RU2737329C1 - Method of artery wall plasty after arteriotomy - Google Patents

Abstract

FIELD: medicine.SUBSTANCE: invention relates to medicine, specifically to vascular surgery. Longitudinal incision of about 6 mm is performed, then two oblique incisions are made on each side of the artery with length of 3 mm each. Skew sections are located diametrically opposite to each other and are located at angle of 135° in relation to longitudinal section. Artery plasticity is performed by fixing the autovenous patch to the angles of the longitudinal incision with the help of two U-shaped sutures with leaving the threads, by means of one of the threads on the side of the artery closest to the operator, the oblique incision is closed, and another thread is attached to the side nearest to the operator of autovenous patch. Using one of the threads on the far side of the artery, the oblique incision is sutured, and the other side is sutured with an autovenous patch far from the operator.EFFECT: method provides wide operational access, reduces the risk of thrombosis, achieves high clinical outcomes.1 cl, 1 ex, 4 dwg

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.

There is a classic method of longitudinal arteriotomy, in which the hole in the artery is sutured longitudinally with a twisted vascular suture (Ostroverkhov G. E. Operative surgery and topographic anatomy. Kursk: Kursk Medical University, 1996, S. 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 the hole in the artery is sutured with a transversely twisted vascular suture atraumatic non-absorbable monofilament with two needles at the ends (Littmann I. Operative 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.

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

The disadvantage of this method is additional surgical trauma, lengthening the operation time.

The closest to the claimed method is the method of longitudinal arteriotomy with plastics of the artery wall by fixing the autovenous patch with a vascular suture after preliminary application of two sutures-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).

As disadvantages, one can note the small size of the arteriotomy opening, which does not provide good surgical access to the artery.

EFFECT: improved operative access to the artery, reduced risk of thrombosis, and achieved good results in patients' treatment.

The stated technical result in the method of plastics of the artery wall after arteriotomy is achieved by performing a longitudinal incision with a length of about 6 mm, then performing two oblique incisions on each side of the artery with a length of 3 mm each. The oblique cuts are located diametrically opposite each other and are at an angle of 135 ° in relation to the longitudinal section. Artery plasty is performed by fixing the autovenous patch to the corners of the longitudinal incision using two U-shaped sutures leaving the threads, using one of the threads on the side of the artery closest to the operator, an oblique incision is sutured, and the other side of the autovenous patch is sewn with the other thread. Using one of the threads on the side of the artery farthest from the operator, an oblique incision is sutured, and with the other thread, the side of the autovenous patch farthest from the operator is sewn.

Comparison of the proposed method for performing arteriotomy and plastics 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 diagram of the section. FIG. 2 depicts an artery after incisions and an autovenous patch Z. FIG. 3 shows a diagram of the imposition of two U-shaped sutures-holders. FIG. 4 shows a view of the artery after plastic surgery.

In practice, arteriotomy is performed as follows. A 6 mm longitudinal incision is made on the upper wall of the artery R. On each side of the artery, two oblique incisions b and each with a length of 3 mm are made (Fig. 1). The oblique cuts are located diametrically opposite each other at an angle of 135 ° in relation to the longitudinal section. Thus, after performing arteriotomy, two irregularly shaped flaps with apices B-A1-D1-C and B-A2-D2-C are obtained on the artery wall. Autovenous patch Z is cut out with apexes at points A3 and D3 (Fig. 2). When suturing the arteriotomy opening, the autovenous patch Z is placed so that its vertices A3 and D3 are aligned with points A1 and A2, D1 and D2, respectively. Next, two U-shaped sutures are applied in the area of the indicated points of the same name, after tying the threads are not cut off (Fig. 3). The oblique incision b closest to the operator is sutured with one of the remaining sutures, and the side of the autovenous patch closest to the operator is sewn with the other suture on the A3-D3 section, the sutures are cut. The oblique incision c, far from the operator, is sutured, then the side of the autovenous patch, farthest from the operator, is sewn on the segment D3-A3, the threads are cut (Fig. 4).

Execution of the arteriotomy opening of the form proposed by the authors and further plasty of the artery wall using an autovenous patch opens up a wide surgical access for manipulation in the lumen of the vessel; allows to avoid deformation and compression of the vessel lumen in the anastomotic area.

Clinical example.

Patient F., 68 years old, was treated in the vascular department of the Ulyanovsk regional hospital on a vascular bed from 05/28/19 to 06/10/19, the patient was admitted as planned

Diagnosis: Obliterating atherosclerosis of the arteries of the lower extremities. Occlusion of the common femoral artery, critical stenosis of the mouth of the deep 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 in the form of intermittent claudication in the right lower limb. He notes a decrease in the distance of painless walking to 100 meters.

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

On May 30, 19, the operation was performed: direct endarterectomy from the common femoral artery and the mouth of the deep femoral artery on the right. Access was made through Ken's line in the upper third of the right thigh. BOTH, GBA, PBA were isolated from the surrounding tissues, taken on holders. 5000 units of heparin were injected intravenously in a stream. Arteries are compressed. A longitudinal incision was made on the upper wall of BOTH 6 mm long, then two oblique incisions were made on each side of the artery, each 3 mm long, with the oblique incisions being diametrically opposite to each other and at an angle of 135 ° with respect to the longitudinal incision. With the help of a spatula, an atherosclerotic plaque was exfoliated at the mouth of the PBA and GBA; the plaque was removed, and a satisfactory retrograde blood flow was obtained. The inflow of the great saphenous vein was isolated, cut off, cut longitudinally, and an autovenous patch was formed. Fixation of the autovenous patch is carried out using two U-shaped sutures of the holders in the area of the angle of the longitudinal section; using one of the threads, the oblique incision closest to the operator is sutured, and the semicircle of the autovenous patch closest to the operator is sewn with the other thread; the threads are cut. Another thread is sutured in an oblique incision distant from the operator, then the semicircle of the autovenous patch farthest from the operator is sewn; the threads are cut.

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

CDC of the arteries of the lower extremities 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 area of arteriotomy. There are no thrombotic masses in the area of arteriotomy.

Claims (1)

The method of plastics of the artery wall after arteriotomy, which consists in making a longitudinal incision, performing plastics of the artery using an autovenous patch, while stitching it with a vascular suture after preliminary application of two holding sutures at the corners of the defect, characterized in that, in addition to the longitudinal section of the artery two oblique cuts are made with a length of 3 mm each, while the oblique cuts are located diametrically opposite and are at an angle of 135 ° with respect to the longitudinal incision, while the plastic of the artery is performed after the application of two U-shaped sutures-holders, for this with the help of one of the threads an oblique incision is sutured on the side of the artery closest to the operator, and the side of the patch closest to the operator is sewn with the other thread, then the oblique incision is sutured with one of the threads on the side farthest from the operator, and the other side of the patch is sewn with the other thread.

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