CN209187070U - A kind of built-in for rebuilding artificial blood vessel for individuation branch stent type bow portion - Google Patents
A kind of built-in for rebuilding artificial blood vessel for individuation branch stent type bow portion Download PDFInfo
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- CN209187070U CN209187070U CN201821977056.2U CN201821977056U CN209187070U CN 209187070 U CN209187070 U CN 209187070U CN 201821977056 U CN201821977056 U CN 201821977056U CN 209187070 U CN209187070 U CN 209187070U
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Abstract
A kind of built-in for rebuilding artificial blood vessel for individuation branch stent type bow portion, it is related to a kind of artificial blood vessel.The utility model is in order to solve existing full bow replacement operation due to being unable to accurately control bow, the visual area bleeding of drop portion, there are amount of bleeding during patients surgery is big, the Deep Hypothermia Circulatory Arrest time long problem for easily causing spinal cord lesion etc., so that operative mortality rate and complication rate are higher.The utility model includes hard bow portion (20), hard bow portion (20) is identical or equal to the gradually smaller caliber of distal end directional curvature radius from the proximal part arc pipe of radius of curvature, hard bow portion (20) is equipped with multiple branch's windows and cyclic annular dent (24), and hard bow portion (20) is mounted on bow portion initiative pulse support blood vessel (3) inside that individuation branch stent type bow portion rebuilds artificial blood vessel.The utility model is performed the operation for Aortic arch replacement.
Description
Technical field
The utility model relates to the built-ins of artificial blood vessel a kind of, and in particular to a kind of for aorta open surgery
Individuation branch stent type bow portion rebuilds the built-in of artificial blood vessel, belongs to medical instruments field.
Background technique
Dissection of aorta is a kind of big blood vessel acute disease for seriously threatening patient safety.Wherein, acute type A interlayer
(Standford type A), i.e. lesion involve liter, the dissection of aorta in bow portion, is the highest one kind of risk, onset is hurried,
Progress is rapid, lethality is high.Without operative treatment, 24 hours death rates are close to 25%, 48 hour death rate close to 50%, 30
It the death rate is up to 90%.Liter, bow portion blood vessel using surgical resection, displacement lesion are definite effective treatment hands
Section.But the operation of acute type A interlayer is complicated, it is the severe challenge put in face of cardiovascular surgeon that technical requirements are high.To the greatest extent
Pipe, diagnostic techniques and Perioperative Managements measure improve in recent years, but it is reported that acute type A interlayer operative mortality rate still
Up to 15,30%, it would be highly desirable to improve.
Acute type A interlayer operating difficulty is big, and complication is more, in some instances it may even be possible to cause catastrophic big bleeding, limit liter, bow
The development of portion's replacement of aorta operation.Until nineteen eighty-three, it is a wide range of that professor Borst uses trunk artificial blood vessel to carry out in a creative way
Aorta replacement, just succeeds.1991, the improvement of trunk blood vessel was the trunk blood vessel of merging overturning by professor Safi etc., was mentioned
High success rate of operation.It in recent years, is the one of Aortic surgery as trunk vascular treatment dissection of aorta using overlay film frame
Big progress, secondary side open chest surgery needed for can avoid traditional operation.
Currently, the common strategy of bow replacement operation is recycled in vitro as shown in Figure 1:, stoped jumping down entirely, processing is risen actively in advance
Arteries and veins and root, then profound hypothermia, stop recycling, by overlay film trunk stented vessel implantation, release it is very intracavitary in descending aorta, complete bow
Portion Four branches aortic graft distal end and coincideing including overlay film trunk stent-graft proximal part and self descending aorta.
The Deep Hypothermia Circulatory Arrest time, this stage, spinal cord blood supply was interrupted mostly more than 20 minutes, increases and spinal cord injury even paraplegia occurs
Risk.After restoring circulation, it is also necessary to complete on innominate artery, left common carotid artery, left subclavian artery and artificial blood vessel one by one
Respective branch is coincide.Previous anastomotic is more, and especially left subclavian artery position is deep is adjoining recurrent nerve and ductus thoracicus, dissecting
Free and identical more difficult, time-consuming, and bleeding probability also increases therewith, and operative mortality rate and complication rate are higher.
