Chapter 1090: and translation of title, then ===GLOSSARY=== with list of named entities appearing in these lines

The standard at the 1063 Community Hospital is really terrible.

Xie Ning looked at this son-in-law who still didn't know his own identity and found it quite interesting.

The young guy looks a bit simple-minded, honest and diligent, but his surgery is actually quite good. At such a young age, he can go to Mayo and Heidelberg to perform surgery—that's not just ordinary competence.

"Zheng Ren..." Xie Ning just called out, and Zheng Ren's phone rang.

Zheng Ren gave an apologetic smile, his face full of fatigue, and picked up his phone.

"Fu Gui'er, we're going to eat, come with us." Zheng Ren said.

"Huh? Okay, I'll be there right away."

"No need, I'll go myself—it'll be faster. Have someone meet me at the door. Forget it, you come pick me up yourself."

After Zheng Ren finished speaking, he hung up the phone.

"Boss, what's up?" Su Yun was clearly a bit unhappy; she thought this dinner would inevitably cause some embarrassment, which would later become material for mocking Zheng Ren.

But this guy's luck is really good—it seems the professor is facing some difficulty over there. Su Yun thought, feeling a bit regretful.

"Fu Gui'er said that over there, a thoracic aortic stent has descended into the false lumen." Zheng Ren said.

Su Yun's regret vanished, and she couldn't help but shudder.

Aortic dissection is the condition that Cui Heming had on the plane; if it's not type A, it can be treated with endovascular intervention. Now type A can also be treated, but the difficulty is too high, so few people do it.

However, when deploying the stent, a complication can occur—the stent doesn't go into the true lumen of the thoracic aorta but instead enters through a tear into the medial layer, expanding the false lumen.

This can worsen the patient's condition and may lead to death at any moment.

This complication is extremely rare, and when it occurs it's due to the doctor's skill level; domestically, it can be considered a very serious medical accident.

Only after repeated lapses in skill could such a complication happen!

Zheng Ren muttered a complaint to himself.

Zheng Ren had only seen similar reports of such iatrogenic damage in magazines; he still didn't know exactly how to treat it.

He gave an apologetic smile and said, "Uncle Ning, you go ahead and eat; I'll do a procedure. If it goes smoothly, I should be able to join you in about an hour."

"Use me?" Su Yun asked solemnly.

As a doctor, whenever hearing about an emergency surgery, one instinctively places oneself in the situation—a sense of duty at work.

"With Fu Gui'er around, I'll go check the situation; you keep Uncle Ning company for a while." Zheng Ren said.

"Okay." Su Yun agreed.

Although it's a bit regrettable, emergency rescue is still important. Thinking about the stent going into the false lumen and worsening the condition—blood from the aorta rushing wildly into the dissection—now the vessel wall may have torn all the way down to the toes.

MD, the medical level over there with Fu Gui'er isn't great either, Su Yun thought.

Xie Ning looked at this cheap, capable son-in-law, who is still busy even in Heidelberg, Germany, feeling somewhat helpless. However, that side is dealing with an emergency rescue, so it's hard to say anything.

He is quite capable, Xie Ning smiled.

"Doctor Zheng, don't call a car—ride in my vehicle." Zou Jia Hua said.

"Then I won't stand on ceremony." Zheng Ren replied directly.

In fact, when he spoke with Professor Rudolf Wagner, he already had this idea. Zou Jia Hua is sharp; he couldn't possibly miss the meaning.

Just riding in a stretched Lincoln to the surgery—would that be too showy? Zheng Ren hadn't considered that.

After apologizing again to Xie Ning and Zou Jia Hua, Zheng Ren turned and left. An attendant from Zou Jia Hua's side followed, bringing Zheng Ren to the extended Lincoln.

The car rode smoothly; Zheng Ren sat inside, entered the system space, and prepared for surgical training.

The system's operating room rose up; after Zheng Ren entered, he glanced at the images, immediately began operating, the catheter entered, a contrast injection was made, and upon seeing the image he was stunned.

In the experimental subject's thoracic aorta, the stent's proximal end is in the true lumen, while the distal end is in the torn false lumen. The true lumen of the thoracic aorta has almost no blood flow, and although the false lumen isn't as exaggerated as he expected, it has torn directly down to the iliac bifurcation.

This... is way too severe.

The severity of the condition exceeds Zheng Ren's expectations; it's now imminent, and the patient could die at any moment from vascular rupture.

The outer layer of the thoracic aorta is relatively tough, and the patient is somewhat fortunate, so there hasn't been a rupture bleed. The aortic high pressure continues to tear the vessel, extending all the way to the iliac bifurcation.

The vessels here, whether in diameter or wall thickness, cannot compare to the thoracic aorta and could tear at any moment.

If the vessel ruptures, the patient will surely die.

He cursed under his breath, and just as he was about to act, he went blank.

What should I do?

This is an unprecedentedly unfamiliar procedure; even Zheng Ren, at the peak of his ability, begins to feel lost.

Surgery isn't something you can just do on a whim.

Femoral artery puncture normally involves placing a guidewire and catheter inside.

But the patient's current situation requires removing the stent, and it's impossible to operate on both the true and false lumens simultaneously.

A single guidewire and catheter certainly can't handle both sites at once.

Zheng Ren concentrated for a moment, then decided to adopt a technique he had never used before—bilateral femoral artery catheterization.

But there's only him in the system's operating room...

He sighed, focused, and faced the situation. Even if he's alone, what can he do?

He is, after all, a man at the pinnacle of his skill; Zheng Ren encouraged himself.

Under general anesthesia, the experimental subject's bilateral femoral arteries were exposed and sheaths inserted; Zheng Ren didn't even bother with sterile technique, knelt on the narrow operating table, and began the surgery.

After all, if this were a real surgery, the other side could be handed over to Professor Rudolf Wagner; Zheng Ren still holds the professor's ability in high regard.

Bilateral femoral artery puncture: the right catheter goes into the true lumen, the left directly into the false lumen. After inserting a stiff guidewire, a 5F, 95‑cm long guiding sheath is placed at the level of the celiac trunk for angiography, showing that the celiac trunk, superior mesenteric artery, and right renal artery supply the true lumen, while the left renal artery and lumbar arteries supply the false lumen.

The left sheath is placed at the distal end of the existing stent within the false lumen, and a multi‑loop snare is inserted. The right side, via a stiff guidewire, exchanges for a 10F sheath, positioning it in the true lumen 2 cm distal to the stent's original end.

After several failed surgical attempts, Zheng Ren summarized the experience and began to form some ideas about the procedure.

Through the distal end of the 10F sheath, a 5F catheter is inserted and positioned near the snare inside the false lumen. A 0.014‑inch guidewire is advanced, and with the catheter's cooperation it crosses the intimal flap between the true and false lumens into the snare. Afterwards, the guidewire and catheter are placed into the original stent.

After exchanging the guidewire, the balloon dilation window was continuously expanded to a diameter of 25 mm, then a TX2 stent 36 mm wide and 77 mm long was placed, half within the existing stent and half within the true lumen of the abdominal aorta above the celiac trunk.

Angiography shows increased perfusion of visceral Artery and renal Artery.

Shou Bing ends, completion degree 88%.