RU2030168C1 - Method of forming vein valve - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method comprises steps of forming a valve from a free autoplast of subcutaneous vein, had been inverted to outside, by introducing it into a gap of an elastic member of a body, suturing inner surfaces of both branches of the transplant by a lengthwise mean suture, inlet the valve into the gap of the vein through a cross cutout of its wall and fixing the valve at process of suturing the vein injury. EFFECT: enhanced efficiency of plasty of vein valves due to ameliorated mechanical and functional properties of valve structures, being formed, and due to their implanting into any desirable part of a main vein with use a free vein autoplast as plastic material. 1 cl, 6 dwg

Description

 The invention relates to medicine, namely to vascular surgery, and can be used to form missing or destroyed valves of the main veins and arteries.

 It is known that the regional hemodynamics of the lower extremities in humans in an upright position is ensured, inter alia, by the presence of valves in the main venous trunks, which, in combination with the muscular pump of the lower leg, support the outflow of blood toward the heart, overcoming the orthostatic gravity. In patients with congenital absence of venous valves of the lower extremities, acquired by their insufficiency during pathological expansion of the main veins or when the valve apparatus is destroyed after phlebothrombosis, chronic venous insufficiency occurs, causing disability of patients.

 There are various methods for venoplasty, but all of them have serious drawbacks.

 The prototype of the invention is a method of forming valves of the main veins (Auth. St. N 631150). The method consists in the fact that the lateral branch of the main vein is intersected at a distance of 2-3 diameters of the latter, the proximal stump is dissected along the upper wall to the main vein, folded in half intimately inward and stitched along the edges. The resulting venous pocket is invaginated into the lumen of the main vein in the proximal direction along with the elastic ring and the lumen of the valve is sutured. At this level, a support ring of synthetic tissue or femoral fascia is held and fixed around the vein.

 The disadvantages of this method include the fact that the valve is formed only at the level of the confluence of a large branch of the main vein (large saphenous) and plastic is possible only if the plastic properties of this section of the vein are satisfactory. And the final section of the great saphenous vein does not always meet the requirements - many secondary branches flow into it, it is obliterated or its walls are sharply thickened and densified after phlebothrombosis. Further, an extended vascular suture is located on the edge of the newly formed valve, in the place of its contact with the venous wall, which can cause trauma to the intima with functional displacement of the valve.

 The aim of the invention is to increase the efficiency of autogenous venous valve plasty by improving the mechanical and functional properties of the valve structures formed and implanting them in any selected sections of the main vein by using a free venous autograft as a plastic material and using a new valve formation technique.

 This goal is achieved by the fact that in the method of autogenous plastic surgery of the valve of the main vein using an elastic element, the valve is formed from a free autograft of the saphenous vein, turned intima outward, by introducing into its lumen an elastic element of the frame, stitching the inner surfaces of both knees of the graft with a longitudinal middle suture, introducing valve into the lumen of the main vein through a transverse incision of its wall and fixation by a vascular suture.

 Figure 1 gives a segment of the saphenous vein with a probe; figure 2 is an inverted segment of the saphenous vein with an elastic element in the channel; figure 3 and 4 are the stages of formation of the venous valve; figure 5 - the moment of fixation of the venous valve implanted in the lumen of the main vein; figure 6 - the formation of the outer support ring.

 The method is as follows. A segment of saphenous vein 1 (see FIG. 1) with thin walls 3-4 mm long of the main vein is excised and carefully freed from paravasal tissues. Using probe 2, vein 1 (see Fig. 2) is turned intima outward and elastic element 3 is passed through its lumen (for example, a synthetic vein, a metal spiral). The ends of the elastic element 3 are folded together (see Fig. 3) in the opposite direction and tied with an atraumatic thread so that an oval is formed with a long diameter 1.5-2 times the inner diameter of the main vein. The ends of the specified median fixed thread are stitched and fixed to the median node 4, the inner angles of both ends 5 of the venous graft. Then one end of the same thread with a needle with several stitches along the inner surface of one of the graft knees is carried out to the middle of its extension opposite the median node 4 and here is fixed with a loop 6. Then (see Fig. 4) a reverse stroke along the long diameter of the valve oval with a twisted stitch 7 the surfaces of the two graft knees facing each other are sutured and the thread is again fixed to the median node 4. With two separate atraumatic sutures, the outer corners of the two ends of the 8 venous graft are tied to a double elastic element 3 with jeux sides from middle node 4. Venous valve oval formed everted, folded and sewn venous autograft and the elastic member 3 is ready for implantation.

 In a selected section of the main vein (see Fig. 5), after the isolation and compression of the central and peripheral sections, as well as the lateral branches, a transverse venotomy 9 is made on 1/4 of the circumference of the vein. After the inspection of the lumen in the proximal direction, a formed valve is introduced and fixed by suturing the edges of the vein section and passing the threads around the double elastic element 3. For the first fixing sutures, threads from three nodes on the valve base are used, the subsequent sealing suture between the nodes is applied to one of these threads. The excess ends of the elastic element 3 are cut off close to both corners of the venotomy. To prevent the valve from dropping in the retrograde direction with a sharp increase in retrograde pressure at the incision level of the main vein, a support ring 10 (see Fig. 6) of a thin strip of synthetic tissue or femoral fascia is held and fixed. The plastic is finished.

