EP2146650A1 - Dispositif destiné à relier deux vaisseaux sanguins - Google Patents

Dispositif destiné à relier deux vaisseaux sanguins

Info

Publication number
EP2146650A1
EP2146650A1 EP08749379A EP08749379A EP2146650A1 EP 2146650 A1 EP2146650 A1 EP 2146650A1 EP 08749379 A EP08749379 A EP 08749379A EP 08749379 A EP08749379 A EP 08749379A EP 2146650 A1 EP2146650 A1 EP 2146650A1
Authority
EP
European Patent Office
Prior art keywords
blood vessel
support member
section
individual parts
vessel ends
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Withdrawn
Application number
EP08749379A
Other languages
German (de)
English (en)
Inventor
Nicola Rubenstein
Eckhard Alt
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Individual
Original Assignee
Individual
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Individual filed Critical Individual
Publication of EP2146650A1 publication Critical patent/EP2146650A1/fr
Withdrawn legal-status Critical Current

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00477—Coupling
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00831—Material properties
    • A61B2017/00867—Material properties shape memory effect
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
    • A61B2017/1107—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis for blood vessels
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
    • A61B2017/1132—End-to-end connections

Definitions

  • the invention relates to a device for connecting stump abutting ends of two after the mutual connection wornetzender blood vessels (anastomosis) with an insertable into the two ends of the blood vessel to be inserted self-expandable support member, which consists of a mesh or grid or cage with an inner continuous Lumen, wherein the support member in the position of use with its outer cross-section corresponds approximately to the inner cross-section of the respective supported by him blood vessel end.
  • microvascular anastomosis that is, the joining of two blood vessel ends, is one of the most difficult plastic surgery tasks, with technical problems in connecting the blood vessels leading to a very high proportion of failures. Efficient and safe performance of this procedure reduces the time and associated risk of tissue ischemia and also reduces the risk of thrombosis and ischemia-related circulatory disorders.
  • the support part should be able to be inserted easily into the blood vessel ends or the blood vessel ends should be able to be slid well over this support part, which initially has a reduced cross-section.
  • the device mentioned above is characterized in that the support member is enclosed at its two insertable in blood vessel areas each of a peelable ring or piece of tubing or filament winding and held on a reduced cross-section and that the pieces of tubing, rings or filament winding are successively removable ,
  • the support member may be made of plastic or metal, in particular of a mesh or grid. This facilitates the insertion of suture material at the junction. Due to the attachment of peelable rings or pieces of tubing or filament wounds at the two respectively insertable into a blood vessel end areas, the support member can be easily inserted into the blood vessel ends or the blood vessel ends can be well pushed over this still reduced cross-section support member. The removal of the ring or piece of tubing or filament winding can take place in each case after insertion into one of the blood vessel ends, that is to say one after the other. Thus, one area of the support member may initially be automatically supported in its use position in the associated blood vessel end thereof, after which the same can then be done with the wider area at the other end of the blood vessel.
  • the support member of the device may be integrally formed and each be introduced with a part of its longitudinal extent in the two blood vessel ends before their movement together in their contact position. This results in a great security against a mutual lateral adjustment of the blood vessel ends in their connection.
  • the hose or pieces of tubing may have a predetermined breaking point and, in particular, gripping areas or handles on both sides thereof. point. This facilitates removal of the tubing pieces after positioning of the support member, although this engages both blood vessel ends.
  • the pieces of tubing can be torn open and removed laterally, after which the blood vessel ends can be finally pushed together.
  • the support member made of plastic, stainless steel, stainless steel alloy, memory material, memory metal or nitinol and in the state of reduced cross-section inserted into the blood vessel ends and is automatically adapted by the memory effect of his material to the inner cross section of the blood vessel ends.
  • the merging of the two blood vessel ends with the support part inserted therein can be carried out easily, after which the blood vessel ends in the continuing position are secured against mutual lateral deflection due to an automatic expansion of the support part.
  • a Nitinolgeflecht existing support member may be additionally held together by one or two pieces of tubing initially until the support member is sufficiently positioned to pull the pieces of tubing and bring the vessel ends in touching contact.
  • the support member is held at the insertable into the two blood vessel ends sections by at least one filament winding on the smaller diameter and releasable by unwinding or separation of the or the filament winding.
  • a mutual suturing of the blood vessel ends can be avoided by providing oppositely acting barb-like projections on the two support part regions, which extend starting from the outside of the support part in the direction of the respective blood vessel end, ie in the direction of one another. If the blood vessel ends are pushed over such a support part and possibly joined and guided somewhat under pressure with their ends, the barbs can each capture the blood vessel ends on the inside and fix them in the mutual contact position in the axial direction so that they can grow together.
  • a modified embodiment of the support member according to the invention of considerable and advantageous importance may consist in that the support member is formed in two parts and each item of the support member is insertable into one of the blood vessel ends or fits. This also prevents that in the mutual connection of the frontally touching blood vessel ends these or their walls can escape.
  • the two individual parts of the support member in the use position are connected to each other or mechanically coupled.
  • they can first be introduced into the blood vessel ends and then sanjointly connected and connected to them, which at the same time can also bring about contact contact of the blood vessel ends, which are then connected by or through additional measures so far that they can grow together.
  • they can be sewn together or otherwise connected or kept in touching contact by the connection of the two parts of the support member to thereby grow together.
