RU2136223C1 - Method of plasty of renal artery - Google Patents

Abstract

FIELD: medicine, vascular surgery; applicable in prosthetics of renal artery. SUBSTANCE: method includes taking of large subcutaneous vein of femur without tributary; resection of renal artery up to level of its branching; additional incision of branches by side walls within vessel affection; suturing of side walls to form common trunk after removal of changed intima; sewing-in end-to-end reversibly of autovein between formed trunk of renal artery and aorta. EFFECT: reduced labor input and injury by plasty of renal artery. 3 dwg

Description

 The invention relates to medicine, namely to vascular surgery, and can be used for prosthetic renal artery.

 In recent years, significant successes have been achieved in surgical technique for vasorenal hypertension, however, there are known difficulties in renal revascularization with widespread artery damage, which often leads to nephrectomy.

 A known method of prosthetics of the branches of the renal artery using the internal iliac artery [1]. The technique of the operation is as follows. The vessels of the kidney cross with the preservation of the maximum possible length. Distal anastomoses of the branches of the renal artery with the branches of the internal iliac artery end-to-end with simultaneous transarterial hypothermic perfusion / T8-12C / are applied. A proximal anastomosis of the trunk of the internal iliac artery with an end-to-side aorta is performed, and the renal vein is sutured.

 The disadvantages of this method are the limited use of the internal iliac artery in connection with combined lesions of the renal arteries and ileo-femoral segments, functional significance in the blood supply to the lower limb and pelvic organs, great trauma and lengthening of the operation time.

 As a prototype, the method of renal artery plastic surgery with a U-shaped venous graft was chosen [2]. The technique is as follows. A large saphenous vein of the femur with an inflow is taken, the renal artery is isolated, it is resected, the inverse autologous vein is anastomosed with end-to-end branches of the renal artery after destruction of the venous valves, the proximal anastomosis of the saphenous vein with end-to-side aorta is applied.

 However, the known method has significant limitations in its implementation due to difficulties in the selection of a U-shaped graft and its suturing. In addition, the presence of venous valves that are destroyed during the preparation of an autograft for renal artery plastic surgery complicates the operation and does not guarantee complications in the postoperative period associated with insufficiently complete destruction of the valves and trauma to the intima.

 Therefore, the objective of the proposed invention is to reduce the complexity and morbidity of plastic surgery of the renal artery and postoperative complications.

 The problem is solved by the method of renal artery plasty, including the collection of a large saphenous vein, renal artery isolation, renal artery resection, preparation of an autograft, application of anastomoses between the aorta and the proximal end of the autograft, the distal end of the autograft and the renal artery, which implies a technical solution in which , autovenous sampling is carried out without inflow, the renal artery is resected to the level of division into branches, which are additionally dissected along the side walls within the limits of the lesion of the vessel and after removal of the altered intima, they are stitched together with the formation of a common trunk, then the autovein is reversibly stitched between the formed trunk of the renal artery and the end-to-end aorta.

 Distinctive features of the proposed technical solution are significant, since their combination contributes to the solution of the task. So, the autoveins are taken without inflow, since the technology of the proposed method requires a fragment without branches. The resection of the renal artery, in connection with the above, is carried out to the level of branching, but additional branches are cut along the side walls within the limits of the lesion of the vessel. After removal of the intima, a common trunk is formed, which eliminates the need for two distal anastomoses, in the area of which the likelihood of stenosis during surgery and restenosis due to myointimal hyperplasia is 2 times higher due to the smaller diameter of the vessels. The creation of a common trunk allows the autologous graft to be sutured reversibly, avoiding valve destruction and intima trauma, and also makes it possible to use a shorter graft, which arterializes faster.

 The totality of the known and distinctive essential features, such as autogenous sampling without inflow, renal artery resection to the level of division into branches, which are additionally dissected along the side walls within the vessel lesion, removal of the altered intima, stitching of the renal artery branches with each other with the formation of a common the trunk, autologous suturing is reversible between the formed trunk of the renal artery and the aorta, allows the plastic surgery of the renal artery to be the least traumatic and laborious, as well as There is a reduction in the number of postoperative complications.

