From this article you will learn about the shunting of blood vessels and stomach, a detailed review of this operation.
Aortocoronary shunting( CABG)
Bypass surgery is called a surgical operation, during which, with the help of a system of shunts-vascular grafts, an additional bypass is created for the normal blood supply of the site of the myocardium,brain or soft tissues of the legs.
Who performs such interventions? Everything depends on the area of the vascular lesion:
- for heart diseases - the cardiosurgeon performs aortocoronary shunting;
- for disorders of cerebral circulation - a neurosurgeon or neurovascular surgeon performs shunting of cerebral vessels;
- in the pathology of the vessels of the legs - the vascular surgeon conducts shunting of the vessels of the lower extremities.
During gastric bypass surgery during the operation, the stomach is divided into two parts, one of which remains unused in the digestion of food. Subsequently, such a result leads to a more rapid saturation and loss of extra pounds. Gastroshuntirovanie conducts a bariatric surgeon - a doctor engaged in the treatment of obesity by surgical methods.
Aortocoronary bypass surgery( CABG)
CABG is recommended in cases where other methods of restoring normal blood flow in the coronary arteries are ineffective or impossible due to contraindications. What is coronary artery bypass graft? The essence of such an operation is to create a shunt - a by-pass of the circulation from the aorta to the part of the myocardium that suffers from insufficient blood flow. Such a vascular graft later performs the functions of coronary arteries narrowed from atherosclerosis. As a result, a person's heart activity is normalized, and the risk of developing a myocardial infarction and the onset of sudden death significantly decreases.
Indications
The main indications for CABG:
- coronary vessels narrowed by more than 70%;
- forms of angina that are not medically treated;
- ineffectiveness or inability to perform angioplasty or stenting;
- the first 4-6 hours after myocardial infarction or the development of early postinfarction ischemia;
- ischemic pulmonary edema.
There are many indications for performing CABG, and the need for such intervention is determined after a detailed examination of the patient: ECG( different types), Echo KG, coronarography, blood tests.
How is the operation performed?
Before carrying out the CABG the patient passes the necessary preparation for the operation:
- stops taking medications to dilute the blood;
- for 3-5 days goes to the hospital cardiosurgery department;
- receives advice from an anesthesiologist and a physician in physiotherapy;
- passes a number of additional examinations( blood tests, ultrasound of the vessels of the legs, dopplerography of the arteries of the brain, etc.).
CABG can be performed by two methods:
- traditional - on the open chest after sternotomy( a large incision in the middle of the sternum);
- minimally invasive - on a closed chest through small incisions and with the help of endoscopic equipment.
Click on the picture to enlarge Depending on the clinical case, the intervention can be performed on an operating or non-functioning heart( i.e., using an apparatus for artificial circulation).
The operation begins after the onset of general anesthesia. After performing access to the heart, the surgeon once again assesses the condition of the vessels and outlines the places for suturing the future shunt. In parallel, the operating team performs vascular sampling for subsequent transplantation. They can be internal thoracic arteries, radial artery or subcutaneous veins of the leg.
If necessary, the surgeon stops the heart and connects the patient to the device for artificial circulation. Then the doctor performs cuts on the vessels and sews in these places a shunt with special vascular sutures. When the heart is stopped, the cardiac surgeon starts it again. Next, the doctor checks the consistency of the shunt and layer-by-layer sutures the surgical wound.
traditional CABG duration may be from 3 to 6 hours minimally invasive - about 2. In the absence of complications the patient discharge from hospital after performing a conventional method carried out after 8-10 days, and after minimally invasive intervention - after 5-6 days. Shunting
cerebrovascular In some lesions of cerebral arteries restore normal blood circulation can be achieved only by performing a bypass them. The cause of such vascular damage can become a variety of diseases: atherosclerosis, neoplasms, thrombi. If the problem is not eliminated for a long time, a violation of blood circulation can cause the death of large areas of brain tissue and lead to disability or death of the patient. When a shunt is applied that delivers blood to the required site, the ischemia is eliminated, and the brain begins to function normally.
Indications Main indications for bypass surgery of brain vessels:
- aneurysm( widening) of the vessel, untreatable by other means;
- is a tumor that results in carotid artery damage or constriction;
- inability to prevent stroke by medication;
- worsening of the arterial blood flow, which can not be eliminated in other ways;
- hydrocephalus( a violation of the normal development of the brain, associated with excessive accumulation of fluid in it) in newborns.
bypass surgery vascular cerebral arteries assigned only after detailed examination of the patient:. MRI, CT, angiography, duplex ultrasound arterial occlusion balloon research, etc. As
operation is conducted?
Before carrying out shunting of cerebral vessels, the patient undergoes the necessary preparation for the operation:
- quits smoking 14 days before the operation;
- discontinues non-steroidal anti-inflammatory drugs 7 days before the intervention;
- undergoes a number of additional examinations( blood, urine, ECG, fluorography, etc.);
- shaves the hair from the head the day before the operation;
- takes medication prescribed by a doctor.
before transporting the patient to the operating room should be free of artificial nails, piercings and other jewelry, contact lenses and dentures.
