JP2001161726A - Artificial blood vessel - Google Patents

Abstract

PROBLEM TO BE SOLVED: To perform the total substitution operation of the arch of aorta speedily and appropriately and secure smooth blood flow after the operation. SOLUTION: The artificial blood vessel 1 is to be used for the substitution for a lesion of the arch of aorta. The artificial blood vessel 1 comprises a main artificial blood vessel 2 corresponding to the arch of aorta, three artificial branch blood vessels 3 (first-third branch blood vessels 31-33) branched from the main blood vessel 2, and a fourth branch blood vessel 34 with the phase shift at about 90 degrees from the main body vessel 2. The first-third branch blood vessels 31-33 are slanted at about 60 degrees in the extending direction of the main blood vessel 2.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to an artificial blood vessel which is used in place of a resected arch aorta in a total replacement operation for a lesion of the arch aorta.

[0002]

2. Description of the Related Art Conventionally, an artificial blood vessel as shown in FIG. 10 described in Japanese Patent No. 298173 is known.
This artificial blood vessel 100 is used for a total replacement operation on the lesion 201 of the arch aorta 200 ((a) in FIG. 11), and is made of a fibrous material such as polyester and corresponds to the arch aorta 200. The vessel main part 101 includes four side tubes (first to fourth side tubes 102 to 105) formed of the same material and branched from the artificial blood vessel main part 101. The main portion 101 of the artificial blood vessel is formed of a flexible tube (flexible tube) so as to correspond to the arch aorta 200. After the lesion 201 of the arch aorta 200 is excised, it is bent and stored at that position. ing.

[0003] Of the four side tubes, three of the first to third side tubes 102 to 104 are located substantially at the center of the main portion 101 of the artificial blood vessel and are arranged along the major curvature side along the longitudinal direction. Has been established. These correspond to the brachiocephalic artery 202, the left common carotid artery 203, and the left subclavian artery 204. The last fourth side tube 105 among the four side tubes is for receiving body blood supply from a femoral artery (not shown) and performing antegrade blood supply. Sutured.

[0004]

By the way, in the conventional artificial blood vessel 100 as described above, as shown in FIG. 10, the artificial blood vessel main portion 101 is said to have flexibility. Since it is formed in a substantially linear shape, in order to replace it with the lesioned part 201 of the arch aorta 200, as shown in FIG. Must be curved.

Further, as shown in FIG. 10, the first to third side tubes 102 to 104 project from the main part 101 of the artificial blood vessel at a right angle. In the retracted state, depending on the anatomical structure of the human body, FIG.
As shown in FIG. 1 (b), the first to third side pipes 102 to 10
4 to suture the left common carotid artery 203 etc.
It must be folded clockwise with respect to 01.

Further, after the artificial blood vessel 100 is implanted in the body, the first to third side tubes 102 to 104, which have once been bent or twisted, do not return to the original straight state. There is naturally a limit in shape regeneration.

SUMMARY OF THE INVENTION The present invention has been made in view of the above circumstances, and has as its object to provide an artificial blood vessel which is more suitable for treating a lesion of an arch aorta such as an arch aortic dissection or an aortic aneurysm. And

[0008]

According to the first aspect of the present invention,
An artificial blood vessel used for replacement at a lesion position of an arch aorta between an ascending aorta and a descending aorta, and an artificial main blood vessel corresponding to the arch aorta, and juxtaposed along the longitudinal direction from the artificial main blood vessel. An artificial bifurcated blood vessel group comprising the first to third artificial bifurcated blood vessels, and a predetermined angle shifted in the circumferential direction of the artificial main blood vessel with respect to this artificial bifurcated blood vessel group, and in the vicinity of the third artificial bifurcated blood vessel in the longitudinal direction. And a fourth artificial branch vessel provided, wherein the artificial branch vessel group is provided to be inclined from the base toward the descending aorta.

According to the present invention, when performing a total aortic replacement of the arch aorta, the artificial main blood vessel is placed at the resection position with the diseased part being resected, and one end thereof is positioned above the ascending aortic valve ( 3) with the other end facing the resected end face (stump) of the descending aorta while facing the aortic root.
Since the artificial branch blood vessel group composed of the artificial branch blood vessels is provided to be inclined with respect to the artificial main blood vessel, these inclinations are anatomically preliminarily anatomically set to the brachiocephalic artery, the left common carotid artery, and the left subclavian artery. By setting the angle with respect to the artificial main blood vessel so as to correspond to the above, the end faces of the three artificial branch blood vessels can be bent without performing the operation of bending the three artificial branch blood vessels, the left common carotid artery and the left common carotid artery. It becomes possible to face the resected end face of the subclavian artery, and it becomes possible to suture each artificial branch vessel to the brachiocephalic artery or the like in the same state.

