Craig's patient this morning is
克雷格今天早上的病人是
79-year-old retired security guard
79岁的退休保安
John 6 weeks ago he had an accident in
约翰6周前他
the street on the way to his favorite
在去他最喜欢的酒吧的路上在街上出了事故
Pub I was going out the pub and only 10
我正要去酒吧，只有
to 6: at night and I tried over this Cub
晚上10点到6点，我试着这样做
and I felt flat in my
face about a 4 later I got off the bus
大约 4 个小时后，我和 Cub 感觉脸部被压扁了，我下了车
and I thought well yeah I'll have a look
，我想，好吧，我会去
to see there was a r curb or anything
看看有没有路缘石或类似的东西，
like that and I was looking I fell over
然后我就在
the curb next to it and the same same
旁边的路缘石上摔倒了 还是同一个
place but it was about 5 to six this
地方，但这次是下午 5 点到 6 点左右，
time I said I couldn't believe
我说我简直不敢相信，
it after his fall John's daughter took
他摔倒后，约翰的女儿带
him to hospital where scans revealed a
他去医院，扫描结果显示他的
more serious
issue a major swelling in his main
问题更严重，他的主要动脉出现了一个大肿胀，
artery called an aneurysm which could
称为动脉瘤，可能会
rupture at any
随时可能破裂
time this is John's blood vessel running
这是约翰的血管，
down through his belly here called the
从他的腹部流出，这里称为
aort the main blood vessel that comes
主动脉，是从心脏流出的主要血管
out of your heart the elephant in the
房间里的大象
room is this swelling here in John's
是约翰血管中的肿胀，
blood vessel which is the aneurysm
也就是动脉瘤
itself what happens over time this blood
本身 随着时间的推移会发生什么 这条
vessel starts to dilate it it's a bit
血管开始扩张 这有点
like a balloon you know you blow them up
像气球，你知道你把它们吹大了，
they look pretty but they are going to
它们看起来很漂亮，但它们会
get to a point where they're going to
达到
burst the surgery will involve diverting
爆裂的程度，手术将涉及
blood through John's
aneurysm using waterproof mesh tubes
使用防水网状管将血液转移通过约翰的动脉瘤，
called
称为
stance this is introduced into the groin
支架，这被引入 腹股沟
Advanced up under x-ray guidance until
在 x 射线的引导下前进，直到
it's in place and as we pull back on
它到位，当我们把它拉回来时，
this and you can see the graphs start to
你可以看到图形开始在
open up inside the patient until it's
病人体内打开，直到它
fully deployed and the delivery device
完全展开，输送装置
comes out and the stank graft is Left
出来，臭味移植物被
Behind you are we okay to start
留下 你好吗我们可以开始了
[Music]
[音乐]
yes Craig Begins the complex khole
是的 Craig 开始进行复杂的 khole
surgery to insert Sten into Jon's
手术将 Sten 插入 Jon 的
arteries we're trying to make a smaller
动脉我们试图在
hole in his artery as possible from
他的动脉上开一个尽可能小的洞从
there we can navigate ourselves wherever
那里我们可以导航到任何
we need to get to obviously in John's
我们需要去的地方显然 John 的
case we want to get into this aneurysm
病例，我们想深入研究动脉瘤，
so we can fix
以便修复
it Craig inserts metal wire into Jon's
它 Craig 将金属丝插入 Jon 的
blood vessel which will show up on the
血管，这将显示在
X-ray and help them guide the Sten in
X 光片上，并帮助他们引导 Sten
place this wire is is now inside ISC Ary
到位，这根金属丝现在位于 ISC Ary 内，
and heading up inside the aneurism and
并前往 动脉瘤内部，
again this is all just about getting
这只是为了获得
what we call Safe access to help us
我们所谓的安全通道，帮助我们
navigate and see where we're going we
导航，看看我们要去哪里，我们
have to inject a die into the the
必须将一个芯片注入
bloodstream that essentially gives us a
血液，这实际上为我们提供了
road map so we can see where we're
路线图，这样我们才能看到在哪里 我们
going
要
boom one of the major concerns I have
砰的一声，我对约翰最大的担心之一
for John is that he's had relatively
是，他的
poor kidneys for some time and
肾脏已经有一段时间相对较差了，
unfortunately the dye irritates the
不幸的是，染料会刺激
kidneys using the correct amount of dye
肾脏，使用正确数量的染料
or contrast is going to be crucial so as
或造影剂将是至关重要的，这样才
Not to cause IR reversible damage if
不会引起 IR 可逆性损伤如果
your kidneys are already a little bit
