splenic artery-renal artery anastomosis

Splenic-renal artery anastomosis was used in 1956 to treat left renal artery stenosis. Because the surgical method is simple and easy, and the surgical effect is good, it is widely used later. A small number of right renal artery stenosis has also been treated with this method. Based on: 1 the splenic artery and the renal artery have similar diameters, and the anatomical position between the splenic artery is very close. After the splenic artery is free, there is sufficient length for anastomosis and reconstruction with the renal artery. 2 After cutting off the splenic artery, the blood supply of the spleen can be supplied by the branch of the short gastric artery. No splenectomy is needed. The distal part of the spleen artery is still pulsating during surgery. 3 In atherosclerosis, splenic artery opening is rarely involved, and its perfusion pressure can maintain physiological renal hemodynamics, and does not cause a decrease in the expansion force of the renal artery wall, resulting in a series of endocrine pathophysiological changes. 4 cutting the distal part of the splenic artery, the vascular wall itself does not destroy the nutritional artery, and does not cause degenerative lesions of the posterior vessel wall and complications after renal artery angioplasty. Treatment of diseases: renal artery stenosis Indication Transabdominal aorta-renal angiography showed that there were no lesions in the celiac trunk and splenic artery, and the proximal segment of the renal artery was normal in the distal segment. The splenic artery-renal artery anastomosis could be performed. The left kidney was an absolute indication. Can be used as a reference indication. Kidney artery stenosis in children is more suitable for this method. Preoperative preparation 2 weeks before surgery should be given to the general antihypertensive drugs, in order to avoid a sudden drop in blood pressure after surgery, resulting in extremely severe blood perfusion of vital organs and crisis. If the blood pressure is particularly high, and the diastolic blood pressure is as high as 16 to 18.7 kPa (120 to 140 mmHg), a short-acting antihypertensive agent such as -methyldopa (alphamethyldopa) can still be applied, which can appropriately delay the timing of surgery. The experience can last until the preoperative. If surgery is urgently needed and hypertension cannot be controlled, intravenous sodium nitroprusside can be used to meet the conditions required for surgery. The blood volume of such patients is reduced by 500-1500 ml compared with normal, and should be supplemented before surgery to avoid shock caused by postoperative blood pressure drop. Hypokalemia due to secondary aldosteronism and long-term diuretic therapy should be corrected before surgery to reduce the sensitivity of anesthesia and surgery to myocardial irritation. Any infection of the urinary system should be controlled and cleared before surgery. Pyelonephritis is given effective anti-infective treatment 3 weeks before surgery. If azotemia is present, it should be properly corrected. For the stenosis caused by aortitis, comprehensive treatment is needed. After the active period, the local lesions are stable, and surgery can be performed. In order to protect the renal parenchyma that has been damaged by ischemia, it is in the best functional state. In addition to avoiding the use of nephrotoxic drugs, mannitol or furosemide can be administered shortly before surgery. Systemic heparin therapy should also be initiated before surgery to prevent postoperative thrombosis. The above two treatments also need to be repeated before clamping the renal artery and need to be maintained until the end of the operation. Intraoperative central venous pressure monitoring should be done before the catheter and device. The fluids and related instruments required for cold perfusion of the renal arteries that may be performed during surgery should be prepared. Surgical procedure Splenic-renal artery end-to-side anastomosis It can enter the abdominal cavity through a transverse incision in the abdomen The gastric colonic retina adjacent to the colon and its superior edge was dissected, the spleen of the colon and the descending colon were freed, and the inside and the lower were pulled. The stomach is pulled up and separated along the upper edge of the tail of the pancreas, that is, the splenic artery parallel to the upper edge. Gently separate the splenic artery of sufficient length, do not injure the pancreas and retain branches to the pancreas. Traction with a cloth belt, the renal artery is exposed at the lower edge of the deep surface of the pancreas. After the small branch of the renal vein is cut and ligated, it is pulled down, revealing the full length of the renal artery trunk. The renal artery in the distal part of the stenosis is freed, and the normal part that is anastomosed to the splenic artery is selected. The splenic artery is cut before its branch, the distal end is sutured with a silk thread, and the root is closed with an arterial forceps. The spleen artery cavity is lavaged with heparin salt solution. The distal segment was cut into a slope, and the renal artery trunk was under control to complete the spleen-kidney artery end-to-side anastomosis. 2. Spleen-renal artery end-to-end anastomosis If the renal aneurysm needs to be removed, the spleen-renal artery end-to-end anastomosis may be performed. For example, the first grade branch of the renal artery is involved, and the branch can be taken when the splenic artery is cut. After the renal sinus is peeled off, the end-to-end anastomosis between the branches can be performed, but the surgical operation technique is relatively high. If the branch of the splenic artery is inaccessible to the spleen, the two branches of the renal artery can be sewn into a common lumen, and then the end of the splenic artery is anastomosed. For example, the spleen artery is used for the treatment of right renal artery stenosis, and the freely severed splenic artery is anastomosed to the right renal artery via the duodenum. However, the long journey takes across the spine and the effect is not good. It has only been used by some people. In recent years, after the use of hepatic artery-renal artery anastomosis, it has not been used in the right renal artery.

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