I can extract side effects.

Chapter 532 Artificial blood vessel flaccidity, dialysis lifeline

No wonder Fischer didn't care about Sanqing's large-caliber artificial blood vessel.

Because Maikewei is one of the largest suppliers of operating room and ICU medical equipment in the world. It was established in 1838 and has a history of nearly 200 years.

Since the world's first electric operating table was manufactured 90 years ago, it has become the absolute king of ventilators, ECMO equipment (heart-lung machine), artificial blood vessels and other fields through continuous acquisition and development.

Whether it is ECMO, ventilator, or artificial blood vessel, Microway is in a monopoly position, with 70% of the global market share.

As a veteran surgical instrument giant, it has experienced 200 years of ups and downs. It has never seen any storms. Naturally, it did not pay attention to Sanqing, a rising star.

Unlike Terumo, Michael has the self-confidence and arrogance of the Germanic people. He firmly believes that the field of artificial blood vessels, which he has developed by himself, will never be surpassed by any latecomers.

As for the cherry blossom country enterprise, it has been blocked by domestic approval for a long time, and it is in the second echelon. Naturally, it lacks confidence and is timid before fighting.

Of course, this is mainly because the media only reported aortic replacement surgery, which basically uses large-caliber artificial blood vessels with a diameter greater than 10 mm.

The technology of large blood vessels has long been mature and has been widely commercialized, so it is not difficult to realize in theory.

The main reason why domestic artificial blood vessels have been unable to break through is that upstream polyester materials need to be imported, and there are no self-developed materials, so they have been stuck.

Moreover, polyester materials also have a difficulty, that is, blood vessels are prone to clogging after a long time of use.

The arteries are better, because they are thick enough and the patients have been taking anticoagulant drugs for a long time. It often takes a long time for the blockage to occur. It is not obvious at the beginning. It takes long-term tests in the patient's body to ensure that there will be no problems.

In comparison, the 6-10 mm medium-caliber artificial blood vessel is more difficult. This type of blood vessel is generally used to replace venous blood vessels. The blood flow is slower, and blood cells and impurities are precipitated, resulting in thickening of the intima and more prone to thrombus.

If the artificial blood vessel is blocked by thrombus, it means the failure of the transplant, and if the condition is bad, it is even more dangerous than before the transplant.

Therefore, the material selection of artificial blood vessels is very important, and the application of anticoagulant coating is also very critical.

That's why leading companies like Maikewei can build high technical barriers and form a monopoly.

As for artificial blood vessels with a small diameter below 6 mm, it is still an international problem and needs to be filled urgently.

It is also under continuous technological improvement that Mai Kewei has secured the top spot.

However, it has not been able to develop artificial blood vessels below 6 mm.

Therefore, as long as Sanqing does not make a breakthrough in this area, Mai Kewei thinks it is not a problem, and it is difficult to shake his dominant position.

After figuring this out, Fischer stopped worrying and turned his attention to the capacity of the new factory.

It is useless to think about other things, and the most important thing is to resume supply as soon as possible.

******
Kun City, No.1 People's Hospital, Blood Purification Room.

At 5:[-] p.m., at the end of the disembarkation of dialysis patients, the medical staff were busy sorting out data and machines.

Suddenly, hurried footsteps came from outside the door, and a grey-haired old man in his 60s hurried in with the support of his family.

Nurse Xiao Li looked up, and suddenly showed surprise. It turned out to be an old acquaintance, Uncle Liu.

Uncle Liu has been a frequent visitor to the dialysis room since last year. Nurse Li is very familiar with him, and asked with a smile, "Uncle Liu, what's the matter? Didn't you just finish dialysis this morning? Why are you back?"

Before Uncle Liu could speak, the family members next to him shouted anxiously.

"My dad came home from dialysis at noon. He was fine at first, but he found something wrong an hour ago. This impotence seemed to have stopped. We rushed to the hospital. What's going on?"

As soon as the words fell, Nurse Li's face suddenly became serious, and she hurried over to check the internal fistula on Uncle Liu's arm.

Internal fistula is the abbreviation of arteriovenous fistula. It is a common and important access for maintenance hemodialysis in patients with chronic renal failure, and it is the lifeline for patients to survive.

For patients with poor vascular conditions, the upper limb arteriovenous can be anastomosed through surgery, and the artery near the wrist of the forearm and the adjacent vein can be sutured together, so that arterial blood flows in the anastomotic vein, forming an arteriovenous fistula .

This can provide sufficient blood for hemodialysis treatment, reduce the chance of infection, do not affect daily life, and provide adequacy guarantee for dialysis treatment.

