RU2725289C1 - Method of vascular wall plasty after arteriotomy - Google Patents

Abstract

FIELD: medicine.SUBSTANCE: invention relates to medicine, specifically to vascular surgery. A H-shaped incision is made on the arteries. First, a transverse incision of 3 mm is made. Then, two oblique incisions are made on each side of the artery with length of 3 mm each. Skew incisions are at angle of 90° relative to each other and 135° in relation to cross section. Then the transverse incision is closed with the help of two U-shaped sutures with the threads left. By means of the nearest thread on the side of the artery closest to the operator, the oblique incision distant from the operator is sutured. Then, by means of another thread, an oblique cut close to operator is closed. With the help of the remaining thread on the opposite side of the artery, an oblique cut away from the operator is sutured, then – an oblique cut closest to the operator.EFFECT: method enables reducing the risk of thrombosis and achieving good clinical outcomes; opens wide operational access for manipulation in vessel lumen; avoiding deformation and compression of a vessel lumen in an anastomosis region; expansion of the anastomosis occurs without using patches to the vessel, which reduces the operation time and the surgical trauma.1 cl, 7 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 and atherosclerotic stenoses of the brachiocephalic arteries.

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.

There is a method of longitudinal arteriotomy with plastic suturing of a large defect in the vessel wall by fixing an autovenous patch with a continuous twisting edge suture after preliminary stitching of holders at the corners of the defect (Pokrovsky A.V. Clinical angiology. Manual for doctors, edited by academician of RAMS A.V. Pokrovsky M .: Medicine, 2004 p. 331).

Its disadvantage is the need to use a patch, which lengthens the time of the operation and increases the operating injury.

There is a method in which additional sealing of the anastamosis 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 method is artery plastic after arteriotomy, in which the hole in the artery is sutured transversely by a twisted vascular suture with an atraumatic non-absorbable monofilament with two needles at the ends (I. Littmann, Surgical Surgery under the general editorship of Prof. I. Littmann. Budapest: Academy Publishing House: Publishing House of the Academy Hungarian 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.

The technical result of the invention is the elimination of the risk of narrowing the area of the anastamosis, improving its cushioning properties, reducing the risk of thrombosis, achieving good treatment results for patients.

The technical result is achieved by the fact that the arteries produce an H-shaped incision; first, a transverse incision is made with a width of 3 mm, then two oblique incisions are made on each side of the artery with a length of 3 mm each; oblique sections are at an angle of 90 ° with respect to each other and 135 ° with respect to the transverse section; first, the cross section is sutured with the help of two U-shaped seams with leaving threads; using the nearest thread on the side of the artery closest to the operator, the oblique incision distant from the operator is sutured, then with the help of another thread, the oblique incision closest to the operator is sutured; using the remaining thread on the opposite side of the artery, the oblique incision distant from the operator is sutured, then the oblique incision closest to the operator is sutured.

Performing an H-shaped arteriotomy opening 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; the expansion of the anastomosis occurs without the use of patches to the vessel, which reduces the time of surgery and surgical trauma; the formation of the final node of the thread outside the cross section of the gaps of blood vessels.

Comparison of the proposed surgical method for plasty of the vascular wall after arteriotomy with others known in the field of medicine, showed its compliance with the criteria of the invention.

The method of arteriotomy is illustrated with 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 shows oblique sections on the artery wall closest to the operator. In FIG. 4 shows oblique incisions on the artery wall farthest from the operator. In FIG. 5 depicts the plastic surgery stage of arteriotomy, where a transverse incision is sutured with two U-shaped sutures with leaving threads. In FIG. Figure 6 shows the plastic surgery stage of arteriotomy, where a transverse and two oblique incisions are sutured on the artery wall closest to the operator. In FIG. 7 shows the artery after the end of plastic surgery of the arteriotomy hole.

