JP2004275338A - Blood vessel treatment instrument - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide a blood vessel treatment instrument for forming an A-C bypass functioning stably for a long period of time by the anastomosis of an aorta and a radical artery with a suture without using a mechanical joining means in an off-pump coronary artery bypass surgery. <P>SOLUTION: The blood vessel treatment instrument comprises a tube having a plurality of slits in the lengthwise direction and a film which covers the upper surface of the slits and is torn in the direction of the slit. Preferably, the film is stretched at least in the direction of the slit, is made of a polymer material with oriented molecules, and has cuts made in advance. <P>COPYRIGHT: (C)2005,JPO&NCIPI

Description

[0001]
TECHNICAL FIELD OF THE INVENTION
The present invention relates to a vascular treatment device used in a surgical operation, and more particularly, to an anastomosis to an aorta to cut off blood flow in a bypass blood vessel when performing coronary artery bypass surgery under a heartbeat. To a vascular treatment device that performs
[0002]
[Prior art]
In recent years, catheter intervention for patients with ischemic heart disease such as myocardial infarction has become increasingly popular. Typical catheter interventions include coronary vasodilation and endovascular stenting, but these treatments are characterized by being minimally invasive to patients and requiring short hospital stays.
On the other hand, the effectiveness of coronary artery bypass surgery (hereinafter abbreviated as CABG) is widely recognized for patients who are not targeted for catheter treatment. In this method, one end of a bypass blood vessel such as an internal thoracic artery or a gastric omental artery, which has been exfoliated on the peripheral side of a coronary artery where stenosis is caused as a cause of ischemia, is anastomosed to eliminate ischemia.
Because the subject patient of CABG has a plurality of coronary arteries occluded and stenotic, the ascending aorta is calcified, the brain, kidneys, chronic diseases such as respiratory, etc. The risk of these patients for CABG is by no means low. In particular, the greatest risk that the patient must suffer is to stop the heart and to perform extracorporeal circulation using a heart-lung machine. The use of cardiopulmonary bypass for patients with advanced arteriosclerosis is equivalent to sending high-pressure water to a rusted water pipe, resulting in the flushing of extraneous matter in blood vessels, obstructing other blood vessels, and cerebral infarction. May induce complications.
[0003]
In recent years, a method of anastomosis of a bypass graft under heartbeat without using a heart-lung machine has been attempted for such patients, and good results have been obtained. This method is called off-pump coronary anastomosis (hereinafter abbreviated as OPCAB).
The problem with OPCAB is that the heart is moving, and it takes a lot of skill to perform a perfect anastomosis in a short time. If the anastomosis is poor, a blood clot is generated from the anastomosis portion in the coronary artery or the bypass blood vessel, which causes occlusion. This problem has been ameliorated by the development of a device called a stabilizer, for example, as disclosed in Japanese Patent No. 3036686. By using the stabilizer, the movement of the anastomosis part was regulated, and it became possible to anastomose the bypass blood vessel in a stable state, so the accuracy of the anastomosis was improved, and the performance of OPCAB was dramatically improved. .
[0004]
For bypass vessels, vein grafts collected from the lower limbs and arterial grafts such as the internal thoracic artery and gastric omental artery are used.In recent years, the latter has proved to have a good long-term prognosis, and is often used. ing. However, there are not so many arterial grafts that can be used for bypass grafts. Therefore, when it is necessary to create a bypass in two or three branches of a coronary artery, there are many cases where the use of veins cannot be avoided. Further, depending on the portion of the coronary artery to be bypassed, a good anastomosis may not be formed due to the mismatch between the inner and outer diameters and the blood vessel wall. The internal thoracic artery and gastric omental artery are called in situ grafts. Conventionally, blood flowing through the internal thoracic artery and stomach omental artery is sent to the ischemic part. In some cases, it is too small to achieve sufficient blood flow after anastomosis.
As a method of obtaining a high flow rate and maintaining high quality as a bypass, there is an AC bypass using a radial artery. This method bypasses the aorta and the ischemic part with the radial artery.The blood supply source is the aorta, which enables high-pressure blood transmission, and the length of the bypass is minimized, so that pressure loss is reduced. It has the advantage of being small. However, the only way to anastomize the aorta with OPCAB is to partially clamp the aorta, and there is a problem that patients with advanced arteriosclerosis have a high risk.
