim of treatment is to prevent, limit, or reverse target organ damage by lowering the persons high blood pressure to reduce the risk of cardiovascular disease and death.