Aneurysm Resection and Vascular Grafting

Although occlusion surgery can cure aneurysms, gangrene rarely occurs after the main arteries of the extremities are occluded, but its function is difficult to fully recover, often leaving chronic ischemia (such as intermittent breaks, skin chills, edema, ulcers) , muscle atrophy, etc.) signs. Therefore, the principle of treatment of aneurysms in the main arteries should be to seek to remove the tumor sac and repair the arterial passage. Treatment of diseases: congenital coronary aneurysm aortic aneurysm Indication Although occlusion surgery can cure aneurysms, gangrene rarely occurs after the main arteries of the extremities are occluded, but its function is difficult to fully recover, often leaving chronic ischemia (such as intermittent breaks, skin chills, edema, ulcers) , muscle atrophy, etc.) signs. Therefore, the principle of treatment of aneurysms in the main arteries should be to seek to remove the tumor sac and repair the arterial passage. Preoperative preparation 1. The open wound has healed, and the local infection can be treated after it has subsided, without waiting for the establishment of the collateral circulation. 2. Give antibiotics to prevent infection and re-inject tetanus antitoxin. 3. Prepare enough blood. 4. Prepare the inner side of the thigh for the healthy side, in order to prepare the great saphenous vein for transplantation, and prepare artificial blood vessels of different sizes. Surgical procedure Take iliac aneurysms as an example. 1. Position: lateral position, the injured limb is straight down, and the lateral flexion. 2. Control the proximal end of the artery: Place the tourniquet on the thigh for use when necessary. 3. Incision, exposure: A transverse incision is made at the armpit, with the outer end facing upward and the inner end extending downward. A midline longitudinal slit can also be used. Open the upper and lower flaps to reveal muscles and deep fascia. Cut the deep fascia, cut it with a round head, and then open it to the sides. The inner muscles are pulled apart to fully reveal the phrenic nerve and the iliac vein. 4. Separate the iliac vein and cut off the iliac vein: separate the phrenic nerve and pull it to the outside with a thread, taking care not to damage the branch leading to the medial head of the iliac muscle. The posterior wall of the iliac vein often adheres to the artery, and it can be ligated and cut off without separating. Then, the proximal and distal ends are ligated and cut. 5. Control of the radial artery: The proximal end of the radial artery is often enlarged and curved. It is located slightly inside the deep part of the incision. After careful separation, a gauze tape is placed around it for additional use of the blood vessel clamp. After separating the distal end of the radial artery, it is also taken around a gauze. 6. Resection of the tumor sac: Separate against the tumor sac, starting from one side, separating, clamping, cutting and ligating all the branches of the artery one by one before treating the other side. Then, 20 mg of heparin was injected into the tumor sac, and then the proximal and distal ends of the radial artery were blocked with a blood vessel clip, and cut off near the tumor capsule, respectively. Finally, one end of the tumor sac is lifted, and the posterior wall is gradually separated from the deep part of the armpit, and the tumor sac is completely removed. If there is a close adhesion, it does not have to be done barely, and some of the tumor wall can be left behind. 7. Vascular transplantation (1) Select a suitable artificial blood vessel with a diameter of at least 8 mm. If the artery is less than 6mm, or if the blood is not well in the distal segment, the saphenous vein graft should be used instead. The distal end of the radial artery can be cut obliquely to fit the larger artificial blood vessel. (2) Start the anastomosis from the proximal end of the artery. The valgus type fixed-point sutures on both sides were placed, and the anterior and posterior walls were sutured according to the two fixed point anastomosis after ligation. (3) After the proximal end of the anastomosis is completed, the end of the artificial blood vessel is clamped with a finger, and the blood vessel clip at the end of the artery is temporarily loosened, so that the blood is filled with the artificial blood vessel, and then the blood vessel clip is closed. The blood and blood clots in the artificial blood vessels were released, and the proximal anastomosis was covered with a wet gauze. (4) Straighten the injured limb, tighten the artificial blood vessel, cut to the appropriate length, so as not to bend too long. Then, temporarily loosen the blood vessel clip at the proximal end of the artery to check whether the blood countercurrent is smooth. After the blood flow is smooth, a blood vessel clip is placed at the distal end of the artificial blood vessel. Immediately after the artificial blood vessel is close to the distal end of the artery, two end point end anastomosis is performed. However, after continuous suturing the posterior wall, no ligation is temporarily performed. The distal vessel clamp is first relaxed, and the blood is filled with the artificial blood vessel, and after the air is discharged, the suture is tightened. Then, chronically relax the proximal vessel clamp. 8. Stitching the incision: Before suturing the incision, check the color of the pulse in the wound and on the injured side of the foot. Observe the condition of the graft when the knee is flexed. After completely stopping the bleeding, the rubber sheet was placed in the armpit and drained, and the fascia was carefully sutured. Finally, the skin was sutured and bandaged with a multi-layer gauze.

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