RU2733574C1 - Method for end-to-end vascular anastomosis formation - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, specifically to vascular surgery. Longitudinal flap is cut out on the upper wall of the proximal portion of the artery, the length of which is equal to the length of the circumference of the artery cross section, and the width is equal to its diameter. Longitudinal incision is made on the surface diametrically opposite the flap, the length of which is equal to the length of the circumference of the artery cross section, and the width is equal to its diameter. Longitudinal incision is made on the upper wall of the distal portion of the artery, the length of which is equal to the length of the circumference of the artery cross section, and the width is equal to its diameter. On the surface, diametrically opposite, a longitudinal flap is cut out, the length of which is equal to the length of the circumference of the artery cross section, and the width is equal to its diameter. That is followed by forming a vascular anastomosis so that the anastomosis starts in the area of the apex of the longitudinal incision on the proximal portion of the artery, and the end - in the proximal region of the artery proximal to the operator of the base.

EFFECT: method enables eliminating a risk of narrowing the anastomosis, reducing the time of the anastomosis, reducing the risk of thrombosis.

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Description

The invention relates to medicine, namely to vascular surgery and can be used to form an end-to-end anastomosis between sections of an artery when performing reconstructive vascular operations in patients with obliterating diseases of the arteries of the lower extremities.

Known beveled anastomosis, when applied, the ends of the sutured vessels are cut obliquely, which prevents narrowing of the lumen of the anastomosis (Littmann I. Operative surgery under the general editorship of Prof. I. Littmann. Budapest: Publishing House of the Hungarian Academy of Sciences, 1985 p. 176).

The disadvantages of this method include the difficulty in drawing up the correct contour and the ratio of the dimensions of the surface of the vessels.

The known method of Linton, in which the edges of the vessels are cut obliquely and additionally cut longitudinally (Linton RR, Menendez CV. Arterial homografts: a comparison of the results with end-to-end and end-to-side vascular anastomoses. Ann Surg 1955; 142 ( 04) 568-583, discussion, 583-585).

The disadvantage of this method is the difficulty in matching the edges of the vessels.

The known method of expanding the vascular anastomosis according to N.A. Dobrovolskaya by cutting out 2-3 flaps at the ends of the vessels, stitching which together allows you to avoid narrowing of the anastomosis. The shape of the cut out flaps varies depending on the technical conditions of the surgical intervention (Dobrovolskaya N.A. That the doctrine of the injuries of blood vessels and traumatic aneurysms // Russian doctor. -1916. - No. 49. -P. 1164).

The disadvantage of this method is the difficulty of cutting out vascular flaps.

There is a known method in which a longitudinal, opposite to each other, dissection of the walls of blood vessels is performed, so that after applying a circular vascular suture, an autovenous patch is sewn into the dissection zone, which prevents narrowing of the vessel lumen (V.A. Ovchinnikov Ways of connecting vessels / V.A. Ovchinnikov // Scientific and practical medical journal Medicum. Nizhny Novgorod, 2004. - No. 1)

The disadvantages include the need for a separate collection of the donor vein site, which increases the operation time.

Closest to the claimed method is a method of applying an end-to-end vascular anastomosis using a twisted vascular suture with atraumatic non-absorbable monofilament with two needles at the ends, in which, to increase the area of the anastomosis, a cross section of one of the vessels is performed, additionally from the edge one of the vessels is cut off the corner (Belov Y. V. Guide to vascular surgery. M .: DeNovo, 2000. p. 34).

The disadvantages of this method include the difficulty in drawing up the correct contour of the vessels. Also, when the anastomosis is applied, its deformation is possible, which can lead to overlap of the lumen and thrombosis.

The technical result of the invention is to eliminate the risk of narrowing of the anastomosis, improve its shock-absorbing properties, reduce the risk of thrombosis, and achieve good results in the treatment of patients.

The stated technical result is achieved by the fact that a longitudinal flap is cut out in the proximal part of the artery, the length of which is equal to the circumference of the artery cross-section, and the width is equal to the diameter of the artery; on the surface diametrically opposite to the flap, an incision is made, the length of which is equal to the circumference of the cross-section of the artery, and the width is equal to the diameter of the artery. In the distal portion of the artery, an incision is made from above, equal in size to the flap in the proximal portion of the artery, and a flap is cut out on the lower surface, corresponding in size to the incision in the proximal portion of the artery. Then, a vascular anastomosis is formed, both sections of the artery are sutured so that the beginning of the anastomosis is in the region of the apex of the notch on the lower wall of the proximal section of the artery, and the end is in the region of the base of the proximal section of the artery closest to the operator.

Cutting out a longitudinal flap and an incision in both parts of the artery avoids deformation and compression of the vessel lumen in the anastomotic area; expansion of the anastomosis occurs without suturing the "donor" sites to the vessel; it is possible to form an anastomosis using one thread and without using a scalpel; the formation of the end node of the thread outside the section of the lumen of the vessels; linking the size of the incisions to the circumference of the cross-section of the artery facilitates the formation of equal holes in both parts of the artery

Comparison of the proposed surgical approach with others known in the field of medicine has shown that it meets the criteria of the invention.