In conclusion existing full bow replacement operation is due to being unable to accurately control bow, the visual area bleeding of drop portion, there are patient's hands
Amount of bleeding is big during art, the Deep Hypothermia Circulatory Arrest time long problem for easily causing spinal cord lesion etc., so that operative mortality rate and simultaneously
It is higher to send out disease incidence.
Utility model content
Purpose of the utility model is to solve existing full bow replacement operations due to being unable to accurately control bow, drop portion art
Wild bleeding, there are amount of bleeding during patients surgery is big, the Deep Hypothermia Circulatory Arrest time long problem for easily causing spinal cord lesion etc. makes
It obtains operative mortality rate and complication rate is higher.And then it provides a kind of for the artificial blood of individuation branch stent type bow portion reconstruction
The built-in of pipe.
The technical solution of the utility model is:
A kind of built-in for rebuilding artificial blood vessel for individuation branch stent type bow portion, including hard bow portion, hard
Bow portion is identical or equal to the gradually smaller caliber of distal end directional curvature radius from the proximal part curved pipe of radius of curvature
Road, hard bow portion are equipped with multiple branch's windows and cyclic annular dent, and hard bow portion is mounted on individuation branch stent type bow portion weight
It builds inside the bow portion initiative pulse support blood vessel of artificial blood vessel.
Further, the preceding upper limb in the middle section in hard bow portion is equipped with branch's window one, and the latter end upper limb in hard bow portion is equipped with
The middle section facies ventralis of branch's window two, hard bow portion is equipped with branch's window three；Between branch's window one and branch's window two with
And the bow portion surface of hard bow portion proximal part is equipped with cyclic annular dent.
Further, the opening that branch's window one and branch's window three are round or oval, branch's window two are half
The open hole of rounded distal.
Further, the bending angle in hard bow portion is 30 ° -90 °, and the diameter in hard bow portion is 22-32mm, hard bow portion
Bending radius be 30-60mm.
Preferably, hard bow portion bent angle alpha is 30 °, 45 ° or 60 °, and caliber d is 22mm, 24mm or 26mm, bending half
Diameter R is 40mm, 50mm or 60mm.
Preferably, hard bow portion is made of titanium alloy, stainless steel or polypropylene plastic material.
The utility model has the effect that compared with prior art
Design, the application in the hard bow portion of the utility model, improve existing operation method: conventional full bow displacement hand
Art is under Deep Hypothermia Circulatory Arrest, after aortic arch is cut, by the release of descending aorta stenter to implant after the true chamber of descending aorta, needs
By the self arch of aorta drop portion vascular wall of distal end, descending aorta stented vessel two layers of artificial blood vessel part together with proximal end
Four branches aortic graft wall carries out identical.Sutural margin two sides tissue thickness difference is big, is not easy close-fit emergency.Suture drawing cutting causes
Trembling, which occurs, in the sheet aorta wall that fragility can't bear at entry point convinces bleeding after cause recovery recycles by patient analysis.The utility model is using different
Method: after the drop portion initiative pulse support blood vessel 2 that the bow portion of utility model rebuilds artificial blood vessel is discharged, in artificial blood vessel proximal end
After the built-in hard bow portion 20 of insertion is in place, self arch of aorta vascular wall, bow portion are rebuild into artificial blood vessel's wall, beam with cordonnet
Tightly on the cyclic annular dent 24 in built-in hard bow portion 20, knot secured.Complete cycle aorta wall and artificial blood vessel's wall at ligation
Thickness uniformity, no suture, the further destruction of aorta wall caused by entry point.Therefore it can quickly, definitely control out
Blood considerably reduces bow, the visual area bleeding of drop portion, or even can realize above-mentioned visual area without bleeding, solves full bow replacement technique
Maximum difficult point, greatly reduces operation risk and difficulty.
