RU2281701C2 - Method for surgical prophylaxis of pulmonary artery thromboembolism - Google Patents

Abstract

FIELD: medicine, vascular surgery.

SUBSTANCE: one should isolate veins and arteries, squeeze a thrombus-containing vein to carry out thrombectomy through phlebotomic foramen and form arteriovenous fistula. Moreover, the latter should be embraced with possibility to slide along it, at least, twice with a ligature at provisional untightened, at least, double knot. Moreover, additional ligatures should be applied into loop ends of ligatures to provide the chance for their subsequent stretching during ligating the fistula in remote period. The innovation enables to exclude the risk for rethrombosis development at minimal traumatism.

EFFECT: higher efficiency of prophylaxis.

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Description

The invention relates to medicine, namely to vascular surgery, and can be used for venous thromboectomy to prevent retrombosis, which threatens pulmonary embolism.

A known method for the prevention of pulmonary embolism by implanting a cava-filter equipped with intersecting embolus-catching threads made of absorbable material in the stent, the implantation is carried out by percutaneous puncture of the subclavian, jugular or femoral veins, followed by vascularization of the vessel and the applicator into the lower vein, containing a filter, after which the filter is pulled out of the capsule and fixed to the wall of the inferior vena cava (Russian patent No. 2094063, IPC A 61 M 1/34, A 61 F 2/06, "Cava filter", publ. 10/27/97).

A disadvantage of the known method for the prevention of thromboembolism is that its use is possible only in the absence of damage to the walls of the inferior vena cava and surrounding tissues, as well as the fact that the constant presence of a blocking device in the venous system can interfere with the processes of recanalization.

There is also known a method for the surgical prevention of pulmonary embolism, including the allocation of blood vessels, the application of turnstiles on them, the introduction of a balloon catheter into the lumen of the selected vessel in the proximal direction to block the inferior vena cava, thrombectomy through a phlebotomy opening, the insertion of a vascular suture, balloon catheter removal, catheter insertion for regional infusion of antithrombotic drugs (V. S. Vasiliev, E. G. Yablokov, A. I. Kiriyenko. “Pulmonary thromboembolism”, Moscow, “Medicine ", 1979, pp. 93-108).

The disadvantage of this method is that despite the thromboectomy, as a result of the slow flow of venous blood, the possibility of retro-thrombosis is not excluded.

There is also a known method for surgical prophylaxis of pulmonary embolism, selected as a prototype, including vascular excretion, compression of a vein containing a thrombus, thromboectomy through a phlebotomy opening and the formation of a temporary arteriovenous fistula after this (Ed. By Academician BC Savelyev. Phlebology, Moscow, Medicine) 2001, p. 243-245).

The disadvantage of the prototype is that the closure of the fistula is a complex surgical intervention performed in scar tissue. In this case, damage to the great vessels, as well as infectious complications, are not uncommon.

The challenge facing the inventors is the implementation of such surgical prophylaxis of thromboembolism, which would allow with minimal trauma to exclude the risk of retrombosis.

A method for surgical prophylaxis of pulmonary embolism is proposed, including the separation of a vein and artery, compression of a vein containing a thrombus, subsequent thromboectomy through a phlebotomy opening and the formation of an arteriovenous fistula, new in which the arteriovenous fistula is grasped so that it can slip at least twice a thread with provisional, at least double knot, at the same time additional threads are inserted into the loop ends of the thread with the possibility of their subsequent pulling at fistula playing in the distant period.

On the basis of the Chelyabinsk emergency hospital, two operations were performed according to the proposed method. At the same time, the presence of a fistula allowed accelerating the venous blood flow due to arterial blood, which led to a rapid healing of the vein, and the presence of a sliding thread around the fistula made it possible to atraumatically close the fistula after it was no longer needed. At least twice, the thread wound around the fistula allowed the use of additional threads for ligation of the fistula in the long term without traumatic surgery in scar tissue, and the presence of at least a double provisional loose node ensured a sufficiently reliable fistula girth.

In the search process, no solutions were found containing a combination of features of the invention, which allows us to conclude that the solution meets the criteria of "novelty" and "inventive step".

A method for the surgical prevention of pulmonary embolism is as follows.

Using known diagnostic methods, the location of a floating thrombus threatening pulmonary embolism is determined, after which a vein and an artery are isolated, a vein containing a thrombus is squeezed in any known manner, and a thromboectomy is performed through a phlebotomy opening. Then, an arteriovenous fistula is formed from a segment of another sufficiently large vessel as low as possible to the phlebotomy opening, after which the fistula is grasped with the possibility of sliding at least twice with a provisional unobtrusive at least double knot, and additional threads are inserted into the loop ends of the thread with the possibility of subsequent stretching after ligation of the fistula in the long term (after 1-2 months). Vein compression is eliminated, the wound is sutured.

Example. Patient A., 48 years old, was diagnosed with thigh vein thrombosis. Surgical intervention to remove a floating thrombus is necessary. Cut the skin, subcutaneous tissue, fascia, secrete the main vein and femoral artery. A thrombosed vein with a floating thrombus is squeezed on both sides of the thrombus, a phlebotomy hole is made through which the thrombus is removed, for example, with a terminal clamp. After this, the thrombosed vein is crossed, 2-4 suture-holders are laid with synthetic threads on atraumatic needles. As low as possible to the phlebotomy opening, which is then sutured, an arteriovenous fistula is formed from a segment of a large vessel - an arterial branch, supplied, without pulling, at least twice with a thread of prolene - polypropylene non-absorbable monofilament, which has the ability to slip, make a provisional open, at least , a double knot, additional threads are installed in the looped ends of the thread with the possibility of sliding and drawing, which are laid to the skin, after which the wound is sutured. Arterial blood passes through the fistula, washing the vein on which the thromboectomy was performed. After a long period of time (1-2 months), the need for the functioning of the fistula passes. Having cut the skin at the location of the ends of the additional threads, the fistula is tightened with their help, and additional threads are removed by pulling.

Using the proposed method for the surgical prevention of pulmonary embolism allows to achieve a positive result - to avoid vein thrombosis due to the use of arterial blood flow passing through the fistula, while the repeated highly traumatic operation to close the fistula is excluded, which gives a favorable result.

Claims (1)

A method for surgical prophylaxis of pulmonary embolism, including the isolation of a vein and artery, compression of a vein containing a thrombus, subsequent thrombectomy through a phlebotomy opening and the formation of an arteriovenous fistula, characterized in that the arteriovenous fistula is wrapped with at least twice a thread with provisional open double knot, while in the looped ends of the thread insert additional threads with the possibility of their subsequent stretching when ligation of the fistula in Alain period.