In practice, arteriotomy is as follows. A transverse incision (a) of 3 mm wide is made on the upper wall of the artery (Fig. 1). On each side of the artery, two symmetrical sections b1, b2, c1, c2 are made with a length of 3 mm each (Fig. 2). Oblique sections are located at an angle of 90 ° with respect to each other and at an angle of 135 ° with respect to the transverse section. Thus, after performing an arteriotomy on the artery wall, 2 trapezoidal flaps with the vertices A1-B1-FC and A2-B2-H-E and 2 triangular flaps with the vertices of CDE and FGH are obtained (Fig. 3, Fig. 4, Fig. 5) . When suturing the arteriotomy opening, two U-shaped sutures are applied in the area of points A1-A2 and B1-B2, after tying the threads are not cut (Fig. 6).

With the remaining thread closest to the operator, point D is sewn to points A1-A2; then suture oblique, farthest from the operator, cut b1 in the direction from points A1-A2-D to point C; at the end - the thread is cut. Using a new thread, the oblique section b2 closest to the operator is sutured in the direction from point E to points A1-A2-D; at the end - the thread is cut (Fig. 7). With the remaining, distant in relation to the operator, thread point G is sewn to points B1-B2; then suture oblique, farthest from the operator, cut cl in the direction from points B1-B2-G to point F; at the end - the thread is cut. Using a new thread, the oblique section c2 closest to the operator is sutured in the direction from point H to points A1-A2-G; at the end - the thread is cut (Fig. 8).

Using this method will eliminate the risk of narrowing the area of the anastamosis, improve its cushioning properties, reduce the risk of thrombosis and achieve good treatment results for patients.

Clinical example.

Patient F., 66 years old, was treated in the vascular department of the Ulyanovsk Regional Hospital on a vascular bed from 03/18/19. on 03/30/19 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.

03/19/19 operation performed: direct endarterectomy from the common femoral artery and the mouth of the deep femoral artery to 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 transverse incision was made on the upper wall of the OBA with a width of 3 mm, then two oblique incisions were made on each side of the artery with a length of 3 mm each, while the oblique incisions were 90 ° to each other and 135 ° to the transverse incision. With the help of a spatula, an atherosclerotic plaque at the mouth of the PBA and GBA is peeled off; plaque removed, satisfactory retrograde blood flow obtained. The cross-section was sutured using two U-shaped sutures with atraumatic non-absorbable monofilament with two needles at the ends of the prolene 6/0, while the threads were left; using the closest thread on the side of the artery closest to the operator, the oblique section furthest from the operator is sutured, then using another atraumatic non-absorbable monofilament with two needles at the ends of the prolene 6/0, the oblique section closest to the operator is sutured; using the remaining thread from the opposite side of the artery, the oblique incision distant from the operator is sutured, and then the oblique incision closest to the operator is sutured. The clamps are removed, a satisfactory arterial pulsation is obtained. The wound is sutured in layers.

The postoperative wound healed by primary intention. The seams are removed from the skin. Peripheral arterial pulsation on both lower extremities. Central circulatory system of lower limb arteries from 10/10/19: BOTH, PBA, PKA, PBA, ZBA on the right lower limb are passable. The main bloodstream. There is no stenosis in the field of arteriotomy.

Claims (1)

The method of plasty of the vascular wall after arteriotomy using a twisted vascular suture with an atraumatic non-absorbable monofilament with two needles at the ends, characterized in that an H-shaped incision is made on the artery, first they make a transverse incision 3 mm wide, then make two oblique incisions with each the sides of the artery are 3 mm long each, the oblique sections are at an angle of 90 ° with respect to each other and at an angle of 135 ° with respect to the transverse section; First of all, the transverse incision is sutured with the help of two U-shaped sutures, leaving the threads, with the closest suture on the side of the artery closest to the operator, the oblique incision distant from the operator is sutured, then the oblique incision closest to the operator is sutured with the other thread, and with the rest the threads from the opposite side of the artery suture the oblique incision distant from the operator, then the oblique incision closest to the operator.

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