Abdominal aorta-celiac artery bypass and abdominal aorta-superior mesenteric artery bypass

Abdominal aortic-peritoneal artery bridging and abdominal aorta-superior mesenteric artery bypass surgery are used for the treatment of abdominal aorta and major branches of chronic occlusion. The main cause of chronic occlusion of the celiac artery and superior mesenteric artery (SMA) remains atherosclerosis. The main symptoms are triad of digestive tract ischemia: abdominal pain, diarrhea and weight loss. Exacerbation of abdominal pain after eating is characteristic. The danger is that once a thrombosis occurs, which leads to acute ischemia of the supplied organs, extensive gangrene occurs rapidly, which is more common in the small intestine and right colon. The stenosis is generally at the opening of the artery from the abdominal aorta, which is also the pathological anatomical basis of surgical treatment. Angiography can provide an accurate localization diagnosis. Treatment methods include balloon dilatation, local endarterectomy, and bridging. The first two methods have been largely abandoned due to poor long-term efficacy. Treatment of diseases: thoracic and abdominal aortic aneurysms Indication Applicable to signs of digestive tract ischemic symptoms, angiography confirmed that the stenosis is confined to the opening, and the patient's condition can tolerate major abdominal surgery. Contraindications 1. Intraperitoneal infection. 2. Severe adhesions in the abdominal cavity. 3. Those who cannot tolerate major surgery due to severe underlying diseases. Preoperative preparation 1. For patients with malnutrition, short-course parenteral nutrition support should be provided to improve their general condition. 2. Active treatment of possible underlying diseases before surgery. Surgical procedure 1. Take a midline incision, up to the xiphoid, and circumnavigate the umbilicus to the lower 5cm. 2. Comprehensive exploration should pay attention to exclude malignant tumors such as stomach, pancreas, colon, etc., because a few vascular occlusion symptoms are caused by these tumors. Check the digestive tract for ischemic manifestations and mesangial pulsation. 3. Transversely cut the peritoneum of the transverse colon, pull the duodenum up, find the SMA trunk, and free it for a period of time and confirm its patency (the stenosis can not be seen behind the pancreas). 4. Cut the liver and stomach ligament, dissect the celiac artery, and the 3 branches should also be properly dissected. 5. If the lesion only involves SMA and the celiac artery is intact, and the inferior abdominal aortic wall is normal, only the aorta-SMA bridge can be performed. The material can be inverted inverted saphenous vein trunk or polyester artificial blood vessel. The anterior wall of the abdominal aorta below the plane of the renal artery was clamped with a Satinsky forceps and a small piece was removed. One end of the graft vessel was trimmed into a bevel, first anastomosed to the abdominal aorta, with a 4-0 or 5-0 line. If the saphenous vein is too thin, you can cut it to increase the anastomosis. The SMA was blocked with an arterial clip. Complete the second anastomosis and open the blocking forceps. 6. If the lesion involves the celiac artery and SMA at the same time, the "human" shaped artificial blood vessel should be used to make two anastomoses at the same time. To this end, the left lobe of the liver is pulled upward, and the diaphragmatic foot is separated above the root of the celiac artery to reveal the abdominal aorta. The abdominal aorta was clamped with a Satinsky forceps and the anterior wall was excised to form an elliptical hole. The abdominal aorta-artificial end-to-side anastomosis was performed with a 3-0 or 4-0 line. After confirming that no blood leaks, the artificial blood vessel was blocked near the anastomosis and the Satinsky forceps were opened. Block the celiac artery and its branches. Select a thicker, thinner branch and cut a thin arm of the artificial blood vessel to make an end-to-side anastomosis. Open each blocking pliers. The other thin arm that has been clamped under the bifurcation is led downward from the front of the pancreas, and the end-to-side anastomosis is performed with the SMA with a 4-0 or 5-0 line. Open the blocking forceps. complication 1. Although early thrombosis is rare, it is easy to cause intestinal necrosis. Should be closely observed, if necessary, laparotomy for treatment. 2. Anastomotic bleeding. 3. Arterial embolism. 4. Anastomotic intestinal fistula (late).

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