JP2002095666A - Aid for vascular anastomosis - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide an aid for vascular anastomosis which enables a physician performing a vascular bypass surgery to anastomose between a bypassing blood vessel and a bypassed blood vessel quickly and accurately while securing a bloodstream remaining between a center and periphery of a bypassed blood vessel, would not interfere during vascular anastomosis, and is more user-friendly in terms of operatability than an existing one. SOLUTION: An aid for vascular anastomosis is a flexible, hollow duct with openings at both ends and is equipped with at least two bulging parts and a means to take out the duct from the blood vessel on the outer surface of the duct. The duct is flexible and self-restorable, and the bulging parts are placed on the duct in an eccentric manner.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a vascular anastomosis assisting device used for performing coronary artery bypass surgery or vascular bypass surgery for treating coronary artery disease.

[0002]

2. Description of the Related Art In some cases, stenosis occurs in a blood vessel due to arteriosclerosis or the like, and it is difficult or impossible to obtain a blood flow to the peripheral side. In such a case, a bypass operation is performed in which the patient's own artery or artificial blood vessel is anastomosed between the central side and the peripheral side while bypassing the stenotic portion of the blood vessel.

[0003] In order to obtain a good visual field of the anastomotic part when performing this anastomosis, a method of reducing or stopping the bleeding from the anastomotic part by temporarily compressing both ends of the anastomotic blood vessel is generally adopted. Have been. On the other hand, if the stenosis part is not completely closed, there is a concern about peripheral adverse effects due to blocking blood flow during vascular anastomosis,
What can secure the blood flow during the anastomosis operation is desired,
The present inventors previously disclosed a blood vessel anastomosis assisting device having an annular projection (corresponding to a bulging portion of the present invention) of a hollow conduit as disclosed in JP-A-11-335.

However, the above-mentioned blood vessel anastomosis assisting tool has an annular projection (in the bulge portion of the present invention) in the direction of the center of the conduit shaft (the center of the non-bulge portion) and the center of the conduit shaft (in the axis of the non-bulge portion). (Equivalent) is formed (arranged) so that the axial center of the circular cross-section formed by the outer peripheral edge is substantially the same, so that when the bulging portion of the auxiliary tool is inserted into a blood vessel, As shown in FIG. 10, the space formed between the bulging portion and the inserted inner wall of the arterial blood vessel is small, which sometimes hinders anastomosis of the blood vessel. That is, when anastomosis is performed between blood vessels, if the space is small as shown in FIG. 10, the suture needle hits the anastomosis assisting tool and has a disadvantage that it is difficult to perform anastomosis.

[0005]

SUMMARY OF THE INVENTION It is an object of the present invention to provide a blood vessel anastomosis assisting device which has improved the disadvantages of the prior art. That is, the space formed between the bulging portion shown in FIG. 10 and the inserted inner wall of the arterial blood vessel is increased, and in the vascular bypass operation, first, the blood remaining between the central side and the peripheral side of the bypassed blood vessel is obtained. An object of the present invention is to provide a blood vessel anastomosis assisting device capable of quickly and reliably performing an anastomosis between a bypassed blood vessel and a bypass blood vessel while ensuring flow. It is still another object of the present invention to provide a blood vessel anastomosis assisting device that does not hinder the blood vessel anastomosis and is easier to perform a surgical operation (anastomosis) than conventional products.

[0006]

SUMMARY OF THE INVENTION The present invention relates to the method disclosed in
The present invention relates to an improvement of a vascular anastomosis assisting device disclosed in Japanese Patent Application No. 335-335, wherein an annular projection of the vascular anastomosis assisting device is replaced with at least two bulging portions eccentrically arranged in a conduit to perform a treatment at the time of vascular anastomosis. Can be easily and accurately performed. That is, according to the present invention, there is provided a hollow conduit having open ends at both ends and having flexibility and self-restoring property, and at least two hollow conduits are provided on an outer surface of the conduit.
A blood vessel anastomosis assist, wherein two bulges and an extraction means for taking out the conduit from inside a blood vessel are provided, and at least one of the bulges is eccentrically arranged on the conduit. The above-mentioned problem was able to be solved by the tool. However, the means of the present invention is the same as that described in
The invention is not limited to the invention described in No. 5, but includes a flexible hollow conduit having open ends at both ends, at least two bulges on an outer surface of the conduit, and the conduit from inside a blood vessel. The present invention can be applied to all blood vessel anastomosis assisting tools having a structure having a removing means for taking out and has an effect.