According to a second aspect of the present invention, there is provided an artificial blood vessel used for replacement at a lesion position of an arch aorta between an ascending aorta and a descending aorta, the artificial main vessel corresponding to the arch aorta, and An artificial branch blood vessel group including first to third artificial branch blood vessels arranged in parallel along the longitudinal direction from the artificial main blood vessel, and a predetermined angle shifted in a circumferential direction of the artificial main blood vessel with respect to the artificial branch blood vessel group; and A fourth artificial branch blood vessel provided in the vicinity of the third artificial branch blood vessel in the longitudinal direction, and the artificial main blood vessel is arranged in the longitudinal direction with respect to the side facing the juxtaposed position side of the artificial branch blood vessel group. Is subjected to a shortening process at a substantially central portion thereof.

[0011] According to the present invention, the artificial main blood vessel is shortened at a substantially central portion in the longitudinal direction on the side opposite to the side where the artificial branch blood vessel group is juxtaposed.
The side of the artificial main blood vessel that has been shortened is on the side of the minor curvature, and the side of the artificial branching blood vessel group that is juxtaposed is on the side of the major curvature, so that the entire artificial bow is curved. Then, by adjusting the curvature of the arc to the curvature of the anatomical arch aorta in the human body, only the artificial main vessel is placed at the resection position while the lesioned part of the arch aorta is resected. The end face is located above the aortic valve (the stump at the beginning of the aorta), and the other end face faces the resected end face (the stump) of the descending aorta. A proper and quick suturing process can be realized without doing so.

The invention described in claim 3 is the first or second invention.
In the invention described above, the artificial main blood vessel is formed by a bellows tube.

According to the present invention, since the bellows tube can be extended and contracted in the length direction and has a flexibility that can be bent, the artificial blood vessel can be widely used according to the condition of the affected part. State.

According to a fourth aspect of the present invention, in the first aspect of the present invention, the first to fourth artificial branch vessels are provided on both side surfaces of the artificial main vessel facing in the circumferential direction. And a mark for identifying the front and back sides.

According to the present invention, it is easy to confirm the front and back directions of the artificial main blood vessel and the artificial branch blood vessel by performing the operation while visually checking the mark attached to the artificial branch blood vessel.

According to a fifth aspect of the present invention, in the first aspect of the present invention, the first to third artificial branch vessels have an inclination angle toward the descending aorta, the artificial main vessel. 30 ° to 80 ° with respect to the longitudinal direction.

According to the present invention, the inclination angle of the first to third branch vessels with respect to the artificial main vessel of 30 ° to 80 ° is:
An angle suitable for versatility is provided to allow the first to third branch vessels to face the stumps of the brachiocephalic artery, the left common carotid artery, and the left subclavian artery, respectively.

According to a sixth aspect of the present invention, in the fifth aspect, the inclination angle is 50 ° to 70 °.

According to the present invention, when the inclination angle of the artificial branch blood vessel group is set to 50 ° to 70 °, the first to third branch blood vessels can be more preferably used for the brachiocephalic artery, the left common carotid artery, and the left subclavian artery. It is made to face each stump.

[0020]

FIG. 1 is a perspective view showing an embodiment of an artificial blood vessel according to the present invention, and FIG. 2 is a front view thereof. FIG. 3 is a partially enlarged side view of the artificial main blood vessel for explaining the shortening process, and FIG.
(B) shows the shortening processing of the second embodiment, and (c) shows the shortening processing of the third embodiment. FIG. 4 is a partially enlarged front view showing a connection portion between the artificial main blood vessel and the artificial branch tube in FIG.

First, as shown in FIGS. 1 and 2, an artificial blood vessel 1 has an artificial main blood vessel 2 having a diameter of approximately 220 mm to 300 mm, and an artificial main blood vessel 2 branched from the artificial main blood vessel 2. It has a basic configuration consisting of four thinner artificial branch vessels 3.

In the present embodiment, the artificial main blood vessel 2 is formed by a so-called bellows tube in which a fold 21 is formed over the entire length. The fold 21 is formed by an annular valley 22 and an annular ridge 23 over the entire circumference of the artificial main blood vessel 2. The annular valley 22 and the annular ridge 23 are formed by the total length of the artificial main blood vessel 2 in the longitudinal direction. Are formed alternately to form a bellows tube. The fold 21 is also provided on the artificial branch vessel 3. The formation of the folds 21 allows the artificial main blood vessel 2 and the artificial branch blood vessel 3 to freely bend.

