After listening to Director Tai's introduction, Zheng Ren had already sketched out the surgical procedure in his mind.
After heparinization, the abdominal aorta, left common iliac artery, right internal iliac artery, and right femoral artery were blocked. The right common iliac artery and right external iliac artery were incised, and the IABP catheter was removed. After taking it out, you can see that the catheter balloon is twisted and internal thrombosis has formed.
The intimal tear of the right common iliac artery was detected. The tear was from the opening of the right common iliac artery to the opening of the right internal iliac artery. The intima of the right internal iliac artery was torn like a detachment, which was repaired with a 7/0 sliding suture.
It was probably just such an operation process, Zheng Ren knew it well. But now the problem is not here, but the surgery just now.
"When you took out the pipe, you didn't use much strength, right?" Zheng Ren asked worriedly.
The most fearful thing at this time was that Director Tai took out the tube after DSA angiography and pulled hard, causing the intima of the artery to tear.
If that were the case, it would be troublesome.
"No, no." Director Tai said repeatedly, "I watch your surgery live broadcast every day, and I know that you can't solve problems with brute force."
Zheng Ren nodded. Opening his own surgical live streaming room would be of some use.
"I tested it twice and found that it was stuck very badly, so I didn't dare to move it." Director Tai seemed to have made a mistake, and his voice became lower and lower.
"..." Zheng Ren looked at Director Tai's back and already had a bad feeling.
I hope it's wrong, so how can I fix it
Even if the IAPB catheter becomes embedded in the iliac artery and tears the intima of the blood vessel when it is taken out, surgery has to be performed to suture it. I just draw my sword to help, there is no reason to make irresponsible remarks here.
IABP is one of the most widely used cardiac assist devices in clinical practice. Its common complications mainly include lower limb ischemia, arterial injury, local infection and bleeding, and balloon puncture.
When IABP is offline, the balloon counterpulsation catheter cannot be withdrawn smoothly, causing iatrogenic foreign bodies in large blood vessels. It is relatively rare. It is like the first time I went to the Affiliated Hospital of Provincial Medical University and encountered a neurosurgery operation to remove the guide wire. The situation is the same when pushed in.
These are relatively rare things.
In interventional treatment, most of the common vascular iatrogenic foreign bodies, such as stents, guide wires, spring plugs, etc., can be removed from the body through intravascular microcoil extractors, and only a few require surgical removal.
Of course, the premise is that Director Tai doesn't move.
I'm afraid that he has no experience in the process of trying, and will make more mistakes and help more.
Zheng Ren unconsciously put the label of having no clinical experience on the heads of the directors of prefectural and municipal hospitals without any psychological barriers.
Iatrogenic foreign bodies lodged in large blood vessels, if not treated in time, can cause secondary thrombosis, infection, and even ischemia and necrosis of organs and limbs in the blood vessels. When the patient's general condition permits, it should be removed as soon as possible.
"How long has it been incarcerated?" Zheng Ren then asked a crucial question.
"Less than 2 hours."
Not bad, not bad, what a coincidence, Zheng Ren thought to himself. In no more than 3 hours, the possibility and risk of blood clots will be greatly reduced.
However, Director Tai said that he did not pull repeatedly and tried to violently remove the IABP tube, so the possibility of local intimal tearing of the blood vessel was unlikely.
Give it a try, it should be fine, I hope it is.
Along the way, Zheng Ren briefly asked about the interventional machines and related consumables of the People's Hospital.
The operation should be possible. Zheng Ren followed him to the interventional operating room, changed his clothes and went in. He took advantage of the time to change clothes and went to the system operating room for an operation before coming out.
It can be removed, but the broken IABP tube is stuck in a branch of the external iliac artery. It's just that the force to be taken out needs to be twisted and used skillfully, not brute force.
What makes Zheng Ren most gratified is that Director Tai really didn't pull hard, and the lining of the blood vessel is completely fine!
This guy is not bad. Zheng Ren has a good impression of Director Tai, and the mosaic on his face has become lighter.
The surgery that couldn't be done was not done forcefully, and he knew the appropriateness.
"Boss Zheng, I'm really sorry. You came out to play this weekend, but I asked you to rescue me." Director Tai apologized in a low voice.
"It's okay." Zheng Ren smiled and watched the operation process at 4x speed, then put on lead clothing and went to brush his hands.
Lin Yuan followed him silently, also put on his lead clothes, and prepared to go on stage together.
"Do you think there is a high chance of successfully taking it out?" Director Tai asked vaguely.
"Try it." Zheng Ren was still talking to the patient and his family. He was vague and never said whether it was possible or not. If he asked in a hurry, he would mention a lot of complications.
After being a doctor for a long time, you will always have some habits like this, and no one can escape them.
Standing in front of the operating table, Zheng Ren first got used to the machine, and then made a gesture to Director Tai outside the leaded glass, and the airtight lead door slowly closed.
"Director, you are so awesome. How did you convince Boss Zheng to come up?" Mr. Zhai asked from the side.
"Boss Zheng and I have a relationship." Director Tai said coldly.
You can't brag too much, as the saying goes, it's wrong to talk too much. In addition, Director Tai was worried about Boss Zheng, so he glanced at the screen and then looked at Boss Zheng who was doing surgery inside through the leaded glass.
"Director, the vascular department is here." Two doctors walked in wearing isolation suits, and Mr. Zhai whispered.
Director Tai was looking at the screen with all his concentration, his heart already in the sky as he heard Mr. Zhai's verbosity.
The director of the vascular department hurriedly came from home, only to see doctors from the circulatory department and interventional department standing outside.
Is this to give up the surgery and wait for it to happen on my own? There is nothing proud or proud in his heart. This kind of taking the blame to save the situation, naturally the less the better, it is not a good thing for him.
It was hard to say whether the operation would be possible or not. I gave up so early and didn’t try much.
"Director Tai, isn't that good for you? Do you want to try again?" the director of the vascular department said as he walked in.
When he saw Director Tai looking at the screen and not speaking, he thought that Director Tai was confused. When encountering a medical accident, many people will be confused. They did not expect that Director Tai, who has always been domineering, would be like this.
Not inevitable.
But he took one look and was stunned. The airtight lead door of the operating room is closed, and there are doctors operating inside.
It looked like a man and a woman.
Since when did our hospital have a female interventional doctor? Could it be that someone from the circulatory department came on stage to try it
Then he looked at the screen again.
The blood vessels are empty and are undergoing imaging. Isn't this nothing? The director of the vascular department was a little confused.
Today is April Fool's Day, are they looking for their own fun? It's not that serious. You can make any kind of joke in the hospital, but no one would ever joke about emergency treatment.
Immediately, the image on the screen paused, and the airtight lead door slowly opened.