UA134776U - METHOD OF CAROTIDE ENDARTERECTOMY IN A PATIENT WITH MULTIFOCAL ATHEROSCLEROSIS - Google Patents

Abstract

The method of carotid endarterectomy in a patient with multifocal atherosclerosis includes performing eversion endarterectomy from the initial section of the internal carotid artery and fixation of exfoliated intima in the internal carotid artery with sutures on the border of dissection with the formation of an anastomosis between the internal and common carotid artery. carotid artery sutures on the verge of dissection, stitching on the inside of the eversed artery with one propylene thread with two barbed needles, after which the artery is turned to its original position, the needles are cut, the distal ends of the threads are brought to the outside of the artery and then connected. anastomosis.

Description

A useful model belongs to medicine, namely to surgery, and it can be used when performing eversion carotid endarterectomy.

There is a known method of carotid endarterectomy in a patient with multifocal atherosclerosis, which includes performing an eversion endarterectomy from the initial section of the internal carotid artery and fixing the detached intima in the internal carotid artery with sutures at the border of the dissection with the formation of an anastomosis between the internal and common carotid arteries. At the same time, to fix the intima perform additional access |Patent Mo 127332, OO, USA, IPC AbITV 17/00 Bul.

Mo 14, 2018)

The disadvantage of the analogue is high trauma and long operation time.

The task of a useful model is the development of such a method of carotid endarterectomy in a patient with multifocal atherosclerosis, which, due to the fixation of the distal part of the intima of the internal carotid artery with internal sutures, would allow to reduce the time of the operation and reduce its trauma.

The task is solved by the fact that in the method of carotid endarterectomy in a patient with multifocal atherosclerosis, which includes performing an eversion endarterectomy from the initial section of the internal carotid artery and fixing the detached intima in the internal carotid artery with sutures at the border of the dissection with the formation of an anastomosis between the internal and common carotid arteries, according to with a useful model, during fixation, the artery is left everted and the detached intima is fixed in the internal carotid artery with sutures at the edge of the dissection, stitching the everted artery from the inside with one propylene thread with two barbed needles, after which the artery is turned to the original position, the needles are cut, the distal ends of the threads they are brought to the outside of the artery and tied together, after which an anastomosis is formed.

Fixation of the intimate area with internal sutures, with the threads brought out and their tying, reduces trauma and shortens the duration of the operation, as there is no need to perform a second access in the area of fixation.

The method is performed as follows. The bifurcation of the common carotid artery is isolated from the anteagular approach. The external, internal and common carotid arteries are sequentially taken on the tourniquets. A clamp is placed on the internal carotid artery above the stenosis, the common one is clamped

Zo and external carotid artery. The internal carotid artery is cut off from the common carotid artery.

An eversion endarterectomy is performed from the internal carotid artery. The latter is left everted. The detached intima in the internal carotid artery is fixed with sutures on the border of the dissection, stitching the everted artery from the inside with one propylene thread with two barbed needles, after which the artery is turned back to its original position, the needles are cut, the distal ends of the threads are brought to the outside of the artery by reverse traction and connected they argue with each other. Next, an anastomosis is formed between the internal and common carotid arteries. Sequentially squeeze clamps from the common, external and internal carotid arteries. Perform hemostasis. Wounds are sutured in layers, leaving active drainage.

Example

Patient S, 66 years old, medical card number 005143/2018, hospitalized in the Department of Vascular Surgery on August 27, 2018 with complaints of pain in the left leg at rest, trophic changes in the left foot, pain in the right leg when walking up to 100 m. An ultrasound duplex scan revealed stenosis of the left internal carotid artery at 80 95 with a length of 4 cm with acceleration of blood flow to 1.61 m/s. On September 3, 2018, the operation was performed: eversion carotid endarterectomy on the left, femoral-popliteal autovenous shunting on the left (below the knee joint gap) under general anesthesia. The method of eversion carotid endarterectomy was performed with one access as follows. The bifurcation of the common carotid artery was isolated from the anteagular approach. The external, internal and common carotid arteries were sequentially clamped on the tourniquets. A clamp was placed on the internal carotid artery above the stenosis, the common and external carotid arteries were clamped. The internal carotid artery was cut off from the common carotid artery. The mouth of the internal carotid artery was widened by longitudinal dissection of the internal carotid artery and the common carotid artery. An eversion endarterectomy was performed from the internal carotid artery. The latter was left everted.

The detached intima in the internal carotid artery was fixed with sutures at the border of the dissection, stitching the everted artery from the inside with one 6.0 propylene thread with two barbed needles, after which the artery was turned back to its original position, the needles were cut, the distal ends of the threads were brought to the outside of the artery by reverse traction and tied together. An anastomosis was formed between the internal and common carotid arteries. Sequentially, clamps were pressed from the common, external, and internal carotid arteries. They checked the anastomoses for tightness. Hemostasis was performed. The wound was sutured in layers, leaving active drainage. Duration of carotid endarterectomy is 60 minutes. No cerebral ischemic complications were observed during the operation and in the postoperative period. Wounds healed by primary tension. The patient is in satisfactory condition and was discharged for outpatient treatment. At the time of discharge, according to the duplex scan, the carotid arteries on the endarterectomy side are passable, the blood flow is main, there are no signs of intimal flotation in the internal carotid artery.

According to the proposed method, 5 patients were operated on, the average time of artery clamping was 17.6243.3 minutes, the average intervention time was 72.255.2 minutes, the operations were performed from one arteriotomy approach, there were no cerebral ischemic complications. In comparison, in 5 patients operated according to the analogue, the average clamping time was 31.8:4.0, the average intervention time was 125.4414.2 minutes, 1 patient had a small ischemic stroke, operations were performed from two arteriotomy approaches.

Thus, the method allows to reduce the trauma and duration of the operation.

Claims (1)

USEFUL MODEL FORMULA The method of carotid endarterectomy in a patient with multifocal atherosclerosis, which includes performing an eversion endarterectomy from the initial section of the internal carotid artery and fixing the detached intima in the internal carotid artery with sutures at the border of the dissection with the formation of an anastomosis between the internal and common carotid arteries, which differs in that during fixation of the artery leave it everted and fix the detached intima in the internal carotid artery with sutures on the border of the dissection, stitching the everted artery from the inside with one propylene thread with two barbed needles, after which the artery is turned to its original position, the needles are cut, the distal ends of the threads are brought to the outside of the artery and connected are tied together, after which an anastomosis is formed.