RU2664164C2 - Method for forming proximal anastomosis in prostheusing aorta in patients with occlusion of infrarenal division of atherosclerositic genesis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, specifically to vascular surgery. Perform laparatomy. Isolate the abdominal aorta to the level of the renal arteries. Then direct a 4-channel conductor with two swelling cylinders through a jaw inside the bifurcation synthetic prosthesis to its upper edge, where the edge of the prosthesis coincides with the upper edge of the upper balloon. After that, wear the unfolded stent on the upper saggy balloon for half its length – 2 cm. When blowing the upper balloon, the lower half of the stent spreads and it is fixed by hooks to a synthetic vascular prosthesis. After fixing, blow off the upper canister completely. Shift the stent with the prosthesis down the conductor. Perform a puncture of the aorta in the free from calcification and pulsating part of the aorta below the renal arteries. Direct the conductor with blown cylinders upward into the aorta, so that the lower balloon to be located just below the renal arteries, blow the upper balloon until the occlusion of the aorta. Transect the aorta in the transverse direction at the level of the puncture hole. Perform thrombectomy from the proximal aortic stump. Raise the prosthesis of the aorta with the stent to the level of coincidence of the upper edge of the lower balloon with the upper edge of the stent. Blow the bottom balloon, straighten the upper part of the stent at the same time and fix by hooks to the aorta. Through the hole in the conductor between the balloons, aspirate the air from the renal arteries and inject saline to prevent air embolism. Fill the prosthesis through the branch with saline solution with heparin. Blow off the bottom cylinder. Clamp the prosthesis with a soft clamp 3 cm below the stent. Blow off the upper container of the conductor. Remove the conductor from the prosthesis. Apply a clamp to the prosthesis to prevent blood loss.

EFFECT: method makes it possible to form a seamless anastomosis between the calcified aorta and the vascular graft, reduce the traumatism of access, reduce the time of formation of vascular anastomosis, reduce the time of kidney ischemia, exclude radiation exposure to the patient.

1 cl, 6 dwg

Description

The invention relates to medicine, namely to vascular surgery and can be used in the treatment of patients with occlusion of the abdominal aorta of atherosclerotic origin.

The most common pathology of the human arterial system is atherosclerosis with damage to the terminal aorta and lower limb arteries [1].

To date, there are known methods of open and endovascular aortic prosthetics (Belov Yu.V. Guide to vascular surgery with an atlas of surgical equipment. M: De Novo, 2000; 448 and Bokeria L.A., Alekyan B.G. Guide to X-ray endovascular heart and vascular surgery. M: Bakuleva RAMS, 2013).

With all the advantages of the known methods of aortic prosthetics, it should be noted a number of disadvantages regarding the fact that in the known methods the formation of a proximal anastomosis is often performed in patients with severe aortic calcification, it is impossible to pierce the aortic wall even with modern needles, and if an aortic endarterectomy is performed, then the formation vascular anastomosis occurs between a thinned aorta and a synthetic prosthesis, which often creates technical difficulties: increases the risk of insolvency omoza - bleeding, and in the long term aneurysm formation false anastomosis.

The technical result, the achievement of which the creation of this invention is directed, is to increase the effectiveness of surgical treatment of patients with calcification of the abdominal aorta.

In the proposed method, 3 devices are used:

1 - 4-channel conductor with two inflated balloon (2 channels are used to inflate the balloon, 1 - to flush the aorta, 1 - to flush the renal arteries with an outlet between the cylinders;

2 - Synthetic vascular prosthesis;

3 - The clamp (stent) of the aorta.

The technical result is achieved by the fact that in the method of aortic prosthetics in patients with occlusion of the infrarenal aorta of atherosclerotic origin, laparotomy, mobilization of the distal duodenum and extraction of the abdominal aorta to the level of renal artery discharge are performed.

A 4-channel conductor with 2 ballooning balloon is carried inside the bifurcation synthetic prosthesis to its upper edge (the edge of the prosthesis coincides with the upper edge of the upper balloon). A straightened stent is put on the upper deflated balloon half its length (2 cm). When the upper balloon is inflated, the lower half of the stent is expanded (expanded), while the latter is fixed with hooks to the synthetic vascular prosthesis. After fixation - the upper balloon is completely deflated; a stent with a prosthesis is moved down the conductor. Aortic puncture is performed (in the free of calcification and pulsating part of the aorta below the renal arteries), the conductor with deflated balloons is carried up to the aorta, so that the lower balloon is located immediately below the renal arteries. The upper balloon is inflated until the aortic occlusion, cross in the transverse direction of the aorta at the level of the puncture hole, perform thrombectomy from the upper aortic stump. Pull up the aortic prosthesis with a retainer (stent) to the level of coincidence of the upper edge of the lower balloon with the upper edge of the retainer (stent). Inflate the lower balloon, while the upper part of the stent is straightened and fixed with hooks to the aorta.

