Spiral vein grafting superior vena cava bypass shunt

There are many types of superior vena cava bypass shunts, which should be selected according to the anatomical relationship between the superior vena cava obstruction and the azygous vein. 1 Blocking the proximal end of the entrance to the azygous vein: If the azygous vein is unobstructed, the superior vena cava can be treated with the superior vena cava, right atrial appendage or inferior vena cava anastomosis. 2 Blocking the telecentric end of the entrance to the azygous vein: the common saphenous vein is often used as an alternative material for bypass bypass in the chest or chest. Intrathoracic bypass shunt is often performed with an invasive vein-right atrial appendage bypass, internal jugular vein-pericardial superior vena cava or right atrial appendage bypass shunt. Extrathoracic bypass shunt is often referred to as the external jugular vein-saphenous vein bypass shunt. Since the first use of the spiral saphenous vein in the superior vena cava bypass shunt in 1976, satisfactory results have been achieved, so I will introduce it here. Treatment of diseases: superior vena cava syndrome Indication 1. Mainly used for benign superior vena cava obstruction, medical treatment is not good, collateral circulation is difficult to establish. 2. Malignant superior vena cava obstruction, severe symptoms, conservative treatment can not be alleviated. Surgical procedure 1. Incision: A midline incision in the chest, extending to the neck if necessary to expose the internal jugular vein. The groin and thigh are straight incisions for freeing and intercepting the great saphenous vein. 2. Exploring the mediastinal lesions after thoracotomy and biopsy if necessary. Longitudinal cut happy packets, revealing right atrial appendage, superior vena cava and left and right innominate veins. 3. Spiral vein preparation: The length of the great saphenous vein is calculated according to the following formula: the diameter of the unknown vein (mm), the diameter of the saphenous vein, the distance from the junction of the left internal jugular vein and the left subclavian vein to the right atrial appendage (cm). . For example, the diameter of the left unnamed vein is 15 mm, the diameter of the great saphenous vein is 3 mm, and the distance to the right atrial appendage is 8 cm. The length of the great saphenous vein is 40 cm (15 ÷ 3 × 8). Heparin saline was injected after the saphenous vein was intercepted, and all lateral branches were ligated and then cut longitudinally. Select a chest drainage tube or other catheter with a similar diameter to the left unnamed vein as a stent, spirally wrap the longitudinal saphenous vein and the flattened saphenous vein on the stent, and suture the edge of the saphenous vein continuously with a 7-0 Prolene line. , complete the production of spiral veins. Note that the inner wall of the saphenous vein should be attached to the bracket, and the stent should be gentle when exiting from it. 4. Intravenous heparin (100 g/kg), free the blocked left unnamed vein, and ligated near the superior vena cava. The non-invasive vascular clamp blocked the concomitant part of the neck and the subclavian vein, cut off the left innominate vein, cleared the thrombus in the distal vessel, and then used the 7-0 Prolene line to make the spiral vein and the end of the left innominate vein. 5. The cardiac clamp clamps the right atrial appendage, removes the right atrial appendage, cuts the trabecular bone in the auricle, and uses a 5-0 Prolene line to perform an anastomosis between the spiral vein and the right atrial appendage to complete the bypass shunt.