METHOD FOR OPEN AND ENDOVASCULAR PERFUSION OF THE HEAD AND NECK Russian patent published in 2023 - IPC A61B17/12 A61M25/01 A61K31/282 A61P35/00 

FIELD: medicine; endovascular surgery.

SUBSTANCE: invention can be used for open and endovascular perfusion of the head and neck during chemotherapy of brain tumors. An incision is made along the anterior edge of the sternocleidomastoid muscle on the right with a length equal to 1/2 of the length of the sternocleidomastoid muscle from its sternal head. The tissues are separated bluntly and sharply layer-by-layer. The vascular bundle of the neck is exposed on the right. The right common carotid artery (right CCA) and the right internal jugular vein (right IJV) are isolated. The right CCA is clamped with an elastic vascular clamp according to Satinsky. A 5 mm arteriotomy is performed. An anastomosis is formed between the prosthesis polytetrafluoroethylene (PTFE) 5 mm and the right CCA according to the "end to side" type with a continuous twist suture with a 6/0 prolene thread. The prosthesis is washed and clipped at the base with a ligaclip. The clamp on the right CCA is removed with preservation of the distal pulsation. Hemostasis is controlled. A purse-string suture is applied on the anterior surface of the right VJV with a 6/0 prolene thread and taken into the Rummel tourniquet. Without changing the position of the body and head, an incision is made along the anterior edge of the sternocleidomastoid muscle on the left with a length equal to 1/2 of the length of the sternocleidomastoid muscle from its sternal head. The tissues are separated bluntly and sharply layer-by-layer. The vascular bundle of the neck is exposed on the left. The left common carotid artery (left CCA) is isolated. The left CCA is clamped with an elastic vascular clamp according to Satinsky. A 5 mm arteriotomy is performed. An anastomosis is formed between the 5 mm PTFE prosthesis and the left CCA according to the end-to-side type with a continuous twist suture with a 6/0 prolene thread. The prosthesis is washed and clipped at the base with a ligaclip. Remove the clamp from the left CCA while maintaining the distal pulsation. Hemostasis is controlled. Then, a puncture and installation of a 12 Fr introducer into the main vein is performed according to Seldinger. A 50 mm balloon catheter is inserted through a 0.035 guidewire into the projection of the superior vena cava (SVC) orifice under X-ray control. Control inflation of the balloon catheter is performed, positioned and complete occlusion of the SVC orifice is ensured. Heparin is administered intravenously at the rate of 100 U/kg. Upon reaching the calculated activated blood clotting time, the right CCA is cannulated through the prosthesis with an arterial cannula — with a diameter corresponding to the diameter of the prosthesis and a connecting size of 1/4 inch, and the left CCA through the prosthesis with an arterial cannula — with a diameter corresponding to the diameter of the prosthesis and a connecting size of 1/4 inches. Then, the superior vena cava is cannulated by passing a venous cannula — with a diameter corresponding to half the diameter of the VJV, and a connecting size of 1/4 inch, into the right VJV proximally with the positioning of the end of the cannula in the distal segment of the SVC under X-ray control. The start of parallel perfusion of the upper half of the trunk and head is carried out. Next, vascular isolation of the head is performed by compressing the tourniquets proximal to the implanted prostheses of the right and left common carotid arteries while maintaining blood flow through both vertebral arteries and inflating the balloon catheter at the mouth of the SVC with venous outflow from the head and upper extremities along the venous cannula, which is passed into the distal segment of the SVC through right VYAV. The isolated perfusion of the head and neck is started by directing the sampling blood from the system of the superior vena cava to the venous reservoir, then to the oxygenator with a heat exchanger 36°C, and then into the right and left common carotid arteries with a volumetric velocity of 0.5 liters per minute along the formed time contour. 150 mg of Carboplatin are added to the venous reservoir. Next, the closed circuit is washed from the perfusate with an isotonic sodium chloride solution of 500 ml and 500 ml of gelofusin and 300 ml of erythrocyte mass. Stop perfusion is carried out by removing the covers from the carotid arteries and deflating the balloon catheter at the mouth of the SVC. After stabilization of hemodynamics, heparin is decannulated and neutralized with a solution of protamine sulfate at the rate of 1.5 mg of protamine sulfate for every 100 IU of heparin. Final hemostasis is performed. The PTFE prostheses are clipped with two ligaclips each and placed under the neck muscles. The operation is completed by layer-by-layer suturing of the wounds.

EFFECT: invention makes it possible to perform isolated chemoperfusion of the head and neck during chemotherapy of brain tumors with drugs at concentrations many times higher than the concentration with systemic administration, to reduce the trauma of surgical access and thereby prevent the complications associated with it; repeat perfusion in the same patient by cannulating arteries through a prudently preserved vascular access through PTFE prostheses sewn into the CCA, as well as to exclude damage to the CCA wall during cannulation due to indirect cannulation through PTFE prostheses sewn into the CCA.

1 cl, 2 dwg, 1 ex