Chapter 3826: 【3826】first point

   "It is said that the patient has four-vessel disease."

   “They should not just take the internal mammary artery.”

  The selection of grafted blood vessels has been introduced at length, mainly the internal mammary artery and the great saphenous vein. If it is not enough, the right gastroepiploic artery, the radial artery, the superior epigastric artery, etc. can be used.

  The first criterion for choosing a vascular material is that the diameter of the transplanted blood vessel is commensurate with the target blood vessel, so that the connection is good and the blood flow after transplantation is stable and smooth. The diameter ratio is usually one to one to two to one.

  Secondly, to ensure the patency of the grafted vessels, the grafted vessels are detected in advance before surgery, and the doctor repeatedly determines the blood flow during the operation. Therefore, there will be requirements for the thickness of the grafted vessel wall, and it is always impossible to choose a root with a thickened lesion for transplantation.

  Other problems Doctors need to be entangled in the surgical method of how to transplant the same blood vessel material to the target blood vessel. How to trim the most beneficial organ transplantation as mentioned earlier.

  The full name of the internal mammary artery is the internal mammary artery, so there is one called the internal mammary artery, and another called the internal thoracic artery. The anatomical location is inside the thorax, close to the heart.

  The internal mammary artery is taken from the position close to the heart, so there is no need to rush it, and it can be done later together with the heart surgery. Therefore, internal mammary artery grafting is different from that of great saphenous vein.

  The location of the great saphenous vein is relatively far from the heart, so doctors need to make preparations before sampling it.

  In this operation, of course, the great saphenous vein must be removed first, which should be the first technical difficulty of the current operation.

  Saphenous vein harvesting is a very mature and popular operation in the surgical field, because it is a vascular material that surgeons love very much, and it is not limited to coronary artery bypass grafting.

  In the eyes of doctors, the great saphenous vein has the advantages of being straight, long, and easy to access. In addition, its diameter is commensurate with many target blood vessels that need to be transplanted, so it is a natural good material.

  Because the main function of the vein is to bear the return of blood, it is different from the artery that supplies blood to the tissues and organs of the human body, so it is not so important for the human body to take it away.

  For example, clinically common varicose veins of the lower extremities are usually related to the great saphenous vein. It is not a problem to directly deprive the great saphenous vein of high-level ligation in a type of surgery.

  How is the great saphenous vein taken.

  In the past, before the advent of minimally invasive techniques, major operations were required.

  Surgeons cannot operate blindly without the assistance of minimally invasive surgical tools. Only the steps of stripping blood vessels in anatomy class cut skin and muscles layer by layer to expose blood vessels hidden deep in the human body like underground water pipes.

  Such surgical steps lead to the length of the surgical incision as long as the doctor needs to graft the blood vessel.

  How long is the great saphenous vein? From thigh to calf.

  Theoretically, if the doctor wants to obtain a long section of the great saphenous vein, it is possible, but in practice, the traditional surgical knife is used to cut from the thigh to the calf.

   Think about a long scar from the thigh to the calf. Not to mention the ugly scar, such a major operation will definitely bring about surgical sequelae. All kinds of drastic surgical incisions will inevitably injure small nerves without injuring large nerves, and long-term pain and dull pain are inevitable for patients.

  It shows that minimally invasive technology is good, but not all surgeons can master it, and the cost is so expensive that poor patients cannot afford it. By analogy, if you don't care about the money, you can directly take the artificial blood vessel instead of the patient's own blood vessel. Artificial blood vessels are of course more expensive.

  Poverty in medicine itself is really a "disease".

  Back to the current case, there is no artificial blood vessel available for coronary artery bypass grafting.