Aneurysm suture

Intratumoral suture is superior to other occlusive surgery. It can effectively cure an aneurysm without removing the tumor sac, which can fully preserve the collateral blood supply, avoid damage to adjacent nerves and other tissues, and reduce the risk of shock and infection. And the method is simpler. The disadvantage is that when the main artery is occluded, the injured limb often leaves chronic blood supply deficiency, and if the opening of some arterial collaterals in the tumor sac is neglected, or the suture is split, it can cause recurrence of the aneurysm. Treatment of disease: ascending aortic aneurysm aortic aneurysm rupture of congenital aortic sinus aneurysm Indication In the case of an invasive aneurysm of the peripheral artery, if the repair surgery cannot be performed, the intratumoral suture can be selected first. Preoperative preparation 1. For occlusive surgery, in addition to emergency situations, it should be determined whether the collateral blood supply is sufficient and reliable before surgery. In addition to examining the skin color, temperature and pulse of the distal segment of the injured limb, a method of reactive hyperemia can also be applied. Lift the limb up 30° and tie it with your elastic bandage from your finger (toe) until it is below the tumor. Then, use your fingers to squeeze the artery just above the aneurysm. After 5 minutes, the shed is quickly released, but the fingers still hold the artery. If the skin of the injured limb is rapidly reddened from top to bottom within 1 to 3 minutes until the finger (toe), it indicates that the collateral blood supply has been satisfactory. 2. Time is the main factor to promote collateral blood supply. The longer the time, the better the blood supply. Arteries above the intermittent compression of the tumor can also promote collateral blood supply. Preoperative, intraoperative or postoperative sympathetic ganglion block or sympathetic ganglionectomy is a commonly used method to promote collateral blood supply, reduce vasospasm and pain, and is more effective than simple waiting. 3. Those who have had open injury should be injected with 1500 U tetanus antitoxin. 4. There may be a large amount of blood loss during surgery, and adequate blood sources should be prepared. 5. Give antibiotics for 1 to 2 days. Surgical procedure 1. Position in the supine position, injured limbs abduction. 2. Control the area of the proximal end of the artery where the tourniquet can be used. Before the incision of the tumor capsule, the tourniquet should be tightened; when the tourniquet cannot be used, the other part of the tumor is placed above the tumor capsule, and the proximal end of the artery is separated. A gauze strip or a soft rubber tube or a blood vessel clip is prepared to control blood flow if necessary. 3. Cut and expose before the tumor sac is about to be cut, the speed of infusion and blood transfusion should be accelerated, the efficiency of the aspirator should be checked, and the gauze pad and the needle thread of the sutured blood vessel should be prepared, so as to cut the arterial rupture and suture quickly. Stop bleeding. Make a long incision along the radial artery at the midline of the aneurysm. The deep fascia was dissected and carefully separated with a round-headed scissors to reveal the anterior wall of the tumor sac. Be careful not to damage the nerves and iliac veins. 4. Cut the tumor sac and first tighten the gauze band at the proximal end of the artery (or place a blood vessel clamp) to control the bleeding, and then cut the anterior wall of the tumor sac. The incision should be large enough to reveal the arterial rupture in the capsule. Immediately use the aspirator to absorb the blood clots and blood in the capsule, and use your fingers to dig the hemorrhage block to quickly find the ruptured arterial rupture. If there is more bleeding, use your fingers to fill the opening of the artery, or use your fingers to reach the back of the artery and press to stop bleeding. 5. Intracapsular suture repair (1) If there is only one small arterial rupture and the arterial wall is intact, it can be sutured without occluding the arterial cavity. When the finger of the compression crack is gradually removed, and the crack of the exposed portion is gradually removed, the filament thread immersed in the liquid paraffin is gradually used for a few intermittent simple sutures. After repair, a partial wall covering is sutured over the artery to strengthen the suture of the artery. The distance between the upper and lower blood vessels is very close, and it can also be cut off, and the tumor capsule is placed, and the repaired ends are anastomosed. (2) The arterial rupture is generally large, and there is damage to the arterial wall. The proximal and distal ends of the artery and all the collateral vessels leading to the tumor sac must be sutured in the sac. Usually on the proximal and distal sides of the proximal and distal opening of the artery, the medium-sized silk thread is used for each of the two needles 8-shaped or intermittent suture. Each needle should be deep enough to wrap around the entire circumference of the artery end and then tighten the ligation. (3) Sometimes the arteries can be separated from the proximal and distal ends, and the double sutures are more accurate and reliable, and it is guaranteed to avoid damage to tissues such as adjacent nerves. (4) The tumor capsule can be loosely sutured to cover the artery ligation. However, it is generally not necessary to sew, as long as the pressure is applied after the operation, the capsule wall can be closely attached to eliminate the capsule cavity. (5) If the arterial wall is seriously damaged, or the suture is not secure, after all the blood vessels are sutured, the nearby muscles can be transplanted into the capsule, and the wall of the capsule can be sutured on the muscle to strengthen the occlusion of the blood vessel and avoid bleeding and recurrence. To make the intratumoral suture more perfect and firm.