Start From Emergency Doctor

Chapter 156

After the great saphenous vein was filled, the whole blood vessel and the surrounding connective tissue swelled up, and there was no leakage.

Zhou Yuan carefully put the saphenous vein into the diluted heparin saline and temporarily stored it for later use.

“Next, build a subcutaneous tunnel.” Zhou Yuan said.

The function of the subcutaneous tunnel is to provide a channel for implanting the great saphenous vein to connect the thrombus site of the perforating vein with the expensive vein of the upper arm outside.

“Scalpel.”

The position of the opening has been fixed before, and the marker also marked the general direction of the subcutaneous tunnel, just follow the marking line on the arm.

Zhou Yuan opened an opening about 3 cm each at the perforating thrombosis site and the expensive vein on the outer upper arm. Then, the two openings were extended to each other, and a U-shaped subcutaneous tunnel was quickly formed between the two skin incisions.

“Perform the anastomosis of the saphenous vein.” Zhou Yuan said.

He Jianyi took out the saphenous vein in the diluted heparin saline.

“Vascular clamp.”

Zhou Yuan clamped off the connecting blood vessel again.

Next, Zhou Yuan unfolded the large 26 saphenous vein to ensure that the blood vessel was not twisted, and then gently put it into the subcutaneous tunnel.

One end is anastomosed with the expensive vein, and the other end is connected to the perforating vein.

Because there is a certain gap between the great saphenous vein and the two blood vessels, Zhou Yuan trimmed the great saphenous vein. The place where the great saphenous vein connects to the expensive vein is thinned by 11.00mm, which successfully anastomoses with the expensive vein.

“Open your veins.”

He Jianyi opened Gui Yao’s vein.

The saphenous vein began to flood into the blood, producing regular pulsations.

Moreover, the anastomoses of the saphenous vein and the expensive vein had obvious tremors, but there was also no oozing under the microscope.

“A good match.” Zhou Yuan smiled lightly.

“Take the blood clot.”

Without waiting for He Jianyi and others to breathe a sigh of relief, Zhou Yuan started the next operation.

There are many thrombi in He Jianguo’s blood vessels. The vascular endothelium at the thrombus site is severely damaged, the blood flow rate is slowed down, and the viscosity of the blood has also increased.

If the thrombus is not removed, the large thrombus is attached to the blood vessel and may be constantly washed away by the blood flow, causing it to fall off, and even collapse to form many small thrombus.

The consequence of this is that small thrombus or thrombus fragments will flow with the blood to various blood vessels in the body. Although these small thrombus will not have much impact on most blood vessels, but…what about small capillaries?

The volume of the thrombus is larger than the small capillaries, which will cause the capillaries and other small blood vessels to be blocked, and then it will still affect the blood flow throughout the body.

In other words, if the blood clot is not removed, He Jianguo will be a dead end even if he has a blood vessel transplant.(Read more @ wuxiax.com)

“Scalpel.”

“Vascular blocking clamp.”

Zhou Yuan incised the cephalic vein at the elbow, and then clamped the cephalic vein proximal to the heart with vascular blocking forceps to prevent intraoperative bleeding and also effectively prevent the thrombus from being washed away by the blood vessel during the thrombus removal process and carried into other blood vessels. .

“Teacher, help press the vein of the anastomosis.”

He Jianyi heard the words and carefully pressed the junction between the saphenous vein and the expensive vein.

“F5-Fogarty balloon catheter.”

Zhou Yuan intends to use F5-Fogarty balloon catheter for thrombus removal. This method can effectively preserve the length of the blood vessel of AVF and avoid the loss of blood vessel length during reconstruction. This can extend the use time of AVF.

The so-called AVF is a surgical method for patients undergoing hemodialysis for a long time. It is a minor operation of vascular anastomosis. The artery of the forearm close to the wrist and the adjacent vein are sutured, so that arterial blood flows in the vein after the anastomosis, forming a movement. Intravenous fistula.

The F5-Fogarty balloon catheter can effectively shorten the length of the arteriovenous fistula.

Zhou Yuan took the Fogarty tube, inserted X into the cephalic vein, and then injected normal saline into the blood vessel to cause filling.

At the same time, Zhou Yuan picked up the second Fogarty tube, X entered the perforating vein, stared at the B-ultrasound monitor, and manipulated the Fogarty tube to the top of the thrombus.

“Intravenous heparin.”

“How much?” asked the young and naive vascular surgeon.

At this time, heparin is mainly used for anticoagulation, stimulating the release of anticoagulant and fibrinolytic substances from the vascular endothelium, and helping to get thrombus.

“50mg.” Zhou Yuan said.

After the heparin injection, Zhou Yuan carefully manipulated the Fogarty tube through the thrombus body, and then began to slowly pump air into the trachea to expand the volume, thereby fixing the thrombus on the catheter.

After pumping up about 1ml, Zhou Yuan gently pulled the Fogarty tube. He could already feel the resistance, so he stopped gas delivery and carefully pulled the tube.

Soon, the catheter head returned to the vascular incision, and it was obvious that a thrombus was attached to the Fogarty tube.

After removing the proximal thrombus, Zhou Yuan carefully inspected the distal end. After no thrombus was found, he injected heparin saline to flush the lumen.

Of course, in addition to flushing the lumen, the use of heparin saline has another effect-to determine whether the thrombus is completely removed.

If you can see a large amount of heparin saline gushing out of the blood vessel incision, it generally means that the blood vessel is completely unblocked.

“The thrombus was successfully removed and the blood vessels were sutured.”

Zhou Yuan only breathed a sigh of relief when he saw blood rushing from the vascular incision.

For the thrombus on the other side, Zhou Yuan still uses a Fogarty tube. Large thrombus can be pulled out with Fogarty tube, and small residual thrombus can be taken out with Ant’s forceps.

“Complete thrombectomy.”

After this sentence, the operation has basically come to an end.

Zhou Yuan: “Vascular clamp.”

He Jianyi and the others were all taken aback.

Why do we need blood vessels at this time…

Zhou Yuan did not explain too much, and directly clamped the distal cephalic vein with blocking forceps.

“Zhou Yuan, are you planning to…check the thrombus again?” He Jianyi asked.

Zhou Yuan shook his head.

“6F sheath.”

Zhou Yuan placed a 6F sheath in the cephalic vein of the forearm and injected a small amount of heparin saline.

He Jianyi: “Heparin saline…Do you want to anticoagulate and prevent thrombosis?”

Zhou Yuan nodded, “Generally speaking, this step is not needed after blood vessel transplantation and thrombus removal. However, I consider the patient’s age, and the patient’s cephalic vein has experienced intimal weakness. Thrombosis occurred.”

“Injecting heparin saline into the cephalic vein of the forearm can prevent the cephalic vein from forming a blood clot.”

Zhou Yuan put down the needle after finishing the injection.

The two vascular surgeons looked at each other, and they both felt their eyes brightened.

This is the difference between an expert performing an operation and a novice performing an operation.

Experts will modify the details of the operation according to the patient’s age, gender, weight, past medical history and other physical conditions, and will also add or reduce the operation steps to achieve the best cure effect for the patient.

And novices, often just follow the textbooks to perform surgery.

These two methods will be very different in terms of postoperative healing and the emergence of complications. .