RU2725285C1 - Method of arteriotomy and plasty of artery wall - Google Patents

Abstract

FIELD: medicine.SUBSTANCE: invention relates to medicine, specifically to vascular surgery. A longitudinal arterotomy with length of 6 mm is made on the arteries. Then, two oblique incisions are made on each side of the artery with length of 3 mm each. Skew incisions are located at angle of 90° relative to each other and 135° in relation to longitudinal section. Artery wall plasty is performed by fixing an autovenous patch. First, four U-shaped sutures are applied on the corners of the autovenous patch with leaving the threads. Using one of the threads on the side of the artery closest to the operator, the farthest incision is sutured from the operator, another side of the autovenous patch is sutured, using one of the threads on the side of the artery closest to the operator, the nearest oblique incision is sutured to the operator, and the other side of the autovenous patch is sutured with the other suture. Using one of the threads on the far side of the artery, the oblique incision closest to the operator is sutured, and another side is sutured to the next side of the autovenous patch. Using one of the threads on the side of the artery far from the operator, the farthest incision from the operator is sutured, and the other side of the autovenous patch is sutured with the other suture.EFFECT: method provides wide operational access for manipulation in the lumen of the vessel, avoiding deformation and compression of the lumen of the vessel in the area of anastomosis.1 cl, 4 dwg, 1 ex

Description

The invention relates to medicine, namely to vascular surgery and can be used to perform arteriotomy during reconstructive vascular operations in patients with obliterating diseases of the arteries of the lower extremities.

The classic method of longitudinal arteriotomy is known, in which a hole in the artery is sutured with a longitudinally oblique vascular suture (Ostroverkhov G.E. Surgical surgery and topographic anatomy. Kursk: Kursk Medical University, 1996, p. 151).

The disadvantage of this method is the limited space for manipulations in the lumen of the vessel and the likelihood of stenosis in the suture area.

Known transverse arteriotomy with plastic, in which a hole in the artery is sutured transversely by a vascular suture with an atraumatic non-absorbable monofilament with two needles at the ends (I. Littmann, Operational Surgery under the general editorship of Prof. I. Littmann. Budapest: Publishing House of the Hungarian Academy of Sciences, 1985, p. 788 )

The disadvantage of this method is the limited space for manipulation in the lumen of the vessel and the risk of stenosis in the suture area.

There is a known method of arteriotomy with plastic surgery, in which additional sealing of the suture line was carried out using a piece of isolated fascia (Beitinger VF Vascular suture Tomsk: LNO Research Institute of Microsurgery TNC SB RAMS 2005, p. 28).

Its disadvantage is additional surgical trauma, lengthening of the operation time.

Closest to the claimed one is a method of longitudinal arteriotomy with plastic surgery of the artery wall by fixing an autovenous patch with a vascular suture after the preliminary application of two suture-holders at the corners of the defect (Pokrovsky A.V. Clinical angiology. Manual for doctors edited by academician of the Russian Academy of Medical Sciences A.V. Pokrovsky M .: Medicine, 2004 p. 331).

Its disadvantage is the small size of the arteriotomy opening, which does not provide good operational access to the artery.

The aim of the invention is to improve surgical access to the artery, reducing the risk of thrombosis, achieving good treatment outcomes for patients.

The technical result is achieved by the fact that a longitudinal arteriotomy of 6 mm is performed on the arteries, then two oblique incisions are made on each side of the artery 3 mm long each, while the oblique incisions are placed at an angle of 90 ° to each other and 135 ° to to the longitudinal section, and the plastic wall of the artery is performed by fixing the autovenous patch, in this case, four U-shaped suture-holders are applied first at the corners of the autovenous patch with the filaments left. Using one of the threads on the side of the artery closest to the operator, the oblique section furthest from the operator is sutured, one side of the autovenous patch is sewn with the other thread; using one of the threads on the side of the artery closest to the operator, the oblique section closest to the operator is sutured, the next side of the autovenous patch is sewn with the other thread. Using one of the threads on the side of the artery far from the operator, the oblique incision closest to the operator is sutured, and the next side of the autovenous patch is sewn with the other thread. Using one of the threads on the far side of the artery from the operator, the oblique section furthest from the operator is sutured, and the next side of the autovenous patch is sewn with the other thread.

Comparison of the proposed method for performing arteriotomy and plastic surgery of the artery wall with others known in the field of medicine, showed its compliance with the criteria of the invention.

The method is illustrated by graphic material, where in FIG. 1 shows a preliminary sectional diagram. In FIG. 2 shows an artery after making cuts on it from the side closest to the operator. In FIG. 3 depicts a superposition scheme of four U-shaped stitches-holders. In FIG. 4 schematically shows a view of an artery after plastic surgery.

