"I said the patient had four lesions."
"They should have taken more than just the internal mammary artery."
The selection of transplanted blood vessels has been introduced in great detail above. The main ones are the internal mammary artery and the great saphenous vein. If they are 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 transplanted vessel should be proportional to the target vessel, so that a good connection can be achieved and blood flow after transplantation can be maintained smoothly. The diameter ratio is usually one to one to two to one.
Secondly, the patency of the transplanted blood vessels must be ensured. The transplanted blood vessels must be detected before the operation, and the doctor must repeatedly confirm the blood flow during the operation. Therefore, there will be requirements for the thickness of the transplanted blood vessel walls. It is not possible to choose a graft that has thickened lesions for transplantation.
Other issues doctors need to consider are how to transplant the same blood vessels into the target vessels, such as how to trim the organs for the most beneficial effect in transplantation.
The full name of the internal mammary artery is internal mammary artery, so it is called the internal mammary artery and the internal thoracic artery. Its anatomical position is inside the thorax, close to the heart.
The internal mammary artery is close to the heart, so there is no need to rush and it can be done later together with the heart surgery. Therefore, the internal mammary artery transplantation is different from the great saphenous vein.
The great saphenous vein is located far away from the heart, so doctors need to be well prepared if they want to harvest it.
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For this operation, of course, the great saphenous vein must be removed first, which should be the first technical difficulty of the current operation.
Great saphenous vein harvesting is a very mature and popular operation in the surgical field, as it is a vascular material that surgeons love very much and is not limited to use in coronary artery bypass grafting.
In the eyes of doctors, the great saphenous vein has the advantages of being straight, long, and easy to obtain. In addition, its blood vessel diameter is commensurate with many target blood vessels that require vascular transplantation, making it a naturally good material.
Since it is a vein whose main function is to carry blood back, unlike arteries which supply blood to nourish human tissues and organs, it is not that important for the human body to take away blood.
For example, varicose veins in the lower limbs are often related to the great saphenous vein in clinical practice. One type of surgery directly removes the great saphenous vein through high ligation without causing any problems.
How is the great saphenous vein harvested?
Before the advent of minimally invasive technology, surgery required major operations.
It is impossible for surgeons to operate blindly without the assistance of minimally invasive surgical tools. They can only follow the steps of peeling off blood vessels in anatomy class, cutting through the skin and muscles layer by layer to expose the blood vessels hidden deep in the human body like underground water pipes and digging them out.
Such surgical procedures require the length of the surgical incision to be as long as the blood vessel to be transplanted.
How long is the great saphenous vein? From the thigh to the 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.
Imagine a long scar from the thigh to the calf. Not only is the scar ugly, but such a major operation will inevitably bring surgical sequelae. Various drastic surgical incisions will inevitably damage small nerves even if they do not damage large nerves. Long-term pain and dull pain are inevitable for patients.
This shows that minimally invasive technology is good, but not all surgeons can master it, and it is very expensive, so poor patients cannot afford it. By analogy, if you don't care about money, you can 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".
Back to the current case, there are currently no artificial blood vessels available for coronary artery bypass grafting.
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