Due to tremors and murmurs after venous arterialization, both patients and doctors and nurses can intuitively feel the blood flow and monitor their own condition.

But right now, even with the naked eye, the internal fistula blood vessel has completely lost all vitality, there is no movement at all, and the silence is like a dead thing.

Nurse Li's expression changed, and she immediately called the doctor on duty.

The doctor on duty arrived quickly, and after learning about the situation, he immediately made a judgment.

"It should be that the impotence is blocked again."

When the patient's family members heard this, their complexions instantly collapsed and they began to complain endlessly.

"It's blocked again? What's going on?"

"My dad is almost 70 years old. Since he started dialysis last year, he has had 4 surgeries in the past half a year. He has had internal impotence several times before and after. This is the fourth time."

"Is your technology working?"

The doctor on duty comforted: "I understand your feelings, don't worry, the main reason is that the elderly are old and weak, and the blood vessels are in poor condition, and they are prone to blockage. Besides, the puncture done by dialysis is very harmful to the blood vessels themselves. It’s also impossible.”

"Let's focus on the illness first, and let's talk about it after solving the problem?"

After the family members heard this, their faces softened a little. Although they were anxious, they couldn't say anything more.

The doctor on duty got up and made a phone call: "Director, there is an emergency to report to you. Um, okay, urgently start the emergency plan for internal flaccidity blockage, contact the thrombolysis team and access doctor, I understand."

After hanging up the phone, he picked up a portable color Doppler ultrasound and came to the patient's bedside to use ultrasound to evaluate the internal impotence.

When the image of internal flaccid blood vessels appears on the screen, everything is clearly visible and clear at a glance.

It turned out that 1.5 cm away from the inner flaccid opening, near the end of the heart, a small thrombus with a length of 2 cm appeared, which caused the blood flow near the heart to disappear.

"Huh~" The doctor on duty exhaled, and found that the blockage is easy to deal with. As long as the thrombus is cleared in the shortest time, the problem can be solved.

Five minutes later, the director of the urology department and the thrombolytic team arrived together, and after an assessment, they proposed a treatment plan.

"The thrombosis time is still relatively short, you can try thrombolysis first."

At this time, the head nurse also arrived, and immediately cooperated with the puncture and gave intravenous thrombolysis of urokinase.

Under the guidance of ultrasound, the needle tip passes through the internal fistula blood vessel, close to the mouth of the fistula.

With one order, 10 units of urokinase faced the arterial blood and quickly rushed to the thrombus site.

"I hope that the effect of urokinase, coupled with the impact massage of arterial blood flow, can break the thrombus and create a miracle."

"This is the pathway of life, we must persevere and let patients overcome difficulties."

The medical staff looked tense, some were staring at the ultrasound screen, some were staring at the internal atrophy blood vessels, and all of them were praying secretly in their hearts, waiting for a miracle to appear.

However, time passed by every minute and every second, and after a long hour, the infusion of 10 units of urokinase was completed, and the internal flaccid blood vessels still did not move at all.

"No tremor on palpation, no murmur on auscultation, no blood flow on ultrasound evaluation."

"According to past experience, the thrombus that can pass should be reflected at this time, but it hasn't."

After the urology director checked again, he shook his head and said with a look of disappointment on his face.

The already tense hemodialysis room was suddenly enveloped in an atmosphere of disappointment.

The doctors and nurses looked at me and I looked at you, not knowing what to say for a moment.

The director looked around and said in a deep voice: "Don't panic, let's continue to discuss the next treatment plan. Considering that the patient is already suffering from the fourth internal flaccid blockage, the cause of surgical anastomosis is basically ruled out. It should be due to poor vascular conditions, vascular endothelial Abnormal function leads to hypercoagulation, causing repeated internal impotence and blockage."

"It seems that given the patient's physical condition, he may not be able to establish internal impotence. Even if the surgery is performed again, there is a high possibility that thrombus will continue to occur and block the internal flaccid blood vessels. This is not a long-term solution."

"Then we can only advise the patient to change the plan."

The doctors who consulted nodded their heads one after another and started a lively discussion.

"A stable and reliable vascular access is the basic guarantee for smooth hemodialysis."

"Usually, this situation considers the semi-permanent internal jugular vein, or artificial vascular internal fistula."

"The internal jugular vein semi-permanent catheter is simple and easy to implement, and it is a good way to rebuild hemodialysis access."

"This won't work. The patient needs long-term dialysis. The semi-permanent internal jugular vein tube is made of polyester, which can only be used for a short period of time. Over time, it is prone to dysfunction, and it will be difficult to solve it when the time comes."