In the present invention, the expression "the bulging portion is eccentrically arranged on the conduit" means that the axial center of the conduit and the bulging portion are formed based on the outer peripheral edge of the bulging portion. This means that the bulge is formed on the conduit such that the center of the substantially circular cross-sectional shape perpendicular to the direction (hereinafter, the central axis of the bulge) does not coincide. Here, the substantially circular cross-sectional shape is not necessarily limited to a perfect circle, but may be any cross-sectional shape that can assume the concept of a central axis. For example, as shown in FIG. 12, the upper half and the lower half of the sectional shape may have different circular arcs.

The vascular anastomosis assisting device according to the present invention, in which the central axis of the bulging portion as shown in FIGS. 1 to 9 is different from the axis of the conduit, has the bulging portion as shown in FIGS. As shown in FIG. 1, for example, as shown in FIG.
The gap 5 with the (the non-bulging portion 3 of the conduit sandwiched between the two bulging portions) can be widened, and the surgical operation at the time of suturing becomes easy. The eccentricity of the bulging portion may be such that at least one bulging portion is eccentric. For example, when two bulging portions are present as shown in FIG. It is preferable to be eccentric, and usually two bulging portions are provided, but in some cases, two or more, for example, three bulging portions may be provided.

When the two bulges are eccentric, the eccentric directions of the bulges are formed and arranged so that they are substantially on the same side on the conduit, so that the bulges can be eccentric. In addition, the gap between the inner wall of the blood vessel and the anastomosis assisting device can be formed larger. The eccentric direction of the bulging portion is substantially on the same side on the conduit is defined as follows. The a center axis d ₁ of C ₁ point and bulging portion corresponding to the axis of the conduit obtained by connecting a straight line to the eccentric direction line as shown in FIG. 9, 1
One of m ₁ the eccentric direction line at the bulge _portion, the eccentric direction line in another of the bulging portion and m _2, forming the twist angle γ is ± 45 ° between m ₁ and m ₂ as shown in FIG. 9 However, the smaller the angle is, the more preferable it is, and the angle is most preferably 0 °.

[0010]

BEST MODE FOR CARRYING OUT THE INVENTION Non-bulging portion The non-bulging portion (a flexible hollow conduit having open ends at both ends) of the blood vessel anastomosis assisting device of the present invention has a special shape and dimensions such as inner and outer diameters and materials. All those disclosed in Kaihei 11-335 can be employed. Swelling part The vascular anastomosis assisting device of the present invention is characterized in that the swelling part is disposed eccentrically with respect to the conduit, and the configuration of the other swelling part is disclosed in the above-mentioned publication similarly to the non-swelling part. Everything can be adopted. As described above, the vascular anastomosis assisting device of the present invention has various effects due to the characteristic feature that the bulging portion is arranged eccentrically with respect to the conduit. Hereinafter, various embodiments related to the bulging portion of the blood vessel anastomosis assisting device will be described.

[0011] The shape of the swelling portion is required to prevent blood from leaking from the incised blood vessel to the operative visual field side when the vascular anastomosis assisting device is inserted into the blood vessel, and not to damage the inner wall of the blood vessel. From the above, it is preferable that the cross-sectional shape of the non-conduit formed based on the outer peripheral edge of the bulging portion in a plane perpendicular to the axial direction is a substantially circular cross-sectional shape, and further, insertion into a blood vessel. It is most preferable to use a perfect circle or a circular shape close to a perfect circle as shown in FIGS. 7 and 8 because it can easily support the inside of a blood vessel.

[0012] The vascular anastomosis assisting device of the present invention is used for vascular anastomosis.
In order to obtain a wider gap for passing the suture needle,
The bulge is eccentric to the conduit as in
The greater the fit, the greater the effect. Sand
That is, as shown in FIG.
Those with a high degree of mind, such as those shown in FIG.
preferable. In particular, as shown in FIG.
Part of the outer peripheral edge of the bulging portion is outside the non-bulging portion.
Anything that touches the periphery (extrapolation line)
In this case, only a wider gap for passing the suture needle
Is less desirable because it has a large hemostatic effect during vascular anastomosis.
No. In addition, as shown in FIG.
The distance from the bottom surface 8 of the bulge to the upper outer surface 9 (ie,
The outside diameter of the protrusion)₂Bulging portion from the upper outer surface 9 of the non-bulging portion
Let the distance to the top surface 10 (the height of the bulging portion) be n₁And
Come, n₁/ N₂Is preferably in the range of 0.20 to 3.0.
New The n₁/ N₂Is less than 0.20, the inner wall of the blood vessel
11 and the anastomosis assisting device 1 (the non-
The gap 5 with the bulging portion 3) cannot be taken widely, and n₁/ N ₂
If it exceeds 3.0, the flow rate in the conduit will be small
Cut.

