Internal jugular vein-right atrium bypass grafting

Because the lesions compress the superior vena cava or the innominate vein, the tumor is large and the adhesion to the surrounding tissue is severe and cannot be removed. The bypass graft can be used to relieve the superior vena cava obstruction. Commonly used materials include artificial blood vessels, saphenous veins (sewed spiral blood vessels), superficial femoral veins, umbilical veins treated with glutaraldehyde, and the same aorta. Artificial endothelial cell implantation is still in clinical trials. The two are most commonly used. Artificial blood vessels are easy to use, and polytetrafluoroethylene expanded (PTFE) artificial blood vessels are recommended. The diameter of the selected blood vessels must be large enough (18-20 mm) to improve the long-term patency rate. Using the saphenous vein to open the spiral disk to make the superior vena cava substitute or vascular bridge, the patency rate can be obtained for more than 10 years, but the operation technique is troublesome. Spiral vascular bridge manufacturing method: taking the great saphenous vein with heparin saline to pressurize and smear all the collaterals. Longitudinally breaking the saphenous vein, using a tubular stent with the same diameter as the innominate vein or the internal jugular vein, spirally coiling the dissected saphenous vein along the tubular stent, the intima facing the stent, and ligating the ends The venous edge is sutured continuously with a 7-0 non-invasive slip line. The suture should be uniform, and the outer membrane tissue should not enter the anastomosis margin. Vascular bridge length and diameter design: From the inguinal fossa to the anatomy of the great saphenous vein, the diameter of the great saphenous vein in the middle of the femur was measured as the average diameter. The length of the great saphenous vein is equal to the length of the post-production vessel multiplied by the ratio of the diameter of the vascular bridge to the mean saphenous vein diameter. For example, a spiral saphenous vein bridge with a length of 10 cm and a diameter of 12 mm is required, and a saphenous vein with a length of 30 cm and an average diameter of 4 mm is used (10×12/4=30). In fact, the great saphenous vein from the fossa ovalis to the lap can be made into a vascular bridge with a diameter of 12 mm between the innominate vein and the right atrial appendage. Curing disease: Indication The internal jugular vein-right atrium bypass graft is suitable for patients with superior obstruction of the superior vena cava and double innominate veins, and severe and inseparable adhesion to the surrounding. The basis of this technique is that the jugular vein system lacks a venous valve, and the intracranial sinus has good traffic on both sides. The internal jugular vein is enough to make the entire cephalic vein get a satisfactory reflux to relieve the venous congestion. Brain symptoms, and relieve the congestion of the superior vena cava system by reducing the pressure of the collateral circulation. Surgical procedure The patient is lying on his back, his head leaning back and leaning to the left. The midline incision of the chest, after hemostasis, enters the mediastinum, cuts the happy bag, reveals the right atrium. Exploring the superior vena cava lesions, if extended to the double innominate vein, the upper incision can be extended to the right cervical root. The internal jugular vein is found on the outside of the carotid sheath and the internal jugular vein is closed. The non-invasive forceps were used to block the internal jugular vein, and a longitudinal incision was made in the middle. The length was about 1.5 cm. The 10, 12 or 14 cm vascular bridge was used to fit the internal jugular vein, and the 6-0 or 5-0 non-invasive sliding line was used. Stitch, loosen the distal blocking forceps, and after venting, loosen the proximal occlusion forceps. Clamp the right atrium wall with a heart ear clamp, and cut a small opening to match the lower end of the vascular bridge. The method is the same as above. The end of the internal jugular vein-right atrial bypass graft can also be used at the entrance of the right atrial appendage or superior vena cava. The anastomosis should be as far as possible from the lesion to prevent recurrence.