你的肾脏已经有点
vulnerable this die could finish these
脆弱，这个模具可能会结束这些
kidneys off X let's get this device in
肾脏X让我们把这个设备放进去，
so in total three stent will be used to
所以总共有三个支架将用于
reroot Jon's blood supply the first will
重新连接乔恩的血液供应，第一个将
be placed at the top of the aneurysm it
被放置在动脉瘤的顶部，它
must be maneuvered into exactly the
必须 被操纵到完全
correct
正确的
position good position I've got that
位置好位置我已经
tension on The Wire there so hopefully
在电线上得到了张力所以希望
it'll just jump up in a second there you
它会在一秒钟内跳起来你
go there we go okay yeah on a bit
去那里我们去好吧是的
further nice nice yeah you will have
再远一点很好很好是的你会有
that fleeting thought of 1 mm the wrong
那短暂的 错误地考虑了 1 毫米
way and it could be a catastrophe
，这可能是 灾难
really the second stent needs to be
真的第二个支架需要
exactly the correct length and in the
完全正确的长度和
right position to connect to the first
正确的位置来连接到第一个
stent Bingo nice yeah that's that really
支架宾果好是的那真是
nicely we're just taking the final
太好了我们只是在
measurements for the the final piece of
为拼图的最后一块做最后的测量
the jigsa as it were once this last
就像曾经 最后
piece goes in that will be the aneurysm
一块放入的是动脉瘤，
excluded we can all breathe the side
排除后我们都可以呼吸了，侧面
relief
缓解，
this is a risky procedure for a patient
对于像约翰这样虚弱的病人来说，这是一个有风险的手术，
as frail as John so to be a success
所以要想成功，
every stage of the surgery has to be
手术的每个阶段都必须
precise okay I think you got at least
精确，好吗，我想你明白了 至少
two full steps haven't you just the fact
两个完整的步骤，你不是吗？事实上
you've got a problem and you can fix it
你遇到了问题，你可以
sounds really tff with your hands I just
用你的手修复它，听起来真的很好，我只是
love doing that guys can we open a mold
喜欢这样做，伙计们，我们可以打开一个
in blue with all three stents in place
蓝色的模具，所有三个支架都到位了，
Craig has to seal the joints between
克雷格必须
them using balloons will send up a very
使用气球密封它们之间的接头，会将一个非常
soft balloon it's called a molding
柔软的气球（称为成型
balloon into all the areas where the S
气球）送入已
graft has been built and you've got like
构建 S 型移植物的所有区域，然后形成
a a connection or an overlap and
一个连接或重叠，
essentially that goes inside the S graft
本质上就是进入 S 型移植物内部，
and just exerts a bit of outward
只是施加一点向外的
pressure ah it's not too bad is it yeah
压力啊，不算太多 情况很糟糕，是的，
the Sten gra as it opens out you want it
Sten Gra 在打开时您希望它
to have reached its full diameter its
达到其最大直径，其
full potential to check all stent are in
最大潜力检查所有支架是否
place and that the seals are secure
到位，密封是否牢固
Craig injects more D or contrast into
Craig 向 John 的血液中注入更多 D 或造影剂，
John's bloodstream
what we want to see is contrast running
我们希望看到什么 对比剂是否
through the graph and not into the
贯穿整个图表，而不是进入
aneurism
动脉瘤
itself okay we are ready to
本身，好的，我们准备好了
[音乐]，
go it's all landed exactly where I
一切都恰好落在我
wanted it yeah there you're right up to
想要的位置，是的，你现在就在
that
renal see the before picture with the
肾脏上，看到之前的图片，
aneurism all filling sort the after
动脉瘤全部填充了
picture with the contrast just running
对比图之后，只需将
down these graphs into both legs the
这些图表放到两条腿上，当
point where you do your final run and
你进行最后一次跑步时，
you can see that you're on your is
你可以看到你被
excluded and your St graft is sitting
排除在外，你的 St 移植物处于
nicely yeah it's good we're finished you
良好的状态，是的，很好，我们完成了，你
can say things have gone to plan that's
可以说 一切都按计划进行，那是
a really nice
一个非常美好的
moment I think it's gone well it's all
时刻，我认为一切都进展顺利，一切都很
sat nicely and the graph is in a good
顺利，图表也处于一个很好的
place so be considerate an aneurism
位置，所以要考虑
repair through a Hall that's half the
通过一个只有他指甲一半大小的霍尔来修复动脉瘤。
size of his
fingernail it
is
是