Start with the emergency physician

After the saphenous vein is filled, the entire blood vessel and the surrounding connective tissue are inflated 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 pervein thrombosis site with the expensive vein of the lateral upper arm.

“Scalpel.”

The position of the opening has been fixed before, and the marker also marks the general direction of the subcutaneous tunnel, just follow the marking line on the arm.

Zhou Yuan opened a 3cm right opening at the perforating vein thrombosis site and the lateral upper arm noble vein, and then extended the two openings to each other, and a subcutaneous tunnel was quickly formed between the two skin incisions.

“Perform anastomosis of the great saphenous vein.” Zhou Yuandao.

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

“Vascular forceps.”

Zhou Yuan clamped off the connecting blood vessel again.

Then, Zhou Yuan unfolded the saphenous vein to ensure that the blood vessels were not distorted, and then gently put it into the subcutaneous tunnel.

One end is anastomosed with the important vein, and the other end is attached to the perforating vein.

Because there is a certain gap between the great saphenous vein and the two blood vessels, Zhou Yuan pruned the great saphenous vein, and the place where the great saphenous vein connects to the precious vein is cut by 11.00mm.

“Open your veins.”

He Jianyi opened the vein of Guiqiao.

The great saphenous vein began to rush into the blood, producing regular pulsations.

Moreover, the anastomosis of the great saphenous vein and the precious vein has obvious tremor, but there is also no bleeding under the microscope.

“It fits well.” Zhou Yuan smiled easily.

“Take the blood clots.”

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

He Jianguo has multiple thrombs in his blood vessels, and the vascular endothelium at the thrombus site is severely damaged, the blood flow rate is slowed down, and the viscosity of the blood is also increased.

If the thrombus is not removed, the large thrombus attaches to the blood vessel, which may be continuously washed by the blood flow, causing it to fall off and even disintegrate to form many small thrombus.

As a result, small blood clots or fragments of thrombus travel along the bloodstream to various parts of the blood vessels throughout the body. While these small blood clots don’t have much effect on most blood vessels, but… What about small capillaries?

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

In other words, without removing the blood clots, He Jianguo would still die even if he underwent vascular grafting.

“Scalpel.”

“Vascular blocking forceps.”

Zhou Yuan cut the head vein in the elbow, and then blocked the head vein at the clamp end with blood vessels to prevent intraoperative bleeding, and also effectively prevent thrombus flushing during thrombectomy and bring it to other blood vessels.

“Teacher, help press the vein of the anastomotic mouth.”

When He Jianyi heard this, he carefully pressed the connection between the large vein and the important vein.

“F5-Fogarty with cuff catheter.”

Zhou Yuan intends to use F5-Fogarty cystic catheter, which can effectively preserve the vascular length of AVF and avoid the loss of vascular length during reconstruction. This makes it possible to extend the life of the AVF.

The so-called AVF is a surgical method for long-term hemodialysis patients, which belongs to the small surgery of vascular anastomosis, that is, the artery near the wrist of the forearm and the adjacent vein are sutured. Arterial blood flows in the veins after anastomosis. Formation of an arteriovenous fistula.

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

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

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

“Intravenous heparin.”

“How much?” The young and rookie vascular surgeon asked.

At this time, heparin is mainly anticoagulant, stimulates the release of anticoagulant substances and fibrinolytic substances in the vascular endothelium, and helps remove thrombus.

“50mg。” Zhou Yuan said.

After injecting heparin, Zhou Yuan carefully manipulated Fogarty through the thrombus, and then began to slowly inflate into the trachea, expanding the volume, thereby fixing the thrombus on 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 the place where the vascular incision was made, and it became clear that a thrombus was attached to Fogarty.

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

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 at the vascular incision, it generally indicates that the blood vessel is completely unblocked.

“The thrombus was successfully removed and the blood vessel was sutured.”

It wasn’t until he saw that blood began to gush at the vascular incision that Zhou Yuan breathed a sigh of relief.

The thrombus on the other side, Zhou Yuan still uses Fogarty, the large piece of the thrombus can be pulled with Fogarty, and the small piece of residual thrombus can be clamped with ant’s forceps.

“Complete the embolectomy.”

This sentence fell, and the operation has basically come to an end.

Zhou Yuan: “Vascular forceps.” ”

He Jianyi and the others were stunned.

At this time, why do you have to dry the vascular forceps…

Zhou Yuan did not explain much, and directly clamped the cephalic vein at the distal end with blocking forceps.

“Zhou Yuan, are you planning… Check your blood clots again? He Jianyi asked.

Zhou Yuan shook his head.

“6F sheath.”

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

He Jianyi: “Heparin saline… Are you trying to anticoagulate and prevent thrombosis? ”

Zhou Yuan nodded, “Generally speaking, this step is not required after the completion of vascular transplantation and thrombectomy, but I consider the age of the patient, and the patient’s head vein has had a weak endometrium, etc., and there is a possibility that thrombosis will occur again.” ”

“Injecting heparin saline into the head vein of the forearm can prevent the head vein from forming blood clots again.”

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

The two vascular surgeons looked at each other, and both felt their eyes brighten.

Here’s the difference between a specialist and a novice surgery.

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

Novices, on the other hand, often just follow the textbook to do surgery.

And these two methods, whether in terms of postoperative healing and complications, will be very different. _

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