The artificial branch vessel 3 includes a first branch vessel 31, a second branch vessel 32, and a third branch vessel 33 branched from a substantially central position of the artificial main vessel 2, and these first to third branch vessels 31. And a fourth branched blood vessel 34 which is branched at a position shifted by about 90 ° in the circumferential direction of the tube with respect to.

The first to third branch vessels 31 to 33 are formed so that the artificial main vessel 2 is bent upward and convexly in an arcuate manner, and along the ridge line on the outer side (large curvature side) in the curved state. 1 is arranged in order from the left side to the right side in FIG. 1, the fourth branch vessel 34 is directed from the artificial main vessel 2 toward the operator between the second branch vessel 32 and the third branch vessel 33. It is protruding. The artificial branch blood vessel 3 is formed of a bellows tube like the artificial main blood vessel 2, and can freely expand and contract and bend.

The artificial main blood vessel 2 is replaced with a lesioned part 201 of the resected arch aorta 200 (FIG. 11A), and the left end in FIG.
The suture is sewn to the aortic valve side of the resection plane 00 (the aortic root 205 shown in FIG. 11A), and the right end is sewn to the descending aorta.

The first branch vessel 31 has a brachiocephalic artery 202
And the second to fourth branch vessels 32 to 3
Approximately 1 slightly larger than the outer diameter (diameter) of 4 (approximately 8 mm)
The dimensions are set to 2 mm. The second branch vessel 32
Is anastomosed to the left common carotid artery 203, and the third branch vessel 33 is anastomosed to the left subclavian artery 204.

The fourth branch vessel 34 is used for performing body blood supply during the operation in place of the femoral artery. The blood flow from the femoral artery is supplied into the artificial main blood vessel 2 via the fourth branch blood vessel 34 by driving a pump (not shown). The fourth branch vessel 34 is resected after the end of extracorporeal circulation, and the resection opening is sutured.

FIG. 5 is a schematic sectional view taken along line AA of FIG.
In the present embodiment, as shown in FIG.
The angle β between the branch vessels 31 to 33 and the fourth branch vessel 34 is set to 90 °. By doing so, the fourth branch vessel 34 can be brought into a state of facing the operator while the artificial blood vessel 1 is positioned in the replacement space of the affected part.
The connection operation of the blood supply pipe from the extracorporeal device to the branch blood vessel 34 is facilitated. Note that the angle β is not limited to 90 °, and if it is within the range of 15 ° to 165 °, it can be suitably used without disturbing the operation, and 60 ° More preferably, it is set to about 125 °.

Each of the artificial main blood vessel 2 and the artificial branched blood vessel 3 employs an original artificial blood vessel in which a twisted or non-twisted yarn formed by bundling fine polyester fibers is woven in a plain weave structure. In the present embodiment, a so-called sweet-twisted yarn, which is in the middle of a twisted yarn and a non-twisted yarn or in a twisted state close to a non-twisted yarn, is excellent in terms of organization (that is, a twisted yarn is excellent in organization). ).

The weaving structure is not limited to a plain weaving structure, but may be a twill weaving structure, a satin weaving structure, or a variable weaving structure (such as a diagonal weave structure) combining these structures.

The fold 21 is made to be in a state of being already formed when the artificial blood vessel body is woven by the operation of the weft by the shuttle or the like at the time of the bag weaving processing by the loom. The original vascular prosthesis may be woven in a normal cylindrical shape, and the woven material may be subjected to a molding process in a heated state to form the fold 21.

The artificial main blood vessel 2 and the artificial branch blood vessel 3 according to the present invention are formed by coating the artificial blood vessel body thus completed with a protein such as collagen. In this way, the porosity of the artificial blood vessel 1 can be effectively suppressed, and the organization of the artificial blood vessel 1 after the operation is promoted.

In the present embodiment, as shown in FIG. 3, the lower portion of the peripheral surface of the artificial main blood vessel 2 is shortened over a predetermined length in the longitudinal direction by various shortening processes. As a result, the artificial main blood vessel 2 is curved in an arc shape.

First, the shortening process of the first embodiment, shown in FIG. 3A, involves the folds 21 on the minor curvature side being set at predetermined numbers as shown by zigzag lines. In the example shown in FIG. 3A, the folds 21 are attached every three. Due to the joining of the folds 21, the minor curvature side is shortened in the longitudinal direction, so that the artificial main blood vessel 2 is formed into an arcuate shape as a whole. Incidentally, it is optional how many folds 21 are encountered. Prior to the meeting, the fold 21 at the meeting position
A cut may be made in the vertical.

