From Big Medical Encyclopedia

CLIPING OF VESSELS (English clip a clip) — a method of a stop of bleeding or switching off from blood circulation patholologically the changed vessels by means of imposing on them tiny metal clips — clip-on earrings.

To. the page is widely applied in neurosurgery as bandaging of the small vessels in brain fabric which are especially deeply located presents considerable difficulties.

For the first time this method of a stop of bleeding during neurosurgical operations was described by X. Cushing who used the V-shapedly curved silver wire as clips. Due to the development of surgery of vessels of a brain a large number of various clip-on earrings having a special purpose is offered.

Fig. 1. Different types of clip-on earrings: 1 — clip-on earrings NIIEKHAII; 2 — Olivekruna's clip-on earrings; 3 — 5 — spring clip-on earrings (3 — Skovil's clip-on earrings, 4 — Yazargil's clip-on earrings, 5 — Mayfield's clip-on earrings).
Fig. 2. Various types of klipsoderzhatel: 1 and 2 — klipsoderzhatel NIIEKHAII; 3 — the klipsoderzhatel released by the Moscow plant of the electromechanical equipment; 4 and 5 — Yazargil's klipsoderzhatel.

The clip-on earrings prepared from a silver or tantalic flat wire are most often applied to a stop of bleeding in an operational wound. That clip-on earrings did not come off a vessel, on their inner surface the cross notch becomes. Depending on caliber of a vessel clip-on earrings of two sizes — 4,5 and 7 mm (fig. 1) are used. For operability of a clip are loaded in «shop» and their imposing on a vessel it is made by means of special klipsoderzhatel (fig. 2).

Big distribution was gained by clip-on earrings which if necessary can be easily removed from a vessel (fig. 1,2).

In vascular neurosurgery for switching off of aneurisms spring clip-on earrings (fig. 1, 3—5) are widely used. Their advantage is that if necessary they can be easily removed from a vessel, and the effort of a spring in them is calculated in such a way that clips completely blocks a gleam of a vessel, without injuring its wall. Branches of some clip-on earrings have different length and are bent under various corner that in some cases considerably facilitates their imposing on a neck of aneurism.

Spring removable clip-on earrings are applied to temporary overlapping of a vessel. They are widely used during the performance of reconstructive operations on vessels of a brain, napr, at a neostomy between branches superficial temporal and average brain arteries.

Some clip-on earrings used in vascular neurosurgery have a special purpose. So, the clip-on earrings offered by Selverstoun are applied to the gradual dosed narrowing of a gleam of the general carotid artery on a neck (V. of Selverstone). These clip-on earrings represent the metal coupling, in to-ruyu the vessel consists; gradual occlusion of an artery is carried out by the clamping level moving by means of the special screw removed in a wound.

The clip-on earrings offered by Sandt and Nofzinger (T. M. of Sundt, J. D. Nofzinger) for a stop of bleeding from large arteries of a brain are original in principle. These spring clip-on earrings as the coupling, cover a vessel. From the inside they have a dacron vystilka and as a matter of fact are an external prosthesis of a vessel. The clip-on earrings prepared from silver, tantalum or special alloys cause the minimum reaction from surrounding fabrics in the form of local productive inflammatory process. At their correct use the complication, as a rule, is not observed.

See a step Microsurgery .

Bibliography: Cuckoo L. I. and Belyakov P. D. Clip-on earrings and the tool for imposing of clips, Vopr, neyrokhir., No. 3, page 55, 1957; Petrovsky B. V. and Krylov of V. S. Mikrokhirurgiya, page 18, M., 1976, bibliogr.; Hahn I. Opera-tionen und Instrumente, Miinchen, 1976; Sundt T. M. a. Nofzinger J. D. Clip-grafts for aneurysm and small vessel surgery, J. Neurosurg., v. 27, p. 477, 1967; Yasargil M. G. Microsurgery, Stuttgart. 1969.

A. H. Konovalov.