 The proposed set of essential features has not been identified in the sources of patent and scientific information, therefore, the authors believe that it meets the criteria of patentability "novelty" and "technical level".

 In accordance with the claimed technical solution, the method of plastic renal artery is as follows. Thoracophrenolumbotomy in the X intercostal space. The renal part of the aorta is isolated, lateral aortic squeezing is performed, the renal artery and its branches are mobilized, the renal artery trunk is resected to the level of division into branches, which are longitudinally dissected along the lateral side to intact areas, open endarterectomy is performed, a continuous vascular suture is made for the lower edge of the dissected the upper branch and the upper edge of the dissected lower branch, then sew the upper edge of the upper branch with the lower edge of the lower branch in the proximal direction, leaving a free section for nii, equal to the diameter of the autovenous graft, which anastomoses on the type of "end to end". Then the autologous vein is sutured into the aorta according to the "end to side" type.

 Revascularization of the kidney by the proposed method was performed in one patient. An example of a specific implementation of this method is given below.

 Example. Patient T., 55 years old, was admitted to the hospital with complaints of constant headaches, shortness of breath during physical exertion, alternating limp 500 meters.

 Sick since 1990, headaches appeared, there was an increase in blood pressure up to 220/130 mm Hg, resistant to antihypertensive therapy. A multifaceted examination was carried out, including angiography, in which subtotal stenosis of the left renal artery in the middle and distal segments, stenosis of the lower branch, stenosis of the right renal artery were revealed (Fig. 1).

 Clinical diagnosis: atherosclerotic stenosis of the renal arteries, vasorenal hypertension, chronic renal failure, stenosis of the iliac-femoral segments, tibial artery occlusion on the right, XAH-IIA art., Ischemic heart disease, angina, KFK-II, No.

 Operation: thoracophrenolumbotomy in the X intercostal space. The left kidney is bean-shaped, the pulsation in the gate is not determined. The renal artery is occluded to the branches, in the lower branch there is a stenosing plaque for 1 cm, the walls of the upper branch are thickened. A lateral squeezing of the renal aorta was performed, and a renal artery was resected before bifurcation. The branches were longitudinally dissected along the side walls for 13 mm, an endarterectomy was performed, a continuous vascular suture was made between the lower edge of the dissected upper branch and the upper edge of the lower branch. Then, the upper edge of the upper branch is sewn with the lower edge of the lower branch in the proximal direction, leaving a free section for 8 mm with which the end-to-end autologous anastomosed is anastomosed. Performed a proximal anastomosis with an aorta of the type "end to side". The blood flow is restored with the appearance of pulsation in the gates of the kidney.

 Re-hospitalized in the clinic after 5 months. A control subtraction digital aortography was performed. The autovenous prosthesis and branches of the renal artery are passable, non-stenotic (Fig. 2). The nephrophase is symmetrical (Fig. 3). X-ray endovascular dilation of the right renal artery was performed. Discharged from the clinic with antihypertensive effect.

 This method of renal artery plasty can be used in patients with multifocal damage to the renal artery in combination with atherosclerosis of the ileo-femoral segment and should be considered as an alternative to nephrectomy.

Sources of information
1. Kuestner LM, Stoney RJ The case for renal revascularization // Cardiovascular Surgery, 1995, vol. 3, No. 2, p. 141-154.

 2. The prototype. Novick A.C., Straffon R.A. Aortorenal Bypass with a Broached Saphenous Vein Graft for Renal Artery Disease Extending into this Branches // Surgery, 1979, vol. 85, No. 2, p. 225-229.

Claims (1)

 A method of renal artery plasty, including sampling of the saphenous vein of the femur, isolation of the renal artery, resection of the renal artery, preparation of an autograft, application of anastomoses between the aorta and the proximal end of the autograft, the distal end of the autograft and the renal artery, characterized in that the autograft is cut, the renal artery is carried out to the level of division into branches, which are additionally dissected along the side walls within the vessel lesion, and after removal of the altered int We are sewn together to form a common trunk, then autovein reversionny sewn formed between the trunk of the renal artery and the aorta by the type of "end to end".

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