Shunting of the cerebral arteries can be performed in the following ways:
- The procedure is used for the lesion of a small area of the small artery. As a shunt, a vessel is used, taken from arteries feeding the brain envelope. During the operation, the surgeon selects the affected vessel and pulls its end through the created hole( by drilling the skull) to the end of the shunt. After that, he sews them up, restoring the blood flow in the ischemia site.
- The procedure is applied if the diameter of the damaged artery is about 2 cm. As a shunt, a portion of the vessel from the leg or the patient's arm is used. It is sutured into the external carotid artery and is performed in the temporal region. After this, the surgeon removes part of the skull and inserts a shunt into the resulting hole. He then sews it to the affected artery.
In practice, shunting is more often performed when using a vessel that supplies the cerebral membrane. Usually the operation lasts about 5 hours. To anesthetize such interventions, general anesthesia is used, accompanied by artificial ventilation of the lungs.
In hydrocephalus, a special kind of bypass is performed - ventriculo-peritoneal. The essence of this operation is to make a hole in the skull, into which a titanium tube is inserted. Its lower end is connected to the ventricle of the brain. Through the created shunt, the excess fluid that enters the ventricle is delivered to the abdominal cavity and is actively absorbed there.
In the absence of complications before discharge from the hospital, the patient is duplexed to evaluate the functioning of the superimposed shunt and the nature of the cerebral blood flow. In the absence of any violations, the patient is discharged 6-7 days after the operation.
Shunting of the vessels of the lower extremities
Indications for performing shunting of the vessels of the legs can become diseases, accompanied by their significant constriction or expansion, resulting in insufficient blood supply to a site. The decision on the need for such operations is accepted in cases when the course of intensive conservative therapy is ineffective and the existing total disruption of blood flow in the future can lead to the development of gangrene of the affected limb and disability. To restore normal blood circulation in the vessels of the legs, methods can be used to create shunt-prostheses or anastomoses( interconnections) between adjacent normally functioning vessels.
Indications
The main indications for carrying out leg vessel shunting:
- obliterating atherosclerosis;
- peripheral arterial aneurysms;
- endarteritis;
- varicose veins;
- inability to perform angioplasty or stenting;
- threat of gangrene development and inefficiency of conservative therapy.
The choice of the shunting procedure is determined by the results of a patient's examination: MRI, CT, duplex ultrasound of the vessels of the legs.
How is the operation performed?
Before performing such interventions, the patient must undergo a comprehensive examination and the necessary training. Based on the results of the research, the vascular surgeon selects the shunting technique that is appropriate in this clinical case.
Click on the picture to enlarge The operation can be performed under epidural anesthesia or general anesthesia. During the intervention, the surgeon identifies the affected area, performs the incision and fixes in this place one of the ends of the shunt, which is the site of the subcutaneous vein of the thigh or an implant of artificial material. After this, the second end of the shunt is passed through the tendons and muscles to a place located above the lesion and fixed.
Then the surgeon checks the consistency of the woven vascular element. For this, ultrasound and an arteriogram can be performed. After this, surgical wounds are layered in layers.
There are many methods of shunting the vessels of the legs. Usually such operations last about 1-3 hours. In the absence of complications, the patient is discharged from the hospital within 7-10 days.
Gastric bypass
Sometimes, for weight loss, some patients have to perform an operation such as gastric bypass surgery. What it is? This is one of the modern surgical techniques used to reduce hunger and weight loss. It is prescribed to those obese patients who can not achieve the desired results in other ways. The essence of such an operation is to create a "small ventricle" connected to the small intestine. After its implementation, the rest of the stomach stops participating in digestion, the patient's hunger disappears, he consumes less food and grows thin.
Indications
The main indication for gastric bypass surgery is obesity, which can not be eliminated in other ways and is constantly accompanied by a feeling of severe hunger. Sometimes such interventions are performed when there is a difficulty in evacuating food from the stomach in other diseases.
Before performing such intervention, the patient undergoes a complete examination: blood tests, ECG, fluorography, FGDS, etc.
How is the operation performed?
Gastric bypass can be performed by the traditional route or by laparoscopic technique. The operation is always performed under general anesthesia.
There are many varieties of such operations, but in general the essence of such bariatric interventions is to create a "small ventricle", the volume of which will not be more than 50 ml. To do this, with the help of special devices, the surgeon crosses the stomach to the necessary parts. Most of the process is not removed during the operation, and the small intestine is sewn to the formed smaller part. As a result, food from the esophagus falls into the "small ventricle", saturation occurs more quickly and the patient, without experiencing frequent feelings of hunger, grows thin. After the surgery, the surgeon sutures the wound.
The duration of such operations can be from 1 to 1, 5 hours. An extract from the hospital is carried out after 3-4 days.
