Homogeneous vascular transplantation. Presentation on the topic "Vascular suture

The following types of transplantation are distinguished:

• autogenous (autotransplants);
• allogeneic (homogeneous);
• syngeneic (isogenic);
• xenogeneic (xenotransplants);
• explantation (implantation) is a type of plastic surgery in which synthetic materials foreign to the body are used.

Autogenous transplants This is a type of transplantation that is performed within one organism. These are the most successful transplants, since the transplanted fresh organs with an intact structure are characterized by a complete antigenic match with the recipient’s tissues, age and gender characteristics. Autologous tissues can be transplanted with complete separation of the graft from the maternal bed. For example, during coronary artery bypass grafting with coronary disease heart, a segment of the great saphenous vein is sewn between the ascending aorta and the coronary artery of the heart or its branches, bypassing the site of occlusion. Autogenous veins are similarly used to replace large arterial defects or resected arteries damaged by a pathological process.

In free skin grafting, areas of skin are completely isolated and placed in a new location. Transplants, which include epithelium, “stick” to the bottom of the wound and use tissue fluid for nutrition. Thick skin grafts with layers of dermis partially restore nutrition due to tissue fluid into vessels. Therefore, to use a free graft, it is necessary to take into account its tendency to primary shrinkage. Restoration of innervation of the transplanted skin occurs after 3-8 months. Tactile sensitivity appears first, then pain, and lastly temperature.

Based on thickness, full and split flaps are distinguished. Full has all layers of skin without subcutaneous fat. Its thickness makes it possible to transplant only to a wound that has a good blood supply, with no risk of infection. A full flap is cut out using a scalpel, treating the skin in such a way that no subcutaneous fat remains on it. The flap is transplanted onto the wound, sutured, then secured with a bandage. The site from which the graft was cut is sutured or closed by moving the mobilized skin.

The split skin flap consists of the epidermis and part of the dermis. Such flaps are cut using manual or electric dermatomes, which are used to cut a flap of the required thickness and width on the anterior or lateral surface of the thigh, in the gluteal region. To do this, the skin is covered with a thin layer of Vaseline and straightened by stretching, and a dermat is applied to it. set to a certain depth and width, and, pressing slightly, move forward. After cutting out the flap, the area on the skin is covered with sterile gauze pads with an antiseptic, over which a compressive bandage is applied. Epithelization of the donor surface occurs due to the epithelium of the excretory ducts sweat glands and hair follicles for 2 weeks.

The graft is placed on the surface of the wound, straightened and sutured to the edges of the defect, after which it is covered with a gauze bandage soaked in ointment. Change the bandage after 8-10 days.

To close large granulating wounds, it is advisable to use mesh autodermal grafts. To do this, small through incisions are made in a checkerboard pattern using a special apparatus on a split skin flap cut with a dermatome. As a result of stretching the mesh graft, it is possible to increase its area by 3-5 times.

During mobilization of the stem flap, one side of it is not cut off, but is left as a pedicle through which the blood supply occurs. The site where the flap is taken is sutured or covered with a split graft, and the flap is placed on the surface of the defect and secured with sutures. Plastic grafting with a stem flap is advisable to use to cover skin defects on the extremities. The advantage of the method is that the largest defects can be closed in a short time - up to 5 weeks. The disadvantage is that to ensure reliable engraftment, the limbs must be brought together and fixed with a plaster cast.

For skin grafting, bridge-like skin grafts are used, which have a blood supply on both sides. Flaps with narrow pedicles are also used if the pedicle contains an artery of sufficient diameter.

A round stem flap is formed from a flap of skin with subcutaneous fat according to V.P. Filatov. This makes it possible to bring a significant amount of plastic material to the defect and carry out various simulations. The disadvantage of this method is the multi-stage nature and significant duration of plastic surgery (sometimes for several months). The stem flap is formed using two parallel incisions of the skin and subcutaneous fat down to the fascia. Then the flap is prepared, its edges, starting from the inside, and the edges of the defect under the flap are sutured. After the wounds have healed, they move on to training the stem. To do this, the vessels entering the flap are clamped on the side intended for transplantation. The pinching lasts for a few minutes at first, and then for about 2 hours. After 4 weeks, the stem can be transplanted to a new location.

In reconstructive surgery, autogenous bone grafting and plastic peripheral nerves And internal organs. An example of the latter is the widely used plastic surgery of the esophagus with a piece of the stomach, small or large intestine, preserving the mesentery and the vessels located in it (Ru, P. O. Herzen, S.S. Yudin, A.G. Savinykh, B.V. Petrovsky, M. I. Kolomiychenko, I.M. Matyashin).

Allogeneic (homogeneous) transplants This is a type of transplantation that is carried out within one biological species (from person to person, in an experiment, between animals of the same species). These include isogenic (donor and recipient are monozygotic, identical twins sharing the same genetic code) and syngeneic types of transplantation (donor and recipient are first-degree relatives, most often mother and child).

Material for isogenic transplantation is taken from living donors (we are talking about paired organs). Thus, D. Murray in 1954 was the first to successfully transplant a kidney from identical twins, since their tissues are absolutely identical and do not cause an immune conflict. However, with this type of transplantation one has to overcome the ethical barrier associated with organ removal from healthy person. These types of transplantation are the most effective, but the problem of a shortage of organs arises, since it is impossible to organize their banks.

For allogeneic transplantations, cadaveric organs are usually used. In this case, it is possible to organize banks of large organs and, finally, it is possible to use “recycled” tissue, i.e., take specially prepared tissue from a removed organ that has been injured or affected by a pathological process. For example, you can use individual parts of bones after the entire limb.

At xenogeneic (heterogeneous) types of transplantation the donor and recipient belong to different biological species. This is an interspecies transplant. Typically, for clinical purposes, transplants are taken from animals (zoogenic material).

As the French surgeon Jean-Paul Binet established, the closest immunological characteristics to humans are pigs, calves, and monkeys. However, with such transplants the rejection reaction is most pronounced.

Currently, xenogeneic tissues are widely used for plastic surgery of heart valves, blood vessels and bones. To reduce the rejection reaction, the animals from which the transplant is taken are injected with human tissue antigens. Such animals are called chimera donors. Thus, a pig’s liver is temporarily connected to the human body, which suffers from liver failure (most often due to poisoning with inedible mushrooms, dichloroethane).

In the experiment, right ventricular-pulmonary and apicoaortic bypass was developed. In case of stenosis of the pulmonary trunk or aorta, a shunt made of bovine (calf) pericardium or synthetic material with a sewn-in valve (such shunts are called conduits) is placed between the right ventricle and the pulmonary trunk or the left ventricle and the aorta, bypassing the stenosis.

