METHOD FOR RECONSTRUCTING ARTERIOVENOUS FISTULA Russian patent published in 2020 - IPC A61B8/06 

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to surgery, and can be used for reconstruction of arteriovenous fistula. Preoperative ultrasonic examination is performed. Fistulas vein branches are visualized. Vein branches are ligatured through two microincisions on the skin with loops of absorbable suture material, pricking through one incision, conducting under the vein and puncturing from the opposite side through the other incision, sticking the needle into the first prick-out point, holding above the vein under the skin and puncturing through the opposite incision, forming a loop node under the skin. Additionally, an ultrasonic examination involves measuring blood flow velocities in the punctured segment of the vein distally to each of its branches V_nd and in all branches of V_nv. Method includes determining the ratio V_nv/V_nd, where V_nv is volumetric blood flow velocity along the vein branch, V_nd is blood flow velocity in the vein directly distal to the branch, n is the branch number. Only those branches are ligated, the ratio of which is V_nv/V_nd ≥ 0.2. Skin micro-incisions are 4–5 mm long from the diametrically opposite sides of the vein. Then blood pressure is measured and compression is performed with pressure equal to arithmetic average of systolic and diastolic measured arterial pressure by cuff on middle one-third of arm. Ligation is performed in the period of created compression. Needle is selected by curvature 1/2 and length by formula d = π * (L + D + 5), where d - length of needle in mm, L - distance from skin to external wall of vein branch, D - external diameter of vein branch. Suture material is used to form another hinge of two loops, wherein both loops are arranged X-shaped at a pitch equal to the length of the microincision. When tightening the assembly, the compression is stopped in the middle one-third of the shoulder and the arterial blood discharge along the vein of the arteriovenous fistula is simultaneously briefly closed.

EFFECT: method enables to effectively solve the problem of delayed aging of arteriovenous fistula without increasing the risk of developing complications, reliably completely stop blood discharge along the branches and stolen the main vein shaft and preserve haemodynamically insignificant branches by determining before ligation of volume velocity of blood flow in the punctured vein segment and in all its branches.

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