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Transplantation of organs and tissues. Reference

From the end of the 19th century to the present day, a variety of materials have been proposed for replacing vessels- biological (vessels and other tissues) and alloplastic (artificial vascular prostheses).

Of the many methods of arterial reconstruction by transplantation, studied experimentally and tested in the clinic, mainly two are currently used: plastic surgery of arteries with veins and alloplasty with synthetic vascular prostheses. Others are left as unsuitable or are used very limitedly, for example, transplantation of auto-, homo- and heteroarteries, homovenes.

The practical value of grafts used for arterial plastic surgery is determined by biological compatibility, mechanical properties (strength, elasticity, resilience), effect on thrombogenesis, nature and frequency of complications in the immediate and long term after surgery.

Availability is also important, that is, the ability to have a graft of sufficient length and diameter.

Autovenous transplantation is currently the main method of reconstruction of supply arteries of medium and small caliber (diameter less than 8 mm). Autovenous plasty was first developed experimentally and applied at the Carrel clinic (1902, 1906).

The first successful autovenous transplants were used to replace arterial defects that arose after resection of aneurysms: Govenes (1906) used the popliteal vein to replace the popliteal artery defect using the in situ method. Lexer (1907) performed free plasty with a segment of the great saphenous vein of the thigh of a defect in the axillary artery.

In 1949, Kunlin used the great saphenous vein to bypass the occluded femoral artery. Since the late 50s, autovenoplasty has been increasingly used in the surgery of thrombolytic arterial diseases (Dale, Mavor, 1959; Linton, Darling, 1962, 1967; O. Weese et al., 1966).

We (A. A. Shalimov, 1961) were the first to propose a technique for replacing and bypassing peripheral arteries with the accompanying vein of the same name without isolating it from the bed (using the in situ method) during the reconstruction of arteries for obliterating diseases. Most authors currently consider autovenous grafting to be the most preferable method for reconstructing medium- and small-caliber arteries.

This is due to biological compatibility, relative availability and ease of vein removal, elasticity, resistance to infection and relatively low thrombogenic properties. The presence of intact intima ensures long-term functioning of the autovenous graft.

“Surgery of the aorta and great vessels”, A.A. Shalimov

The lack of autogenous vessels of the required diameter, especially for plastic surgery of the aorta and large arteries - “transporting” vessels, encourages the use of homo-, heterovessels and synthetic vascular prostheses. The 60s were a period of enthusiasm for arterial homotransplantation, which was considered as the method of choice for plastic surgery of the aorta and large and medium-sized arteries. The development and application of this method played a major role in the development...

Homografts of large vessels, especially the aorta, can function for a long time. However, at present, the method is practically not used due to the often developing late complications (thrombosis, aneurysms, ruptures, cicatricial narrowings, sclerosis with calcification, outbreaks of infection), as well as the widespread clinical use of more effective alloplastic (for replacing large vessels) and autovenous (for peripheral artery replacement) grafts. Homovenoplasty…

The most promising methods for eliminating the antigenic properties of heterovascular grafts turned out to be methods of enzymatic treatment of them in order to dissolve autogenous proteins (E. N. Meshalkin et al., 1962; Newton et al., 1958, etc.). As a result of appropriate processing, the heterovessel is transformed into a biological collagen tube in the form of a fibrous mesh of adventitia and the inner membrane, which serves as a framework for the formation of the vessel...

As experience in arterial alloplasty accumulated, certain requirements for prostheses were formulated, which were as follows: prostheses should not be pathogenic, should not cause a strong protective reaction (allergic, immune, local tissue reaction, activation of the blood coagulation system, carcinogenesis); must meet certain physical and mechanical requirements - be strong, elastic, flexible, incompressible when bending the limb at the joints, must not...

Of greatest interest in relation to the function and fate of the alloprosthesis is the process of formation, maturation and subsequent involution of the internal lining (neointima) of the prosthesis. At different times after transplantation and in different areas, it has a different structure. The internal fibrin film is gradually replaced by a connective tissue lining. Its surface is gradually covered with endothelium, growing from the side of anastomoses with vessels, as well as from islands of endothelialization...

