SU1674813A1 - Method for microsurgical reconstruction of incompetent valves of veins - Google Patents

Abstract

The invention relates to medicine, namely to vascular surgery, and can be used for the surgical treatment of inconsistency of the deep-vein valve apparatus. The purpose of the invention is to increase the efficiency and decrease the trauma of correction by increasing the area of contact between the valve leaflets. To do this, measure the length of the vein semicircle, cut the vein longitudinally between the valve commissures from proximal to distal, determine the length of the free edge of the valves, after which half of the difference in measured lengths is laid at the free edge of the valve, the needle is passed through these points fix an excess of the free edge of the cusps, tying knots on the outer side of the vein wall. After that, additionally, in the upper and lower levels, the fastenings of the valves impose a purse-string sutures in the adventitial layer of the vein without narrowing its lumen (banding). The method allows to achieve the restoration of the function of the valve apparatus of the veins and to avoid the recurrence of the disease. The method is recommended for implementation in practical health care. 1 z p f-ly. with y

Description

The invention relates to medicine, in particular to vascular surgery, and can be used for the surgical treatment of the inconsistency of the deep vein valve apparatus.

The purpose of the invention is to increase the efficiency of correction by increasing the contact area of the valve leaflets, as well as reducing the number of relapses.

The method is carried out as follows.

In the upper third of the thigh, the common, superficial and deep femoral veins are separated, and a valve is located at the mouth of the superficial femoral vein. The circumference of a vein above the valve is measured, distal

valve impose vascular clamp. Blood is squeezed in the proximal direction. In case of retrograde blood flow, the inconsistent valve passes it into the subvalvular segment. Put the clamp proximal to the valve, the vein is cut lengthwise between the commissures of the valves, starting 1 cm proximal to them. and extend 2 cm in the distal direction. The length of the free edge of the valves is measured, and half of the difference between the length of the free edge of the leaf and the length of the vein semicircle is laid on it at each commissure.

Then, through a puncture from the outside to the inside, above the level of the commissure, enter the lumen of the vein.

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an atraumatic needle with a thread, picking up the free edge of the valves at a distance of the length of the excess edge of the commissure that was separated from the commissure, pulling the thread out and tying the knot on the outer side of the vein wall. A similar operation is performed on the opposite commissure. In this case, the free edge of both valves is raised to the level of nodes on the wall of the vein. Venotomic hole sutured. The valve function is monitored, the venous pressure is raised to 500-600 mm of water column. Filters in the form of pouches are drawn above and below the valve in the adventitial layer, which tie without narrowing of the lumen of the vein (bandaging). The operation is performed with an operating microscope under 8-12 fold magnification and microsurgical instruments. The wound is sutured in layers.

Example. Patient B., was admitted to the clinic with complaints of swelling, rapid fatigue, orthostatic cruralgia of the right lower extremity, hyperpigmentation of the skin of the right tibia. According to the data of ultrasound doppler and retrograde femoral phlebography, the inconsistency of the superficial femoral vein valves was revealed. Operation: microsurgical reconstruction of the inconsistent valve of the superficial femoral vein on the right, phlebectomy and the great saphenous vein. The incision is in the upper third of the right thigh 8 cm long. The common, superficial and deep femoral veins are distinguished. An incompatible valve is revealed at the mouth of the superficial femoral vein. The circumference of a vein is 38 mm. Longitudinal venotomy and a length of 2 cm between the commissures. The length of the free edge of the valves is 27 mm, the difference between the length of the free edge and the length of the semicircle of the vein is 8 mm. The free edges of the cusps at each commissure were marked by points at a distance of 4 mm. Under a 12-fold increase in the atraumatic needle with a thread 8-0 prolene through a puncture of the vein wall from the outside to the inside above the level of the commissure by 4 mm was inserted into the lumen of the vein, free edges of the valves in the place of pending points near one commissure were picked up, the needle with the thread was pulled out knot. The same manipulation was performed by another commissure. The venotomic incision is sutured by a continuous knot, the function of the valve is checked. In the area of the upper and lower levels of fastening of the valves in the adventitious layer of the vein, pouch sutures were made and veins were fastened without plication. Next, the phlebectomy of the great saphenous vein is performed.

In the postoperative period, the edema and pains in the right lower extremity disappeared, according to the control tetrapolar reografiya and Doppler ultrasound, the valve function is satisfactory,

At the control examination after a year there were no complaints, according to non-invasive research methods, the valve functions well.

The method was applied in 216 patients with inconsistency of the valve apparatus of the veins of the lower extremities. There were no postoperative complications associated with the operation. One year after surgery, there was no recurrence of the disease.

The method is recommended for implementation in practical health care.

Claims (2)

1. A microsurgical reconstruction method of an incompatible valve apparatus of the veins, including opening the vein, tightening the valve leaflets, characterized in that, in order to increase the correction efficiency by increasing the contact area of the valve leaflets, the length of the vein semicircle is cut through the vein longitudinally in the area upper hemisphere proximal to commissure level from proximal to distal between the commissures, the length of the free edge of the valves is determined, after which half of the difference of the measured lengths is laid on the free edge of the valves, the points of which are subsequently fixed above the level of the commissures. 2. A method according to claim 1, characterized in that, in order to reduce the number of relapses, additionally, in the area of the upper and lower levels of fastening of the cusps, they add pouch sutures in the adventitia without narrowing the lumen of the vein.