  • the connecting or coupling parts of at least one of the two individual parts of the support part can protrude so far from the mutually facing edges or end faces of this item that they lie against one another or against each other pressed end faces of the blood vessel ends are connected in the use position with the counterparts on the other item.
  • the support part be it in one piece or made up of two detachable individual parts, has an inner lumen or a continuous inner longitudinal cavity and only on the inside of the wall of the blood vessels, the cross-section of which otherwise remains largely free is present.
  • the connecting or coupling parts which are arranged and projecting onto the support part for mutual coupling or connection thus likewise run as far as possible in the region of the inside of the blood vessels and on a cross section or diameter which is released from the support part in its interior.
  • the two individual parts of the two-part support part can be expandable cage-like plastic, metal or stainless steel pieces which are pressed together and can be inserted independently of one another into the respective open end of the blood vessel to be connected.
  • the two-part design of the support member has the advantage that its individual parts m the blood vessel ends are easier to insert.
  • the individual parts of the two-part support part can, after insertion into the respective blood vessel end, be removed by means of a dilatation aid or balloon catheter or due to a production of memory material, e.g. Nitmol, to be expandable to their utility measure.
  • a dilatation aid or balloon catheter or due to a production of memory material, e.g. Nitmol, to be expandable to their utility measure.
  • the component parts of the two-part support member may have outside barbs or protrusions for positive locking within the blood vessel ends. Even with a two-part design of the support part, such barb-like projections can therefore be provided for the axial fixing of the blood vessel ends, so that after the mutual connection of the individual parts by sewing or by mechanical coupling, the blood vessel ends are also fixed in the axial direction.
  • each of the individual parts of the support member so deeply into the blood vessel ends that they are coupled together, but that the blood vessel ends slightly above these individual parts or over at least one of the individual parts survive, so that they are in the mutual contact contact under a certain mutual pressure, which improves the mutual sealing and favors the growing together.
  • the plastic, metal mesh or metal mesh existing, in particular cage-like support member may - be it in one piece, be it consists of two separate parts - at least partially coated, for example, with I ⁇ di- oxide, carbon, pharmaceutical or pharmaceutical or mole - Cellular biological products.
  • I ⁇ di- oxide, carbon, pharmaceutical or pharmaceutical or mole - Cellular biological products By such a coating, the healing process and the growing together of the vessel ends can be promoted. If necessary, other medical effects can be achieved thereby.
  • a device that is present above all as a one-piece support member in first compressed form and can be inserted in this form in the blood vessel ends, where it in its central region, for example by a Tweezer-like device can be held and manipulated until it is inserted into both open ends of the two vessels.
  • the connection of the two blood vessel ends can, if necessary, be stabilized by pinholes, before the support member is released for self-expansion.
  • the fixation of the support member on the walls of the blood vessels can be done with arranged on this support part barb-like projections or hook anchors.
  • a support member made of two individual parts When using a support member made of two individual parts, these in turn, in turn, can be used independently in compressed form. gig from each other in the respective open end of the blood vessel to be connected. With a widening aid or by self-expansion, the items can be expanded to the required diameter, thereby freeing and keeping an internal cross-section in the blood vessel like a one-piece support member. After their mutual merging they can be connected and, for example, hooked together, whereby an anastomosis of the overlying, the individual parts of the support member surrounding blood vessels is caused. The fixation can in turn be done by barb-like projections or hook anchors integrated into the individual parts.
  • FIG. 1 shows a longitudinal section through two vessel ends to be connected to one another, wherein a device according to the invention in the form of a one-piece support part - comprising pieces of hose which define its cross-section on the outside - has already been largely introduced into these two blood vessel ends;
  • Fig. 2 is a representation corresponding to Figure 1, wherein from the introduced into one of the blood vessel ends region of the support part of the cross-section low-holding tube is removed, while the other part in the other blood vessel end still by a corresponding
  • Hose piece is held together, 3 shows an illustration corresponding to FIGS. 1 and 2 after the removal of both pieces of tubing and the pushing together of the two blood vessel ends on the outside of the one-piece, an inner lumen-containing support part, which has barb-like
  • FIG. 4 shows an illustration of a modified embodiment corresponding approximately to FIG. 2, in which the support part belonging to the device or forming it is formed in two parts and one individual part of this two-part support part is inserted into one of the vessel ends to be connected,
  • FIG. 5 shows an illustration corresponding to FIG. 3 after the mutual connection or coupling of the individual parts of the two-part support part, whereby the end faces of the vessel ends to be connected have come into close contact with each other, FIG.
  • Fig. 6 is a balloon catheter for applying the individual parts of the support member, wherein the item has a reduced cross section, and
  • Fig. 7 is a view according to Figure 6 after the expansion of the item of the support member, which happens in use after insertion into a blood vessel end.
  • An essential part of the device mentioned is a support part 3 which can be inserted into the two ends 1 of the blood vessel 2 to be connected (compare FIGS. 3 and 5).
  • this support part 3 can be introduced into the ends 1 of the blood vessel 2 to be connected so far that the end faces 4 of the blood vessel ends 1 can be brought into contact contact with one another or have this contact contact according to FIGS. 3 and 5.
  • the outer cross section of the support part 3 in the position of use corresponds approximately to the inner cross section of the respective
  • Walls 1a defined in this position of use according to Figure 3 and 5 at the same height against lateral deflection.
  • the support member 3 may be made of plastic or metal, in particular of a mesh or grid, as it is indicated m two embodiments in different forms.
