Chapter 3826 【3826】The First Point

"It was said that the patient had four-vessel disease."

"They should take more than just the internal mammary artery."

As for the selection of transplanted blood vessels, we have introduced them in detail earlier. The main ones are the internal mammary artery and the great saphenous vein. If it is not enough, the right gastroepiploic artery, radial artery, superior epigastric artery, etc. can be used.

The first criterion for selecting vascular materials is that the diameter of the grafted vessel should be commensurate with that of the target vessel, so that it can be well connected and maintain smooth and smooth blood flow after transplantation. The diameter ratio is usually one to one to two to one.

Secondly, it is necessary to ensure the patency of the grafted blood vessels. The grafted blood vessels are pre-detected before surgery. During the surgery, the doctor repeatedly determines the blood flow. Therefore, there are requirements for the thickness of the wall of the grafted blood vessels. You cannot always choose a thickened root with lesions for transplantation.

For 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 it is called the internal mammary artery and the internal thoracic artery. Its anatomical location is within the chest, 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.

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

Great saphenous vein harvesting is a very mature and popular operation in the surgical community, 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 blood vessel diameter is commensurate with many target blood vessels that require blood vessel transplantation, making it a naturally good material.

Because veins are mainly responsible for the return of blood, unlike arteries, which supply blood to nourish human tissues and organs, it is not that important to the human body if taken away.

For example, clinically common varicose veins of the lower limbs are usually related to the great saphenous vein. One type of surgery directly removes the high ligation of the great saphenous vein without causing any problems.

How is the great saphenous vein harvested?

Before the advent of minimally invasive techniques, previous surgeries required extensive surgery.

It is impossible for a surgeon to operate blindly without the assistance of minimally invasive surgical tools. He can only cut the skin and muscles layer by layer like the steps of peeling off blood vessels in anatomy class to expose the blood vessels hidden deep in the human body, such as 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 sequelae. Various radical surgical incisions will inevitably injure small nerves even if they do not damage the large nerves. Long-term pain and dull pain are inevitable for the patient.

It shows that minimally invasive technology is good, but not all surgeons can master it, and the cost is very expensive, and 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.

Medically speaking, poverty itself is really a "disease".

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