Next, the shortening process according to the second embodiment shown in FIG. 3B is a process in which the adjacent ridges 21a of the fold 21 on the minor curvature side of the artificial main blood vessel 2 meet each other. is there. In the example shown in FIG. 3B, the ridges 21a of the folds 21 are skipped by one. The meeting position is indicated by a small black circle. Incidentally, it is optional how many ridges 21a of the fold 21 meet.

Next, in the third embodiment shown in FIG. 3C, on the side of the minor curvature of the artificial main blood vessel 2, the back surfaces of the adjacent ridges 21a of the fold 21 are sewn (see FIG. 3). The sewing position is indicated by a small black circle in (c)),
Due to the sharpening of the ridge 21a, the minor curvature side shrinks, so that the artificial main blood vessel 2 maintains an arcuate curved state.

The curved curve of the artificial main blood vessel 2 is set so as to be optimally greatest in terms of the greatest common denominator from the anatomical point of view of the human body.
By arranging the artificial main blood vessel 2 at the position where 01 has been resected, both ends of the artificial main blood vessel 2 are not particularly bent without applying a bending operation (the artificial main blood vessel 2 has both ends in advance according to the resection state of the arch aorta 200). The length dimension is set so that the part is cut off and fits in the cut position.) The cut portion is set in the cut position in a state facing the cut surface (stump) of the arch aorta 200.

FIG. 6 is an enlarged cross-sectional explanatory view showing the pitch of the folds 21 of the artificial main blood vessel 2. The folds 21 are formed in a zigzag shape in a state where the folds 21 are vertically oscillated around a center line extending in the left and right directions. The pitch of the folds (distance between the fold walls 21c in one cycle, 1 crimp) S1 is 4 mm in the present embodiment.
It is set to ± 1 mm. The distance S2 between the upper and lower peaks 21a is also set to 4 mm ± 1 mm. The reason for this setting is that if the value exceeds this value, the pressure loss on the inner wall surface of the artificial blood vessel 1 becomes large and it becomes impossible to secure a good blood flow. This is because the suturing operation in a narrow surgical space after excision of the diseased part 201 of the arch aorta 200 becomes difficult.

Although the fold 21 of the artificial branch vessel 3 is similarly dimensioned, the fold 21 of the artificial branch vessel 3 is limited to the same size as that of the artificial main vessel 2. Instead, for example, the dimension may be set smaller than that of the artificial main blood vessel 2 so as to be proportional to the tube diameter ratio.

The first to third branch vessels 31 to 33 are positioned at a predetermined angle α with respect to an orthogonal line L 1 orthogonal to the direction in which the ridge line L extends (ie, tangent) at the position of the ridge line L of the greater curvature of the artificial main blood vessel 2. (FIG. 2) only the ascending aorta side (that is, the left side of FIG. 2)
It is provided at an angle. The angle α is set in a state where the artificial main vessel 2 is placed in the resection space where the lesioned part 201 of the arch aorta 200 has been resected, without performing a positioning operation such as bending the first to third branch vessels 31 to 33, The upper end surfaces of the first branch blood vessel 31, the second branch blood vessel 32, and the third branch blood vessel 33 are respectively resected surfaces of the brachiocephalic artery 202, the left common carotid artery 203, and the left subclavian artery 204 (FIG. 11A). The angle is set so as to oppose the greatest common factor.

For joining the artificial branch vessel 3 to the artificial main vessel 2, a connection hole corresponding to the diameter of the artificial branch vessel 3 is formed at a target portion of the artificial main vessel 2, and the angle of the connection hole is formed at the edge of the hole. This is performed by suturing the edges of the artificial branch blood vessel 3 cut diagonally so as to be α, with the base edges facing each other. By doing so, as shown in FIG.
Both are obliquely joined to each other. The junction is particularly carefully coated with collagen so that the zero-porosity of the junction is reduced.
)) is ensured.

Therefore, when the artificial blood vessel 1 is placed in the resection space during the operation, the first to third branch blood vessels 31 to 33 are particularly used.
It is possible to concentrate on the suturing process between the first to third branch blood vessels 31 to 33 and the brachiocephalic artery 202 without paying attention to align the upper end of the vein with the resection surface of the brachiocephalic artery 202 or the like. , Faster surgery is realized.

