SU1650102A1 - Of protecting brain at reconstructive carotid artery operations - Google Patents

Abstract

This invention relates to medicine, namely to vascular surgery. The method allows to reduce postoperative complications, which is achieved by using for shunting the radial artery at the level of the lower third of the forearm, cooling the boat and the donor hand with total blood multiplication.

Description

This invention relates to medicine, namely to vascular surgery.

The purpose of the invention is the reduction of postoperative complications.

The method is carried out as follows.

Expose the common external and internal carotid arteries with a cut along the inner edge of the nodding muscle. At the same time, a radial artery is isolated in the lower third of the patient's forearm.

After hemostasis, heparin is administered intravenously at the rate of 3 mg / kg. A proximal part of a silicone catheter with an inner diameter of 3-4 mm is led to the radial artery.

The volumetric blood flow velocity is measured, after which the catheter is connected to the direct blood pressure sensor of the monitor complex. If necessary, the volumetric blood flow velocity along the shunt is increased by medicamentally increasing the systemic arterial pressure with its constant control on the monitor.

The donor limb is laid on it, then the arm is brought closer to the surgical wound. The common and external carotid arteries are clamped for a short time (less than 1 minute), and in the affected area, the common and internal carotid arteries are opened. The distal part of the catheter is guided to the upper corner of the wound of the internal carotid artery and is fixed with a temporary ligature.

By clamping the proximal part of the catheter, retrograde arterial pressure in the internal carotid artery is measured. If it is less than 50% of the systemic arterial pressure, then. Further stages of the surgical procedure are carried out with the shunt running (with retrograde arterial pressure indicators in the internal carotid artery, more than 50% of the systemic shunt is removed and the surgical aid is performed without the shunt according to the generally accepted method).

Against the background of a working shunt, endarter rectomy is performed by moving the distal part of the catheter under the control of vision. The incision of the artery is sutured on a shunt, which is removed when the last suture is tightened.

The proximal part of the catheter is removed from the radial artery, sutured or transferred

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are called. Surgical wounds on the neck and arm are sutured in layers and, if necessary, drained.

Inactivation of heparin is carried out with 1% protamine sulfate under the control of activated blood clotting time.

Example. Ill I., 61 years old. She was admitted to the clinic of nervous diseases with a diagnosis of acute ischemia in the basin of the left fronto-orbital artery. A Seldinger arteriography revealed the pathological tortuosity of both internal carotid and left vertebral arteries. Sick operated. Under endotracheal anesthesia on the left side of the neck, the common, external and internal carotid arteries are highlighted. At the same time, the right radius artery in the lower third of the forearm is exposed. During revision, the left internal carotid artery has a pathological tortuosity in the form of two loops with angular bends over 8 cm. Against the background of total heparmization (heparin 3 mg / kg), the radial artery is cannulated. In artificial hypertension 170-180 per 100 mm Hg. Art. volumetric blood flow through the shunt is 176 ml / min. The right arm with a cannulated radial artery is lined with ice bubbles and brought to a wound in the neck. Pinched carotid arteries. In the above pathological tortuosity

the distal part of schuite was installed in the cranial direction of the internal carotid artery and retrograde arterial pressure was measured - 25 mm Hg. cf., which is 15% of the systemic. After prophylaxis of air embolism, a radial-carotid perfusion was started. Time to squeeze the carotid arteries 40 s. With a perfusion pressure of 70-80 mm Hg. Art. pathologic tortuosity of the internal carotid artery with end to end anastomosis is resected. Before applying the last suture of the anastomosis, the carotid arteries are again clamped and the shunt is removed. The duration of re-occlusion 1 min. Shunt operation time 21 min. 8 during the operation, the nature of the electroencephalogram does not change. Smooth postoperative course

Claims (1)

Invention Formula A method of protecting the brain in reconstructive operations on the carotid arteries, including temporary bypass surgery, characterized in that, in order to reduce postoperative complications, the radial artery at the lower third of the forearm is used to bypass the shunt and donor limb during total heparinization blood.