Detailed description of the invention
Fig. 1 is existing full bow displacement+trunk stenter to implant schematic diagram；
Fig. 2 is that the individuation branch stent type bow portion of the utility model rebuilds the structural schematic diagram after artificial blood vessel's release；
Fig. 3 is that the individuation branch stent type bow portion of the utility model rebuilds artificial blood vessel and its conveying device is discharging
Before, the spare schematic diagram under restrained condition；
Fig. 4 is that the individuation branch stent type bow portion of the utility model rebuilds artificial blood vessel and its built-in hard bow portion exists
Perspective diagram under use state；
Fig. 5 is the side view in hard bow portion；
Fig. 6 is the top view in hard bow portion；
Specific embodiment
Specific embodiment 1: illustrating that present embodiment, present embodiment include hard bow portion 20 in conjunction with Fig. 2 to Fig. 6, firmly
Matter bow portion 20 is identical or equal to the gradually smaller caliber of distal end directional curvature radius from the proximal part arc of radius of curvature
Shape pipeline, hard bow portion 20 are equipped with multiple branch's windows and cyclic annular dent 24, and hard bow portion 20 is mounted on individuation branch branch
Frame type bow portion is rebuild inside the bow portion initiative pulse support blood vessel 3 of artificial blood vessel.
Present embodiment can fast implement the suture connection of aorta ascendens rapid free.
Specific embodiment 2: illustrating present embodiment in conjunction with Fig. 2 to Fig. 4, in the hard bow portion 20 of present embodiment
The preceding upper limb of section is equipped with branch's window 1, and the latter end upper limb in hard bow portion 20 is equipped with branch's window 2 22, hard bow portion 20
Middle section facies ventralis is equipped with branch's window 3 23；So set, rebuilding the Y of artificial blood vessel for the branch stent type bow portion of utility model
What shape bow part branch 6, branch stent blood vessel 5, bow part branch 47 had reserved each comfortable arch of aorta enters blood mouth, guarantees all heads
The abundant blood supply of brachial artery；The Position Design of branch's window 2 22 has agreed with left subclavian artery under normal circumstances on bow top
Issue position, it is ensured that it carries out accurate intracavitary therapy in situ, it is avoided to be displaced and interior leakage；Branch's window 1 is corresponding
The common root of innominate artery and left common carotid artery, the position of branch's window relatively to the right, Xiang Qianyi, right shift makes it
There is larger space between branch window two, so that the cyclic annular dent 24 of hemostasis by ligation can take up sufficient space, guarantees
Ligation effect does not influence branch's blood supply again, shifts forward so that the collar shape sutural margin 1 around 6 roots of branch of Y shape bow part is aobvious
It is exposed to the front for rebuilding cantle top, after extracorporal circulatory system, is sutured with the self aorta wall of reservation, is taken precautions against postoperative remote
The small probability event of phase bleeding.Anastomotic site table is shallow, easily operated.Other compositions and connection relationship and one phase of specific embodiment
Together.
Specific embodiment 3: illustrating present embodiment, one 21 He of branch's window of present embodiment in conjunction with Fig. 2 to Fig. 4
The opening that branch's window 3 23 is round or oval, branch's window 2 22 are the open hole of semicircular distal.So set,
Branch's window one is consistent with the common root Y shape of the left common carotid artery bow part branch shape of 6 roots with innominate artery, and opening is omited
Greater than the root that Y shape bends part branch 6, guarantee the blood supply of 2 brachiocephalic artery abundances；Branch's window 2 22 is located at hard bow portion 20
Distally, the root of corresponding left subclavian artery.The arch of aorta can transfer backward after left subclavian artery sending under normal circumstances,
Individuation variation is larger, therefore hard bow portion is unsuitable too long.Branch's window 2 22 is using the open shape design of semicircular distal, both
The opening of left subclavian artery has been reserved in hard bow portion, has guaranteed that its blood supply is unaffected, and it is left to increase cyclic annular dent as far as possible
The width in the hard bow portion of side, it is ensured that hard bow portion 20 is unlikely to tilt when ligation stress.Other compositions and connection relationship
It is the same as one or two specific embodiments.
Specific embodiment 4: illustrate present embodiment in conjunction with Fig. 2 to Fig. 4, the hard bow portion 20 of present embodiment it is curved
Bent angle is 30 ° -90 °, and the diameter in hard bow portion 20 is 22-32mm, and the bending radius in hard bow portion 20 is 30-60mm.So
Setting, the arch of aorta of the form in hard bow portion relatively normal physiological condition, the bore in hard bow portion reach normal physiological
The bow portion bore of state makes the bow portion after rebuilding and brachiocephalic artery haemodynamics restore normal.Other compositions and connection relationship
It is identical as specific embodiment one, two or three.
