Scalpel in vessels

Heart disease cannot be separated from blood vessel disease. The heart and blood vessels are a single cardiovascular system. Blood vessel disease, like heart disease, can arise from a variety of reasons.

Elderly people often suffer from general arteriosclerosis. In this disease, organic salts are deposited in the walls of blood vessels. In this regard, the vessels coarse, their walls lose elasticity, become brittle, then the vessel narrows and blood circulation is disturbed.

Such changes can be observed not only in the elderly, but also in middle-aged people. The fact is that the entire cardiovascular apparatus is under the constant influence of the central nervous system, which regulates the contraction and expansion of blood vessels, as well as the movement of blood through them. Various disorders of the nervous system (caused by an improper lifestyle, diseases, severe nervous shocks) affect the correct contraction and dilation of blood vessels, change their functions. Under the influence of this, premature arteriosclerotic disorders can develop.

We will only touch on those diseases of the blood vessels in which surgical treatment is most often used. Among them, the most common are thrombophlebitis, varicose veins of the lower extremities and obliterating endarteritis. Doctors pay special attention to the fight against these diseases. Patients with obliterating endarteritis, varicose veins and thrombophlebitis are subject to mandatory registration and clinical examination. They are carefully examined and treated in outpatient and inpatient conditions.

Of course, prevention plays a significant role in the fight against these diseases. To prevent the development of pathological conditions and subsequent complications, the causes of the disease are identified, harmful occupational factors are eliminated, a special diet and work regime is established. General treatment is also used - elastic bandages, special stockings, various medications. But the most radical method of treating these diseases is still surgery.

It is known that varicose veins of the lower extremities often leads to various complications: blockage of veins, thrombophlebitis, the formation of trophic ulcers. When the expansion of the veins reaches a significant degree, the dilated saphenous veins are excised along the limb. With thrombophlebitis, for this purpose, the central section of the great saphenous vein is necessarily bandaged at the site of its confluence with the femoral eyelid, and then the dilated, thrombosed veins are excised and removed. Most often, the operation is performed after some time after an attack of acute thrombophlebitis, when the inflammatory process around the clogged vein weakens. In this case, the patient is administered antibiotics and anticoagulants (drugs that reduce blood clotting).

All that has been said applies to the surgical treatment of lesions of the subcutaneous, superficially located veins.

It is much more difficult to treat patients with deep vein thrombosis of the lower extremities. This disease in the acute stage is accompanied by significant swelling of the lower limb, pain, high fever. Surgical treatment according to the method described above in this case is impossible, since deep vein ligation leads to a sharp violation of blood circulation and swelling of the limb.

Surgeons working in this field are trying to remove a thrombus - a blood clot from a vein or replace a section of a blocked deep vein with a vascular graft or prosthesis made of synthetic material. Replacing one vein with another is a completely possible operation.

Sometimes it is difficult to decide on the extent of the spread of thrombosis - to determine whether the disease has captured only the saphenous veins or deep veins are also affected. In these cases, venography, a diagnostic method in which the venous system is filled with a so-called contrast agent, is of great importance. With the help of venography, it is possible to determine the insufficiency of the valves of the veins, a violation of their activity. This technique makes it possible to choose the correct operational tactics, as well as to avoid complications.

Among the vascular diseases subject to surgical treatment, obliterating endarteritis occupies a special place. Most often it occurs in old age with general arteriosclerosis, as well as in younger people with impaired vascular tone. The disease is accompanied by severe pain, limp, ulceration, often on the toes, and gangrene of the foot, and then the lower leg.

When examining patients with endarteritis, it is usually possible to establish the places where individual parts of the vessel are affected. This makes it possible to remove clotting blood clots from the vessel and restore normal blood circulation. With limited narrowing of the vessel on the basis of arteriosclerosis, it is possible to dissect a section of the affected artery and replace it with a vascular graft or prosthesis made of plastic materials.

If it is impossible to remove the clotting blood clot, a bypass is applied. For example, when the femoral artery narrows in the middle, the anastamosis is placed between the iliac artery and the lower segment of the femoral or popliteal arteries. Vascular substitutes are taken from deceased people and preserved in special formulations, and most often they are frozen at very low temperatures and dried.

Then the future vascular prosthesis is placed in sterile, hermetically sealed tubes. In this form, it can persist for a long time.

Vascular prostheses made of synthetic materials - dacron, teflon or lavsan - are made in the form of corrugated tubes of various diameters and thoroughly sterilized before use.

In case of defects in one of the walls of the vessel, patches made of synthetic materials or flaps of blood vessels are used. Vascular surgery is becoming more common.

Suturing of the arteries is carried out either by hand, tightening the ends with sutures, or using a specially made apparatus for applying a vascular suture.

This apparatus is the pride of Soviet scientists. It is not only simple and easy to use, but also very versatile. With its help, the lengths of the vessels can be connected with tantalum staples in a variety of ways - "end to end", "end to side" and "side to side". The creation of this apparatus greatly contributed to the development of vascular surgery.

Not always, with lesions of the vascular system, surgical treatment is carried out by operations on the veins or arteries. With obliterating endarteritis, in cases where vascular changes caused by nervous disorders prevail, lumbar and sacral sympathetic nerve nodes or thoracic sympathetic nodes are removed.

The development of vascular surgery made it possible to timely and effectively treat thromboembolic disease - blockage of the lumen of large arteries. This disease is often accompanied by necrosis of the limbs. In simple cases with thromboembolic disease, the operation is reduced to removing a blood clot. If the disease is running, has become severe and it is impossible to remove the blood clot, a bypass anastamosis is applied to the vessel between the healthy parts of the artery. These operations began to be successfully carried out only in recent years.

Currently, there is every opportunity to replace or suture vessels with a variety of damage. So, in addition to the diseases listed above, surgical treatment of aneurysms and congenital vascular anomalies is widely used. For injuries and injuries of a blood vessel, early surgery usually gives excellent results.Thanks to the development of vascular surgery, there is already an experience of successful replantation - engraftment - of a newly lost or damaged limb. In these cases, the soft tissues are connected, the vessels are sutured, and the bones are fastened with a metal pin.

But even if we exclude these rare cases, it should still be emphasized once again that vascular surgery has allowed surgeons to successfully deal with many diseases that were previously only treated with therapeutic treatment.

Kukin N.N. - Ways of surgery

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