RU1806618C - Method for intraoperation determination of excessive length of free margin of incompetent venous valve cusps - Google Patents

Abstract

The invention reduces the time required to complete an operation. The essence of the method is as follows. Under general anesthesia, an incision is made along the anterior-medial surface of the thigh, beginning immediately under the inguinal fold, extending laterally from the Ken lines downward over a length of 10-15 cm. The total (OBV), superficial (PBV) and deep (ABV) femoral veins are distinguished. The PBB valve is found, and after its insolvency is identified, the occluders are applied to the OBB, the WBG and the PBB. A vein in the sinus region is cut longitudinally between the commissures. Next, with two micro-forceps, a vein is taken for adventitia. The invention relates to medicine, namely to microvascular surgery. The purpose of the invention is to increase the accuracy and simplify the determination technique. The proposed method allows to reduce the time of the operation, it eliminates lengthy measurements, and the ability to control the quality of the roar of the base area of the commissures on both sides and parted. At the same time, the free edge. the valve stem is sagging distally. With a vascular hook, the leaflets are grasped and removed into the hole in the vein over the entire excess length of the leaflet free edge. The free edge of the cusps is sutured to the length by which it protrudes in excess from under the edges of the hole in the vein. Suturing is done by thread 8/0 by piercing the vein from the outside to the inside through the base of the commissures with grasping the excess free edge of the cusps into stitches until it is returned to the position perpendicular to the axis of the vein. When dilating the valve sinus at the ends of the sutures, the edges of both flaps lie parallel to each other with the same tension in a straight line. The venotome opening is sutured continuously with 8/0 thread. Removing the clamp from the proximal end of the vein by retrograde filling of the sinus blood and the absence of it distal to the bottom of the valve judges the valve's closure function. With PBV and GBV remove the clamps. At the end of the operation, the wound is sutured tightly leaving graduates in the subcutaneous tissue. (L 00 about o 00 of the design before the stage of suturing the vein avoids the likelihood of reoperations. This goal is achieved by the fact that in the method of intraoperative determination of the excess length of the free edges of the cusps of the n, natural venous valve, including opening the vein between comissural elevations measurement

Description

cusps, after a longitudinal venotomy, the vein is spread over commissural elevations, and the excess length of the free edges of the cusps is determined by the height of excretion of the middle sections of the cusps of the valve from the venotomy wound.

An example, Patient M. 51 years old, a medical history of Ms 9209, an employee, was admitted to the clinic 12.09.90 g, with complaints of edema that appeared in the first half of the day, which did not completely disappear after rest; orthostatic cruralgia, the presence of varicose veins, trophic disorders of the skin of the left lower leg. Sick since 19 years, gradually the disease progressed and was manifested by all the symptoms of the first pregnancy.

When viewed on the anterior-medial surface of the left thigh and left tibia in the great saphenous vein pool, varicose nodes with palpation are painless, mild-elastic consistency. The ankle, and the lower third of the left lower leg are swollen. The swelling is dense, with pressure, the lobes remain. In the lower third of the lower leg, the circular zone of induction is 6 cm wide. In retrograde femoral phlebography, the insufficiency of the femoral-popliteal segment was revealed (discharge of contrast medium to the upper third of the lower leg). In ultrasound dopplerography - valve failure of the superficial femoral vein. The hopelessness of conservative therapy is taken into account. The patient has proposed microsurgical reconstruction of the valve of the superficial femoral vein with extirpation of the large saphenous vein, to which she agreed. On 3.10.90, under endotracheal anesthesia, a microsurgical reconstruction of the superficial femoral vein valve was performed, and a large saphenous vein of the left lower limb was removed. A section with a length of 12 em on the antero-medial surface of the left thigh, which begins immediately below the inguinal fold and runs lateral to the Ken line down, distinguishes common (OBV), surface (PBB) and deep (GBV) femoral veins. An insignificant valve was found at the mouth of the WSP, which was located 6 cm below the discharge of the HBV. After testing the valve and detecting its insolvency, on-off switches, on-off heaters and on the mouth of the onshore safety switches are superimposed. Venotomy between commissures

exactly in the middle over 8 mm. During the audit of the valves, it turned out that the valves are overgrown, their free edge sours below the bottom of the valve. To determine the amount of excess free edge, the valvular sinus is spread by diluting the base of the commissures with two microvascular forceps in opposite directions perpendicular to the axis of the vein. Leaflet free edge

taken by a tricuspid graft in the middle of its length and removed from the venous opening to the entire excess length. The value by which the free edge of the valves protrudes from under the edges of the incision in the vein was

 excess length of free edge. The established excess length of the free edge was sutured by suturing the vein wall in the area of the base of the commissures on both sides and grasping in a suture with suturing and tying knots on the outer surface of the wall, veins in the projection area of the base of the commissures. When diluting the veins at the ends of the sutures, the upper edge of both folds lies

perpendicular to the axis of the vein, with each

the free edge lies parallel to each other on the same line. The venotomy opening was sutured with 8/0 thread. With the removal of the occlusor.a with OBV venous sinus

filled to the bottom of the valve; there is no blood flow distal to the sinus. For twin testing, the valve is healthy. Control of hemostasis. Layered stitches for wounds. Elastic bandage.

Claims (1)

The patient was examined 3 months after the operation. The disappearance of edema, symptoms of orthostatic cruralgia, trophic skin disorders are noted. In Doppler ultrasound, the reconstructed PBB valve is healthy. SUMMARY OF THE INVENTION A method for intraoperatively determining the excess length of the free edges of leaflets of an inconsistent venous valve, including opening the vein between commissural elevations, measuring the valve leaflets, characterized in that, in order to increase the accuracy and simplify the determination technique, after a longitudinal venotomy, the veins are flattened commissural elevations, and the magnitude of the excess. The length of the free edges of the valves is determined by the height of the removal of the middle sections of the valve cusps from the venotome wounds.