Further, as the shape of the bulging portion, it is necessary to remove the blood vessel anastomosis assisting tool from inside the blood vessel immediately before the blood vessel anastomosis is completed. It is desirable to make. A preferred shape is a droplet (tear drop) type. Droplets (tears)
The shape of the mold may be 2, as shown in FIGS.
The two bulging portions have the same shape, and each bulging portion is symmetrical with respect to the left and right sides with respect to the conduit axial direction. As shown in FIG. An embodiment of the present invention includes one in which the portion is asymmetrical with respect to the conduit axial direction, one in which the shapes of the two bulging portions are different as shown in FIGS. 3 and 5, and the like. However, the shape of the bulging portion of the present invention is not limited to those shown in these drawings. In addition, the boundary surface (portion) between the bulging portion and the non-bulging portion is a blood vessel insertion,
In order to prevent the vessel from being caught on the blood vessel wall at the time of withdrawal, it is desirable to connect the vessel with a curve that smoothly joins.

In the bulging portion, the angle at the time of insertion is α, and the angle at the time of removal is β, as shown in FIGS. Here, the angle at the time of insertion means that an arc portion in contact with the blood vessel wall of a bulge on the side where the vascular anastomosis assisting device of the present invention is inserted into a blood vessel (for example, a coronary artery) has an axis of a non-bulge portion (conduit). The angle at the time of extraction means that the arc portion of the bulging portion that comes into contact with the blood vessel wall before the vascular anastomosis assisting device of the present invention is completely removed from the inside of a blood vessel (for example, a coronary artery). (Conduit) axis. When the insertion angle α of the bulging portion shown in FIG. 4 exceeds 45 °, the tube is easily caught on the blood vessel wall when the auxiliary tool is removed from the blood vessel. Preferably, it is 60 °. On the other hand, at a shallow angle of less than 20 degrees, the total length of the tube becomes longer.
° is desirable. Further, when the angle β at the time of removal of the bulging portion shown in FIG. 4 exceeds 46 °, the tube becomes easily caught on the blood vessel wall when the auxiliary tool is inserted into and removed from the blood vessel, and the angle β at the time of removal is increased. If the angle is smaller than 19 °, the gap 5 is reduced.

As the material of the bulging portion, any synthetic resin material can be used, but a material such as ethylene-vinyl acetate copolymer (EVA), polyamide, or silicone, which does not easily damage the inner wall of the blood vessel, is preferable. The bulging portion may be formed of a different material from the non-bulging portion of the conduit, but is preferably made of the same material as the non-bulging portion of the conduit.
Those having a Shore hardness of about 20 to 80 D by S are preferable. If the hardness is lower than 50, the tube is easily kinked in the blood vessel, and if it is higher than 70D, the inner wall of the blood vessel may be damaged.

The take-out means is shown in FIG.
As disclosed in the above, it is desirable that a thin and strong thread (string) is connected to the center of the non-bulging portion. For example, a preferred embodiment having a shape and dimensions of a fishing line or the like and a material of silk, polyamide, or polyolefin is used. Further, it may be a tubular linear object as disclosed in JP-A-2000-5185.

[0017]

BRIEF DESCRIPTION OF THE DRAWINGS FIG. Example 1 (Structure of FIG. 5) The vascular anastomosis assisting tool 1 is composed of a polyurethane hollow conduit (non-bulging portion 3) in which two bulging portions 2 are formed near respective ends, and a non-bulging portion. Silk 5-0 bonded to the center of 3
Of the suture 4. The inner diameter of the non-bulging portion 3 is 0.7 mm,
The outer diameter (n ₂ ) is 1.0 mm, the length L ₁ of the central portion of the non-bulging portion is 10.0 mm, the axial length L ₂ of the bulging portion is 3.0 mm, and the height of the bulging portion. n1 is 1.0 mm. The thickness of the non-bulging portion is 0.15 mm.