Specific embodiment 5: illustrating present embodiment in conjunction with Fig. 2 to Fig. 4, the hard bow portion 20 of present embodiment is bent
Angle [alpha] is 30 °, 45 ° or 60 °, and caliber d is 22mm, 24mm or 26mm, radius of curvature R 40mm, 50mm or 60mm.So set
It sets, the arch of aorta form of the form in hard bow portion relatively normal physiological condition, makes the bow portion haemodynamics after rebuilding
Restore normal physiological condition.Other compositions and connection relationship and specific embodiment one, two, three or four are identical.
Specific embodiment 6: illustrating present embodiment in conjunction with Fig. 2 to Fig. 4, the hard bow portion 20 of present embodiment is by titanium
Alloy, stainless steel or polypropylene plastic material are made, preferably titanium alloy.So set, having than ideal biocompatibility.It is other
Composition and connection relationship are same as the specific embodiment one.
Specific embodiment 7: the built-in of present embodiment includes hard ascending part, hard ascending part is in straight or slight curved
Bent tubular, hard ascending part are mounted on the inside of aorta ascendens Yu ascending part initiative pulse support blood vessel 4, and hard bow portion 20 is mounted on bow
Inside portion's initiative pulse support blood vessel 3.So set, realizing the suture connection of aorta ascendens rapid free, other compositions and connection relationship
It is identical as specific embodiment one to six.
Embodiment 1
The utility model is applied in actual use to be rebuild on artificial blood vessel in individuation branch stent type bow portion, this is artificial
Blood vessel includes: initiative pulse support blood vessel 1, and the line vasculature part of making of drop portion initiative pulse support blood vessel 2 extends for bending to proximal part
Portion's initiative pulse support blood vessel 3 and ascending part initiative pulse support blood vessel 4, bow portion initiative pulse support blood vessel 3, issuing includes one point
Multiple bow parts branch including branch stented vessel 5；The principal length of initiative pulse support blood vessel 1 be 300mm, diameter 24mm,
Initiative pulse support blood vessel 2 length in drop portion is 120mm；Branch stent type bow portion rebuilds the structural schematic diagram after artificial blood vessel's release such as
Shown in Fig. 2；
The branch stent blood vessel 5, including drop thin-walled artificial blood vessel A-1 and multiple branch's metallic support A-2, thin-walled people
Work blood vessel A-1 is sewed with multiple cyclic annular branches' metallic supports in Nei Bi, branch root extend for one section of unsupported overlay film with
The latter end upper limb that bow portion makes line blood vessel main body 14 is coincide and is connected by suture；5 length of branch stent blood vessel is 32mm, and diameter is
12mm, thin-walled artificial blood vessel's A-1 constituent material is polyester woven object, cylindrical such as thin dacron fabric blood vessel.
Drop portion initiative pulse support blood vessel 2 is by descending aorta metallic support 12 and makes line artificial blood vessel and forms, and makes the artificial blood of line
Inside pipe wall is sewed with multiple cyclic annular descending aorta metallic supports 12；The main body of drop portion initiative pulse support blood vessel 2 and ascending part 4, bow portion 3
Be it is integrated make line blood vessel, constituent material is polyester woven object, such as dacron blood vessel.
The descending aorta metallic support 12 is the annular enclosed carrier unit of Z-shaped or wavy shaped configuration, each bracket
Between unit independently of one another, by wave crest to wave crest or trough to trough in the form of arrange.Metallic support 12 is closed by nickel-titanium shape memory
Gold or cochrome silk etc. customize, and constitute straight tube shape on the whole.
Bow portion initiative pulse support blood vessel 3, main body issue Y shape bow part branch 6, bow part branch 47, branch stent blood
Pipe 5 bends part branch three, and Y shape bow part branch 6 is further separated into bow part branch 1 and bow part branch 29；Above-mentioned branch's diameter is
10-16mm；9 one-tenth 60 ° of bow part branch 1 and bow part branch 2.