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 belong to different species of the same genus.

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 (muscle connective tissue), cartilage, pericardium, bone fragments, and nerves are more often performed.

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 the introduction of microsurgical technology into clinical practice, 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. Transplantations of toes from the foot to the hand, transplantation of the greater omentum (fold of peritoneum) to the lower leg, and intestinal segments for esophagoplasty have become important.

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.

Tissue allotransplantation is used most often for transplantation of the cornea, bones, bone marrow, and much less often for transplantation of pancreatic b-cells for the treatment of diabetes mellitus, hepatocytes (for acute liver failure). Brain tissue transplants are rarely used (for processes accompanying Parkinson's disease). 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

Vein transplantation found its application in vascular surgery in peacetime and wartime before all other transplantation methods.

Carrel (1905), Lexer (1907), Leriche (1909), V.R. Braitsev (1916) and others developed and substantiated this method, which has not lost its significance. As numerous studies by experimenters and surgeons have shown, the vein segment fits perfectly into tissue defects, even into the wall of the artery. In this case, the wall of the transplanted vein is nourished by the blood in its lumen. Thrombosis of a venous autograft, according to experimental data and clinical experience, occurs relatively rarely. All this suggests the possibility of using some veins (v. saphena magna, v. femoralis, v. jugularis externe) for autotransplantation to restore the patency of large arterial vessels.

However, it is necessary to point out the disadvantages of vein transplantation, some of which are significant. In the process of long-term study of transplants, it first became clear that aneurysms of the wall of the transplanted vein sometimes occur. These complications do not develop immediately, but after several months and even years. In addition, during long-term observation in, as well as in a chronic experiment, there were cases of obstruction of the venous autograft, which was explained, on the one hand, by thrombosis of its lumen, and on the other, by scarring of the vein walls. Finally, the venous autograft may be subject to rupture due to high blood pressure (thoracic, iliac vessels).

To improve the results of vein transplantation, some used wrapping of the transplanted venous vessels with a plate from the fascia lata of the thigh, a muscle flap on the leg, or a section of the small intestine (devoid of mucosa) on the mesentery. The technique of wrapping the venous transpallant with plastic fabric, tantalum mesh and other materials is also used. All these methods have not yet been sufficiently tested and should be treated with caution due to possible scarring of the venous wall, as well as a sharp violation of its elasticity.

The technique for transplanting a vein into an arterial defect is as follows. After determining the need to replace a section of the artery, its diameter and the length of the vessel defect are measured. Then the vein is carefully exposed and isolated, sparing its wall from injury in every possible way, and resected over a length exceeding one and a half times the arterial defect. The graft is washed with saline and placed in a weak heparin solution.

After this, the proximal and then the distal ends of the artery are sutured end to end with the vein autograft using a circular vascular suture. In this case, the peripheral end of the vein should be sutured to the central end of the artery, the central end of the vein should be sutured to the peripheral end of the artery, otherwise the blood flow may be obstructed by the venous valves. A circular suture can be carried out manually, preferably with atraumatic needles, as well as using the NIIEKHAI apparatus or Donetsky rings.

The article was prepared and edited by: surgeon

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Rupture, narrowing or blockage of blood vessels (most often arteries) can be life-threatening or cause disability. Blockage of the arteries can occur due to atherosclerosis (narrowing of the lumen of the vessel) or for some other reasons (for example, due to thrombosis, embolism, etc.). However, modern vascular surgery has reached such heights that the damaged blood vessel can be replaced with an artificial one or taken from a donor. In case of damage to the abdominal artery or leg artery, the use of prostheses arises. Dentures can be made from different materials, such as plastic.

Implantation of an artificial vessel

The complexity of such an operation depends to the greatest extent on the location of the affected artery. For example, surgery to replace a large branch of the abdominal artery is very complex and lasts several hours. Meanwhile, the operation to replace the artery of the lower limb is simpler. In order for the surgeon to determine the feasibility and extent of the operation, the location and degree of narrowing of the bloodstream, as well as the length of the affected area, a contrast agent is injected into the vessel before implantation and X-rays are taken. However, there are cases when, due to the nature of the damage to the artery, prosthetic surgery is impossible. In addition, the results of surgery to implant a blood vessel prosthesis are unsatisfactory, so it is often abandoned.