Explantation This is a type of transplantation that involves replacing biological tissue with synthetic material. Thus, vascular prostheses woven or knitted from Dacron, Teflon, and fluoro-lonlavsan are widely used. Valves made of Teflon (Golikov prosthesis) or biological tissue (standard valve-containing prostheses, for example, a Dacron vascular prosthesis with a porcine valve) are often sewn into them. Ball heart valves are also widely used and are installed in the mitral and aortic positions. Artificial joints (hip, knee) and heart were created.

There may still be transplants orthotopic And heterotopic. Orthotopic transplants are carried out in the same place where the affected organ was (it is usually removed) (orthotopic transplantation of the heart, liver). A heterotopic type of transplantation is the transplantation of an organ into another, unusual topographic anatomy place, by connecting the vessels of the organ with the vessels of the recipient located nearby. An example of a heterotopic transplant is the transplantation of a kidney into the iliac region, and a pancreas into the abdominal cavity. A heterotopic liver transplant into the left hypochondrium after removal of the spleen is possible.

The article was prepared and edited by: surgeon

VASCULAR SURE. VESSEL TRANSPLANTATION. VEIN OPERATIONS IN CHILDREN. COMPLETED: ALEXANDROVA O. A. 604 -4 GR. OM SURGERY TEACHER: ZHAKSYLYKOVA A. K.

ATRAUMATIC INSTRUMENTATION To perform operations on blood vessels, it is necessary to use special atraumatic instruments that ensure delicate handling of the vascular wall. Much of the credit for their development goes to American vascular surgeons at the Mayo Clinic, as well as Michael De. Becky. Vascular instruments include vascular forceps with atraumatic cutting, thin and well-knit vascular scissors, sharp vascular scalpels, soft vascular clamps with long ratchet clamps. The application of general surgical clamps to the main arteries leads to inevitable thrombosis of the latter. To temporarily clamp large vessels, you can use tourniquets (loops made of thin fragments of infusion systems, onto which pieces of thicker drainage tubes are placed). Various probes and catheters are widely used (for example, the Fogarty catheter for embolectomy).

ACCESS In modern vascular surgery, basic surgical approaches have been developed to all large vessels, mainly to the areas of forks. When performing access, it is necessary to observe the principles of atraumatic opening of the vessel's own fascial sheath: The vascular sheath is opened, as a rule, bluntly, using a dissector. Sometimes a solution of novocaine is injected into the vagina to avoid reflex spasm. The separation of the artery and vein is performed extremely carefully. Movements with the instrument are made “from the vein,” i.e., try not to direct the tip of the dissector towards the wall of the vein in order to avoid its rupture. The vessel must be separated from the surrounding tissue on all sides for the length necessary for convenient application of clamps. They try to remove sympathetic nerve fibers from the surface of the vessel. Thus, we perform periarterial sympathectomy and eliminate reflex vasospasm in the periphery.

PROJECTIONS OF THE MAIN NERVOVASCULAR BANDS OF THE LIMB OPERATIVE ACCESS TO THE VESSELS: DIRECT – carried out strictly along the projection line (to deep-lying formations) CIRCULAR – carried out outside the projection line (to superficially lying formations)

REQUIREMENTS FOR THE VASCULAR SUTURE: Creation of tightness along the anastomosis line; There should be no narrowing of the lumen along the suture line; The sutured ends of the vessel along the suture line should touch the inner membrane - the intima; The suture material should not be in the lumen of the vessel; There should be no obstacles to the blood flow in the area where the suture is applied; The edges of the vessel should be trimmed sparingly; The vessel should not dry out; The distance between stitches is 1 mm.

c VASCULAR SUTURE CLASSIFICATION: By method of application: manual suture; mechanical suture - performed using a vascular stapling device. In relation to the circumference: Lateral (up to 1/3); Circular (over 2/3); a) Wrapping (Carrel, Morozova seam); b) Everting (suture of Sapozhnikov, Braitsev, Polyantsev); c) Intussusception (Soloviev’s suture). b a HTTP: //4 ANOSIA. RU/

Currently, a polypropylene (non-absorbable) atraumatic thread is used to apply a vascular suture. In adults, this is a continuous wrapping seam according to the pattern “from outside to inside - from inside to outside.” In young children, a U-shaped interrupted suture is used. Historical meaning They have everting sutures, A. Carrel’s suture, as well as a mechanical (hardware) vascular suture.

SEAM OF F. BRIAN AND M. JABOULEI This is the so-called U-shaped, intermittent (knotted) everting suture. Such a suture will not impede the growth of the anastomotic zone if it is used in a young body. The principle of adaptation of the intima with everting stitches, proposed by the authors, has found its application and further development in a large number of modifications (E.I. Sapozhnikov, 1946; F.V. Balluzek, 1955; I.A. Medvedev, 1955; E. N. Meshalkin, 1956; Yu. N. Krivchikov, 1959 and 1966; V. Dorrance, 1906; A. Blalock, 1945; I. Littman, 1954).

SUCH I. MURPHY J. Murphy in 1897 proposed a circular invagination method of vascular suture. At first, this modification attracted attention, since the problem of sealing the suture was solved quite simply, but the basic principle of vascular anastomosis - contact of intima with intima - was violated by simple invagination of one segment into another. Therefore, the suture used by the author and other researchers, as a rule, led to thrombosis, and Murphy’s original idea was forgotten for a long time.

A. CARREL'S SEAM Carrel's seam is an edge wrapping seam, continuous, between three knot holders, which are applied through all layers at an equal distance from each other. The frequency of stitches depends on the thickness of the vessel wall and varies from 0.5 to 1 mm. This technique has become widespread and is used most often, being the basis for the development of numerous modifications of vascular connections.

DORRANCE SEAM A - STAGE I; B - STAGE II The Dorrance seam (V. Dorrance, 1906) is marginal, continuous, two-story

SEAM L. I. MOROZOVA The seam A. I. Morozova (a simplified version of the Karell seam) is also a twisting, continuous one, but involves the use of only two holders. The role of the third holder is performed by the thread of the continuous seam itself.

APPLICATION OF MARGINAL SUTURES IN THE EVENT OF INCONSISTENCE IN THE CALIBER OF VESSELS A - METHOD OF N. A. DOBROVOLSKAYA; B METHOD Y. N. KRIVCHIKOV; B - METHOD OF SEIDENBERG, HURVIT AND CARDBOARD N. A. Dobrovolskaya in 1912 proposed an original seam for connecting vessels with different diameters (Fig. a). In order to ensure good adaptation of such vessels, the circumference of the smaller one is increased by applying two notches located 180° from each other. For the same purpose, Zaidenberg and his colleagues (1958) crossed a vessel with a smaller diameter in the zone of its division (Fig. c), and Yu. N. Krivchikov (1966) and P. N. Kovalenko and his colleagues (1973) ) cut off the end of the smaller vessel at an angle (Fig. b).

