CN216535654U - Artificial blood vessel for replacing aortic arch - Google Patents

Abstract

The utility model relates to the technical field of artificial blood vessels, in particular to an artificial blood vessel for replacing an aortic arch, which comprises a branch artificial blood vessel and an aortic artificial blood vessel which are separated from each other before an operation is finished; the proximal end of the branch artificial blood vessel is used for being communicated with the side wall of the aorta artificial blood vessel, and the distal end of the branch artificial blood vessel is used for being communicated with the cut free end of the innominate artery, the cut free end of the left common carotid artery and the cut free end of the left subclavian artery. When the artificial blood vessel is used for aortic arch replacement surgery, the technical problems of deep low temperature rest cycle time, extracorporeal circulation time and long selective cerebral perfusion time of the existing aortic arch replacement surgery can be solved. The scheme can be applied to the operation of wide aortic dissection tumor or aneurysm involving ascending aorta, aortic arch and descending aorta, the probability of damage to important organs of a patient after operation can be reduced, and the operation difficulty is reduced.

Description

Artificial blood vessel for replacing aortic arch

Technical Field

The utility model relates to the technical field of artificial blood vessels, in particular to an artificial blood vessel for replacing an aortic arch.

Background

For extensive aortic dissection or aneurysms involving the ascending, aortic arch and descending aorta, a challenge remains for many cardiovascular surgeons due to the complexity of the surgical strategy and difficulty in visualization of the descending aorta. Currently, Sunskin's surgery is commonly used for treatment, namely, total arch replacement of the aortic arch and a nasal-bracket procedure using four branches of blood vessels.

Chinese patent CN108309507A discloses a composite aortic arch reconstruction system and a method for using the same. The four-branch blood vessel comprises a main blood vessel, an upper arch branch and a perfusion branch, wherein the upper arch branch and the perfusion branch are communicated with the main blood vessel, and the upper arch branch comprises a head arm branch, a left neck main branch and a left subclavian branch which are arranged in parallel. When the system is used, extracorporeal circulation is established via the right axillary artery intubation, brain perfusion is performed selectively and smoothly, and circulation is stopped at 25 deg.c and deep low temperature. The operation process comprises implanting a stent blood vessel into descending aorta, completing full-arch replacement by four branch artificial blood vessels, and sequentially reconstructing the aorta (the descending aorta proximal end, the left common carotid artery, the ascending aorta, the left subclavian artery and the last innominate artery). After the distal anastomosis is completed, early rewarming and reperfusion are completed as soon as possible to reduce cerebral and coronary ischemia. However, the prior art has the following technical problems: the deep low temperature stop cycle time, the extracorporeal cycle time and the selective brain perfusion time are long, and the human body is easily damaged; the anchoring zone is limited, affecting the surgical field of view; the operation is complicated, the anastomotic stoma is too much, and bleeding is easy to occur.

SUMMERY OF THE UTILITY MODEL

The utility model aims to provide an artificial blood vessel for replacing an aortic arch, which is used for solving the technical problems of long deep low temperature circulation stopping time, long extracorporeal circulation time and long selective cerebral perfusion time of the conventional aortic arch replacement operation.

In order to achieve the purpose, the utility model adopts the following technical scheme:

an artificial blood vessel for replacing an aortic arch, comprising a branched artificial blood vessel and an aortic artificial blood vessel which are separated from each other before completion of an operation; the proximal end of the branch artificial blood vessel is used for being communicated with the side wall of the aorta artificial blood vessel, and the distal end of the branch artificial blood vessel is used for being communicated with the cut free end of the innominate artery, the cut free end of the left common carotid artery and the cut free end of the left subclavian artery.