Further, by performing such an angle setting for the first to third branch vessels 31 to 33, the blood flow after the operation becomes smooth, and the brachiocephalic artery 202 and the left common carotid artery 2
The selective cerebral perfusion through the cerebral perfusion 03 can be performed more reliably.

FIG. 7 is an explanatory front view for explaining the dimensional relationship of such an artificial blood vessel 1. As shown in FIG. 7, in the present embodiment, the first to third branch vessels 31
The angle α between the direction in which the direction of extension 33 extends and the direction in which the artificial main blood vessel 2 extends is set to approximately 60 °, but the present invention is not limited to the case where the angle α is 60 °. Instead, it can be set freely within the range of 30 ° to 90 ° according to the characteristics of the individual. For this purpose, several types having different angles (for example, 40 °, 50 °, 60 °, 70 °, and 80 °) may be prepared in advance.

The direction in which the fourth branch vessel 34 extends,
Although the angle γ between the direction in which the artificial main blood vessel 2 extends is set to 90 °, the angle is not particularly limited.
Various angles can be set.

The first branch vessel 31 and the second branch vessel 3
2 and the gap dimension d2 between the second branch vessel 32 and the third branch vessel 33 are both 5 m.
m to 10 mm so that the first to third branch vessels 31 to 33 can be easily anastomosed to the brachiocephalic artery 202 or the like.

The length d3 from the left end of the artificial main blood vessel 2 to the first branch blood vessel 31 is 100 mm, and
The length d4 from the right end to the third branch vessel 33 is 200
mm, the length d5 from the left end of the artificial main blood vessel 2 to the fourth branch vessel 34 is set to 120 mm, respectively, but these dimensions are set to be longer than necessary dimensions, and the lesion at the time of surgery is set. The distal end is cut off in accordance with the condition of the affected part after the part 201 has been removed, and is used for actual use.

In this embodiment, the artificial main blood vessel 2 is provided with three upper line marks 41 on the major curvature side in parallel with the ridge line L and opposed to the ridge line L at the minor curvature portion. A single lower-side line mark 42 for identifying the lower side is attached to the corresponding position. Furthermore, the artificial branch blood vessel 3 (first to fourth artificial branch blood vessels 31 to 34) is provided with three front side line marks 43 parallel to each other on the front side (the side to which the surgeon faces at the time of surgery). ,
On the back side, one back side line mark 44 is attached so as to be distinguishable from the front side line mark 43 on the front side, so that the front and back of the artificial branch vessel 3 can be more easily and reliably performed.

As the line marks 41 to 44, a color that is complementary to the color of the fabric of the artificial blood vessel 1 or a color that stands out is adopted, so that the line marks 41 can be easily obtained during the operation.
~ 44 can be visually confirmed. Incidentally, in this embodiment, since the material of the artificial blood vessel 1 is substantially white, the line marks 41 to 44 are black.

In the weaving process of the artificial blood vessel body, the line marks 41 to 44 are formed by interposing a black thread as a warp among the juxtaposed white threads so that the artificial main blood vessel 2 and the artificial It can be attached to the branch vessel 3.

Such a line mark 41 is formed on the artificial blood vessel 1.
The total replacement can be performed more accurately by the addition of.

Although not shown, both ends of the artificial main blood vessel 2 are positioned with respect to the axis of the artificial main blood vessel 2 such that the length of the small curved portion is slightly shorter than the length of the large curved portion. It may be inclined. By doing so, even if the radius of curvature of the artificial main vessel 2 is large (that is, it is not so much curved), each end face of the artificial main vessel 2 can be easily opposed to each cut end face of the arch aorta 200. It may be.

However, when the artificial main blood vessel 2 is formed of a plain woven tissue, if the artificial main blood vessel 2 is cut obliquely with respect to the axis thereof, the weft thread which is annularly woven is cut and easily unraveled. Become. In order to eliminate such inconvenience, at the time when the estimation of the required length of the artificial main blood vessel 2 by the examination before the operation is completed, the artificial artificial blood vessel 2 is straightened in parallel with the weft so as to have the estimated length. The end of the blood vessel 2 may be cut, and thereafter, some of the folds 21 at the end position on the minor curvature side may be sutured or clipped. By doing so, the loosening of the yarn is eliminated.

