METHOD OF TREATING CEREBRAL AND UPPER LIMB VENOUS HYPERTENSION SYNDROME ACCOMPANYING SUPERIOR VENA CAVA SYNDROME AND/OR BILATERAL BRACHIOCEPHALIC VENOUS OCCLUSION ASSOCIATED WITH ARTERIOVENOUS FISTULA Russian patent published in 2016 - IPC A61B17/00 

FIELD: medicine.

SUBSTANCE: 5 cm incision is made above v. basilica along the anterior surface of an upper third of the arm with separating an arteriovenous fistula of v. basilica throughout 4-5 cm. The second incision 2 cm long is made on the upper periphery of an anterior axillary line on the same side of the body. Then the third incision 4 cm long is made from a longitudinal approach in the iliac region above an inguinal ligament so that a lower border of the wound is found at the level of the middle of the inguinal ligament and 2 cm above. That is followed by separating a front border of a neurovascular bundle through the fourth 5 cm incision from a retroperitoneal approach, 2 cm lower and 2 cm in the medial direction from the middle of the inguinal ligament. A sapheno-femoral junction and great saphenous vein are separated throughout 4 cm. A tunnelling instrument is used to deliver a graft subcutaneously through an approach in the axillary region from a shoulder wound - into the wound along the anterior axillary line and into the wound of the iliac region, further - in the retroperitoneal direction along the neurovascular bundle under the ligament through a vascular lacuna to the sapheno-femoral junction. After systemic heparinisation with unfractionated heparin 5000 units, v. basilica is clamped throughout 3-4 cm at distal and proximal wound edges. A longitudinal 20 mm venotomy is made, and a graft end to vein side anastomosis of the arteriovenous fistula v. basilica is created. The great saphenous vein is clamped within the sapheno-femoral junction and 4 cm in the distal direction, and the longitudinal 20 mm venotomy is made. The graft end to vein side anastomosis of the graft and great saphenous vein is created. In special situations, a spiral-reinforced collagen and silver acetate-impregnated knitted Dacron graft 8 mm×70 cm in size is used as a graft.

EFFECT: method allows to arrest the cerebral venous hypertension syndrome, prevent the onset of extravascular compression or shunt folding, and reduce the risk of shunt infection.

2 cl, 1 ex, 17 dwg