The application method, the principle and the advantages of the scheme are as follows: before the operation is completed, the branch artificial blood vessel and the aorta artificial blood vessel are in a separated state, so that the condition for the operation with the branch priority is created. The branch-first surgery is generally: the heart output blood flow can flow back to the axillary artery through the femoral artery and the artificial pipeline, and perfuse the right common carotid artery and each branch blood vessel which are communicated in sequence. The anastomosis of the three branches is completed before the extracorporeal circulation starts, so that the extracorporeal circulation time can be shortened, and the brain has established whole brain perfusion when the circulation is stopped at the deep hypothermia, so that the cerebral blood flow is more sufficient. Then, replacing the diseased part on the aorta by using the aorta artificial blood vessel; and finally, communicating and fixing the branch artificial blood vessel and the aorta artificial blood vessel. In the operation of replacing the diseased part on the aorta by using the artificial aorta blood vessel, the patient is subjected to the deep low temperature circulation stopping operation, and the deep low temperature circulation stopping time is in positive correlation with the incidence rate of postoperative brain and other important organ injuries. In the conventional aortic arch replacement surgery based on the traditional grandson surgery, a branch artificial blood vessel and an aortic artificial blood vessel are usually fixed together in advance, and an operation of replacing a diseased region on the aorta with the aortic artificial blood vessel needs to be performed first, and then three branches (a innominate artery, a left common carotid artery and a left subclavian artery) are fixed on the branch artificial blood vessel. This results in the need to operate under extracorporeal circulation throughout the procedure, resulting in longer extracorporeal circulation times and greater injury to the patient. The artificial blood vessel adopting the scheme can carry out the operation of treating three branches before extracorporeal circulation (called as branch priority), thereby shortening the extracorporeal circulation time; and the whole brain perfusion is established at the beginning of the operation, so that the selective brain perfusion during the deep hypothermia stopping circulation is avoided, the brain blood flow is more sufficient, and the probability of damage to the nervous system and important organs is reduced.

Preferably, as a refinement, the branched artificial blood vessel comprises a branched artificial blood vessel trunk, one end of the branched artificial blood vessel trunk is communicated with the aortic artificial blood vessel, and the other end is communicated with the first branch, the second branch and the third branch.

In the prior art, no special branch artificial blood vessel suitable for branch-first operation exists, and the scheme is still originated. The branch artificial blood vessel is an integrally formed whole, and during operation, the three branches on the arch can be directly sutured at corresponding positions without performing redundant mouth shearing or temporary artificial blood vessel assembling and suturing and other work. The manual suture operation is troublesome, the anastomotic stoma is many and irregular, the bleeding risk in the operation is increased, the scheme can avoid the above situation, and the smooth operation is facilitated.

Preferably, as a modification, the first branch communicates with the severed free end of the innominate artery, the second branch communicates with the severed free end of the left common carotid artery, and the third branch communicates with the severed free end of the left subclavian artery. Each of the three branches is intended for anastomotic connection to a respective artery.

Preferably, as a modification, the diameter of the branched artificial blood vessel trunk is 14-18mm, the diameter of the first branch is 10-12mm, and the diameters of the second branch and the third branch are 8 mm. The above dimensions are compatible with the dimensions of the innominate artery, the left common carotid artery and the left subclavian artery.

Preferably, as a refinement, the aortic artificial blood vessel is provided with a first opening. The first opening is used for communicating a branch artificial blood vessel trunk of the branch artificial blood vessel.

Preferably, as a refinement, the diameter on the aortic artificial blood vessel is 24-30 mm. The above dimensions are adapted to the dimensions of the aorta.

Preferably, as a refinement, the distal end of the aortic artificial blood vessel is fixed with an elephant trunk support. The trunk stent is placed in a blood vessel to expand the blood vessel, simultaneously reduces the impact of blood flow on an aortic dissection, and can effectively prevent the dissection from being broken. In the technical scheme, the aortic dissection refers to a true and false two-cavity separation state that blood in an aortic cavity enters an aortic media from an aortic intimal tear part to separate the media and expand along the major axis direction of the aorta to form an aortic wall.

Preferably, as a refinement, the aortic artificial blood vessel is integrally formed with the trunk support. The artificial blood vessel and the trunk support at the far end are designed in an integrated manner, so that an anastomotic stoma can be reduced, the surgical process can be accelerated, and the deep low temperature cycle stopping time can be shortened.

Drawings

Fig. 1 is a perspective view of the structure of a human aorta.

Fig. 2 is a perspective view (after completion of the operation) of the artificial blood vessel for aortic arch replacement of example 1.

Fig. 3 is a schematic perspective view of an artificial blood vessel for aortic arch replacement in example 2 (after completion of the operation).

Fig. 4 is a plan view of the splicer of example 2.

Fig. 5 is a top view of an outer ring of the coupling of embodiment 2.

Fig. 6 is a front view of an inner ring of the adapter of embodiment 2.

Detailed Description

The following is further detailed by way of specific embodiments:

reference numerals in the drawings of the specification include: ascending aorta 1, aortic arch 2, descending aorta 3, innominate artery 4, left common carotid artery 5, left subclavian artery 6, branch artificial blood vessel trunk 7, third branch 8, aortic artificial blood vessel 9, trunk support 10, first opening 11, first branch 12, left common carotid artery suture stump 13, left subclavian artery suture stump 14, second branch 15, branch for connection 16, fixing sleeve 17, inner ring 18, outer ring 19, annular protrusion 20, annular groove 21 and mounting seam 22.