SUTURE OF N. A. BOGORAZ (SUTURNING OF A VASCULAR DEFECT WITH FIXATION OF A PATCH) Suture of N. A. Bogoraz (1915) is a plastic suturing large defect in the vessel wall by fixing the patch with a continuous wraparound edge suture after preliminary application of suture stays at the corners of the defect.

STRENGTHENING THE AREA OF VASCULAR ANASTOMOSIS A - V. L. KENKIN’S METHOD; B - METHOD SP. SHILOVTSEVA For better sealing of the line of vascular anastomosis, N.I. Bereznegovsky (1924) used a piece of isolated fascia. V.L. Khenkin proposed autovein and allograft for this purpose (Fig. a), and SP. Shilovtsev (1950) - muscle (Fig. b).

A. A. POLYANTSEV’S SEAM (WIRING, CONTINUOUS BETWEEN THREE U-SHAPED HOLDERS) A. A. Polyantsev’s seam was proposed by the author in 1945. It is winding, continuous, between three U-shaped everting holders.

E. I. Sapozhnikova's seam (CONTINUOUS WANTED BETWEEN TWO NODE HOLDERS) E. I. Sapozhnikov's seam (1946) - continuous, welt-like, between two nodal supports. A thread is used with two straight needles, which are injected towards each other at the base of the cuffs.

SUTURE OF THE POSTERIOR WALL IN THE IMPOSSIBILITY OF VESSEL ROTATION (I) AND INVAGINATION SUCHURE ACCORDING TO G. M. SOLOVIEV (II): I: A - L. BLELOCK METHOD, B - E. N. MESHALKIN METHOD, B VIEW OF THIS SUTURE AFTER TIGHTENING THE THREAD; II: A-B - STAGES OF SEAM FORMATION

METHOD Y. N. KRIVCHIKOV A - APPLICATION OF U-SHAPED SUTURES; B FORMATION OF THE CUFF; I - APPLICATION OF A CONTINUOUS SUIT; D - STRENGTHENING THE CUFF Yu. N. Krivchikov (1959) developed an original invagination suture (Fig. a-d) with a single cuff (everting, covered with a cuff created from the vessel itself). This modification, according to the author, ensures good adaptation of the intima and minimal protrusion of threads into the lumen of the vessel, creates a reliable seal and also allows the formation of a reinforcing cuff from any segment of the vessel.

I. I. PALAVANDISHVILI’S RING (STRETCHING THE HOLDERS WITH THE HELP OF SPRINGS) I. I. Palavandishvili (1959) to simplify the technique of applying a manual seam according to Carrel, created a metal ring with a diameter of 12 cm with three springs to which the holders are attached. Such a device gives the lumen of the vessel triangular shape and frees the assistant's hands.

SEAM G. P. VLASOV (PREVENTION OF NARROWING OF THE ANASTOMOSIS ZONE) A feature of the proposed circular suture, in contrast to the continuous one with overlaps, is that both ends of the threads “walk” one after another and are connected to each other. The stitch formed resembles a machine stitch, only the longitudinal thread is located on one side. Advantages this method consist, firstly, in the fact that there is no corrugation of the walls of the stitched vessels between the stitches; secondly, the longitudinal arrangement of twisted threads along the roller between the stitches promotes close contact of the walls of the vessels and reduces the possibility of bleeding.

A. M. DEMETSKY’S SUMMER (PREVENTION OF NARROWING THE ANASTOMOSIS ZONE) A. M. Demetskiy (1959) proposed a suture that eliminates the narrowing of the anastomotic zone. The author cut off the ends of the sutured vessels at an angle of 45°, while the length of the suture and the flow hole in the anastomosis zone increased by 2 times.

N. G. STARODUBTSEV’S METHOD (PREVENTION OF NARROWING AND TURBULENCE IN THE ANASTOMOSIS AREA) N. G. Starodubtsev and co-workers (1979) developed and studied in detail a new type of anastomosis, in which its narrowing is eliminated and the conditions for the occurrence of turbulent blood flow are practically eliminated. This type of connection is called a “Russian castle” anastomosis.

SHOW J. N. GADZHIEV AND B. KH. ABASOVA (EVERTERING DOUBLE-SIDED CONTINUOUS MATTRESS) A - INITIAL STAGE; B - FINAL STAGE A peculiar modification of the vessel suture was developed by J. N. Gadzhiev and B. Kh. Abasov (1984). In order to increase the tightness and prevent bleeding from the anastomosis, prevent narrowing of the anastomotic zone and thrombosis of the reconstructed arteries, the authors proposed an everting bilateral continuous mattress suture.

I. LITTMAN'S SEAM (INTERRUPTED MATTRESS BETWEEN THREE U-SHAPED HOLDERS) Littman's seam (1954) is an intermittent mattress seam between three U-shaped supports, which are applied at an equal distance from each other.

RECONSTRUCTIVE OPERATIONS ARE PERFORMED WITH THE PURPOSE OF RESTORING THE MAIN BLOOD FLOW IN THE IMPAIRMENT OF VASCULAR patency Disobliterating operations are aimed at restoring the patency of an occluded segment of a vessel: Thrombus - or embolectomy: a) Direct (through an incision in the vessel) b) Indirect (with a Fogarty catheter from another vessel) Thrombus endarterectomy – removal of a blood clot along with thickened intima. Plastic surgery are aimed at replacing the affected vessel segment with an auto-, allo-, xenograft or vascular prosthesis. Bypass surgery - with the help of vascular prostheses or an autograft, an additional path for blood flow is created, bypassing the occluded segment of the vessel. HTTP: //4 ANOSIA. RU/

Option of endarterectomy with sewing in a patch angioplasty Plastic surgery of the deep femoral artery (profundoplasty) according to Martin. The superficial femoral artery is occluded. An autovenous patch is sewn into the mouth of the deep artery of the thigh. According to Yu. V. Belov

BYPASS A bypass to bypass the obstruction to blood flow. At the same time, the possibility of residual blood flow remains Femoropopliteal bypass Bifurcation aorto-femoral bypass (Lerisch operation), BABS According to Yu. V. Belov, Burakovsky-Bockeria

PROSTHETICS Application of a bypass path to bypass the obstruction to blood flow with complete exclusion of the affected area from the blood flow. Bifurcation aorto-iliac prosthesis for an aneurysm of the infrarenal aorta with transition to both aortas. According to Yu. V. Belov

STENTS In modern intravascular surgery, many techniques have become possible thanks to the use of intravascular stents. Stents - weeding tubes - holding devices located in the lumen of the vessel. They were first developed by Charles Dotter in the late 60s of the 20th century. Many modifications of stents have been proposed. Basically, they can be divided into three groups. 1. Balloon expandable. These are the stents used most often. The stent is placed on an inflating catheter balloon. Inflating the balloon causes stretching of the wire structure of the stent, the latter expands, cuts into the wall of the vessel and is fixed. 2. Self-expanding stents are guided to the area of ​​interest inside the introducer catheter, and then pushed into the lumen with a mandrel. Expansion of the spring stent leads to its fixation in the vessel wall. 3. Thermally expandable stents.