Thus, the invention differs from the prototype in the following features:
- free autovenous plastic is used, which allows you to find and use the most suitable plastic material with the thinnest wall, without its pathological changes, without lateral branches;
- the valve can be implanted in any selected section of the main vein, any number of valves can be formed, regardless of the presence of lateral branches of the main vein;
- the valve is formed not by the marginal suture, but by the middle suture of the graft, as a result of which the traumatic effect of its edges on the intima of the vein is significantly reduced - the valve configuration is significantly improved, and therefore its adaptation to the internal lumen of the vein - the length of the intravascular suture is reduced, which reduces the conditions for thrombus deposition on the surface of the valve.

 The use of an elastic synthetic vein or a metal spiral as an elastic valve frame increases the choice of its mechanical characteristics and allows radiological control of the valve.

 Clinical observation.

 Patient Sinitsyn E.N., 28 years old, was admitted to the clinic 02/26/87, I / b N 906. Complaints of swelling and fatigue of the lower extremities, trophic ulcer of the right leg. More than 10 years after phlebothrombosis of deep veins. Objectively: swelling of both thighs and legs. On the right lower leg - hyperpigmentation of the skin, in the lower third - trophic ulcer 2.5x3 cm. Moderate varicose veins of the saphenous veins of both legs.

 Rheovasography of the right lower leg - decreased pulse blood flow, difficulty in venous outflow, signs of arterial hypertonicity.

Phlebomanometry of the right lower limb:
Horizontal position 115 mm long

 Vertical position 1250 mm long

 Sample Valsalva 1360 mm East

 Muscular load 1270 mm. Art.

 Antegrade phlebography is a recanalized form of post-thrombophlebitis syndrome. On a retrograde phlebogram - absolute valvular insufficiency IV tbsp.

 Operation March 20, 87. Under endotracheal anesthesia, a longitudinal section along the anteroposterior surface of the right shoulder is exposed, carefully isolated from paravasal tissue and excised for 6 cm. The wound is sewn up. Using a probe, the vein is turned intima outward. A plastic vein with a cross section of 0.5 mm was introduced into its lumen. The latter is curved in the form of an oval ring with diameters of 2.5 and 1.5 cm. The ends of the vein in the opposite direction are connected by a monolithic atraumatic thread. After cutting off the surplus of the graft with the same thread, the internal angles of both ends of the graft are stitched and tied to the median node. Next, one end of the atraumatic suture is carried out by several longitudinal stitches along the inner edge of one graft knee to the opposing midpoint, is fixed here with an overlap, and after this an obstructive suture is put in reverse, bringing both graft knees together. With two separate sutures, the outer corners of both ends of the graft are fixed to the twin vein on both sides of the median site. The formed valve is placed in a heparin solution.

 A vertical incision in the upper third of the right thigh below the inguinal fold reveals a common femoral vein and its branches, and turnstiles are laid out. Marked sclerosis of paravasal tissue, vein wall density was noted. After tightening the turnstiles, the wall of the common femoral vein is transversely dissected by 1/4 of the circumference above the level of inflow of the deep femoral vein. The lumen of the vein is uneven, with constrictions, with tuberous dense thickenings. After separation of the jumpers, a formed valve is introduced into the lumen of the vein in the proximal direction, and three seams fixed on it are sutured, capturing both edges of the venous wall and the base of the valve. Additional sealing sutures on the vein wall and valve base. Cut off excess plastic vein. A strip of synthetic tissue was held around the vein at the venotomy level and fixed with sutures, forming a valve support ring. Turnstiles were removed, hemostasis was checked, sutures on the wound. Discharged with improvement. The ulcer healed after 1 month. In June 1988, the second stage of treatment was the operation of ligation of perforating veins of the right lower leg according to Linton. Examined a year after the first operation. Works as a crane operator. Swelling of the right lower leg is insignificant, the left lower leg is swollen. There is no trophic ulcer on the right lower leg.

Phlebomanometry of the right lower limb:
Horizontal position 110 mm in. Art.

 Vertical position 115 mm in. Art.

 Valsalva sample 1250 mm in. Art.

 Muscular load 1140 mm. Art.

 Retrograde phlebography - in the femoral artery, a weak retrograde blood flow, valvular insufficiency of the II degree.

 The marked incomplete overlap of the lumen of the vein with an implanted valve in an upright position should be associated with a deformation of the inner surface of the recanalized lumen of the femoral vein.

 In total, 8 operations of the formation of the femoral vein valve according to the proposed method in patients with chronic phlebothrombosis have been performed to date. Duration of observation of 2 months. up to 2.5 years. Plastic results are good and satisfactory. Not a single case of vein thrombosis at the site of plastic surgery was noted.

 The present invention is expediently used to form missing or destroyed valves of the main veins and arteries.

Claims (1)

 METHOD FOR FORMING A VENOUS VALVE, including invagination of a cross-stitched previously dissected inflow venous stump with fixation of the valve base on an elastic ring, characterized in that, in order to increase the efficiency of correction of venous blood flow due to the free choice of the required valve installation level, a valve is formed from an autologous valve petal "with a size exceeding the diameter of the operated vein, for which the transplant vein is turned intima outward and an elastic string is drawn through its lumen, whereby the graft create oval knee medial surface which is crosslinked between a concealed vascular suture, then through a transverse incision in the vein lumen formed by introducing valve and fix it in venous wounds suturing.

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