SU1286179A1 - Method of axillary femoral arterial shunting - Google Patents

Abstract

The invention prevents thrombosis. The upper limb on the side of the operation is retracted by 90 °. The femoral vessels, the distal subclavian artery and the proximal axillary artery are isolated. The total length of the isolated arterial trunk is 10-11 cm. The axillary artery is transversely crossed above the discharge of the subscapularis artery. A vascular prosthesis is sewn into the proximal end of the end-of-end type, the distal part of which under the pectoral muscles and under the skin of the anterior thoracic and abdominal walls is brought into the incision in the femur to the femoral artery and anastomized with it. Additionally, the prosthesis is sewn at an acute angle on the end-to-side type into the muscular-femoral shunt and on the end-to-end type is anastomosed with the distal axillary artery segment. 1 il.

Description

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The invention relates to medicine, more specifically to vascular surgery, and can be used during an axillary-femoral bypass surgery,

The purpose of the invention is to prevent thrombosis by increasing the volumetric blood flow in the shunt and reducing the turbulence of blood flow in the anastomosis area.

The drawing shows the superimposed proximal anastomosis, General view.

The method is carried out as follows.

The position of the patient - on the back. The upper limb on the side of the operation is set aside 90 °. After isolating the femoral vessels, making sure that they are suitable for performing reconstruction, they begin to isolate the distal subclavian artery and the proximal axillary artery. A skin incision is made 2 cm lateral to the edge of the sternum. The incision is continued up to the edge of the subclavian muscle and brought downwards along the deltoid-pectoral sulcus to the level of the humeral head. Dissect the fascia and subcutaneous tissue. The clavicular fibers of the pectoralis major muscle were stupidly diluted. After dissection of the clavicular-thoracic fascia, the subclavian artery is extracted in the loose tissue of the sternoclavicular triangle, which is taken on a taped blade. Then, with the help of the downstream sector, taking into account the location of the arterial trunk, they take a holder, isolate and cross the tendon part of the pectoralis major muscle, which allows the artery to continue to be released in the distal direction. Thus, the distal subclavian and proximal axillary arteries become available for manipulation. The total length of the isolated arterial trunk is 10-AND. See Small arteries (arteries of the chest and shoulder process, lateral arteries of the chest), as well as muscle branches and the associated veins cross and bandage. After the vascular clips are applied, the axillary artery 1 is transversely crossed above the discharge of the subscapular artery 2, since it is known that relieving the axillary artery after the escapement of the subscapular artery creates less favorable conditions for collateral circulation in the case of thrombosis of the axillary artery in the shunt artery and shunt hilar artery in the case of thrombosis in the axillary artery, there is less favorable conditions for collateral circulation in the case of thrombosis This turns off the intersystem anastomosis of the transverse artery of the scapula with the artery surrounding the scapula.

Vascular prostheses with a diameter of 8-10 mm are used as an axillary femoral shunt.

A vascular prosthesis of 4 diameter is sewn into the proximal segment 3 of the intersected axillary artery by the end-to-end type

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8–10 mm rum, the distal part of which under the pectoral muscles and under the skin of the anterior pectoral and abdominal walls is cut into the incision in the femur to the femoral artery and anastomose with it. The restoration of the axillary artery is carried out with an additional prosthesis 5 with a diameter of 6 mm, which is sewn at an acute angle on the side-to-side end into the axillary-femoral shunt and on the end-to-end type anastomose it with the distal axillary artery segment 6.

In this way, a formed U-shaped anastomosis is obtained. The difference in the diameter of the prosthesis is used in order to increase the volume of blood flow through the shunt.

Example. Sick 68 years. Diagnosis: Leriche syndrome, atherosclerotic occlusion of both iliac arteries, trophic stitch of the left thigh stump, decompensated ischemia of the right lower limb. Concomitant diseases; chronic ischemic heart disease, coronary and cardio sclerosis, pneumosclerosis, hypertensive disease I-I1 st. Complaints on admission to pain at rest in the right lower extremity. Ill for 15 years when pain began to appear when walking in the lower limbs. In 1981, due to the athero-sclerotic gangrene of the left lower extremity, it was amputated at the level of the upper third of the thigh. A month before admission after supercooling, a trophic stump of the left thigh stump appeared, which reached 12X15 cm. At the same time, severe pain began to appear at rest in the right lower extremity. On admission - the state of average weight, dramatically increased nutrition. In the lungs - weakened breathing, isolated dry rales. Pulse 96 beats per 1 min. HELL - 170/100 mm Hg Art. 02/04/1985, axillary aortography was performed in which the occlusion of the left iliac and femoral arteries was detected, stenosis (more than 70%) of the right iliac artery and the occlusion of the left femoral artery in the lower third (3 cm diastasis) with satisfactory filling of the popliteal segment. 02/20/1985, the right-sided axillary-femoral shunting was made using a synthetic prosthesis with a diameter of 8 mm. The axillary artery is crossed above the discharge of the subscapularis artery. The vascular prosthesis is sewn into the proximal segment of the axillary artery of the end-to-end type. Next, a U-shaped anastomosis is formed. During the operation, the initial blood flow (volumetric) along the axillary artery is 275 ml / min. After the formation of an axillary-shunt shunt, blood flow through the axillary artery was 725.5 ml / min, along the axillary artery - the area after the anastomosis, through which blood directly enters the arm (additional branch, 6 mm in diameter) - 323 ml / min.

Distal anastomosis of the axillary-femoral shunt is applied end-to-end with the femoral artery. The postoperative course is smooth, the wounds healed by primary tension, the pain in the right lower extremity has completely disappeared. The patient is moved with crutches. Conservative treatment of the stump of the left thigh stump was performed. Was discharged for outpatient follow-up care at the polyclinic at the place of residence 26 days after surgery. Examined 3 months after surgery. No pain in the right lower extremity was noted, the pulsation of the axillary-femoral shunt is distinct. The pulse on the right upper limb is distinct at all levels.

Thus, according to the proposed method, the axillary-femoral shunting of the blood flow is immediately directed to the vascular prosthesis, preventing turbulence of the blood flow in the axillary artery and

in the axillary-femoral shunt, which ensures an increase in the volumetric blood flow velocity. This significantly reduces the risk of lower limb gangrene.

Claims (1)

Invention Formula The axillary-femoral arterial bypass graft, comprising the imposition of a proximal anastomosis of the prosthesis with the axillary artery and a distal anastomosis of the prosthesis with the femoral artery of the end-to-end type, characterized in that, in order to prevent thrombosis, the proximal anastomosis is applied with the axillary artery by means of an artery to the artery. its intersection above the discharge of the subscapularis artery, and the blood flow in the axillary artery is restored due to the additional prosthesis, which connects the distal segment along muscular type arteries end to end with axillary-femoral nym shunt at an acute angle type end to side.