In the present technical solution, the term "proximal end" refers to the proximal end, and the end of the blood vessel or artificial blood vessel close to the heart is called the proximal end; the term "distal end" refers to the distal end, the end of a blood vessel or vascular prosthesis distal to the heart being referred to as the distal end; the term "anastomosis" refers to the procedure and method of joining two fractured surfaces of an organ.

Example 1

As shown in FIG. 1, the aorta of the human body includes ascending aorta 1, aortic arch 2 and descending aorta 3, and the ascending aorta 1 is originated from the left ventricle (not shown) and originates the left and right coronary arteries at the beginning to nourish the heart wall. The aortic arch 2 is a direct continuation of the ascending aorta 1 in an arch shape, and the descending aorta 3 is a direct continuation of the aortic arch 2. On the convex side of the aortic arch 2, the innominate artery 4 (brachiocephalic trunk), the left common carotid artery 5, and the left subclavian artery 6 are sequentially issued from left to right (referring to the orientation of fig. 1). The aortic arch 2 is easy to generate pathological changes, and when the pathological changes occur, an artificial blood vessel needs to be used for replacing the pathological changes.

The scheme relates to an artificial blood vessel for replacing an aortic arch 2, and particularly relates to an artificial blood vessel for replacing an aortic arch, which comprises a branch artificial blood vessel, an aortic artificial blood vessel 9 and an elephant nose bracket 10, as shown in figure 2. In the present embodiment, the branched artificial blood vessel includes the branched artificial blood vessel trunk 7, the first branch 12, the second branch 15, and the third branch 8 which are integrally formed. The lower end of the branch artificial blood vessel trunk 7 is open and is used for connecting an aorta artificial blood vessel 9. The upper end of the branched artificial blood vessel trunk 7 is a blind end which is communicated with the first branch 12, the second branch 15 and the third branch 8.

The aortic artificial blood vessel 9 is provided with a first opening 11, and after the operation is completed, the proximal end (i.e. the end close to the heart and the aortic artificial blood vessel 9, the proximal end) of the main branch artificial blood vessel 7 is fixed on the first opening 11 of the aortic artificial blood vessel 9 by suturing. Before the operation is completed, the branch artificial blood vessel and the aortic artificial blood vessel 9 are separated to facilitate the operation. After the completion of the operation, the right end of the aortic artificial blood vessel 9 is fixed to the left end of the trunk stent 10 by suturing (anastomosis), but before the completion of the operation, the aortic artificial blood vessel 9 and the trunk stent 10 are separated. The diameter of the branch artificial blood vessel trunk 7 is 14-18mm, the diameter of the first branch 12 is 10-12mm, and the diameters of the second branch 15 and the third branch 8 are both 8 mm. The free end created after the left common carotid artery 5 was severed was sutured to the distal end of the second branch 15. The distal end of the first branch 12 is sutured to the severed free end of the innominate artery 4. The distal end of the third branch 8 is fixed with the cut free end of the left subclavian artery 6 by sewing. The trunk support 10 is placed in the true lumen of the aortic arch 2 and descending aorta 3. The aorta artificial blood vessel 9 is used for replacing part of the ascending aorta 1, the lower end of the aorta artificial blood vessel 9 is sewed (anastomosed) and fixed with the residual part of the ascending aorta 1, the upper end of the aorta artificial blood vessel is sewed (anastomosed) and fixed with the cutting surface of the aortic arch 2, and the aorta artificial blood vessel is anastomosed and fixed with the left end of the trunk stent 10 by the conventional sewing means.

The process of installing the artificial blood vessel for replacing the aortic arch at the aorta through the operation is as follows:

in the case of general anesthesia, the patient is intubated on the right axillary and femoral arteries. A median sternal incision was made to expose the heart and the aortic arch 2, three branches of the free arch (innominate artery 4, left common carotid artery 5 and left subclavian artery 6).

