Start as an Emergency Physician

After the saphenous vein is filled, the entire blood vessel, along with the surrounding connective tissue, swells up without leakage.

Zhou Yuan carefully put the saphenous vein into the diluted heparin saline for temporary storage.

"Next, build a subcutaneous tunnel. Zhou Yuandao.

The function of the subcutaneous tunnel is to provide a passage through which the saphenous vein is implanted, thus connecting the transvenous thrombosis site to the lateral upper arm vein.

"Scalpel. "

The position of the opening had been fixed beforehand, and the marker had marked the general direction of the subcutaneous tunnel, which could be followed by the marking line on the arm.

Zhou Yuan made a 3cm right incision at the site of the vein thrombosis and the expensive vein of the upper arm on the outside, and then extended the two incisions to each other, and a U subcutaneous tunnel was quickly formed between the two skin incisions.

"Perform anastomosis of the saphenous vein. Zhou Yuandao.

He Jianyi took out the saphenous vein in the diluted heparin saline.

"Vascular clamps. "

Zhou Yuan clamped the connecting blood vessel again.

Then, Zhou Yuan unfolded the saphenous vein, making sure that the blood vessels were not distorted, and then gently placed it into the subcutaneous tunnel.

One end is anastomosed to the vein, and the other end is connected to the vein.

Because there is a certain gap between the saphenous vein and the two blood vessels, Zhou Yuan trimmed the saphenous vein, and the place where the saphenous vein connects to the important vein was cut 11.00mm.

"Open your veins. "

He Jianyi opened the vein.

The saphenous vein begins to pour blood, creating a regular pulsation.

In addition, there was a significant tremor at the anastomosis of the great saphenous vein and the important vein, but no bleeding was found under the microscope.

"Good fit. Zhou Yuan smiled lightly.

"Take the blood clot. "

Without waiting for He Jianyi and the others to breathe a sigh of relief, Zhou Yuan began the next step of surgery.

He Jianguo had multiple thrombis in his blood vessels, and the vascular endothelium at the thrombus site was severely damaged, the blood flow slowed down, and the viscosity of the blood also increased.

If the clot is not removed, large blood clots may be washed away by the blood stream and may even break down to form many small blood clots.

As a result, small blood clots or fragments of blood clots can travel with the blood to various parts of the blood vessels throughout the body. While these small blood clots don't have much of an impact on most blood vessels, but... What about small capillaries?

The size of a blood clot is larger than that of a small capillary, which can lead to blockage of small blood vessels such as capillaries, which can still affect the flow of blood throughout the body.

In other words, without removing the blood clot, He Jianguo would still be a dead end even if he underwent vascular transplantation.

"Scalpel. "

"Vascular blocking forceps. "

Zhou Yuan cut the cephalic vein of the elbow, and then used blood vessels to block the cephalic vein at the sandwich end of the clamp to prevent intraoperative bleeding, and it can also effectively prevent the thrombus from washing away and carrying it to other blood vessels during thrombectomy.

"Teacher, help press the veins of the anastomosis. "

When He Jian heard this, he carefully pressed the connection between the big vein and the important vein.

"F5-Fogarty with capsule catheter. "

Zhou Yuan planned to use the F5-Fogarty sac catheter to take the thrombus, which can effectively preserve the vascular length of the AVF and avoid the wear and tear of the vascular length caused by reconstruction. This allows AVF to be used for a longer period of time.

The so-called AVF is a surgical method for patients undergoing hemodialysis for a long time, which is a minor surgery for vascular anastomosis, that is, the artery near the wrist of the forearm and the adjacent vein are sutured, so that the arterial blood flows in the vein after anastomosis, forming an arteriovenous fistula.

The F5-Fogarty balloon catheter can effectively shorten the length of an arteriovenous fistula.

Zhou Yuan took Fogarty, X in the cephalic vein, and then injected normal saline into the blood vein, resulting in filling.

At the same time, Zhou Yuan picked up the second Fogarty tube, X the vein, stared at the B-ultrasound monitor, and manipulated Fogarty to reach the top of the blood clot.

"Heparin is given intravenously. "

"How much?" asked the young, rookie vascular surgeon.

At this time, heparin is mainly anticoagulant, stimulates the vascular endothelium to release anticoagulant substances and fibrinolytic substances, and helps to remove blood clots.

“50mg。 Zhou Yuan said.

After injecting heparin, Zhou Yuan carefully manipulated Fogarty through the thrombobody, and then began to slowly pump air into the trachea, expanding the volume to fix the clot to the catheter.

After pumping almost 1ml, Zhou Yuan gently pulled Fogarty, and he could already clearly feel the resistance, so he stopped the gas delivery and carefully pulled the catheter.

Soon, the catheter tip returned to where the vessel had been incised, and it was evident that Fogarty had a blood clot attached to it.

After the proximal thrombus was removed, Zhou Yuan carefully examined the distal end again, and after finding no blood clot, he injected heparin saline to flush the lumen.

Of course, in addition to flushing the lumen, the use of heparin saline has another role - to determine whether the thrombus has been completely removed.

If a large amount of heparin saline can be seen gushing out of the vascular incision, it usually means that the blood vessel is completely unblocked.

"The thrombus was successfully removed and the blood vessels were sutured. "

It wasn't until he saw that blood began to gush from the incision of the blood vessel that Zhou Yuan breathed a sigh of relief.

For the thrombus on the other side, Zhou Yuan still uses Fogarty, the large thrombus can be pulled by Fogarty, and the small residual thrombus can be removed by using ant forceps.

"Completion of the embolectomy. "

This sentence fell, and the operation was basically over.

Zhou Yuan: "Vascular clamp." "

He Jianyi and the others were stunned.

What do you need vascular forceps at this time...

Zhou Yuan didn't explain too much, and directly clamped the cephalic vein at the distal end with a blocking forceps.

"Zhou Yuan, are you going to... Check the blood clot again?" He Jianyi asked.

Zhou Yuan shook his head.

"6F sheath. "

Zhou Yuan had a 6F sheath in the head vein of his forearm and a small amount of heparin saline.

He Jianyi: "Heparin saline... Do you want to anticoagulate and prevent blood clots?"

Zhou Yuan nodded, "Generally speaking, this step is not required after the completion of vascular grafting and thrombectomy, but considering the age of the patient, and the patient's cephalic vein has had a weak intima and so on, it is possible that blood clots may occur again." "

"Injecting heparin saline into the cephalic vein of the forearm can prevent the clotting to form in the cephalic vein. "

Zhou Yuan finished the injection and put down the needle.

The two vascular surgeons looked at each other, and both felt that their eyes lit up.

Here's the difference between a specialist doing surgery and a novice doing it.

According to the patient's age, gender, weight, past medical history and other physical conditions, the specialist will modify the details of the surgery, and will also add or reduce the surgical steps to achieve the best cure for the patient.

And novices, often just follow the textbook to do the surgery.

These two methods will be very different in terms of postoperative healing and the emergence of complications. _

Feilu reminds you: there are three things to read - collection, recommendation, and points