The ascending part initiative pulse support blood vessel 4, bow portion initiative pulse support blood vessel 3 are respectively in the former middle section, the latter and its Y shape
The junction of the root of bow part branch 6, collar shape sutural margin 2 11, collar shape sutural margin are connected each by medical suture outward
One 10.Collar shape sutural margin constituent material is polyester woven object, such as terylene or polytetrafluoroethylene (PTFE) (PTFE).
The conveying device is by two groups of mutually independent release systems: drop portion initiative pulse support blood vessel 2 discharges system and divides
Branch stented vessel 5 discharges system composition, and initiative pulse support blood vessel 2 release system in drop portion is pulled back bar 16 and drop portion lashing wire by drop portion
17 compositions, 5 release system of branch stent blood vessel are formed by branching back to pull rod 18 and branch's lashing wire 19.Before implantation, use is medical
Suture respectively fetters drop portion initiative pulse support blood vessel 2 and branch stent blood vessel 5, greatly reduces the two cross-sectional diameter
In stand-by state, as shown in Figure 3.
The built-in hard bow portion 20 is the arc pipe that radius of curvature, caliber are equal, wherein section preceding upper limb,
Latter end upper limb and middle section facies ventralis are respectively equipped with branch's window 1, branch's window 2 22, branch's window 3 23；In branch's window
Cyclic annular dent 24 is equipped between one 21 and branch's window 2 22 and on the bow portion surface of 20 proximal part of hard bow portion.
Embodiment 2
The principal length of initiative pulse support blood vessel 1 is 320mm, diameter 26mm, and wherein drop portion initiative pulse support blood vessel 2 is main
Body length 140mm；Branch stent blood vessel 5 length 34mm, diameter 14mm.45 ° of 20 bending angle of hard bow portion, caliber are
24mm, bending radius 50mm.Other are same as Example 1.
Embodiment 3
The principal length of initiative pulse support blood vessel 1 is 340mm, diameter 28mm, and wherein drop portion initiative pulse support blood vessel 2 is main
Body length 160mm；Branch stent blood vessel 5 length 36mm, diameter 16mm.60 ° of 20 bending angle of hard bow portion, caliber are
26mm, bending radius 60mm.Other are same as Example 1.
Illustrate the operating process of the utility model in conjunction with Fig. 2 to Fig. 6:
When operation, it can be intubated and be irrigated through right side axillary artery, profound hypothermia after stopping circulation, splits a liter master along antetheca long axis
Artery and the arch of aorta, the branch stent type bow portion after taking binding rebuild artificial blood vessel such as Fig. 3, drop portion initiative pulse support blood vessel
2 and branch stent blood vessel 5 be inserted into descending aorta and the true chamber of left subclavian artery respectively simultaneously, adjust the angle, successively pull back branch
Pull back bar 18, drop portion pulls back bar 16, and medical suture is freed therewith, and branch stent blood vessel 5 and drop portion initiative pulse support blood vessel 2 are immediately
It is released in place, the intracavitary therapy of corresponding two arteries of completion.
Then, the hard bow portion 20 built-in from the insertion of the proximal part of ascending part initiative pulse support blood vessel 4, makes its branch's window one
21, branch's window 2 22, be respectively aligned to Y shape bow part branch 6, the root of branch stent blood vessel 5.With thick line by the self arch of aorta
Vascular wall, bow portion make line blood vessel main body, tighten on the cyclic annular dent 24 in built-in hard bow portion 20, knot.As shown in Figure 4.
By bow part branch 47 carry out antegrade perfusions, be sequentially completed left common carotid artery, innominate artery coincide.Then ascending part master is carried out
Bow portion reconstruction operations are completed at the end end or intralumenal anastomosis of 4 proximal end of arterial bracket blood vessel and aorta ascendens.
For some cases, proximal part lesion can be first handled during cooling, such as the replacement of row aorta root and bilateral hat
Shape arterial ostium transplants (Bentall), the aorta petal for retaining aortic sinus and aorta ascendens and replaces the operation such as (Wheat), it
Afterwards, profound hypothermia, stop recycling, as aforesaid operations carry out the reconstruction of bow portion.It is carrying out 4 proximal part of ascending part initiative pulse support blood vessel and is rising to lead
Artery artificial blood vessel it is identical when, can apply the utility model built-in hard ascending part, carry out rapid free suture connection.