Stents are used either independently as devices for permanent dilatation of a vessel, or together with intravascular prostheses to retain them. When treating false arterial aneurysms, a Dacron endoprosthesis with two stents at the ends is endovascularly applied to them and fixed by expanding the stents. The aneurysm cavity is switched off from the bloodstream. Surgeries on the aortic arch may require turning off the natural blood flow and require complex equipment. Stent with antiproliferative drug coating - intravascular prosthesis made of cobalt-chrome alloy with coating, releasing medicinal substance, preventing repeated narrowing of the vessel. The medicinal layer subsequently dissolves.

MODERN TECHNOLOGIES IN VASCULAR SURGERY Intravascular dilation and stenting Balloon catheter with Palmaz stent Coronary angiogram before and after the procedure

TRUE FALSE ANEURYSMS (TRAUMATIC) Currently, operations are predominantly performed to exclude the aneurysm from the bloodstream or to remove it and replace it with a vascular prosthesis. TYPES: ARTERIAL VENOUS ARTERIO-VENOUS Three groups of operations: surgical interventions, the purpose of which is to cause a cessation or slowdown of blood flow in the aneurysmal sac and thereby promote the formation of a blood clot and obliteration of the cavity or reduce the volume of the aneurysmal sac. This is achieved by ligating the leading end of the artery proximally from the aneurysmal sac (Anel and Gunther methods); operations in which the aneurysmal sac is completely excluded from the circulation (Antillus method) or its removal like a tumor (Filagrius method); operations aimed at restoring completely or partially blood circulation by suturing the arterial fistula through the aneurysmal sac - endoaneurysmorrhaphy (methods of Kikutsi - Matas, Radushkevich - Petrovsky) HTTP: //4 ANOSIA. RU/

OPERATIONS FOR VARICOSE VEINS OF THE LOWER EXTREMITIES There are 4 groups of operations: removal of veins, ligation of the main and communicating veins, sclerosis of veins, combined. ACCORDING TO MADELUN - removal through an incision along the entire length of the BSVB ACCORDING TO BABCOCK - removal of the BSVB using a probe through 2 small incisions ACCORDING TO NARATU - ligation and removal of dilated veins on the lower leg through separate incisions ACCORDING TO TROYANOV-TRENDELENBURG - high ligation of the BSVB at the point of entry into the femoral ACCORDING TO COCKET – suprafascial ligation of the communicants ACCORDING TO LINTON - subfascial ligation of the communicants ACCORDING TO SHEDE, ACCORDING TO CLAP – percutaneous ligation of veins (for scattered veins) The Troyanov operation is more often performed. Trendelenburg-Babcock-Narata. HTTP: //4 ANOSIA. RU/

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For vascular reconstruction, many options for vascular grafts have been proposed: autovein, autoartery, human umbilical cord vein, xenoartery, alloven, synthetic prostheses, etc. Currently, autovenous grafts and synthetic prostheses are mainly used. The practical value of grafts used for arterial plastic surgery is determined by biological compatibility, mechanical properties, effect on thrombogenesis, and the frequency of complications in the immediate and long-term periods after surgery. In table 1 presents the modern international classification of grafts and vascular transplantation.

Table 1. International Classification of Organ and Tissue Transplantation (1973)

Graft material	Type of transplant		Name of graft
	Old name	New name	Old name	New name
Transplantation of non-living substrate	Allotransplantation	Explantation	Allogeneic	Explant
Organs of a different kind	Heterotransplantation	Xenotransplantation	Allogeneic	Xenogeneic
Organs and tissues of the same type	Homotransplantation	Allotransplantation	Homogeneous	Allogeneic
The patient's own tissues and organs	Autotransplantation	Autotransplantation	Autogenic	Autolytic
Genetically similar (identical twins)	Isotransplantation	Isotransplantation	Isogenic	Isogenic

Autovenous plasty was first developed experimentally and used in the Carrel clinic (A. Carrel, 1902-1906). Lexer (Lexer, 1907) performed free plastic surgery of the axillary artery defect with a segment of the great saphenous vein of the thigh. J. Kunlin (1949) used the great saphenous vein of the thigh to bypass the occluded femoral artery. The use of an autovein for the reconstruction of medium- and small-diameter arteries remains the “gold standard” to date. Indications for performing autovenous shunting are most often occlusive-stenotic lesions of the femoral-popliteal-tibial segment, carotid system, renal arteries, visceral branches of the abdominal aorta, coronary arteries, etc. In this case, the most successful transplant is the great saphenous vein. Before surgery, it is recommended to investigate the suitability of the autovein for bypass grafting using duplex scanning. Bypass surgery using an autovein is possible in two options: reversed autovein and in situ. The reversed vein has been successfully used as a short bypass. For a long shunt, the vein must be of sufficient diameter throughout. Autovenous shunting using the in situ technique is less traumatic, more physiological, and uniform narrowing of the shunt ensures adequate blood flow and maintains its longer viability. The vein in the in situ position was first used in 1959 by the Canadian surgeon Cartier. Among domestic researchers A.A. Shalimov (1961) was the first to report the results of using this technique.

Homoplasty in humans was first used by Pirovano (Pirovano, 1910), but without success. And the first successful homotransplantation of the artery in the clinic was performed by R.E. Gross et al. (R.E. Gross et al., 1949). For arterial preservation, the authors used Tyrode's fluid, 4% formalin solution, 70% ethyl alcohol, plasma, etc. In 1951, lyophilization of vessels (freezing, drying) was proposed (Marrangoni and Cecchini). Homotransplantation of arteries was widely used in the 60s of the last century (N.I. Krakovsky et al., 1958). Homografts are a scaffold for the formation of a new vascular wall and connective tissue.

For bypass grafting of the femoral artery, umbilical veins (Ibrahim et al., 1977; B.C. Krylov, 1980) and heterovascular (bovine and porcine carotid arteries) grafts (Rosenberg et al., 1964; Keshishian et al. , 1971). The most promising methods for eliminating the antigenic properties of heterovascular grafts turned out to be methods of their enzymatic treatment, with the help of which autogenous proteins are dissolved.

Porous synthetic plastic prostheses made from Vignon were first proposed in 1952 (Voorhess, Jaretski, Blakemore). In the first half of the last century, tubes made of rubber, silver, glass, ivory, polyethylene, and plexiglass were used to replace vessels in experiments (F.V. Balluzek, 1955; B.S. Krylov, 1956; D.D. Venediktov, 1961 g., etc.).