Hereinafter, an embodiment of a surgical procedure for total replacement of the aortic arch using the artificial blood vessel 1 according to the present invention will be described in detail with reference to FIG. FIG. 8 is an explanatory diagram for explaining the total replacement operation. In this embodiment, the selective cerebral perfusion method (selective cerebral perfusion method) is used.
perfusion (SCP)) (for this,
The present inventor has found that "surgical treatment of an anomalous circulation in comparison with the hypothermic circulation arrest method (HCA)".
eurosms of the transverse
aortic arch. With the title "J Card
iovascSurg 30: 402, 1989 ". ) Is an example in the case of applying.

First, an incision is made in the sternum longitudinally and in both supraclavicular fossa to obtain the ascending aorta, arch aorta, arch branch artery (brachiocephalic artery 202, left common carotid artery 203 and left subclavian artery 204 (FIG. 11 (a)) and the descending aorta were exposed, and in some cases, the left fourth intercostal thoracotomy was performed to expose the peripheral side of the descending aorta just above the diaphragm. Extracorporeal circulation was started by blood removal from the right atrium using the two-stage cannula 6, while a left ventricular vent was inserted from the right upper pulmonary vein. After blocking the ascending aorta under electrical ventricular fibrillation, a chemical (blood cardioplegia) 7 for temporarily stopping the activity of the heart is injected into the aortic root part 205 as shown in FIG. In the case of a case with aortic regurgitation, the aorta may be incised and the chemical 7 may be directly injected into the left and right coronary ostia.

Next, the rectal temperature was reduced to 2 by cooling by extracorporeal circulation.
At about 2 ° C., the ascending aorta 206 was released and the systemic circulation from the lower limb femoral artery was temporarily stopped. Then, as shown in FIG. 8B, the incised arch aorta 200 is inspected, and the lumens of the brachiocephalic artery 202 and the left common carotid artery 203 are confirmed from the inside of the arch aorta 200, and then the cannulation is performed. And the execution of selective cerebral perfusion was started.

Thereafter, the descending aorta 207 on the distal side of the origin of the left subclavian artery 204 is completely cut off. In the case of aortic dissection, the outside of the descending aorta 207 is reinforced with a felt 4 made of polytetrafluoroethylene ( FIG. 8 (c)). In the case of aortic dissection, the distal dissection cavity was closed in the same manner as the central dissection cavity.

Next, the replacement of the artificial blood vessel 1 according to the present invention was started. First, as shown in (c) of FIG. 8, the right peripheral side of the artificial main blood vessel 2 is attached to the central end of the descending aorta 207 reinforced with the felt 4 by a 3-0 prolane (Prol).
ene) Continuous suture was performed using a thread.

After the anastomosis between the artificial main blood vessel 2 and the descending aorta 207 by this suture is completed, as shown in FIG. 8D, the third branch blood vessel 33 is connected to the left subclavian artery 204 by 4-0 prolane thread. And sutured continuously.

Then, as shown in FIG. 8E, the blocking forceps 5 is re-engaged between the second branch vessel 32 and the third branch vessel 33 of the artificial main vessel 2, and then the blood is sent from the aorta. Perfusion by changing to the fourth branch vessel 34
8 and antegrade blood transfer was performed to resume heating. During this time, the left peripheral side of the artificial main blood vessel 2 was sutured to the stump of the aortic root part 205 using 3-0 prolane thread.

Subsequently, as shown in FIG. 8F, after air is removed from the artificial main blood vessel 2, the blocking forceps 5 of the artificial main blood vessel 2 are removed to resume coronary perfusion, and the defibrillation of the heart is performed. Was done.

Next, as shown in FIGS. 8F and 8G, the artificial branch vessel 3 is connected to the first branch vessel 31 and the second branch vessel 32 in the order of the brachiocephalic artery 202 and the left common carotid artery 203. Were sutured using 4-0 prolane threads, and the corresponding ones were anastomized. The cannula 6 for selective cerebral perfusion was removed immediately before the anastomosis of each artificial branch vessel 3 was completed.

Finally, as shown in FIG. 8H, the fourth branch vessel 34 for blood supply is cut off from the trunk portion, and the cutout is sutured to form the artificial blood vessel 1 of the arch aorta 200.
The total replacement operation for is completed.

FIG. 9 shows a total aorta 20
FIG. 2 is a perspective view showing a state in which a lesioned part 201 is replaced with an artificial blood vessel 1. As described in detail above and as shown in FIG. 9, the artificial blood vessel 1 of the present invention has a state in which the fold 21 on the minor curvature side of the artificial main blood vessel 2 is stitched to maintain an arcuate shape. The first to third branch vessels 31 to 33 are the artificial main vessel 2
Is provided at a predetermined angle with respect to the above, in the above-described total replacement of the arch aorta 200, the artificial main blood vessel 2 is placed in the replacement space after the removal of the arch aorta 200, The left and right peripheral sides of the artificial main blood vessel 2 naturally oppose the stump of the aortic root part 205 and each stump of the descending aorta 207, and the first to third branch vessels 31 to 33.
Indicates that each of the distal ends has a brachiocephalic artery 202 and a left common carotid artery 2
03 and the stump of the left subclavian artery 204.