For most of cases, rise, collar shape sutural margin reserved in bow portion initiative pulse support blood vessel main body need not use.
A small number of cases will can rise, in bow portion initiative pulse support blood vessel main body in vitro after circulation terminates to take precautions against long-term postoperative bleeding
Reserved collar shape sutural margin carries out the connection that coincide with corresponding self aorta wall, realize the arch of aorta, aorta ascendens it is interior
Portionization such as figure five.Or the internalization of the arch of aorta, part aorta ascendens such as figure six, for further taking precautions against long-term postoperative bleeding
Small probability event.
Above-described embodiment within the spirit and principle of the utility model, is appointed not to limit the utility model
What modification, equivalent replacement, improvement etc., should be included within the scope of protection of this utility model.
Claims (6)
1. a kind of built-in for rebuilding artificial blood vessel for individuation branch stent type bow portion, it is characterised in that: it includes hard
Matter bow portion (20), hard bow portion (20) are that radius of curvature is identical or gradually become smaller from proximal part to distal end directional curvature radius
The equal arc pipe of caliber, hard bow portion (20) is equipped with multiple branch's windows and cyclic annular dent (24), hard bow portion
(20) it is mounted on bow portion initiative pulse support blood vessel (3) inside that individuation branch stent type bow portion rebuilds artificial blood vessel.
2. a kind of built-in that artificial blood vessel is rebuild for individuation branch stent type bow portion according to claim 1,
It is characterized by: the preceding upper limb in the middle section in hard bow portion (20) is equipped with branch's window one (21), on the latter end in hard bow portion (20)
Edge is equipped with branch's window two (22), and the middle section facies ventralis in hard bow portion (20) is equipped with branch's window three (23)；In branch's window one
(21) between branch's window two (22) and the bow portion surface of hard bow portion (20) proximal part is equipped with cyclic annular dent (24).
3. a kind of built-in that artificial blood vessel is rebuild for individuation branch stent type bow portion according to claim 2,
It is characterized by: the opening that branch's window one (21) and branch's window three (23) are round or oval, branch's window two
It (22) is the open hole of semicircular distal.
4. according to claim 1,2 or 3 a kind of for built in individuation branch stent type bow portion reconstruction artificial blood vessel
Device, it is characterised in that: the bending angle in hard bow portion (20) is 30 ° -90 °, and the diameter in hard bow portion (20) is 22-32mm,
The bending radius in hard bow portion (20) is 30-60mm.
5. a kind of built-in that artificial blood vessel is rebuild for individuation branch stent type bow portion according to claim 4,
It is characterized by: hard bow portion (20) bending angle (α) be 30 °, 45 ° or 60 °, caliber (d) be 22mm, 24mm or 26mm, it is curved
Bilge radius (R) is 40mm, 50mm or 60mm.
6. a kind of built-in that artificial blood vessel is rebuild for individuation branch stent type bow portion according to claim 5,
It is characterized by: hard bow portion (20) is made of titanium alloy, stainless steel or polypropylene plastic material.
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| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CN201821977056.2U CN209187070U (en) | 2018-11-28 | 2018-11-28 | A kind of built-in for rebuilding artificial blood vessel for individuation branch stent type bow portion |
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| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CN201821977056.2U CN209187070U (en) | 2018-11-28 | 2018-11-28 | A kind of built-in for rebuilding artificial blood vessel for individuation branch stent type bow portion |
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| CN209187070U true CN209187070U (en) | 2019-08-02 |
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| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN109452988A (en) * | 2018-11-28 | 2019-03-12 | 李�杰 | A kind of built-in for rebuilding artificial blood vessel for individuation branch stent type bow portion |
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2018
- 2018-11-28 CN CN201821977056.2U patent/CN209187070U/en not_active Expired - Fee Related
Cited By (1)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN109452988A (en) * | 2018-11-28 | 2019-03-12 | 李�杰 | A kind of built-in for rebuilding artificial blood vessel for individuation branch stent type bow portion |
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