  • the support member 3 is integrally formed and each with a part or a half of its longitudinal extent in the two blood vessel ends 1 - according to Figure 1 and 2 before their movement together in their contact position according to FIG 3 - can be inserted. It can be seen especially in Figure 1, that this support member 3 is enclosed at its two insertable into the blood vessel 1 areas each of a peelable piece of tubing 5 and is held on a smaller cross-section than the inner cross section of the blood vessel ends 1 to this mutual insertion, for example with the help a tweezer, about in the middle of the support member 3 attacking instrument easier.
  • tube pieces 5 a detachable or detachable ring or a filament winding could also be provided in each case.
  • the tube pieces 5 have a predetermined breaking point 6 extending on the axial direction and gripping areas or handles 7 on both sides, so that the tube pieces are easily torn open after pushing the blood vessel end 1 or inserting the supporting part 3 into the blood vessel ends 1 with its two insertion areas and can be moved away to the side, wherein this can be done sequentially according to the figures 1 to 3.
  • a piece of tubing 5 can be peeled, ie torn open and moved away laterally, whereby the one area of the support part 3 automatically widens into its position of use and the corresponding end of the vessel 1 is supported on the inside. Thereafter, the same happens to the second tube piece 5, wherein the inner support of the support member 3 allows pushing the blood vessel ends 1 together.
  • barb-like projections 8 which act in opposite directions to one another on both support part regions, extend starting from the outside of the support part 3 in the direction of the respective blood vessel end 1 or end face 4, ie in the direction of each other. Consequently for example, the blood vessel ends 1 can be displaced in the axial direction via these projections 8, but are prevented from moving in opposite directions, which already leads to a mutual connection of the blood vessel ends 1.
  • the first part position according to FIG. 2 can first be fixed with suture, for example, and / or the end position according to FIG. 3 can also be additionally secured with suture material.
  • the barb-like projections 8 can also be dispensed with and the mutual connection of the blood vessel ends 1 at their end faces 4 can be carried out only with suture material.
  • the blood vessel ends 1 are prevented from dodging relative to each other in the lateral direction or even only their walls 1a, because the support member 3 defines the blood vessel ends 1 in the position of use against such evasive movements.
  • FIGS. 4 to 7 show a two-part support part 3, wherein, according to FIGS. 4 and 5, each individual part 31 and 32 of the support part 3 can be inserted into one of the blood vessel ends and fits.
  • the two individual parts 31 and 32 of the support member 3 are connected to each other and mechanically coupled in a manner to be described.
  • FIGS. 6 and 7 For introducing these individual parts 31 and 32 into the respective associated blood vessel end 1, a balloon catheter 9 shown diagrammatically in FIGS. 6 and 7 can be used, wherein FIG. 6 shows on the end-side balloon 10 of the balloon catheter 9 an individual part 31 still having a small outside cross-section 32, which can be expanded according to FIG. 7 with the aid of the balloon 10, but only after insertion into one of the blood vessel ends 1.
  • FIG. 4 it can be seen that the connecting or coupling parts 11 of an item 31 of the support member 3 relative to the other support member 32 facing edge or the end of this item 31 protrudes so far that it is in accordance with Figure B contiguous or against each other pressed end faces 4 of Blood vessel ends 1 is connected in use position with the counterparts 12 on the other item 32.
  • hooks 12 are provided as counterparts to the eyelets 11 in Use position in the eyelets 11 are engaged or snapped.
  • a plurality of such eyelets 11 and hooks 12 may be distributed on the circumference of the individual parts 31 and 32, but expediently at least two points opposite each other at a diameter points.
  • FIGS. 4 and 5 it is indicated that the individual parts 31 and 32 can be inserted so deeply into the blood vessel ends 1 that they protrude slightly axially relative to these individual parts 1 and 2, so that, according to FIG. 5, they are interconnected by the mutual coupling of the individual parts 31 and 32 with some pressure against each other at their end faces 4 and possibly can bulge up slightly, as shown in Figure 5 slightly exaggerated in order to achieve the highest possible connection.
  • the two individual parts 31 and 32 of the two-part support member 3 may initially according to Figure 6 have a smaller cross section and circumference and made of expandable material, such as plastic, metal or stainless steel and be introduced independently with the help of the balloon catheter 9 in the respective open end 1 of the blood vessel 2 to be connected, after which they with the help of the balloon catheter 9 or other expansion aid or due to a production of memory material, such as nitinol, in their position of use according to FIG 4 are expandable.
  • expandable material such as plastic, metal or stainless steel
  • the individual parts 31 and 32 of the two-part support member 3 have on the outside barbs or projections 8 for positive fixing within the blood vessel ends 1, these barb-like projections 8 also starting from the outside of the support member 3 toward the respective blood vessel end 1 or the front page 4, so expand towards each other.
  • the consisting of plastic, metal mesh or a metal mesh, in particular cage-like support member 3 be it in one piece or two parts, at least partially coated and that, for example, with iridium, carbon, pharmaceutical or pharmaceutical or molecular biological products to vor to achieve all medical effects.
  • the device for connecting butt ends 1 of two blood vessels 2 (anastomosis) continuing after the mutual connection has, above all and essentially, a support part 3, for example made of plastic or metal, in particular insertable into the two ends 1 of the blood vessel 2 to be connected Form of a braid or grid or cage, on.
  • the support member 3 is so far inserted into the blood vessel ends 1 that the end faces 4 of the blood vessel ends 1 can be brought into contact with each other and in Use position have this Berstoffmind.
  • the outer cross section of the support part 3 in the position of use approximately corresponds to the inner cross section of the respective blood vessel 1 and has an inner passage cross section (lumen), so that the blood can flow unhindered, but the touching blood vessel ends 1 at the same height inside each other and against a lateral Dodge relative to each other and / or are set against lateral deflection of the blood vessel walls 1a.
  • the support member 3 may be one piece or two parts.