Therefore, there is no need to bend the artificial main blood vessel 2 or bend the first to third branch blood vessels 31 to 33 during the operation.

The fourth branch vessel 34 is the artificial main vessel 2
Since it is provided between the second branch vessel 32 and the third branch vessel 33 in the above, the fourth branch vessel 34 is pulled out to the outside without any trouble even in the incised narrow replacement space.
The fourth branch vessel 34 does not interfere with the operation.

Further, the artificial main blood vessel 2 is provided with an upper line mark 41 and a lower line mark 42 for visually checking the upper and lower sides thereof, and the artificial branch vessel 3
Has a front side line mark 43 and a back side line mark 44 (FIG. 1) for visually recognizing the front and back sides.
By using these line marks 41 to 44 as a guide, the operation of the total replacement operation becomes easy.

The present invention is not limited to the above embodiment, but includes the following contents.

(1) In the above embodiment, a polyester yarn is employed as a raw material for a skeleton of an artificial vascular prosthesis made of a woven product constituting the vascular prosthesis 1. However, the present invention is not limited to the skeleton material. The raw material of the body is not limited to a polyester yarn, and a polyamide yarn, a polytetrafluoroethylene yarn, or the like can be used.

(2) In the above embodiment, collagen is coated on the artificial vascular prosthesis, which is the raw material of the artificial blood vessel 1, but the present invention relates to the use of collagen for coating the artificial vascular prosthesis. The present invention is not limited thereto, and proteins such as gelatin and human albumin may be used.

(3) In the above-described embodiment, the so-called woven type, which is formed by weaving the original yarn in a sack weave, is used as the artificial blood vessel body. The blood vessel body is not limited to the woven type, and may be a so-called knit type obtained by knitting a raw yarn. However, since the knit type has a large porosity, it is preferable to apply a thick coating to prevent this.

(4) In the above-described embodiment, as a marker for identifying the upper and lower sides or the front and back of the artificial blood vessel 1, lines extending in the longitudinal direction of the artificial main blood vessel 2 and the artificial branch blood vessel 3 and complementary to the color of the cloth and their colors Although the marks 41 to 44 are provided, the present invention employs the line marks 41 to
The number is not limited to 44, and various characters, figures, symbols, and the like may be used.

[0073]

According to the first aspect of the present invention, since the artificial branch blood vessel group juxtaposed to the artificial main blood vessel is inclined from the root toward the descending aorta, the total replacement of the aortic arch can be performed. At the time of application, with the diseased part removed, the artificial main vessel is placed at the resection position, one end of which faces the aortic root, and the other end faces the stump of the descending aorta. Without performing extra operations such as bending the three artificial branch vessels, their end faces are
It can face the stump of the left common carotid artery and the left subclavian artery, and each artificial branch vessel can be easily sutured to the brachiocephalic artery or the like.

According to the second aspect of the present invention, the artificial main blood vessel is subjected to a shortening process at a substantially central portion in the longitudinal direction on the side facing the side where the artificial branch blood vessels are arranged side by side. Therefore, by adjusting the arcuate curvature of the artificial main blood vessel formed by the shortening process to the curvature of the anatomical arch aorta in the human body, it is possible to artificially cut the lesion of the arch aorta. Simply placing the main blood vessel in the resection position allows one end to be located at the stump of the aortic root and the other end to face the stump of the descending aorta.

According to the third aspect of the present invention, since the artificial main blood vessel is formed by the bellows tube, the bellows tube can be extended and contracted in the longitudinal direction, and has flexibility that can be bent. Therefore, the artificial blood vessel can be provided with a wide adaptability according to the condition of the affected part.

According to the fourth aspect of the present invention, the artificial branch blood vessel is provided with a mark for identifying the front and back sides, and the operation can be more easily performed by recognizing the marks provided on the artificial main blood vessel and the artificial branch blood vessel. It can be performed.

According to the fifth aspect of the present invention, the first to the third
Since the inclination angle toward the descending aorta of the artificial branch blood vessel is set to 30 ° to 80 ° with respect to the longitudinal direction of the artificial main blood vessel, the first to third branch blood vessels are connected to the brachiocephalic artery with versatility. , The left common carotid artery and the left subclavian artery can be suitably opposed.

