traumatic arteriovenous fistula surgery

Trauma is the main cause of acquired arterial and venous fistula. For example, gunshot wounds, stab wounds, and cuts cause the same movements and veins in the same sheath to be damaged at the same time, resulting in abnormal communication between the veins and veins. In a small number of cases, extensive motor and venous abnormal traffic in multiple channels may be caused by contusion, crush injury and comminuted fracture. The site of traumatic arteriovenous fistula is more common in the extremities, 50% of the lower extremities, followed by the arteriovenous fistula between the radial artery, the common carotid artery and the subclavian artery and its corresponding vein. Traumatic arterial and venous sputum presentation, simple sputum between the veins is rare, most of the arterial side of the traumatic aneurysm or venous side of the aneurysm-like dilation or aneurysm between the artery and vein. Multiple channels can also be formed by multiple blood vessels. Traumatic arteriovenous fistulas, diagnosed clearly require surgery. Curing disease: Indication Surgical and venous fistulas generally require surgery. In the past, most scholars advocated that the timing of the operation was 3 to 6 months after the trauma, and the collateral circulation was established to perform the operation of ligating the movement and the sputum. However, with the advancement of vascular surgery, early surgery is currently advocated. It is easy to find a mouthwash for repair or vascular transplantation in the early stage of trauma. If it has been delayed to 5 ~ 7d, local traumatic inflammatory tissue reaction has begun to appear, local swelling, blood vessel wall is fragile, then bleeding infection is easy to occur, can be separated by 1 to 2 months, after the tissue reaction subsides, then surgery. Patients who have entered the chronic phase should undergo surgery as soon as possible. A serious drawback of advanced surgery is that swelling cannot be eliminated. Because of the long-term presence of arteriovenous and venous fistulas, the veins are extremely dilated and the venous valve function is destroyed. Although the operation has treated the mouthwash and eliminated the venous hypertension, the problem of blood backflow remains unresolved. Contraindications As long as the general condition allows, there is no local infection, no surgical contraindications. If there is cardiopulmonary dysfunction, it should be corrected as much as possible. Large venous and venous sputum itself is the cause of cardiopulmonary dysfunction. Sometimes it does not deal with arterial and venous sputum, and cardiac dysfunction cannot be completely corrected. Preoperative preparation 1. Apply antibiotics systemically before the start of surgery. If the limbs have inflammation or ulcer formation, the infection should be basically controlled. 2, those with mental dysfunction should try to improve heart function first. 3. Fully estimate the difficulty of surgery, prepare artificial blood vessels of appropriate size or design the extraction site of autologous veins. Surgical procedure 1. Incision In the inguinal region, a longitudinal incision is made in the direction of the femoral artery. The skin, subcutaneous tissue, and deep fascia are cut, and the adductor muscle is pulled to the inner side, and the sartorius muscle is pulled to the outside, that is, the part of the femoral arteriovenous fistula can be revealed. 2, dissect the arteries and veins of the arteries, veins, proximal and distal The rubber band is bypassed to control blood flow, or the forceps are used to control blood flow. Peel the wall of the arteriovenous iliac artery, where there are dense scar tissue and numerous vascular perforators, which should be ligated to stop bleeding and straight to the vicinity of the fistula. The vein side wall is then peeled off to completely free it. 3, closed surgery Closed surgery involves ligation of the proximal main artery of the fistula to reduce blood flow and ligation of the upper and lower arteries, ie, four heads of ligation. The former is suitable for arteriovenous fistulas in the neck or deep pelvis, when the distal arteries and veins are difficult to be exposed; the latter is only suitable for arteriovenous fistulas of the branches of the blood vessels below the elbow and knee joints, and the distal limbs are not affected after the four heads are ligated. Blood supply. 4, venous repair of arterial fistula For small venous and venous fistulas with small venous lesions, the arterial fistula can be repaired by vein. First, block the proximal and distal blood flow of the fistula, and cut the vein wall to find the fistula. Sutured continuously with 5-0 sutures. The incision of the vein can be sutured, or the ligature can be ligated and the venous stump can be fixed to the artery wall. 5, arteriovenous fistula resection blood flow reconstruction Control the blood flow at the far end, and remove the fully free moving veins and veins near the fistula. The vein side is repaired or cut and ligated; if there is no tension on the arterial side, do the end-to-end anastomosis, if there is tension to do autologous vein or artificial blood vessel transplantation.

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