A new and promising direction in arterial plastics is the use of porous vascular prostheses of woven, knitted, braided and monolithic construction made of polyamide (nylon, nylon), polyester (dacron, perylene, lavsan) and polytetrafluoroethylene (teflon, fluorlon) and other fibers. A prosthesis is a frame, which after some time is covered with a connective tissue capsule. Capsule formation goes through the following main phases:

• compaction of the prosthesis with the formation of a fibrin lining along its inner surface;
• ingrowth of the prosthesis frame with granulation tissue;
• organization of the connective tissue capsule of the vessel wall;
• degeneration or involution of the newly formed wall.

Vessels grow from the vascular bed through the pores of the graft 1-2 weeks after surgery. After 6-12 months, the formation of a connective tissue vascular wall around the prosthesis frame occurs. Outer and inner connective tissue capsules are formed. The internal lining (neointima) is gradually covered with endothelium, growing from the side of the anastomosis of the prosthesis with the vessels. Deposits of loose fibrin structures cause a narrowing of the lumen and lead to thrombus formation.

Prostheses should not be pathogenic and cause a strong protective reaction. They must be strong, elastic, flexible and reliably sterilized. S. Wesolowski et al. (1961-1963) introduced the concept of surgical and biological porosity.

Surgical porosity is an indicator of the bleeding of the prosthesis wall after its inclusion in the bloodstream. It is determined by specific water permeability (the amount of water seeping through 1 cm 2 of the vessel wall in 1 minute at a pressure of 120 mm Hg).

For the normal development and existence of neointima, porosity is required, at which through 1 cm 2 of synthetic tissue in 1 minute at a pressure of 120 mm Hg. Art. 10,000 ml of water will pass through (biological porosity).

Surgical porosity is characterized by the following feature: with it, no more than 50 ml of water should pass through 1 cm2. Thus, biological porosity is 200 times greater than surgical porosity.

Biological porosity is an indicator of the germination of the prosthesis wall by connective tissue from outer shell to the inner one. An increase in biological porosity leads to the threat of profuse bleeding through the wall of the prosthesis. The desire to combine these two opposing properties, i.e. large biological and low surgical porosity, led to the idea of ​​​​creating combined semi-absorbable prostheses, consisting of absorbable and non-absorbable components.

Prostheses impregnated with gelatin (Carstenson, 1962), semi-biological, consisting of synthetic and collagen threads (A.M. Khilkin et al., 1966; S. Wesolowski, 1962), water-soluble synthetic fiber vinol (A.G. Gubanov, 1962), etc. In order to prevent thrombosis, prostheses with heparin and with braided silver thread have been proposed (V.L. Lemenev, 1975).

The causes of thrombosis in the long term are: altered neointima of the prosthesis; hemodynamic disorders; changes in the blood coagulation system.

A decrease in blood flow velocity is often caused by a narrowing of the distal anastomosis, an increase in peripheral resistance, blood turbulence, which depends on the difference in the diameters of the graft and the bypassed artery, and the progression of the underlying atherosclerotic process.

The most serious complication when using alloprostheses is wound suppuration. Infectious complications are observed during reconstruction of the aortoiliac zone in 0.7%, aortofemoral - in 1.6% and femoro-popliteal zone - in 2.5% of cases. When infected, the prosthesis becomes a foreign body with a rejection reaction, and a granulation shaft forms around it. In this case, arrosive bleeding from the anastomosis site may occur. In order to prevent surgical infection, it has been proposed to introduce materials containing antibiotics into the prosthesis.

As a result of changes in the physicochemical properties of prostheses, their strength, elasticity, and resilience decrease. Over the years, “fatigue” of polymer materials has been observed. So, after 5 years, the loss of strength is 80% for propylene and 60% for dacron. None of the used prostheses made of Teflon, Dacron, Fluorlon and Dacron are an ideal means of replacing blood vessels. In 1974, the textile company Gore (W.L. Gore et al.) developed a new synthetic prosthesis made of microporous polytetrafluoroethylene (PTFE) and named “Gore-Tech”. Due to their qualities, these prostheses quickly became widespread in the United States and then in other countries of the world.

In 1994, JSC Research and Production Complex Ecoflon in Russia developed a technology for the production of vascular prostheses from PTFE under the brand name Vitaflon. Samples of prostheses underwent comprehensive medical and biological tests in the polymer laboratory (head professor N.B. Dobrova) Science Center cardiovascular surgery of the Russian Academy of Medical Sciences and clinical trials in many vascular centers. The results of the experimental and clinical trials showed that prostheses have high biological inertness, good plastic properties, high thromboresistance, zero surgical porosity and reliable “implantability” into the recipient’s body. Prostheses are applicable not only for plastic surgery of arteries, including medium-sized ones, but also of veins, where there are more favorable conditions for thrombus formation. The high thromboresistance of the material is due to the fact that the inner wall of the prosthesis has a smooth hydrophobic surface, which improves the interaction of the prosthesis wall with blood, and this property is maintained during long periods of implantation. The development of thin-walled Vitaflon prostheses opens up the prospect of their use for plastic surgery of small-caliber arteries.

Selected lectures on angiology. E.P. Kokhan, I.K. Zavarina

Cardiovascular surgery: bypass surgery of heart vessels without a heart-lung machine - video

Cardiovascular surgery: how coronary stenting is performed - video

The site provides background information for informational purposes only. Diagnosis and treatment of diseases must be carried out under the supervision of a specialist. All drugs have contraindications. Consultation with a specialist is required!

Definition and synonyms of cardiovascular surgery

Cardiovascular surgery is a medical surgical specialty within which surgical interventions of varying degrees of complexity are performed on the heart and large blood vessels, such as the aorta, pulmonary trunk, etc. In principle, cardiovascular surgery was previously a branch of general surgery, but as surgical techniques became more complex, the requirements for the doctor’s qualifications increased accordingly. To master the techniques of operations on the heart and blood vessels, surgeons needed to study a large amount of information, and to maintain their professional skills at the proper level, perform only these surgical operations. In addition, for operations on the heart and blood vessels, it was necessary to develop special auxiliary manipulations, such as a heart-lung machine, anesthesia technique, and others, which provide an optimal result with minimal risk of complications. In general, we can say that cardiovascular surgery has become a separate medical specialty in the same way as all others (for example, gastroenterology, pulmonology, etc.) due to an increase in the volume of knowledge and the need for narrow specialization.

Cardiovascular surgery in American and European medical schools it refers to the specialty cardiothoracic surgery , which is somewhat different from the Russian version. Cardiothoracic surgery includes all possible surgical procedures in the thoracic cavity, that is, cardiovascular surgery in the Russian structure of specialties, and additionally all operations on the lungs, esophagus, etc. That is, a cardiothoracic surgeon has a broader specialty compared to a Russian cardiovascular surgeon.