Abstract

L'invention concerne un dispositif destiné à aboucher (anastomose) les extrémités (1) de deux vaisseaux sanguins (2) se prolongeant après cette liaison bout à bout. Ce dispositif comporte avant tout et essentiellement un élément support (3) à introduire dans les deux extrémités (1) à relier du vaisseau sanguin (2), cet élément étant par exemple en plastique ou en métal et se présentant notamment sous la forme d'un treillis, d'un réseau ou d'une cage. L'élément support (3) peut être introduit dans les extrémités (1) du vaisseau sanguin à une profondeur qui permet de mettre en contact les faces frontales (4) des extrémités (1) du vaisseau sanguin, lesquelles restent en contact en position d'utilisation. La section transversale externe de l'élément support (3) en position d'utilisation correspond approximativement à la section transversale interne du vaisseau sanguin (1) correspondant et sa section de passage interne (lumière) permet un écoulement sanguin sans entrave, les extrémités (1) du vaisseau sanguin en contact étant toutefois à même hauteur fixées ensemble côté interne, afin de parer un déport latéral l'une par rapport à l'autre ou bien un déport latéral des parois du vaisseau sanguin (2). L'élément support (3) de l'invention peut être composé d'une ou de deux parties.
EP08749379A 2007-05-11 2008-05-07 Dispositif destiné à relier deux vaisseaux sanguins Withdrawn EP2146650A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
DE102007022060A DE102007022060A1 (de) 2007-05-11 2007-05-11 Vorrichtung zum Verbinden zweier Blutgefäße
PCT/EP2008/003669 WO2008138529A1 (fr) 2007-05-11 2008-05-07 Dispositif destiné à relier deux vaisseaux sanguins

Publications (1)

Publication Number Publication Date
EP2146650A1 true EP2146650A1 (fr) 2010-01-27

Family

ID=39811868

Family Applications (1)

Application Number Title Priority Date Filing Date
EP08749379A Withdrawn EP2146650A1 (fr) 2007-05-11 2008-05-07 Dispositif destiné à relier deux vaisseaux sanguins

Country Status (4)

Country Link
US (1) US8388634B2 (fr)
EP (1) EP2146650A1 (fr)
DE (1) DE102007022060A1 (fr)
WO (1) WO2008138529A1 (fr)

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Also Published As

Publication number Publication date
DE102007022060A1 (de) 2008-11-13
WO2008138529A1 (fr) 2008-11-20
US20100324653A1 (en) 2010-12-23
US8388634B2 (en) 2013-03-05

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