Shunt placement

During this operation, unforeseen complications may arise even after careful consideration of all the circumstances. Therefore, attempts are made to bypass the affected area of ​​the artery by applying a so-called shunt. In this case, the ends of the prosthesis are sewn into the healthy part of the vessel, one above the affected area, and the other below. Atherosclerosis affects all arteries to varying degrees. If during the operation the doctor notes thinning of the artery walls, then the surgical technique for artery replacement becomes significantly more complicated.

If the operation of applying a shunt to bypass the narrowed section of the vessel is successful, then in order to avoid blocking the prosthesis with a blood clot, medications that reduce blood clotting are prescribed. Of course, these medications do not guarantee 100% protection against re-occlusion, but they can reduce its likelihood.

In what cases is an artificial vessel implanted?

Atherosclerotic damage to the arteries can be of varying degrees of severity. As the disease progresses, swelling of the arterial walls and damage to their inner layer is noted. Then calcification of the vessel begins. The lumen of the bloodstream gradually decreases and, in the end, it narrows so much that it impedes the movement of blood. For example, due to insufficiency of arterial circulation in the extremities, patients experience intermittent claudication, when convulsive pain is felt in the calf muscles when walking. Then the pain appears at rest, during sleep. Treatment consists of implantation of an artificial vessel. Implantation of the prosthesis is also indicated for expansion of the abdominal aorta. Otherwise, the aneurysm may rupture, leading to significant blood loss.

Is such an operation dangerous?

The most difficult operations are to replace the blood vessels of the abdominal aorta. However, complications can also arise with vascular prosthetics of the lower limb. The so-called emergency operations performed in case of sudden blockage of an artery of the lower limb are considered extremely difficult.

Even if the operation to implant an artificial blood vessel was successful, this does not mean that the blood vessel will not become blocked again. Therefore, after surgery, the patient must take medications. In order to reduce the risk of a blood clot, it is necessary to eliminate risk factors and lead an active lifestyle.

Slide 2

Atraumatic instruments

To perform operations on blood vessels, it is necessary to use special atraumatic instruments that ensure delicate handling of the vascular wall. Much credit for their development belongs to American vascular surgeons at the Mayo Clinic, as well as Michael DeBeki. Vascular instruments include vascular tweezers with atraumatic cutting, thin and well-knit vascular scissors, sharp vascular scalpels, soft vascular clamps with long ratchets. 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).

Slide 3

Slide 4

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 point the tip of the dissector towards the wall of the vein 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.

Slide 5

PROJECTIONS OF THE MAIN VASCULAR-NEW BUNCHES OF THE LIMB

OPERATIVE ACCESS TO VESSELS: DIRECT – carried out strictly along the projection line (to deep-lying formations) CIRCULAR – carried out outside the projection line (to superficially lying formations)

Slide 6

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.

Slide 7

VASCULAR SURE

CLASSIFICATION: By method of application: hand stitch; 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). a b c http://4anosia.ru/

Slide 8

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 “outside in - inside out” pattern. In young children, a U-shaped interrupted suture is used. Everting sutures, A. Carrel's suture, as well as mechanical (hardware) vascular suture are of historical importance.

Slide 9

Seam F. Briand and M. Jabouley

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; Y.N. Krivchikov, 1959 and 1966; A. Blalock, 1954;

Slide 10

Seam 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.

Slide 11

Seam A. Carrel

The Carrel 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 stitch frequency 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.

Slide 12

Dorrance suture a - stage I; b - stage II

The Dorrance seam (V. Dorrance, 1906) is marginal, continuous, two-story

Slide 13

Shov L.I. Morozova

Shov A.I. Morozovaya (a simplified version of the Carell seam) is also a wrapping, continuous, but involves the use of only two holders. The role of the third holder is performed by the thread of the continuous seam itself.