The proximal end of the branched artificial blood vessel trunk 7, the distal ends of the first branch 12, the second branch 15 and the third branch 8 are then clamped closed with a vascular clamp. The second order canal is inserted into the right atrium of the patient to establish the CPB (i.e. in cardiac surgery, conventional extracorporeal circulation, which is not described herein in detail for the prior art). But at the moment, the machine does not start to rotate, the temperature is not reduced, the heart is not perfused with the arrest liquid, and three branches on the treatment arch are not treated when the heart does not arrest. The mean arterial blood pressure of the patient was maintained at around 80 mmHg. The innominate artery 4 was occluded and transected 1cm distal to the artery, and the stump on the arch was sutured continuously (forming the innominate artery 4 suture stump, not shown). The severed free end of the innominate artery 4 is anastomosed to the distal end of the first branch 12 and the free end is sutured to the distal end of the first branch 12. After this is done, the vascular clamp distal to the first branch 12 may be opened. Then, the left common carotid artery 5 is cut and its stump is sutured to form a left common carotid artery suture stump 13. The severed free end of the left common carotid artery 5 is anastomosed to the distal end of the second branch 15 and the free end is sutured to the distal end of the second branch 15. After this is done, the vascular clamp distal to the second branch 15 may be opened. The left subclavian artery 6 is then severed and the stump is continuously sutured to form the left subclavian artery suture stump 14. The severed free end of the left subclavian artery 6 is anastomosed and sutured to the distal end of the third branch 8, and after this is done, the vessel clamp at the distal end of the third branch 8 is opened. Thus, the supply of blood in the three branches of the arch bypasses the aortic arch 2 and is communicated with the branch artificial blood vessels.

After the three branches on the arch are processed, the CPB starts to turn the machine, the temperature is reduced, and cardioplegia is directly perfused from the openings of the left and the right coronary arteries. The ascending aorta 1 is replaced by an aortic prosthesis 9 having a diameter of 24-30 mm. The aortic arch 2 is incised between the innominate artery 4 suture stump and the left common carotid artery suture stump 13, and then severed at a location of the ascending aorta 1 distal to the aortic arch 2. The excised vessel portion (including part of the ascending aorta 1 and part of the aortic arch 2) is replaced with an aortic prosthesis 9. An elephant trunk support 10 is placed in the true lumen of the aortic arch 2 and the descending aorta 3, and the proximal end of the aortic artificial blood vessel 9 is sutured with the ascending aorta 1 left after cutting. The distal end of the aortic artificial blood vessel 9 is sutured to the trunk support 10 and to the aortic arch 2 in its cross-section. A circular opening (first opening 11) is cut in the aortic prosthesis 9 replacing the ascending aorta 1 and sutured to the proximal end of the branch prosthesis trunk 7. After the above operation is completed, the heart is jumped again, and the operation effect picture is shown in fig. 2.

The existing aortic arch 2 replacement surgery based on the traditional Sunshen operation needs to perform Deep Hypothermia Circulatory Arrest (DHCA) operation and aortic replacement first, and then treat the three branches on the arch. DHCA is an important means for treating complex cardiovascular diseases, and can reduce the core temperature of a patient to 18-25 ℃ so as to reduce the metabolic rate and protect nerve cells. But postoperative coagulation function may be obstructed, and perioperative complications such as arrhythmia are also high in risk. DHCA time is positively correlated with the incidence of post-operative brain and other vital organ damage. According to the scheme, three branches are treated under the condition of not cooling (called as branch priority), and then the DHCA and the aorta are replaced, so that the DHCA time is greatly shortened, and the probability of damage to important organs is reduced. In this embodiment, the branched artificial blood vessel and the aortic artificial blood vessel 9 are two parts separated from each other before the operation, so that the branch-first operation becomes possible.

In addition, no special branch artificial blood vessel suitable for branch-first operation exists in the prior art, and the scheme is still pioneered. The branch artificial blood vessel is an integrally formed whole, and during operation, the three branches on the arch can be directly sutured at corresponding positions without performing redundant mouth shearing or temporary artificial blood vessel assembling and suturing and other work. The manual suture operation is troublesome, the anastomotic stoma is many and irregular, the bleeding risk in the operation is increased, the scheme can avoid the above situation, and the smooth operation is facilitated.

