"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.
Other problems doctors need to worry about are how to transplant the same blood vessel material to the target blood vessel. As mentioned before, how to prune the organ transplant is most beneficial.
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 harvested. Its location is close to the heart, so there is no need to rush. It can be done at the back together with the heart surgery. Therefore, the internal mammary artery harvesting and transplantation are different from the great saphenous vein.
The great saphenous vein is located far away from the heart, so doctors need to be prepared before harvesting it.
In this operation, it is of course necessary to remove the great saphenous vein first, which should be the first technical difficulty in 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?
In the past, surgery before the advent of minimally invasive technology required major incisions.
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.
This kind of surgical procedure means that the length of the surgical incision must be as long as the doctor needs to transplant 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, a traditional surgical incision is used to cut from the thigh to the calf.
Think of a long scar from thigh to calf. Not to mention the ugly scar, such a major surgery 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 it is very expensive, and poor patients cannot afford it. By analogy, if you don't care about money, you can directly use artificial blood vessels instead of the patient's own blood vessels. Artificial blood vessels are of course more expensive.
Medically speaking, poverty itself is really a "disease".
Returning to the current case, there is currently no artificial blood vessel available for coronary artery bypass grafting.
(End of chapter)
