transvenous arterial repair

This procedure repairs the arterial stenosis from the venous cavity to eliminate arteriovenous fistulas and maintain access to the arterial lumen. The method is relatively simple, and there is no need to separate the tumor sac, which can avoid the blood supply of the injured side branch, often can cure the arteriovenous fistula, rarely cause chronic ischemic signs of the injured limb, and the pupil is not large and the artery wall is healthy. It is a very satisfactory method. Treatment of diseases: congenital pulmonary arteriovenous fistula, pulmonary arteriovenous fistula Indication This procedure repairs the arterial stenosis from the venous cavity to eliminate arteriovenous fistulas and maintain access to the arterial lumen. The method is relatively simple, and there is no need to separate the tumor sac, which can avoid the blood supply of the injured side branch, often can cure the arteriovenous fistula, rarely cause chronic ischemic signs of the injured limb, and the pupil is not large and the artery wall is healthy. It is a very satisfactory method. However, if the arterial wall is not perfect and there are weaknesses such as deterioration or destruction and are ignored, the aneurysm may be secondary after surgery. Another example is that the pupil is large, and the lumen of the artery can be narrowed after suturing, and even the risk of arterial occlusion is caused. In addition, multiple pupils may be missed and cause recurrence, which should be noted. Contraindications The patient is too old and should be filled with poor general condition. 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 1500u 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. Control the proximal artery: the upper tourniquet; if the tourniquet cannot be used, a small incision can be made on the top of the tumor to expose and separate the proximal end of the artery and wrap around a gauze. 2. Incision, exposure: centered on the most obvious part of the tremor, a long incision along the femoral artery, fully revealing the arteriovenous tumor and its proximal and distal arteries and veins. The most obvious part of the tremor, that is, the location of the arteriovenous fistula, is separated along the blood vessel to separate the proximal and distal ends of the artery and vein, respectively. The arteries usually have blood vessel clamps; the veins can be wrapped around the gauze tape or a piece of rubber tube on the gauze band. After tightening, the hemostatic forceps are used to clamp the gauze band to block blood flow. In the site where the tourniquet can be used, the tourniquet placed before surgery can also be tightened without separating and controlling the distal and proximal ends of the artery and vein. 3. Incision of the vein: In the site where the arteriovenous fistula is located, the vein is cut longitudinally, and the blood is removed, and the arteriovenous fistula can be found. 4. Sewing the arteriovenous fistula (1) If there is only a small pupil, the arterial wall is still sound, and there is no obvious deterioration or destruction. The filament can be used for simple continuous or intermittent suture to restore the passage of the artery. Otherwise, other surgical methods must be used. (2) If the wall of the femoral vein is still intact, an incision can be made to suture the vein continuously to preserve the vein. Generally, the distal end of the vein can be ligated and then cut, and then the two edges of the residual vein wall adhering to the artery wall are covered and sutured on the repaired fistula to strengthen the suture. complication An aneurysm can be secondary to the operation.