Misheng's right subclavian artery amputation and suture and right upper extremity blood circulation reconstruction

The abnormality of the arterial origin originates from the upper part of the descending aorta, the distal part of the left subclavian artery, and follows the esophagus to the right axilla. It is also called the retroesophageal right subclavian artery. Most patients are asymptomatic, but are prone to complications such as tumor-like dilation, even embolism, upper limb ischemia, and aneurysm rupture. Some patients may have symptoms of dysphagia, irritating dry cough, and hoarseness in the early stages of tracheal and esophageal compression. Patients with symptoms should undergo surgical treatment and ligature to cut off the right subclavian artery. In 1946, Gross first surgically cut off the right subclavian artery and achieved good results. However, after the adult patient cuts the blood vessel, it may affect the blood supply to the right upper limb or cause the subclavian artery stealing syndrome. Revascularization should be performed, including the distal right subclavian artery transplanted to the aortic arch, or the right common carotid artery or nameless. Arterial anastomosis. Treatment of diseases: subclavian artery stealing syndrome Indication If the trachea and/or esophagus have obvious symptoms of compression, surgical treatment should be performed immediately after diagnosis to avoid suffocation. Preoperative preparation 1. People with respiratory infections should apply antibiotics before surgery and remove respiratory secretions to control infection. 2. Infants and young children with malnutrition must be given supportive treatment such as transfusion and rehydration before surgery to improve the general condition. Surgical procedure Common incision (1) Right neck incision, the superficial subclavian artery is cut in the plane of the right common carotid artery, and the distal end of the blood vessel is anastomosed to the right common carotid artery. This path is small, but it cannot be lost. The blood vessel is treated at the origin of the right subclavian artery. (2) chest median incision and right neck incision, suitable for concurrent intracardiac malformation. (3) Left chest and posterior incision, suitable for simple ligation and cutting of the right subclavian artery. (4) Left chest posterior incision and right neck incision, which is suitable for cutting the blood vessel at the origin of the lower right subclavian artery and reconstructing the blood circulation of the right upper limb. This path surgery field is well exposed. Taking this incision as an example, the surgical procedure is described below. 2. The fourth intercostal space of the left chest is inserted into the chest. Cut the mediastinal pleura. 3. Free descending of the upper aorta to determine the origin of the right subclavian artery. Freely the beginning of the right subclavian artery, the blood vessel wall is often thin, and even tumor-like expansion, the operation should be detailed and accurate when peeling, so as not to damage. After the blood vessels are free, two non-invasive vascular clamps should be placed at the root to block the blood vessels, and the sutures should be cut after suturing. The proximal stump should be 1 cm long. At the same time, the adhesion tissue of the esophagus and blood vessels should be fully freed. 4. Make a transverse incision at the base of the right neck or a longitudinal incision along the anterior border of the sternocleidomastoid. The distal end of the right subclavian artery that had been ligated and severed was moved to the right neck, and a mandible with an inner diameter of 6 to 8 mm was connected to the ascending aorta. complication 1. Tracheal softening Due to long-term compression of the trachea, once the vascular malformation is corrected, some patients may have airway obstruction leading to airway obstruction and asphyxia. It should be processed immediately. 2. Injury of the trachea and bronchus due to the adhesion of the deformed blood vessels to the trachea and bronchus, inadvertently can damage the trachea or bronchi, resulting in tracheal or bronchopleural palsy. Once it occurs, it should be immediately closed drainage, systemic application of antibiotics to control infection. Long-term non-healing should be treated surgically.