According to the sixth aspect of the present invention, the first to the third
Since the inclination angle toward the descending aorta side of the artificial branch blood vessel was set to 50 ° to 70 ° with respect to the longitudinal direction of the artificial main blood vessel, the first to third branch blood vessels were changed to the brachiocephalic artery, the left common carotid artery, and the left subclavian artery. It can be more suitably opposed to the stump of each artery.

[Brief description of the drawings]

FIG. 1 is a perspective view showing an embodiment of an artificial blood vessel according to the present invention.

FIG. 2 is a front view of the artificial blood vessel shown in FIG.

FIG. 3 is a partially enlarged side view of an artificial main blood vessel, wherein (a) is a shortening process of the first embodiment, (b) is a shortening process of the second embodiment, and (c) is a third embodiment. This is for describing the process of shortening the form.

FIG. 4 is a partially enlarged front view showing a connection portion between the artificial main blood vessel and the artificial branch tube in FIG. 1;

FIG. 5 is a schematic sectional view taken along line AA of FIG. 1;

FIG. 6 is an enlarged sectional explanatory view showing a pitch of a fold of the artificial main blood vessel.

FIG. 7 is an explanatory diagram in a front view for explaining a dimensional relationship of the artificial blood vessel.

FIGS. 8A to 8H are explanatory diagrams for explaining total replacement surgery.

FIG. 9 is a perspective view showing a state in which a lesion of the arch aorta is replaced with an artificial blood vessel by total replacement.

FIG. 10 is a perspective view showing a conventional artificial blood vessel.

FIG. 11A is a perspective view showing a lesioned arch aorta, and FIG. 11B is a perspective view showing a state in which a lesion of the arch aorta is replaced by a conventional artificial main blood vessel.

[Explanation of symbols]

 REFERENCE SIGNS LIST 1 artificial blood vessel 2 artificial main blood vessel 21 fold 21 a ridge 21 b valley 21 c fold wall 22 annular valley 23 annular ridge 200 arch aorta 201 diseased part 202 brachiocephalic artery 203 left common carotid artery 204 left subclavian artery 205 aortic aorta Beginning 206 ascending aorta 207 descending aorta 3 artificial branch vessel 31 first branch vessel 32 second branch vessel 33 third branch vessel 34 fourth branch vessel 4 felt 5 blocking forceps 6 cannula 7 chemical 8 perfusion

Claims (6)

[Claims] 1. An artificial blood vessel used for replacement at a lesion position of an arch aorta between an ascending aorta and a descending aorta, comprising: an artificial main vessel corresponding to the arch aorta; An artificial branch blood vessel group including first to third artificial branch blood vessels arranged side by side along a predetermined angle in a circumferential direction of the artificial main blood vessel with respect to the artificial branch blood vessel group, and An artificial blood vessel, comprising: a fourth artificial branch blood vessel provided in the vicinity of an artificial branch blood vessel; wherein the artificial branch blood vessel group is provided to be inclined from a root toward the descending aorta. 2. An artificial blood vessel used as a replacement at a lesion position of an arch aorta between an ascending aorta and a descending aorta, the artificial main vessel corresponding to the arch aorta, and a longitudinal direction from the artificial main blood vessel. An artificial branch blood vessel group including first to third artificial branch blood vessels arranged side by side along a predetermined angle in a circumferential direction of the artificial main blood vessel with respect to the artificial branch blood vessel group, and A fourth artificial branch vessel provided in the vicinity of the artificial branch vessel, wherein the artificial main vessel is short at a substantially central portion in the longitudinal direction with respect to a side opposed to the side where the artificial branch vessels are arranged side by side. An artificial blood vessel, which has been subjected to sizing processing. 3. The artificial blood vessel according to claim 1, wherein the artificial main blood vessel is formed by a bellows tube. 4. The artificial blood vessel according to claim 1, wherein each of the first to fourth artificial branch vessels has a mark attached to both sides facing each other in a circumferential direction of the artificial main vessel to identify the front and back sides. 4. The artificial blood vessel according to any one of 3. 5. The artificial blood vessel according to claim 1, wherein an inclination angle of the first to third artificial branch vessels toward the descending aorta is 30 ° to 80 ° with respect to a longitudinal direction of the artificial main vessel. 5. The artificial blood vessel according to any one of 1 to 4. 6. The artificial blood vessel according to claim 5, wherein the inclination angle is 50 ° to 70 °.