In practice, arteriotomy is as follows. On the upper wall of the artery R, a longitudinal incision is made with a length of 6 mm. On each side of the artery, two symmetrical oblique cuts b, c, d, e of 3 mm length each are performed (Fig. 1). Oblique sections are located at an angle of 90 ° with respect to each other and at an angle of 135 ° with respect to the longitudinal section. Thus, after performing an arteriotomy on the artery wall, 4 trapezoidal flaps with the vertices B-F1-G1-C, C-G2-H2-E, E-H1-I1-D and D-I2-F2-B are obtained (Fig. 2 ) When suturing the arteriotomy opening, an autovenous patch Z is placed so that its vertices F3, G3, H3 and 13 are aligned with points F1 and F2, G1 and G2, H1 and H2, II and 12, respectively; then four U-shaped suture-holders are applied in the region of the indicated points of the same name, after tying the threads are not cut (Fig. 3). An oblique incision b is sutured with one of the remaining threads, and an autovenous patch is sewn on the segment F3-G3 with the other thread; the threads are cut. The oblique incision s is sutured, then the autovenous patch is sewn on the segment G3-H3; the threads are cut. The oblique incision e is sutured, then the autovenous patch is sewn on the segment H3-I3; the threads are cut. The oblique incision d is sutured, then the autovenous patch is sewn on section I3-F3; the threads are cut (Fig. 4).

Performing the described form of the arteriotomy opening and plastic of the artery wall using an autovenous patch opens up wide surgical access for manipulation in the lumen of the vessel; avoids deformation and compression of the lumen of the vessel in the area of the anastomosis.

Clinical example.

Patient F., 70 years old, was treated in the vascular department of the Ulyanovsk Regional Hospital on a vascular bed from 05/18/19 to 05/30/19. The patient was admitted as planned

Diagnosis: Obliterating atherosclerosis of lower limb arteries. Occlusion of the common femoral artery, critical stenosis of the mouth of the deep femoral artery on the right. KHAN 26 st of the right lower limb.

Anamnesis of the disease: the patient for a long time notes complaints of pain as an intermittent claudication in the right lower limb. Notes a decrease in the distance of painless walking to 100 meters.

In local status: the right lower limb is cool to the touch. Arterial pulsation on the right lower limb is not determined, peripheral on the left. Movement in sensitivity in the lower extremities in full.

05/20/19, the operation was performed: direct endarterectomy from the common femoral artery and the mouth of the deep femoral artery on the right. Accessed via Ken in the upper third of the right thigh. OBA, GBA, PBA were selected from the surrounding tissues, taken to the holders. 5000 units of heparin were injected intravenously. Arteries are pinched. A longitudinal section was made on the upper wall of the OBA with a length of 6 mm, then two oblique sections were made on each side of the artery with a length of 3 mm each, while the oblique sections were at an angle of 90 ° with respect to each other and 135 ° with respect to the longitudinal section. With the help of a spatula, an atherosclerotic plaque is exfoliated at the mouth of the PBA and GBA; plaque removed, satisfactory retrograde blood flow obtained. An inflow of a large saphenous vein was isolated, cut off, longitudinally dissected, an autovenous patch formed. The fixation of the autovenous patch is carried out using four U-shaped stitches of the holders; using one of the threads on the side of the artery closest to the operator, the oblique section furthest from the operator is sutured, one side of the autovenous patch is sewn with the other thread; using one of the threads on the side of the artery closest to the operator, the oblique section closest to the operator is sutured, the next side of the autovenous patch is sewn with the other thread; using one of the threads on the side of the artery far from the operator, the oblique incision closest to the operator is sutured, the next side of the autovenous patch is sewn with the other thread; using one of the threads on the side of the artery far from the operator, the oblique incision distant from the operator is sutured, and the last side of the autovenous patch is sewn with another thread.

The postoperative wound healed by primary intention. The seams are removed from the skin. Peripheral arterial pulsation on both lower extremities

The CDC of the arteries of the lower extremities from 10.10.19 g: BOTH, PBA, PKA, PBA, ZBA on the right lower limb are passable. The main bloodstream. There is no stenosis in the field of arteriotomy. There are no thrombotic masses in the field of arteriotomy.

Claims (1)

The method of arteriotomy and plastic surgery of the artery wall, which consists in making a longitudinal section of the artery, performing artery plastic surgery using an autovenous patch, and stitching it with a vascular suture after preliminary suturing-holders at the corners of the defect, characterized in that in addition to the longitudinal section of the artery two oblique incisions are made 3 mm long each, and they are located at an angle of 90 ° relative to each other and at an angle of 135 ° with respect to the longitudinal section, the fixation of the autovenous patch is carried out using four U-shaped stitches of the holders, while using one oblique incision distant from the operator is sutured on one of the threads on the artery side closest to the operator, and one side of the autovenous patch is sewn with the other thread, using the oblique incision closest to the operator on one side of the artery, and the next side of the autovenous seam sewn on with the other thread patches using one of the threads farthest from the operator with The oblique incision closest to the operator is sutured to the side of the artery, and the next side of the autovenous patch is sewn with the other thread, using one of the threads on the far side of the artery from the operator, the oblique incision distant from the operator is sutured, and the last side of the autovenous is sewn with another thread.

Images