Air from the renal arteries is aspirated through a hole in the conductor between the cylinders and physiological saline is injected to prevent air embolism. For the same purpose, the prosthesis through the jaw is filled with saline with heparin, and then the lower balloon is deflated. The prosthesis is clamped gently 3 cm below the stent and the upper conductor balloon is deflated. The conductor is quickly removed from the prosthesis, a clamp is immediately applied to the latter to prevent blood loss.

The method is as follows.

The operation is performed under combined endotracheal anesthesia. An inspection of the femoral arteries is performed from access along the Kenna line from two sides. With adequate pathways of arterial outflow, a laparotomy, mobilization of the distal 12 duodenal ulcer and allocation of the abdominal aorta to the level of renal artery discharge are performed. A 4-channel conductor (Fig. 1, 2) is passed through the jaw into the bifurcation synthetic prosthesis to its upper edge (the edge of the prosthesis coincides with the upper edge of the upper balloon). An uncovered stent is put on the upper deflated balloon half its length (2 cm) (Fig. 3). When the upper balloon is inflated, the lower half of the stent is expanded (expanded), while the latter is fixed with hooks to the synthetic vascular prosthesis. After fixation - the upper balloon is completely deflated; a stent with a prosthesis is moved down the conductor. Aortic puncture is performed (in the free of calcification and pulsating part of the aorta below the renal arteries), the conductor with deflated balloons is carried up to the aorta, so that the lower balloon is located immediately below the renal arteries (Fig. 4). The upper balloon is inflated until the aortic occlusion, cross in the transverse direction of the aorta at the level of the puncture hole, perform thrombectomy. A prosthesis worn on a conductor with a retainer (stent) is pulled up until the unstretched upper part of the stent coincides with the lower balloon. The lower balloon is inflated, while the upper part of the stent is straightened and fixed with hooks to the aorta (Fig. 5).

Air from the renal arteries is aspirated through a hole in the conductor between the cylinders and physiological saline is injected to prevent air embolism. The prosthesis through the jaw is filled with saline with heparin, and then the lower balloon is deflated. The prosthesis is clamped gently 3 s below the stent and the upper conductor balloon is blown off. The conductor is quickly removed from the prosthesis, a clamp is immediately applied to the latter to prevent blood loss (Fig. 6).

Next, suturing of the distal stump of the aorta is performed. The distal branches of the prosthesis are performed retroperitoneally on the hips and form distal anastomoses between the femoral arteries and branches of the prosthesis. After the implementation of hemostasis, layered wound closure is performed.

The advantages of this method compared to the manual formation of an anastomosis:

1. The possibility of the formation of a seamless anastomosis between the calcified aorta and the vascular graft (in patients).

2. The trauma of access is reduced, since there is no need to allocate the aorta for the application of a proximal vascular clamp;

3. The time of formation of a vascular anastomosis decreases, the time of renal ischemia decreases.

4. A laparoscopic method of forming an anastomosis is possible.

5. No expensive radiological equipment is required and there is no radiation load on the patient.

Thus, this method is effective in the treatment of patients with aortic calcification.

Information sources

1. Belov Yu.V. A guide to vascular surgery with an atlas of surgical techniques. M: De Novo, 2000; 448.

2. Bokeria L.A., Alekyan B.G. Guide to endovascular surgery of the heart and blood vessels. M .: Bakuleva RAMS, 2013.

Claims (1)

A method of aortic prosthetics in patients with occlusion of the infrarenal aorta of atherosclerotic origin, characterized in that after laparotomy and separation of the abdominal aorta to the level of renal artery discharge, a 4-channel conductor with two inflated balloons is passed through the jaw into the bifurcation synthetic prosthesis to its upper edge, where the edge of the prosthesis coincides with the upper edge of the upper balloon, an unstretched stent is put on the upper deflated balloon for half its length - 2 cm, while the upper of the first balloon, the lower half of the stent is expanded, while the latter is fixed with hooks to the synthetic vascular prosthesis, after fixing the upper balloon is completely deflated; the stent with the prosthesis is moved down along the conductor, the aorta is punctured in the calcine-free and pulsating part of the aorta below the renal arteries, where the conductor with deflated balloons is carried up into the aorta so that the lower balloon is located immediately below the renal arteries, the upper balloon is inflated until the aorta is occlusion, cross the aorta in the transverse direction at the level of the puncture opening, perform a thrombectomy from the proximal stump of the aorta, pull up the aortic prosthesis with the stent to the level of coincidence of the upper edge of the lower score on the upper edge of the stent, the lower balloon is inflated, while the upper part of the stent is straightened and fixed with hooks to the aorta, air from the renal arteries is aspirated through the hole between the cylinders and physiological saline is injected to prevent air embolism, for this purpose, the prosthesis is filled through the jaw saline solution with heparin, after which the lower balloon is deflated, the prosthesis is clamped gently 3 cm below the stent and the upper conductor balloon is deflated, the conductor is removed from the prosthesis, immediately applied to the last A clamp is used to prevent blood loss.

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