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Zhou Yuan carefully placed the great saphenous vein in the diluted heparin saline for temporary storage.

"Next, we will build a subcutaneous tunnel."Zhou Yuan said.

The function of the subcutaneous tunnel is to provide a channel to implant the great saphenous vein, thereby connecting the site of the perforating vein thrombosis and the basilic vein of the upper arm on the outside.

""

The opening position had been fixed before, and the marker also marked the general direction of the subcutaneous tunnel. Just follow the markings on the arm.

Zhou Yuan made a 3cm incision at the site of the perforating vein thrombosis and the basilic vein on the outside of the upper arm. Then, he extended the two incisions toward each other, and a U-shaped subcutaneous tunnel was quickly formed between the two skin incisions.

"Perform anastomosis of the great saphenous vein."Zhou Yuan said.

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

""Vascular clamp."

Zhou Yuan clamped the connecting blood vessel again.

Then, Zhou Yuan spread the great saphenous vein and made sure that the blood vessel was not twisted before gently inserting it into the subcutaneous tunnel.

One end was anastomosed with the basilic vein, and the other end was connected to the perforating vein.

Because there was a certain gap between the great saphenous vein and the two blood vessels, Zhou Yuan trimmed the great saphenous vein and thinned the place where the great saphenous vein connected to the basilic vein by 11.00mm. This successfully anastomosed with the basilic vein.

"Open the basilic vein.

He Jianyi opened the basilic vein.

Blood began to flow into the great saphenous vein, producing a regular pulsation.

Moreover, there was an obvious tremor at the anastomosis between the great saphenous vein and the basilic vein, but no bleeding was found under the microscope.

"The match is good." Zhou Yuan smiled easily.

""Remove the blood clots."

Before He Jianyi and the others could breathe a sigh of relief, Zhou Yuan began the next step of the operation.

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

If the blood clots are not removed, large blood clots attached to the blood vessels may be constantly washed away by the blood flow, causing them to fall off, or even break up and form many small blood clots.

The consequence is that small blood clots or blood clot fragments will flow with the blood to various blood vessels throughout the body. Although these small blood clots will not have much impact on most blood vessels, but... what about small capillaries?

The volume of the blood clots is larger than that of small capillaries, which will cause blockage of small blood vessels such as capillaries, and then it will still affect the flow of blood throughout the body.

In other words, if the blood clots are not removed, He Jianguo will still be dead even if he undergoes a vascular transplant.

"Scalpel"

""

Zhou Yuan cut open the cephalic vein at the elbow, and then clamped the cephalic vein at the center with a vascular clamp to prevent bleeding during the operation. It can also effectively prevent the thrombus from being washed away during the thrombectomy and carried to other blood vessels.

"Teacher, please help me press the vein at the anastomosis."

Hearing this, He Jianyi carefully pressed the connection between the great vein and the basilic vein.

"F5-Fogarty balloon catheter."

Zhou Yuan planned to use the F5-Fogarty balloon catheter to remove the blood clot. This method can effectively preserve the length of the AVF blood vessel and avoid the loss of blood vessel length during reconstruction. This can extend the use time of the AVF.

The so-called AVF is a surgical method for patients undergoing long-term hemodialysis. It is a minor vascular anastomosis operation, which involves suturing the artery near the wrist of the forearm and the adjacent vein. Arterial blood flows in the anastomosed vein to form an arteriovenous fistula. The

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

Zhou Yuan took over the Fogarty, inserted it into the cephalic vein, and then injected saline into the blood vessel to fill it.

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

"Intravenous heparin"

"How much?" asked the young and inexperienced vascular surgeon.

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

"50mg." Zhou Yuan said.

After injecting heparin, Zhou Yuan carefully manipulated Fogarty to pass through the thrombus, and then began to slowly pump air into the trachea to expand the volume, thereby fixing the thrombus on the catheter.

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

Soon, the catheter head returned to the place where the blood vessel incision was located, and it was clearly visible that a thrombus was attached to Fogarty.

After the proximal thrombus was removed, Zhou Yuan carefully checked the distal end again. After no thrombus was found, he injected heparin saline to flush the lumen.

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

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

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

It was not until he saw blood gushing out from the incision that Zhou Yuan breathed a sigh of relief. For the blood clot on the other side, Zhou Yuan used Fogarty again. Large blood clots could be pulled out with Fogarty, and small residual blood clots could be clamped out with the Ant's forceps.

"The thrombectomy is complete."

After this sentence was said, the operation was basically over.

Zhou Yuan:"Vascular clamp."

He Jianyi and others were stunned.

Why do we need vascular clamps at this time...

Zhou Yuan did not explain too much, and directly clamped the distal cephalic vein with a blocking clamp.

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

Zhou Yuan shook his head.

"6F sheath."

Zhou Yuan placed a 6F sheath in the cephalic vein of the forearm and injected a small amount of heparin saline.

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

Zhou Yuan nodded,"Generally speaking, this step is not necessary after completing vascular transplantation and thrombectomy, but I took into account the patient's age and the fact that the cephalic vein of the patient had a weak endothelium, so thrombosis may occur again."

"Injecting heparin saline into the cephalic vein of the forearm can prevent the cephalic vein from forming blood clots again."

After Zhou Yuan finished the injection, he put down the needle.

The two vascular surgeons looked at each other and felt their eyes light up.

This is the difference between an expert doing surgery and a novice doing surgery.

Experts will modify the details of the surgery according to the patient's age, gender, weight, medical history and other physical conditions, and will also add or reduce surgical steps to achieve the best healing effect for the patient.

Novices often just do surgery according to textbooks.

These two methods will be worlds apart in terms of postoperative healing and the occurrence of complications._Feilu reminds you: Three things to do when reading - collection, recommendation, and sharing