The way to restore the integrity of the wall of a blood vessel

 

(57) Abstract:

The invention relates to medicine, in particular to a method of restoring the integrity of the vascular wall with wounds and injuries. The objective is to reduce recovery time. In the frame of the vessel catheter with expanding cuff, which completely covers the defect in the vascular wall during the pulling of the catheter, and then impose the required number of stitches, and before tying the last suture cuff is emptied, the catheter is removed and the suture tied. The method does not require anatomical vessel selection of Lodge, the stitches are made with preserved blood flow. It can be applied in anatomically difficult areas, does not require much time, significantly reduces the risk of additional injury of the vascular wall, does not require special training of the surgeon and expensive equipment, can be applied in any hospital, including and not specialized. 1 Il.

The invention relates to medicine, in particular to methods for recovery of the vascular wall with injuries and traumas.

Known and traditionally used the following methods to restore the vascular wall: pressure vessels, tamponade, the imposition of vascular suture [1] Most of these methods requires anatomical allocation of the vessel from the surrounding tissue. The main drawback of this phase of the operation is a real possibility of additional injury of the vascular wall, and hence, increased bleeding, and sometimes the inability to stop it, which negatively affects the quality of the operation or results in death of the patient. Traditionally used methods of restoring the integrity of the vascular wall requires some preparatory phase, and therefore time.

Closest to the claimed method is the recovery of the vascular wall by imposing vascular suture. Its essence lies in the fact that after the separation of the vessel from surrounding tissue and cease it blood flow are sutured to the defect wall (Novikov Y. P. Vilani M. P. Protsenko N. Century. Minchenko C. K. Emergency after angiosurgical assistance).

The disadvantage of this method, selected as a prototype, is that the mere selection of a vessel of the bed can lead to additional injury to the wall, especially if it is thin-walled. Incurred additional bleeding leads to a rapid increase in blood loss, significantly complicates the imposition of vascular suture, requires additional identification of the vessel or leads to death bol is only due to the fact, it is impossible to distinguish the damaged vessel. Preparation of the vessel for the suturing requires time. The pinching leads to ischemia of the relevant body or segment of a limb that is unfavorable factor, and sometimes leads to irreversible changes, forcing us to expand the scope of the operation. All these shortcomings affect the results of treatment, lead to severe disability or death of the patient.

In the method of restoring the integrity of the wall of a blood vessel by suturing the wound of the vessel catheter with expanding cuff, which is filled with a sterile solution to a size that allows to completely cover the defect in the vascular wall during the pulling of the catheter, the lumen of the catheter pinch clamp, place the required number of single joints, but before tying the last seam of the cuff is empty, the catheter is removed and the suture tied.

According to the literature not found the way to restore the integrity of the wall of a blood vessel by suturing with pre-obturation of the defect in the vascular wall of the catheter with expanding cuff.

The proposed manipulation in the area of the defect in the vascular wall much is etera with expanding the cuff in the wound of the vessel allows in the most shortest period of time to stop or drastically reduce bleeding. Extended cuff a few turns of the wound edges of the vessel, facilitating suturing of the defect. Put the cuff obtulerunt only the defect walls and completely blocks the blood flow in a large vessel, thereby stopping profuse bleeding from a major vessel is without its mobilization and clamping.

The drawing shows a diagram of the proposed method.

The method is as follows.

After establishing the source of bleeding and to identify the nature of the defect in the vascular wall is temporarily pressed by a finger, and then into the lumen of the vessel through a defect catheter with expanding cuff 1. It expands sterile solution to a size that allows to completely obturate the defect with reverse bending of the catheter 2. The lumen of the catheter is clamped by the clamp 3. In this position it is held by the assistant. The bleeding stops. Atraumatic needle synthetic thread popelement from the lower and upper corners of the wound are sutured 4. Non thread and needle are selected depending on the caliber shivamoga vessel 5. Seams should be imposed, be bound vessel from the inside outwards and so as not to pierce the cuff. Perinci vessel is in anatomically inaccessible place, after stopping the bleeding by blocking vascular defect extended cuff surgeon in a more relaxed atmosphere can extend an existing access or remove grossly damaged body, creating more favorable conditions for the imposition of vascular suture. As the catheter with expanding cuff can be used urinary Foley catheter with a diameter of 5 mm or more depending on the size of the defect.

P R I m m e R. the Method was applied to the victim with severe concomitant injuries to the head, chest and abdomen, accompanied by the shock of III degree. Injury received in a car accident(history N 17646, mountains. hospital N 40) 10 December 1990 So, during inspection of the abdominal cavity was detected circular deep gap liver on the border of the left and right anatomical lobes, avulsion of the hepatic veins in the area of anastomosis with the inferior Vena cava and the breakdown of the latter, due to significant destruction of the liver left lobe resected, the stump is sutured. Identified a defect in the Vena cava is pressed by a finger, but at the slightest attempt to impose a seam instantly resumed profuse venous bleeding. Therefore, in the lumen of the vessel a catheter was introduced with expanding cuff. the La defect in the vessel. The lumen of the catheter is kinked clip. The bleeding stopped. On the vascular wall imposed separate seams, and before tying the last cuff emptied and the catheter removed.

The proposed method has the following advantages: it does not require anatomical vessel selection of Lodge, reduces the risk of additional injury of the vascular wall. Shortens the time required to stop profuse bleeding, and therefore, decreases the amount of blood loss, closure of the vessel is made with preserved blood flow, which is especially valuable if allowance is made against the background of the shock. The described method may be the only real to run if the damage is in anatomically difficult areas, for example in navalnyj the liver hilus, in the field of vascular gate aperture and so on, the Proposed method does not require large expenditures on additional expensive equipment or special training of the surgeon, can be applied in almost any conditions, including and not a specialized hospital.

The WAY to RESTORE the integrity of the WALL of a BLOOD VESSEL by suturing, characterized in that the wound of the vessel catheter with ASD is the effect of the vascular wall at pulling of the catheter, its lumen pinch clamp, and then impose the required number of single joints, but before tying the last seam of the cuff is empty, the catheter is removed and the suture tied.

 

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