In addition, in the countries of the former USSR, cardiovascular surgery is often called cardiac surgery , since most of the operations performed by doctors of this specialty are one or another intervention on the heart and its vessels.

What operations are performed as part of cardiovascular surgery?

Within the framework of cardiovascular surgery, various operations are performed on the heart or large vessels in the presence of severe diseases of the latter, which cannot be eliminated by conservative means. Most often, cardiovascular surgeons perform operations to treat coronary heart disease, heart failure and arrhythmias, as well as to eliminate congenital or acquired defects and tumors of the heart, aorta or pulmonary trunk. The reasons that led to the formation of severe defects, tumors or coronary heart disease are not important for cardiac surgery, since during surgical intervention the normal physiological state of the organ is restored. This allows you to improve the functioning of the organ, improve the patient’s quality of life and significantly prolong his life. In addition, cardiovascular surgery includes heart or large vessel transplantation in its range of activities.

Currently, in the centers or departments of cardiovascular surgery, specialists of the relevant profile perform the following surgical interventions:

• Vascular bypass surgery (aorto-femoral bifurcation, iliofemoral, femoral-popliteal, aorto-coronary);
• Elimination of aortic aneurysm (prosthetics, bypass surgery, etc.);
• Elimination of aneurysm of the left ventricle of the heart;
• Stenting of large vessels (for example, carotid, femoral, coronary arteries, etc.);
• Balloon angioplasty (restoration of blood vessel patency);
• Introduction and installation of a pacemaker;
• Elimination of congenital and acquired heart defects;
• Replacement heart valve a special prosthesis;
• Aortic valve replacement;
• Heart valve transplant;
• Heart transplant;
• Treatment of infective endocarditis;
• Pulmonary artery catheterization;
• Pericardiocentesis.

The listed operations are technically quite complex and require special equipment.

Almost all cardiovascular operations are aimed at eliminating any mature or congenital structural disorder of the heart or blood vessels, which is fatal. This means that the goal of cardiovascular surgery is to restore the blood supply to the heart itself, as well as its ability to pump out blood, ensuring adequate blood supply to all other organs and systems.

Congenital defects are usually detected in childhood and, accordingly, are operated on by pediatric cardiovascular surgeons. In the vast majority of cases, adults have various acquired diseases that lead to deformation of the structure of the heart and blood vessels, which interferes with normal life. As a rule, if such disorders are not corrected in time during the necessary cardiovascular surgery, then the person dies within a short period of time, since the heart and blood vessels are not able to provide the volume of functions necessary to maintain life.

Thus, we can conclude that cardiovascular surgery is the last possible way treatment of diseases of the heart and blood vessels associated with disruption of their structure and functioning.

For what diseases is cardiovascular surgery used?

Cardiovascular surgery is usually used when conservative treatment turns out to be ineffective and the disease progresses steadily. Also, doctors are forced to treat diseases of the heart and blood vessels surgically if a person applies for medical care in later stages, when conservative therapy will be ineffective and useless.

Currently, cardiovascular surgery using the above operations treats the following diseases:

• Cardiac ischemia;
• Heart failure functional class II – III;
• Pulmonary embolism (PE);
• Mitral, tricuspid or aortic valve defect caused by rheumatism, consequences of the inflammatory process (pericarditis, endocarditis, etc.), trauma or other reasons;
• Stenosis (sharp narrowing of the lumen) of the aortic valve caused by any reason;
• Infective endocarditis;
• Aneurysm of the aorta or left ventricle of the heart;
• Some types of arrhythmia ( ventricular tachycardia, bradyarrhythmia and atrial fibrillation), which can be eliminated with a pacemaker;
• The presence of pericardial effusion, which creates tamponade and prevents the heart from pumping out the required volume of blood normally. Such tamponade can form during myocardial infarction, tuberculosis, connective tissue diseases, viral infections, malignant neoplasms and uremia;
• Pulmonary hypertension;
• Severe left ventricular failure;
• Myocardial infarction with severe complications, such as severe hypotension, sinus tachycardia, rupture of the interventricular septum, acute mitral regurgitation or cardiac tamponade;
• Acute myocardial infarction;
• Coronary artery stenosis caused by atherosclerosis or other reasons;
• Angina;
• The presence of an episode of resuscitation for sudden cardiac death syndrome;
• People involved in ensuring the safety and health of others (for example, pilots, bus drivers, etc.) who have a cardiac abnormality as determined by stress tests, even if it does not manifest clinical symptoms.

In the presence of the above diseases, the help of a cardiovascular surgeon is not always necessary, since conservative therapy can also be successful. That is why, for each disease, there are clear criteria according to which they determine whether a particular person needs cardiovascular surgery. Moreover, for the same disease, a person can be treated using various cardiovascular operations. The choice of a specific operation is made by a doctor based on an analysis of the person’s general condition, existing contraindications and indications, as well as the characteristics of the course of the disease and the expected benefits. Accordingly, the cardiovascular operation that has the lowest risk of complications in combination with the expected maximum benefit is selected.

Cardiovascular surgery can be performed several times during a person's life. Typically, subsequent surgical procedures are performed when complications develop, relapses, insufficient effectiveness of the previous operation, deterioration of the person’s condition, or the addition of another pathology.

Brief description of the most common cardiovascular operations

Let us consider which operations from the arsenal of cardiovascular surgery are used in various cases to treat certain diseases of the heart and large vessels.

Coronary artery bypass grafting (CABG)

This operation is the sewing of an additional blood vessel through which the blood supply to the heart will occur instead of blocked and damaged coronary arteries. To understand the essence of the operation, you need to imagine a hose through which water flows. If the hose is blocked in any area, water will stop flowing beyond that area. However, if we insert a small piece of hose into the slits in the pipe so that one of its holes is above the blockage and the second below, we will get a shunt through which water can flow further again.

The same thing is done during coronary artery bypass grafting. That is, those vessels through which blood normally flows to the heart muscle become too narrow due to atherosclerotic plaques and cannot provide the required volume of blood. Because of this, the heart muscle (myocardium) experiences oxygen starvation and suffers from ischemia. And since delete atherosclerotic plaques and in some cases it is impossible to expand the lumen of blood vessels, they resort to applying a bypass shunt. One end of the shunt is inserted into the aorta, and the other into a section of the coronary arteries located beyond the site of severe narrowing. Typically, multiple shunts are placed during surgery to ensure blood supply to all areas of the heart muscle (see Figure 1).

Picture 1– Scheme of application of direct shunts.

A vein isolated from the tissues of the forearm or lower leg is usually used as a bypass.