"Artificial vascular insufficiency is not good. They are all products of the older generation. There are various clinical problems. The patency time is short, and it is easy to cause complications and high infection rate. And the price is also very expensive. Patients already need long-term dialysis, and the financial burden is very high. It’s not a good idea either.”

"The patient's autologous vein transplantation is a good way, with good compatibility, no need to worry about antigens, no high cost of consumables, fewer complications, and better postoperative recovery. Although the operation is a bit cumbersome, it is the best choice for patients."

"But I checked the veins of the patient's lower extremities. The blood vessels are much thinner than ordinary people. I'm afraid I can't do internal flaccid blood vessels."

"Hey, what should I do? It seems that there is no way to have the best of both worlds."

"It's not impossible to have the best of both worlds." The director of urology suddenly had an idea in his heart and said in a deep voice.

"What do you think, if Sanqing's artificial blood vessels are used for transplantation?"

"It can be used on the aorta. The diameter must be thick enough, and the elasticity is also very good. They are all biomaterials and have good compatibility. Don't worry about antigenicity."

"Because it is a clinical trial, it can be used for free. I have seen those patients who underwent aortic replacement surgery, and the postoperative recovery is very good. So far, there have been no negative reviews."

Surprised eyes appeared in the eyes of the doctors, and they immediately began to think about it, and kept putting forward their own opinions.

"It sounds like a good idea. I just don't know how durable it is. Patients need to get needles every week for dialysis. After a long time, I don't know if this artificial blood vessel will hold up?"

"Don't worry about this. It's better than the patient's own blood vessels. How fragile are the patient's own veins?"

"I haven't used it for a long time. I don't know how the unblocked rate is. It won't cause blood clots after a few weeks of use, right?"

"Probably not. It is thicker than veins and flexible enough. If a thrombus does occur, it can be treated with intervention."

"That's right, this method is indeed feasible."

The urology director looked at the clock on the wall, two hours had passed since the off-duty time.

From time to time, footsteps could be heard outside. It was the family members waiting outside the door, pacing back and forth anxiously, waiting for the final result.

He coughed lightly and immediately made a decision.

"That's it, just transplant Sanqing's artificial blood vessel for internal flaccidity surgery."

"I'm going to explain to the family members that you should make preoperative preparations quickly."

At this time, the family members were already in a panic, almost as if grasping at the last straw, and immediately agreed to the operation plan.

The director of urology called the medical representative of Sanqing and asked about the model of the artificial blood vessel.

"Sanqing is about 6-8 mm. Is it a medium-caliber artificial blood vessel suitable for arteriovenous fistula surgery?"

Because veins are usually transplanted for internal impotence, the diameter of the blood vessel should not be too thick, but it should not be too thin, preferably 6-8 mm.

"We can provide any caliber, even more than 6mm, but if it is used for arteriovenous fistula, we also have a more suitable blood vessel, which is a small-caliber blood vessel of 5mm."

"You can rest assured, because the elasticity is sufficient, and the toughness is also strengthened, which can be suitable for long-term dialysis needle puncture, and it also has self-healing function."

Hearing this, the director of urology was shocked: "What? You still have 5mm small-caliber blood vessels? This is awesome. This is an international problem, and you have solved it?"

Immediately, he was overjoyed again: "That's even better, you hurry up and send a 5mm artificial blood vessel over."

The upper arm veins are relatively thin. If they are too thick, it is difficult to bury them in the subcutaneous tissue. Of course, the thinner the better while retaining the same function.

"Okay, we'll be there soon."

Half an hour later, the artificial blood vessel arrived.

The operation went smoothly, and everyone was racing against time in order to let the patient unblock the thrombus as soon as possible.

Firstly, the thrombus-prone flaccid vessel is resected, and an artificial venous vessel of the same length is transplanted, and then it is connected with the artery to artificially form a direct channel between the arteriovenous in the body.

The purpose of the operation is to increase the blood flow of superficial veins, facilitate puncture, and facilitate hemodialysis.

Although the 5mm blood vessels are small in diameter, they are still thicker than the 2.5mm superficial veins. After the transplantation, an obvious bulge appeared on the patient's arm.

When the last stitch is sutured, the chief surgeon loosens the venous clamp first, and then loosens the arterial clamp to completely open the blood flow.

In an instant, everyone's eyes were on the past.

A finger rested on the protruding vein and paused for three seconds.

"Obvious vascular tremors can be felt, and the blood flow has finally recovered."

"Fortunately, the operation was successfully completed."

"Look, the color Doppler ultrasound also detected blood flow."

So far, the road of life has opened again!

Everyone smiled tacitly and applauded at the same time.

(End of this chapter)