medical road high rise

Chapter 183 Vascular Transplantation
Chapter 183 Vascular Transplantation
After four years of dialysis, the patient still has various complications, and his body has reached a certain limit. He is a critically ill patient. If he is not careful, the patient will have accidents.

Qin Feng entered the observation room and carefully examined the anterior wall cephalic vein and found that the gentle pulsations of the forearm cephalic artery were clustered, but the vibrato was extremely weak.

"Do a color Doppler ultrasound for the patient first." Qin Feng said.

The doctors in the emergency department quickly arranged for the patient, and the results of the color Doppler ultrasound came out relatively quickly.

Qin Feng glanced at the results, and said: "The patient's cephalic vein aneurysm at the upper end of the forearm has expanded, accompanied by thrombus formation. Returning blood flowed into the side branches, forming a thrombus. At the same time, the venous return was blocked. I preliminarily judged that the patient may have venous hypertension. Pain with internal fistula."

After a while, Director Dong and Zhao Qi also rushed over.

"Is there a preliminary diagnosis?" Director Dong asked.

"Yes, venous hypertension with internal fistula pain."

Director Dong glanced at the color Doppler ultrasound results, nodded and said: "Indeed, the patient's condition, I also suspect that it is venous hypertension with internal fistula pain. At the same time, the thrombus is serious, and the thrombus needs to be dredged. Now we need the specific situation of the thrombus to see the degree of embolism."

As the deputy director of vascular surgery, Director Dong's diagnosis still has a brush.

Naturally, other doctors in the emergency department would not go to other vascular surgeons. After all, Qin Feng and Director Dong, including Zhao Qi, both came from the vascular department, but they are now under construction in the emergency department.

"Doctor, you must save my dad!" the patient's son said with a trembling voice.

Director Dong said with an ugly face: "The patient's operation is too difficult, mainly due to physical reasons, and may not be able to support the entire operation."

"Director Dong, I have an idea." Qin Feng said.

Both Director Dong and Zhao Qi turned their heads to look at Qin Feng, Qin Feng said slowly: "The patient's physical condition is not enough to support the long-term operation process, then we can shorten the operation time, and use the great saphenous vein graft to bridge it." gone?"

Saphenous vein graft bridging?

Director Dong and the others were taken aback for a moment, looking at Qin Feng blankly.

"You see, the patient's elbow vein has a thrombus, which blocks the main blood vessel that has the thrombus. Then we can use the side branch to return to the heart." Qin Feng said, "On the color ultrasound, the bypass of the thrombus blood vessel They are all unblocked, and the bypass shunt can be used to block the main road, cut the blood vessel and remove the embolus."

"Why not use interventional surgery? It would be better to directly perform internal fistula and use CUFF catheter implantation for dialysis?" Zhao Qi suggested.

"This method is indeed possible, but the patient is old and has many diseases in the body. The success rate of giving up the internal fistula and implanting a CUff catheter for dialysis can be said to be 0. Even if it is successful, can the patient recover? It's still a problem." Qin Feng shook his head.

Director Dong nodded. In fact, the two options are very difficult, but relatively speaking, the blood vessel transplantation proposed by Qin Feng is more friendly to patients, and it is more technically challenging for doctors.

"Xiao Qin, tell me what you think." Director Dong said.

Qin Feng nodded, picked up the marker pen and drew on the old man's arm, marking the superficial skin except for the thrombus in the perforating vein, anastomotic stoma, upper arm vein, and forearm cephalic vein.

"This is where the thrombus occurred, so we can do a blood vessel transplant here." Qin Feng pointed to the place where the thrombus pierced the vein.

As he spoke, Qin Feng took a marker and connected the thrombus in the penetrating vein with the vein on the outer upper arm.

"In this way, blood from the upper arm veins can also enter the perforating veins, allowing blood flow to resume circulation."

Qin Feng's words are very short, but every step is eye-catching.

After listening to Qin Feng's narration, Zhao Qi nodded. He had never thought about this method of restoring blood circulation and solving the thrombus problem through the bypass.

It turned out that this was the gap between him and Qin Feng.

I used to think it was technical, but now it seems that I still studied too little, stayed in place for too long, and even ran out of ideas.

Although this operation is still a bit difficult, with Qin Feng here, there are no surprises.

"We use the great saphenous vein to bridge, reconstruct the outflow tract of the arteriovenous fistula, and finally take out the thrombus." Qin Feng put on the pen cap and said.

The great saphenous vein is a superficial fascia under the skin that starts in front of the medial malleolus and extends to the left and right sides of the thigh.

And this vein is congenitally suitable for transplantation, and it belongs to type O blood in the blood vessel.

"Okay, Xiao Qin, I will leave this operation to you." Director Dong was also decisive. Since Qin Feng proposed the operation plan, then this operation will be performed by Qin Feng directly.

"Then go ahead with the surgery, the old man's condition is not very good." Qin Feng glanced at the patient's pupils.

At the same time, the patient's heart rate and blood pressure begin to drop, and he may go into shock at any time.

"Push it to the operating room." Qin Feng took over the command and started commanding.

Zhao Qi followed Qin Feng closely. He must be Qin Feng's assistant for this operation.

Enter the operating room.

The patient on the operating bed was already unconscious. Qin Feng and others performed simple first aid and stabilized the patient's heart rate and blood pressure. Lu Shan directly began to inject anesthesia.

The patient's situation was also told to Lu Shan in advance. When Lu Shan inserted the needle, he used epidural anesthesia.

"Supine position."

Zhao Qi and Lin Xue quickly adjusted the patient's posture to facilitate Qin Feng's operation.

"The anesthesia is complete." Lu Shan said in a muffled voice.

Qin Feng nodded and looked up at the time.

"Operation begins."

The scalpel was directly slapped on Qin Feng's hand by Lin Xue. Without any pause, Qin Feng skillfully cut open the outer skin, and then separated the subcutaneous tissue, muscle tissue, etc. in turn, and found the blood vessel caused by the thrombus by the way, and measured the need for transplantation. the vessel length.

"50.31mm."

"Zhao Qi, please remember." Qin Feng said.

Sometimes, a surgery requires too many things, and the chief surgeon cannot remember all of them. At this time, assistants are needed to shine.

This is why those older doctors like to bring young assistants. Young people have a good memory.

Qin Feng's next step was to meet directly to intercept the blood vessels and anastomose the severed parts at the same time.

"Has the disinfection been done?" Qin Feng asked after removing the blood vessel.

"it is done."

Qin Feng glanced at the position of the lower abdomen, the femoral artery has been revealed, and it has indeed been sterilized.

Zhao Qi's progress is also visible to the naked eye, at least now he can understand the next step of the operation without having to speak too much.

Qin Feng made a longitudinal incision of about 6cm with a scalpel, and then Qin Feng asked Zhao Qi to stuff gauze into the incision after completing the inner incision to prevent infection.

In addition, the subcutaneous tissue was cut, and the superficial fascia and fossa ovale were cut at the incision of the femoral artery.

Once the fossa ovale is seen during the operation, it proves that the great saphenous vein has been found. This place is the confluence of the femoral artery and the great saphenous vein. If there is one, there must be the other.

(End of this chapter)