Coronary artery bypass surgery is performed when the lumen of the coronary vessels is narrowed by at least 70% of normal. Until a narrowing of the coronary vessels occurs by the specified amount, coronary artery bypass surgery is not performed, even if the person has experienced more than one heart attack and suffers from angina, shortness of breath and heart failure. This is due to the fact that the volume of the operation is very large, and with a smaller percentage of narrowing of the coronary arteries, it is quite possible to resort to other, less invasive methods of restoring blood supply to the heart muscle, such as angioplasty and stenting.

Angioplasty

Angioplasty is the restoration of the patency of the heart and other vessels by expanding their lumen from the inside with special devices. This entire cardiovascular operation is called percutaneous transluminal coronary angioplasty (PTCA). To perform PTCA, special devices are required in the form of deflated balloon-shaped balls, which are inserted into the narrowed cardiac vessel through carotid artery. That is, the balloon is first inserted into the carotid artery, then gradually moves through the blood vessels up to the coronary vessels and is inserted into the required sharply narrowed area. In this section, the balloon is inflated so that its volume expands the lumen of the vessel. Thanks to this manipulation, the coronary vessel receives normal lumen and the ability to provide the necessary volume of blood for the myocardium.

Angioplasty is performed when there is a sharp narrowing of one or more coronary vessels, when oxygen deficiency develops in any limited area of ​​the myocardium supplied with blood from this blocked artery. In such a situation, angioplasty allows you to restore blood supply to the myocardium without resorting to a major surgical operation of coronary artery bypass grafting.

However, in the long term, angioplasty is not a reliable treatment for coronary artery stenosis, since quite often the procedure must be repeated due to recurrence of narrowing of the vessel. Coronary artery bypass grafting has certain advantages over angioplasty, since it allows normalizing the blood supply to the myocardium for a long period without the risk of its disruption due to recurrent stenosis coronary artery. But cardiovascular surgeons consider the primary production of angioplasty justified, as a more gentle and less invasive method of treatment, which allows achieving pronounced therapeutic effect. If the blood supply to the myocardium can be restored with the simpler manipulation of angioplasty, then there is no need to resort to the much more complex operation of coronary artery bypass grafting, which, in fact, is the last treatment option.

In addition, in recent years it has been possible to significantly increase the effectiveness of angioplasty and reduce the risk of recurrent stenosis through the use of special devices - stents. The angioplasty procedure involving the placement of stents is called stenting surgery.

Stenting

Stenting is a more effective angioplasty procedure using stents. All manipulations during stenting are almost the same as during angioplasty, that is, a special balloon is inserted into the narrowed vessel, expanding its lumen. Then, to hold the vessel in this position and, accordingly, prevent its re-stenosis, it is fixed with stents. The stent has appearance, similar to a regular spring (see Figure 2), which is inserted into the lumen of the vessel after its expansion. For manipulation, various modifications of stents are used, which are selected by the doctor depending on the size and condition of the narrowed coronary vessel. After stenting surgery, it is necessary to take antiplatelet agents - drugs that prevent active thrombus formation. The optimal antiplatelet agents currently are Clopidogrel and Aspirin.

The effectiveness of stenting is comparable to coronary artery bypass grafting, but it is much simpler and less invasive. Therefore, people who do not have 70% or more narrowed heart arteries are recommended to undergo stenting rather than coronary artery bypass grafting.

Figure 2– Various modifications of stents

Introduction and installation of a pacemaker

The introduction and installation of a pacemaker is carried out for normalization heart rate and prevention of deadly arrhythmias, the development of which, as a rule, does not have time to save a person. Currently there are various models pacemakers, which are selected individually depending on the type of arrhythmia. Typically, the pacemaker is inserted through the carotid artery, just like a stent or angioplasty balloon. Then the device is adjusted to the person and left for life, periodically changing the batteries in it.

Removal of aortic aneurysm or left ventricular wall

An aneurysm is a thinning and simultaneous protrusion of the wall of an organ. Accordingly, an aortic or ventricular aneurysm is a thinning of the wall of a given blood vessel or heart and its protrusion into the chest cavity. Any aneurysm is very dangerous, since the thinned wall of the vessel or ventricle of the heart may not withstand the blood pressure and rupture. In such a situation, a person dies almost instantly.

If a person is diagnosed with an aneurysm of the aorta or ventricle of the heart, then they resort to surgical treatment, which consists of excision of a thinned section of the organ, suturing the free ends of its wall and draping it over a special mesh made of durable material. The mesh supports the wall of the aorta or ventricle of the heart, preventing it from thinning and bulging again, forming a new aneurysm.

Elimination of heart and vascular defects

Elimination of heart and vascular defects is complex surgical intervention, during which doctors completely correct existing anatomically incorrect organ structures. For example, in the absence of a septum between the ventricles or atria, an abnormal structure of blood vessels and valves, and other similar conditions, doctors can, during an operation, transform the structure of the organ into a normal one, removing unnecessary parts and sewing on the necessary ones. In most cases, heart and vascular defects are successfully eliminated by experienced specialists in the field of cardiovascular surgery.

Surgeries to eliminate heart and vascular defects must be performed as soon as possible after their detection. If these are detected in newborns, then they can be operated on literally from the first day of birth. In some cases, the baby’s life depends on how quickly the operation is performed and the congenital heart or vascular defect is eliminated.

Prosthetics and transplantation of heart valves, aorta or pulmonary valve

The valves of the heart, aorta or pulmonary trunk are susceptible to various diseases with the formation of defects, which are a change in their normal anatomical shape with functional insufficiency. With defects, the valves of the heart and large vessels collapse loosely and do not open completely, as a result of which blood is poorly pushed into the systemic and pulmonary circulation and is thrown back, which causes various clinical symptoms. To eliminate this pathology, cardiovascular surgeons simply remove the defective valve during the operation and insert a prosthesis in its place.

Modern prosthetic heart valves and blood vessels are of excellent quality and can completely normalize hemodynamics. Valves can be entirely artificial, created from synthetic materials, or natural, made from bovine or pork tissue. Biological valves take root well, but wear out quickly, so they have to be replaced frequently (once every 3 to 5 years) with new ones. And artificial valves last until a person’s death, but after their installation it is necessary to constantly take antiplatelet drugs (Clopidogrel or Aspirin).

Replacement of heart valves is carried out using a catheter, which is inserted into the vessels and advanced along them to the required area. Then, through the same catheter, the doctor removes the worn valve and installs a new one in its place. The operation is relatively simple and non-invasive, so the patient does not actually need to go to the hospital for several weeks to have the heart valves or blood vessels replaced.

Pulmonary artery catheterization involves the insertion of a special hollow catheter into the pulmonary trunk. This operation is performed for various acute diseases of the heart or blood vessels (for example, shock, cardiac tamponade, myocardial infarction, pulmonary hypertension, etc.), when it is necessary to normalize a person’s condition or distinguish one pathology from another. The operation is performed under local anesthesia and under X-ray control. Currently, pulmonary artery catheterization is carried out primarily for diagnostic purposes to distinguish between diseases that manifest similar clinical symptoms.