Example 2

In this embodiment, a modification is made on the basis of embodiment 1, and as shown in fig. 3, the aortic artificial blood vessel 9 is integrally formed with the branch for connection 16, and the branch for connection 16 and the branch artificial blood vessel trunk 7 are fixed by using a connector, so that a complicated suturing process is not required. As shown in fig. 3 and 4, the coupling comprises an inner ring 18, an outer ring 19 and a fixing sleeve 17. The proximal end of the branch artificial blood vessel trunk 7 is sleeved outside the inner ring 18, and the outer ring 19 is sleeved outside the distal end of the branch 16 for connection. The fixing sleeve 17 is composed of two semi-annular semi-sleeves, and connecting lugs are integrally formed at the left end and the right end of each sleeve and provided with through holes for bolts to pass through. When the artificial blood vessel is anastomosed, the far end of the branch 16 for connection is sleeved at the near end of the branch artificial blood vessel trunk 7, then the two half sleeves of the fixed sleeve 17 are sleeved outside the outer ring 19, finally the two half sleeves are fixed together by using bolts and nuts, the outer ring 19 is abutted against the outer side of the inner ring 18, the branch 16 for connection and the branch artificial blood vessel trunk 7 which are positioned between the two half sleeves are clamped tightly, and the branch 16 for connection and the branch artificial blood vessel trunk 7 are fixed. As shown in fig. 5 and 6, the inner side of the outer ring 19 is integrally formed with annular projections 20 (three, only one of which is visible in the drawings), and the outer side of the inner ring 18 is integrally formed with annular grooves 21 for receiving the corresponding annular projections 20. Due to the arrangement of the annular protrusion 20 and the annular groove 21, the connection branch 16 and the branch artificial blood vessel trunk 7 existing between the two branches can be tightly abutted by matching, so that no gap exists between the connection branch 16 and the branch artificial blood vessel trunk 7, and the possibility of bleeding at the joint of the two artificial blood vessels is reduced. The side wall of the outer ring 19 is provided with a mounting slit 22 which penetrates through the outer ring 19 along the axial direction of the outer ring, and due to the existence of the mounting slit 22, the diameter of the outer ring 19 can be changed slightly, so that the outer ring 19 is conveniently sleeved on the inner ring 18. The scheme can realize the quick assembly of the branch artificial blood vessel and the aorta artificial blood vessel 9, and is more convenient and easier than the suture operation.

Example 3

The embodiment is improved on the basis of the embodiment 1, the aorta artificial blood vessel 9 and the trunk stent 10 are integrally formed, and the distal end of the aorta artificial blood vessel 9 and the trunk stent 10 are integrally designed, so that anastomotic stoma is reduced, and the deep low-temperature arrest cycle time can be shortened.

The descriptions in the embodiments and the like in the specification can be used to explain the contents of the claims. While the embodiments of the present invention have been described in detail with reference to the accompanying drawings, it is to be understood that the present invention is not limited to the embodiments and that various changes and modifications may be effected therein by those skilled in the art without departing from the spirit and scope of the utility model. These should also be construed as the scope of the present invention, and they should not be construed as affecting the effectiveness of the practice of the present invention or the applicability of the patent. The techniques, shapes, and structural parts, which are omitted from the description of the present invention, are all known techniques.

Claims (8)

1. An artificial blood vessel for replacing an aortic arch, which is characterized in that: comprises a branch artificial blood vessel and an aorta artificial blood vessel which are separated from each other before the operation is completed; the proximal end of the branch artificial blood vessel is used for being communicated with the side wall of the aorta artificial blood vessel, and the distal end of the branch artificial blood vessel is used for being communicated with the cut free end of the innominate artery, the cut free end of the left common carotid artery and the cut free end of the left subclavian artery.

2. The artificial blood vessel for aortic arch replacement according to claim 1, wherein: the branch artificial blood vessel comprises a branch artificial blood vessel main body, one end of the branch artificial blood vessel main body is communicated with the aorta artificial blood vessel, and the other end of the branch artificial blood vessel main body is communicated with the first branch, the second branch and the third branch.

3. The artificial blood vessel for aortic arch replacement according to claim 2, wherein: the first branch is communicated with the cut free end of the innominate artery, the second branch is communicated with the cut free end of the left common carotid artery, and the third branch is communicated with the cut free end of the left subclavian artery.

4. The artificial blood vessel for aortic arch replacement according to claim 3, wherein: the diameter of the main trunk of the branched artificial blood vessel is 14-18mm, the diameter of the first branch is 10-12mm, and the diameters of the second branch and the third branch are both 8 mm.

5. The artificial blood vessel for aortic arch replacement according to claim 4, wherein: the aorta artificial blood vessel is provided with a first opening.

6. The artificial blood vessel for aortic arch replacement according to claim 5, wherein: the diameter of the aorta artificial blood vessel is 24-30 mm.

7. The artificial blood vessel for aortic arch replacement according to claim 6, wherein: the trunk support is fixed at the far end of the aorta artificial blood vessel.

8. The artificial blood vessel for aortic arch replacement according to claim 7, wherein: the aorta artificial blood vessel and the trunk support are integrally formed.

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