The method of forming a vascular anastomosis is illustrated by graphic material, where in FIG. 1 shows a proximal artery and a distal artery; in FIG. 2 section diagram for them; in FIG. 3 shows a diagram of cutting out a longitudinal flap and an incision in the proximal section of the artery; in FIG. 4 shows a diagram of cutting out a longitudinal flap in the distal section of the incision artery; in FIG. 5 shows a diagram of the imposition of a vascular anastomosis, top view; in FIG. 6 shows a diagram of the imposition of a vascular anastomosis, bottom view; in FIG. 7 shows the final view of the anastomosis. In the figures, the following designations are adopted: 1 - proximal area of the anastamosis, 2 - distal area of the anastamosis, 3 - longitudinal flap in the proximal area of the artery, 4 - incision in the proximal area of the artery, 5 - longitudinal flap in the distal area of the artery, 6 - incision in the distal area arteries.

In practice, the formation of a vascular anastomosis is carried out as follows. Anastomosis is formed with a continuous twisted vascular suture with atraumatic non-absorbable monofilament with two needles at the ends. On the proximal part of the artery 1, on its upper edge, a longitudinal flap 3 is cut out, the length (c1) of which is equal to the circumference of the artery cross-section (π⋅d1), and the width e1 is equal to its diameter, and the cross-section b1; on the surface diametrically opposite to the flap, an incision is made in the proximal section of the artery 4, the length of which al is equal to the circumference of the artery cross-section (π⋅d1), and the width f1 is equal to its diameter d1 (Fig. 2). On the distal section of the artery 2, an incision 6 is made on the upper wall, the length (c2) of which is equal to the circumference of the artery cross-section (π⋅d1 = π⋅d2) and equal to the length of the longitudinal flap of the proximal section of the artery 3 (c2 = c1); its width e2 is equal to the diameter of the artery d2 and is equal to the width (e1) of the longitudinal flap of the proximal section of the artery 3. On the surface diametrically opposite to the cutout of the distal section of the artery 6, a longitudinal flap 5 is cut out, the length of which (a2) is equal to the circumference of the cross-section of the artery (π⋅d2 = π⋅d1) and is equal to the length of the longitudinal incision of the proximal artery 4 (a2 = a1), its width (f2) is equal to the width of the longitudinal incision of the proximal artery 4 (f2 = f1). After performing these manipulations, a cut in the form of an ABCD rhombus is formed in the proximal area (Fig. 3), and on the distal portion of the artery a cut in the form of an EFGH rhombus (Fig. 4). The beginning of the anastomosis - points A and E are sutured (Fig. 5). Next, one of the ends of the thread continues a continuous suture, points B and F are sewn, then they move towards C and G - the entire anastomosis section farthest from the operator is sewn with the transition to segment b1 (Fig. 6). The rest of the anastamosis is stitched with the other end of the thread with a continuous suture. The node is formed on in the area of points D and H on the site of the anastomosis closest to the operator, outside the lumen of the vessel (Fig. 7).

The use of this method in practice will eliminate the risk of narrowing of the anastomosis, reduce the time of anastomosis, reduce the risk of shunt thrombosis or arteriovenous fistula and achieve good treatment results for patients, as well as reduce economic losses during surgery. Clinical example.

Patient F., 69 years old, was treated in the vascular department of the Ulyanovsk regional hospital on a vascular bed from 03/11/19 to 03/21/19, the patient was admitted in a planned manner

Diagnosis: Obliterating atherosclerosis of the arteries of the lower extremities. Occlusion of the lower third of the superficial femoral artery on the right. KHAN 2b article of the right lower limb.

Anamnesis of the disease: the patient for a long time notes complaints of pain like intermittent claudication in the right lower extremity. Notes a decrease in the distance of painless walking.

In local status: the right lower limb is cool to the touch. Arterial pulsation on the right lower limb only on BOTH.

03/12/19, the operation was performed: loop endarterectomy from the lower third of the superficial femoral artery on the right with the formation of an end-to-end anastomosis. The postoperative wound healed by primary intention. The stitches were removed from the skin. Arterial pulsation is peripheral.

Ultrasound of the arteries n-k from 10.10.19 g: BOTH, PBA, PKA, PBBA, ZBBA on the right lower limb are passable. The main blood flow. There was no stenosis in the anastomotic region of the lower third of the PBA.

Claims (1)

A method of forming an end-to-end vascular anastomosis between the proximal and distal portions of the artery using a twisted vascular suture with atraumatic non-absorbable monofilament with two needles at the ends, characterized in that a longitudinal flap is cut out on the upper wall of the proximal portion of the artery, the length of which is the circumference of the cross-section of the artery, and the width is equal to its diameter; on the surface diametrically opposite to the flap, a longitudinal cut is made, the length of which is equal to the circumference of the cross-section of the artery, and the width is equal to its diameter; on the upper wall of the distal section of the artery, a longitudinal cut is made, the length of which is equal to the circumference of the cross-section of the artery, and the width is equal to its diameter; on the surface, diametrically opposite, a longitudinal flap is cut out, the length of which is equal to the circumference of the artery's cross-section, and the width is equal to its diameter; then, a vascular anastomosis is formed, so that the beginning of the anastomosis is in the region of the apex of the longitudinal cutout in the proximal portion of the artery, and the end is in the region of the base of the proximal portion of the artery flap closest to the operator.

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