Treatment of infective endocarditis

Currently, the term “endocarditis” refers to any infectious and inflammatory process that affects the inner lining of the ventricles or atria of the heart, valves and endothelium of surrounding blood vessels. Most often in the practice of a cardiovascular surgeon, valvular endocarditis occurs that has developed in tissue areas directly adjacent to the implanted prosthesis.

If endocarditis develops, conservative treatment with antibiotics or surgery can be performed. Surgery with subsequent support with antibiotics and their introduction directly into the tissues affected by inflammation is performed only in cases of circulatory failure of stages NYHA III–IV or NYHA II with hemodynamic defects.

Surgical treatment of endocarditis can be performed more than once during a person’s life.

Pericardiocentesis

Pericardiocentesis is a puncture of the outer lining of the heart in order to suction the existing effusion and further determine the cause of its occurrence. Pericardiocentesis is a diagnostic procedure that allows you to find out the cause of fluid accumulation between muscle layer and the external cardiac sac. The most common causes of effusion between the pericardium and myocardium are the following conditions:

• Tuberculosis;
• Viral infection;
• Connective tissue diseases;
• Increased level of urea in the blood;
• Malignant tumors;
• Myocardial infarction;
• Complications after heart surgery.

Pericardiocentesis is usually performed under X-ray guidance, continuously monitoring heart rate, blood pressure, partial pressure of oxygen, and taking an ECG.

Heart transplant

A heart transplant is a technically complex operation, which is performed only in cases where nothing else can be done to help the sick person. Typically, a heart transplant can extend a person's life by at least 5 years.

Features of cardiovascular surgery (heart-lung machine, chest incision, catheter access)

For heart operations, a heart-lung machine is often used in surgical practice. Since this device is not used in other operations, it can be confidently attributed to the features of cardiovascular surgery.

During the entire operation, this device pumps blood through the vessels instead of the heart, which is emptied to obtain optimal visibility of the affected tissues and, accordingly, improve the quality of the surgeon’s work.

A heart-lung machine is a pump with various devices through which the blood of the human body passes and is saturated with the necessary amount of oxygen. To start it, the surgeon makes an incision in the aorta and inserts a large cannula connected to a heart-lung machine. The second cannula is inserted into the atrium and blood also flows through it to the device. In this way, the blood circulation is closed in a circle due to the apparatus, and not the heart.

Venous blood from the atrium flows out due to gravity and enters the heart-lung machine, where the pump pumps it into the oxygenator and saturates it with oxygen. From the oxygenator, blood is pumped through a filter into the arterial cannula and, under pressure, flows directly into the aorta. This is how continuous blood supply to organs and tissues is ensured against the background of an immobilized heart on which the operation is performed.

For operations on the heart, aorta or pulmonary trunk, it is necessary to gain access to them, that is, to get inside chest. To do this, you need to somehow penetrate the ribs that form the rigid frame of the chest. In cardiovascular surgery, two main types of incisions are used to open the chest and gain access to the heart and blood vessels:
1. Sawing the sternum along its entire length and opening the chest completely by stretching the ribs in different directions.
2. An incision is made between the 5th and 6th ribs and stretched to the sides.

In each case, the doctor decides which incision will be made to gain access to the heart and blood vessels based on the person’s condition and his own preferences.

In addition, a characteristic feature of cardiovascular surgery is catheter access for certain operations and diagnostic procedures. So, catheter access is the insertion of a hollow catheter tube into any large vein, for example, femoral, iliac, jugular (under the armpit) or subclavian. Then this catheter is advanced through the blood vessels to the heart, aorta or pulmonary trunk and, having reached the required area, is fixed. After which, under X-ray or ultrasound control, a thin and flexible string similar to a wire is delivered through this catheter. necessary tools or prosthetics, which are used to perform the operation. This catheter access allows the operation to be performed in a day hospital without resorting to general anesthesia and opening the chest cavity. Accordingly, the deadline full recovery after surgery performed through catheter access, much less compared to opening the chest cavity. Catheter access has become widespread for angioplasty, stenting, cardiac replacement and aortic valves, as well as installation of a pacemaker. Thanks to this access, the above operations are performed quickly and allow you to normalize your health.

Transplantation(late lat. transplantatio, from transplanto- transplantation), tissue and organ transplantation.

Transplantation in animals and humans is the engraftment of organs or sections of individual tissues to replace defects, stimulate regeneration, during cosmetic operations, as well as for the purposes of experiment and tissue therapy. The organism from which the material for transplantation is taken is called a donor, the organism into which the transplanted material is implanted is called a recipient, or host.

Types of transplantation

Autotransplantation - transplantation of parts within one individual.

Homotransplantation - transplantation from one individual to another individual of the same species.

Heterotransplantation - a transplant in which the donor and recipient are related different types one kind.

Xenotransplantation - a transplant in which the donor and recipient belong to different genera, families and even orders.

All types of transplantation, as opposed to autotransplantation, are called allotransplantation .

Transplanted tissues and organs

In clinical transplantology, autotransplantation of organs and tissues is most widespread, because With this type of transplantation there is no tissue incompatibility. Transplantations of skin, adipose tissue, fascia ( connective tissue muscles), cartilage, pericardium, bone fragments, nerves.

Vein transplantation, especially the great saphenous vein of the thigh, is widely used in vascular reconstructive surgery. Sometimes resected arteries are used for this purpose - the internal iliac artery, the deep femoral artery.

With implementation in clinical practice microsurgical technology, the importance of autotransplantation has increased even more. Transplantations on vascular (sometimes nerve) connections of skin, musculocutaneous flaps, muscle-bone fragments, and individual muscles have become widespread. Important We acquired transplants of toes from the foot to the hand, transplantations of the greater omentum (fold of the peritoneum) to the lower leg, and segments of intestine for esophagoplasty.

An example of organ autotransplantation is a kidney transplant, which is performed for extensive stenosis (narrowing) of the ureter or for the purpose of extracorporeal reconstruction of the vessels of the renal hilum.

A special type of autotransplantation is the transfusion of the patient’s own blood during bleeding or deliberate exfusion (withdrawal) of blood from the patient’s blood vessel 2-3 days before surgery for the purpose of its infusion (administration) to him during surgery.

Allotransplantation of tissues is used most often in transplantation of the cornea, bones, bone marrow, much less often - when transplanting pancreatic b-cells for treatment diabetes mellitus, hepatocytes (in acute liver failure). Brain tissue transplants are rarely used (in processes accompanying diseases Parkinson's). Mass transfusion of allogeneic blood (blood of brothers, sisters or parents) and its components is a mass transfusion.

Transplantation in Russia and in the world