The angle α at the time of insertion of the bulging portion is 45 °, and the angle β at the time of removal is 45 °, which is the same angle in this embodiment. As can be seen from the figure, the two bulges are both formed above the conduit axis X, and the two bulges are formed so as to have substantially the same shape and size. Left and right are symmetric with respect to Y.

[0019]

Advantages of the Invention By disposing the bulging portion eccentrically with respect to the conduit, a large gap is obtained between the inner wall of the blood vessel and the anastomosis assisting tool at the time of vascular anastomosis, and the passage of the suturing needle becomes easier than the conventional product. Therefore, the treatment is easily and reliably performed,
Time can also be reduced. 2. In the auxiliary device of the present invention, since the swelling portion and the non-swelling portion of the conduit are connected by a smooth curve like a liquid drop type, etc.
At the time of removal, there is little risk of damaging the intima of the blood vessel, and these operations are easy.

[Brief description of the drawings]

FIG. 1 is a schematic view showing a shape of a bulge in one embodiment of a vascular anastomosis assisting device of the present invention.

FIG. 2 is a schematic view showing a shape of a bulging portion in another embodiment.

FIG. 3 is a schematic view showing a shape of a bulging portion in another embodiment.

FIG. 4 is a schematic diagram showing an insertion angle α and a removal angle β in a bulging portion.

FIG. 5 is a schematic diagram showing the shape and dimensions of one preferred embodiment of the present invention.

FIG. 6 is a schematic diagram showing a relationship between the outer diameter of the non-bulging portion: n ₂ and the height of the bulging portion: n ₁ .

FIG. 7 is a schematic diagram showing a state in which a part of the outer peripheral edge of the bulging portion is in contact with the outer peripheral edge of the non-bulging portion.

FIG. 8 is a schematic diagram showing a bulged portion having a small degree of eccentricity.

FIG. 9 is a schematic diagram showing the degree of twisting of the eccentric lines of each bulge to show that the eccentric directions of the two bulges are on substantially the same side on the conduit.

FIG. 10 is a schematic view showing the shape of a bulging portion of a conventional vascular anastomosis assisting device.

FIG. 11 is a schematic cross-sectional view of a bulging portion of a conventional vascular anastomosis assisting device, showing a shape of the bulging portion along a plane perpendicular to an axis.

FIG. 12 is a view showing a cross section of a bulging portion in which the upper half and the lower half of the cross section have different arcs.

[Explanation of symbols]

 1. Vascular anastomosis aid 2. Swelling part 3. Non-bulging part 4. Suture (take-out means) 5. Gap 6. 6. Outer peripheral edge of bulge 7. Outer peripheral edge of non-bulging portion 8. Bottom surface of non-bulging portion 9. Upper outer surface of non-bulging portion Top surface of bulge 11. Inner wall of blood vessel m1. Eccentric direction line of one bulge m2. Eccentric direction line of the other bulge γ. Twist angle between eccentric direction lines m1 and m2 n1. Bulge height n2. Outer diameter of non-bulging part α. Insertion angle β. Removal angle L1. Central part length of non-bulging part L2. Axial length of bulge X. Conduit axis Y. Center line

Claims (7)

[Claims] 1. A flexible hollow conduit having open ends at both ends, the conduit having on its outer surface at least two bulges and withdrawal means for removing the conduit from within a blood vessel. Wherein the conduit has flexibility and self-restoring properties, and at least one of the bulging portions is eccentrically arranged on the conduit. 2. A blood vessel anastomosis assisting device according to claim 1, wherein a cross-sectional shape in the axial direction of the conduit formed at the outer peripheral edge of the bulging portion is substantially circular. 3. The blood vessel anastomosis assisting device according to claim 1, wherein the bulging portions are formed and arranged so that the eccentric directions of the two bulging portions are on the same side on the conduit. 4. The vascular anastomosis assisting device according to claim 1, wherein a part of the outer peripheral edge of the bulging portion is in contact with the outer peripheral edge of the non-bulging portion. 5. The inclination angle α at the time of insertion of the bulging portion is 20 to 45.
The vascular anastomosis assisting device according to any one of claims 1 to 4, wherein the angle is °. 6. The inclination angle β at the time of removal of the bulging portion is 19 to 45.
The vascular anastomosis assisting device according to any one of claims 1 to 5, wherein the angle is °. 7. The diameter of the non-bulging portion is n ₂ and the height of the bulging portion is n _1.
When a _blood vessel anastomosing aid according to any one of claims 1~6 _n 1 / n ₂ is in a range of 0.20 to 3.0.