SU1655474A1 - Method for treating the acute and chronic arterial impassibility cases - Google Patents

Abstract

The invention relates to medicine, namely to vascular surgery, which can be used in case of obstruction of the arteries. The purpose of the invention is to prevent postoperative complications by preserving the endothelium with the antithrombotic property. When a shunt is applied, an autoven is used, the valves of which are destroyed by ultrasound, the oscillation frequency of which is 25-30 kHz. This method allows to preserve the antithrombotic properties of the endothelium of the vein and is recommended for practical use.

Description

The invention relates to medicine, namely to vascular surgery, and can be used in case of arterial obstruction.

The purpose of the invention is to prevent postoperative complications by preserving the endothelium with the antithrombotic property.

Example 1: Patient K., 57 years old, was admitted to the clinic with complaints of pain in the left lower extremity, moving lameness 50-100 m. Ill for about 1 year. The examination according to digital subtraction angiography revealed an occlusion in the superficial femoral artery from the left to the middle third of the thigh with a length of about 5 cm, a sharp narrowing of the artery to the lower third of the thigh. Stenosis of the common iliac artery on the right. Using Doppler ultrasound, a decrease in regional systolic pressure of up to 90 mm Hg was detected. on the posterior tibial artery and

lack of blood flow in the anterior tibial artery.

Endovascular depression of the common iliac artery stenosis was performed on the right. The operation was performed on the left-sided femoral-popliteal shunting by an in situ autovenov.

Under epidural anesthesia, a bifurcation of the femoral artery is revealed in the incision in the upper third of the left thigh. All arteries pulsate well, smooth to the touch. The proximal part of the popliteal artery is separated by an additional incision through the joberoeus mucus. Artery does not pulsate, m gka. Produced femoral-popliteal shunting using the great saphenous vein in situ. From the incision in the upper third of the thigh, a large saphenous vein 4 mm in diameter is separated, at the mouth it is crossed at the clamps, its proximal end is transcribed with silk. The distal vein (2-3 mm in diameter) is isolated from an incision in the lower third of the thigh, where the vein is also crossed and its peripheral section is transferred. All visible inflows of the vein are tied and crossed. In the upper wound, an ultrasonic instrument (waveguide) was inserted into the lumen of the vein in the distal direction, and two valves with an ultrasound frequency of 25 kHz were destroyed. After appropriate preparation of the common femoral and popliteal arteries, anastomosis was performed with a large saphenous vein as an end-to-side continuous suture using a 6/0 synthetic thread on the atraumatic needle. After recovery of the main blood flow in the vils pulse in the posterior tibial artery. The wounds are sutured in layers tightly. The duration of the operation is 3 hours.

With control ultrasound dopplerography, the regional systolic pressure on the left posterior tibial artery increased to 130 mm Hg. According to the ultrasonic flowmetry, the volume flow through the shunt is at a speed of 144 ml / min, the pulse index is 2.73, the shunt diameter is 4.21 mm.

The patient was discharged in a satisfactory condition. 6 months after the operation, there are no complaints, the shunt passes.

Example 2. Patient G., 40 years old, will be admitted to the clinic with complaints of pain about the right lower limb, intermittent lameness of 15–20 meters, as well as pain in the foot at rest. Ill for about 3 years. Distal subtraction angiography of the pelvis and lower extremities was performed. You have occluded the right superficial femoral artery all the way to the popliteal artery. Stenosis of the distal right popliteal artery. With ultrasound dopilerography, a reduction in regional systole pressure was observed at the posterior tubercular artery up to 40 mm Hg, at the anterior tibial artery pressure O

The operation performed right-side femoral-popliteal bypass surgery (below the knee) with the help of the great saphenous vein in situ.

Under the epidural anesthesia, a trofurcation of the popliteal artery with a diameter of 5 mm and a diameter of the tibial arteries of 2 mm was highlighted with a tibi-medial access. The artery is dense, does not pulsate. The posterior bolsheterzovaya artery and the small fibula artery are soft, the anterior one is obliterated. An incision in the upper third of the thigh indicates a bifurcation of the femoral artery, its diameter is 10 mm. deep femoral arteries with a diameter of 4 mm, superficial - 5 mm (dense, does not pulsate). Produced femoral-infrapopliteal shunting with the help of the great saphenous vein in situ. From access to the upper third of the thigh highlighted

the great saphenous vein is at the mouth (its diameter is 4.5 mm), its proximal end is tied up and crossed by silk. From the incision in the upper third of the leg, a large saphenous vein was isolated and crossed,

0 its distal end is transferred by silk. In the wound of the upper third of the thigh in the distal direction, an ultrasonic instrument (waveguide) was inserted and 6 valves were destroyed (3 valves on the thigh and 3 valves on the tibia). The working frequency is 30 kHz, the oscillation amplitude is 25 microns. During the operation, one additional incision was made in the lower third of the thigh. All visible tributaries of the vein are transferred. Further

0 the popliteal artery is cut longitudinally into 3 cm with a transition to the tibioperione trunk. There is marked atherosclerosis, arterial stenosis in this area. The anterior tibial artery is obliterated, the posterior is passable 40 cm, the retrograde blood flow is satisfactory. An anastomosis has been imposed between the popliteal artery and the distal venous graft in an end-stitch style with a continuous seam of the synthetic i-jnTi on the atraumatic needle. Then, a longitudinal arteriotomy and femoral artery was made at the bifurcation site with a length of 2 cm and the anastomosis with the proximal venous graft section was applied with a continuous suture with a synthetic thread B / O on the atraumatic needle. Restored major blood flow. Percutaneously pulsating collateral (venous graft) bandages are tied on the thigh. The wounds are sutured in layers tightly.

In the case of a control digital subtraction postoperative angiography, it was noted that the shunt passes through the entire protrusion, but there is an uncorrected large collateral branch between the shunt and the femoral vein, through which the shunt flow was significantly blocked.

0 In connection with this, a repeated operation was performed in which the collateral thigh-popliteal shunt was tied up. Under local anesthesia, in the lower third of the thigh, 3 collateral

5 branches. Immediately after ligation on the posterior tibial artery, there was a distinct pulse in the wils (the pulse was weakened before the operation).

Two weeks later, ultrasonic flowmetry was produced - volumetric rate

blood flow was 195 ml / min; blood flow velocity was 24 cm / s.

With the control ultrasound dopplerography, the regional systolic pressure in the left lower extremity increased: in the posterior tibial artery up to 100 mm Hg, in the fibular to 100 mm Hg. In satisfactory condition, the patient was discharged home. 5 months after the operation, there are no complaints, the shunt passes.

When using ultrasound with a frequency of 25-30 kHz, partial damage to the endothelium is noted (the muscle membrane does not suffer), which is fully restored in 3-4 weeks and practically does not occur.

0

differs from the intact vein, which is confirmed by morphological studies.

The method is recommended, but not practical.

Claims (1)

The invention The method of treatment of acute and chronic obstruction, with teriyu, including autovenous shunting with the destruction of the autoshunta valves. characterized in that, in order to prevent postoperative complications by preserving the endothelium with the antithrombotic property, the valves are sonicated, and the frequency of the ultrasonic oscillation should be 25-30 kHz.