Slide 14

Application of marginal sutures in case of discrepancy in the caliber of vessels a - method N.A. Dobrovolskaya; b - method Yu.N. Krivchikova; c - method of Seidenberg, Hurvit and Carton

N.A. Dobrovolskaya in 1912 proposed an original suture 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) intersected 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 the end of a smaller vessel at an angle (Fig. b).

Slide 15

Shov N.A. Bogoraza (suturing of a vessel defect by fixing a patch)

Shov N.A. Bogoraz (1915) is a plastic suturing of a large defect in the vessel wall by fixing the patch with a continuous wraparound edge suture after preliminary application of stay sutures at the corners of the defect.

Slide 16

Strengthening the area of ​​vascular anastomosis a - method V.L. Henkin; b - SP method. Shilovtseva

For better sealing of the vascular anastomosis line, N.I. Bereznegovsky (1924) used a piece of isolated fascia. V.L. Henkin proposed autovein and allograft for this purpose (Fig. a), and SP. Shilovtsev (1950) - muscle (Fig. b).

Slide 17

Shov A.A. Polyantseva (twisting, continuous between three U-shaped holders)

Slide 18

Shov E.I. Sapozhnikov (continuous welt-like between two knot holders)

Shov E.I. Sapozhnikova (1946) - continuous, welt-shaped, between two node holders. A thread with two straight needles is used, which are injected towards each other at the base of the cuffs.

Slide 19

Suture of the posterior wall if rotation of the vessel is impossible (I) and invagination suture according to G.M. Solovyov (II): I: a - method of L. Blelock, b - method of E.N. Meshalkin, in the form of this seam after tightening the thread; II: a-c - stages of seam formation

Slide 20

Method Yu.N. Krivchikova a - application of U-shaped sutures; b - formation of the cuff; i - application of a continuous U-shaped suture; d - strengthening the cuff

Yu.N. Krivchikov (1959) developed an original intussusception 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.

Slide 21

Ring I.I. Palavandishvili (stretching handles using springs)

I.I. To simplify the technique of applying a hand suture according to Carrel, Palavandishvili (1959) 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 a triangular shape and frees up the assistant’s hands.

Slide 22

Shov G.P. Vlasov (prevention of narrowing of the anastomotic zone)

The peculiarity of the proposed circular seam, 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. The advantages of this method are, firstly, 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.

Slide 23

Seam A.M. Demetsky (prevention of narrowing of the anastomotic zone)

A.M. Demetsky (1959) proposed a suture that eliminates 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.

Slide 24

Method N.G. Starodubtseva (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.

Slide 25

Shov J.N. Gadzhieva and B.Kh. Abasov (inverting 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.

Slide 26

I. Littman seam (intermittent mattress between three U-shaped supports)

Littman suture (1954) - an interrupted mattress suture between three U-shaped supports that are applied at equal distances from each other.

Slide 27

restoration of blood vessels using the Donetsk gauge

  • Slide 28

    Reconstructive operations are performed to restore the main blood flow in case of vascular obstruction

    Disobliterating operations - 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) Thrombendarterectomy - removal of a blood clot along with thickened intima. Plastic surgeries 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://4anosia.ru/

    Slide 29

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

    Slide 30

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

    Slide 31

    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

    Slide 32

    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. Balloon expandable. These are the stents used most often. The stent is placed on the inflating balloon of the catheter. 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. 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. Thermal expandable stents.

    Slide 33

    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. An antiproliferative drug-eluting stent is an intravascular prosthesis made of a coated cobalt-chromium alloy that releases a drug substance that prevents re-narrowing of the vessel. The medicinal layer subsequently dissolves.

    Slide 34

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

    Slide 35

    ANEURYSMSTrue False (traumatic) TYPES: arterial venous arteriovenous

    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 contribute to the formation of a blood clot and obliteration of the cavity or a decrease in 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) Currently, operations are mainly performed to exclude the aneurysm from the bloodstream or remove it and replace it with a vascular prosthesis. http://4anosia.ru/

    Slide 36

    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 MADELUNG - 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 where it enters the femoral ACCORDING TO COCKETT - 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-Trendelenburg-Babcock-Narat operation is more often performed. http://4anosia.ru/

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