subclavian arterial patch plasty

Subclavian artery ligation is suitable for extensive stenosis or occlusion of the carotid artery, causing cerebral ischemia, but can not be established by carotid endarterectomy or superficial temporal artery-brain artery anastomosis. Surgery, cerebral ischemic disease surgery, and other extracranial-intracranial anastomosis of neurosurgical cerebrovascular disease. Treatment of diseases: carotid stenosis Indication The carotid system is extensively stenosis or occlusion, causing cerebral ischemia, but can not be established by carotid endarterectomy or superficial temporal artery-brain artery anastomosis. Contraindications 1. Older patients, with severe systemic diseases such as lung, heart, kidney, liver disease, diabetes, etc. 2. There are already serious and persistent neurological dysfunctions. 3. Although there is stenosis or occlusion of the internal carotid artery or middle cerebral artery, but no neurological symptoms, cerebral blood flow (CBF) is also normal, indicating that the collateral circulation is sufficient. 4. There is extensive cerebral infarction in the blood supply area or inner capsule of the middle cerebral artery. It is estimated that even if the anastomosis is successful, it is difficult to improve the symptoms. Preoperative preparation 1. Adequate cerebral angiography, including bilateral carotid angiography and at least one side of vertebral angiography, should be comprehensively understood for cerebral vascular stenosis and collateral circulation. 2. CT scan to determine the presence and extent of cerebral infarction. 3. Determination of cerebral blood flow. 4. Prepare the scalp as usual. 5. Give preventive antibiotics. Surgical procedure 1. The left intercostal space of the fourth intercostal space is inserted into the chest. 2. Cut the mediastinal pleura longitudinally along the descending aorta. 3. Free descending segment of the descending aorta. 4. Ligation of the arterial catheter. 5. Place the non-traumatic blocking forceps and remove the stenotic aorta. 6. Design the incision and ligation of the left subclavian artery at the origin of the vertebral artery. 7. Clamp the aorta, incision of the left subclavian artery and aortic stenosis. 8. Suture the inferior subclavian artery with the descending aortic incision. 9. The left subclavian artery can be anastomosis at the end of the left common carotid artery. complication 1. When the subclavian artery is used as the blood supply artery, gas, hemothorax and thoracic duct injury may occur. 2. Radial nerve injury. 3. Intracranial hematoma.

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