Brachiocephalic vein-right atrium bypass graft

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. Curing disease: Indication The brachiocephalic-right atrium bypass graft is suitable for long-term obstruction caused by compression of the superior vena cava, and the tumor cannot be removed. Surgical procedure The patient is supine, with the shoulders and backs raised, the head tilted back, the chest midline incision, cut the happy bag, find the right atrium, find the superior vena cava and the right or left innominate vein above it and freely explore, and wrap around the normal nameless vein. Block the belt for backup. Intravenous injection of heparin, non-invasive vascular wall clamps were used to close the right innominate vein, and a 2.0 cm longitudinal incision was made on the side wall. The spiral vessel or artificial blood vessel was used, and one end was cut into a slope to match it with 6-0 or 5- 0 No injury injury slide line for continuous valgus suture, loosen the side wall clamp after the anastomosis is completed, check the anastomosis without blood leakage, and block the blood flow of the vascular bridge with the blood vessel clamp. The lower end of the vascular bridge was anastomosed to the right atrium. The right lateral wall of the right atrium was clamped with a heart clamp. The 2 cm incision was made with scissors on the atrial wall of the clamp. The anastomosis method was the same as above, and the last needle was not knotted. After the forceps have exhausted the gas in the cavity, the suture is ligated, the fungus pliers are placed, and the bypass graft is completed. Carefully check the artificial blood vessel anastomosis and other parts of the chest cavity for bleeding. After stopping the bleeding completely, the chest can be closed layer by layer. If the atrium has a serious adhesion to the surrounding tissue and is not easily revealed, the lower end of the bypass vessel can be fitted to the right atrial appendage. After the end of the vascular bridge is anastomosed with the unnamed vein, the right atrial appendage is clamped with the auricle clamp, and the apex of the auricle and the trabeculae of the cavity are removed to ensure the smooth flow of the incision and the right atrium. The other end of the vascular bridge is anastomosed to the right atrial appendage.

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