Department of Vascular Surgery, "Democritus" University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece.
Department of Vascular Surgery, "Democritus" University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece.
Ann Vasc Surg. 2021 Aug;75:527-530. doi: 10.1016/j.avsg.2021.03.036. Epub 2021 Apr 26.
End-to-end anastomosis in small arteries can be challenging, especially when the stumps are in spasm after traumatic transection. We describe a novel technique to facilitate such anastomoses under local anesthesia, presenting a 24-year old patient who suffered complete traumatic transection of the left ulnar artery. After having found and prepared the proximal and distal stumps, a soft polyurethane feeding tube (La-med Healthcare, India) and a vein cannula were inserted in the proximal and distal stump, respectively, without using vascular clamps. The manipulation of the catheters offered excellent visualization and widening of the anastomotic line, enabling simultaneous infusion of heparinized saline or vasodilating agents. The anastomosis was completed with no stenosis and pulpable pulses were restored immediately postoperatively. At 1-month follow-up, the Allen test was normal with a normal regular flow of the ulnar artery at duplex ultrasound. The described technique ensures efficient sealing avoiding clamping, casts the small lumens, provides optimal visualization of the anastomotic aspects and prevents stenosis. We believe it should have a place in the surgeon's armamentarium.
小动脉端端吻合可能具有挑战性，尤其是在创伤性横断后残端痉挛时。我们描述了一种在局部麻醉下便于进行此类吻合的新技术，介绍了一位 24 岁的患者，他遭受了左尺动脉完全性创伤性横断。在找到并准备好近侧和远侧残端后，分别将柔软的聚氨酯喂养管（印度 La-med Healthcare）和静脉套管插入近侧和远侧残端，而不使用血管夹。导管的操作提供了极好的可视化效果，并扩大了吻合线，从而能够同时输注肝素化盐水或血管扩张剂。吻合完成后没有狭窄，术后立即恢复了可触及的脉搏。在 1 个月的随访中，Allen 试验正常，双功能超声显示尺动脉的正常规则血流。所描述的技术可确保有效的密封，避免夹闭，包裹小腔，提供最佳的吻合可视化效果，并防止狭窄。我们认为它应该在外科医生的武器库中占有一席之地。