As an anastomosis of a blood vessel with another blood vessel, there is a method in which blood vessels are joined to each other by mechanical means after an opening is created as disclosed in Patent Document 1. However, those actually put into practical use have been blocked by mechanical means, and have not been able to stably perfuse the periphery of the stenosis for a long period of time.
[0005]
[Patent Document 1] US Pat. No. 6,524,322
[Problems to be solved by the invention]
An object of the present invention is to provide a vascular treatment device for creating an AC bypass that stably functions over a long period of time by anastomosis between the aorta and the radial artery with a suture, without using mechanical joining means in OPCAB. It is in.
[0007]
[Means for Solving the Problems]
The present invention
(1) a vascular treatment device comprising a tube having a plurality of slits in a length direction and a film covering an upper surface of the slit, wherein the film is torn in the slit direction;
(2) The vascular treatment device according to (1), wherein the film is stretched at least in a slit direction and is made of a polymer material in which molecules are oriented.
(3) The vascular treatment device according to (1) or (2), wherein a cut is made in the film in advance.
[0008]
BEST MODE FOR CARRYING OUT THE INVENTION
Hereinafter, the present invention will be described in detail with reference to the drawings. FIG. 1 is a view showing a vascular treatment tool according to an embodiment of the present invention, wherein a is a view showing an entire image, and b is an enlarged view of a distal end portion thereof. FIG. 2 is a diagram for explaining a method of using the vascular treatment device according to the present invention.
[0009]
As shown in FIG. 1A, a plurality of slits (2) are provided at the tip of the tube (1), and one end of the slit (2) is open at the end of the tube (1). The optimum number of the slits (2) differs depending on the diameter of the blood vessel to be anastomosed with the aorta, but is preferably 6 to 10 when using the radial artery. The length, width and shape of the slit (2) are not particularly limited as long as there is room for a suture needle used for anastomosis to pass freely.
[0010]
The tube (1) is formed of a hard material, the lumen is closed in a region without the slit (2), and a film (3) is arranged on the outer periphery of the slit. The film (3) is formed from a material that tears easily in the direction of the slit (2) when an external force is applied. As such a material, a crystalline polymer material, and a film in which molecules are oriented uniaxially stretched at least in the slit direction and molecules are preferably used, for example, polytetrafluoroethylene resin, nylon resin, polyester resin, polyethylene resin Etc. can be preferably used. Further, in order to make the film more easily torn, a plurality of cuts may be made in advance on the surface of the film.
[0011]
Next, a method of using the vascular treatment device will be presented with reference to FIG. 2 to clarify the effects of the present invention.
An opening (11) is made in the wall of the aorta (10) by a method such as punching (FIG. 2-a), and a film (3) portion of a vascular treatment tool is inserted into the opening (11), and the opening (11) is opened. Close up. At this time, the slit (2) is made to protrude from the aorta (10) by about half. Next, a suture (12) is applied to the aortic wall for each slit provided in the vascular treatment device. The suture (12) is passed from the outside to the inside of the aortic wall and then through the film (3) and from the inside to the outside of the bypass graft (15) (FIG. 2-b).
[0012]
When the insertion of the suture (12) is completed for all the slits, the vascular treatment device is removed (FIG. 2-c). At this time, since the film (3) is oriented in the direction of the slit (2), the film (3) can be torn from the portion where the suture (12) is applied by removing the vascular treatment tool ( Fig. 2-c). When the removal of the vascular treatment device is completed, the sutures (12) are tightened one by one while holding the opening with the operator's finger to prevent the ejection of blood, and the anastomosis is completed if the sutures are tied.
【The invention's effect】
As is apparent from the above description, the use of the blood flow treatment device of the present invention allows the aorta and the radial artery to be anastomosed with a suture in OPCAB without using a mechanical joining means, and A-functioning stably for a long time. It is possible to create a C bypass.
[Brief description of the drawings]
FIG. 1 is a view showing a blood flow treatment device according to an embodiment of the present invention, wherein “a” is an overall view and “b” is an enlarged view of a distal end portion thereof.
FIG. 2 is a view for explaining a method of using the blood flow treatment device of the present invention.
[Explanation of symbols]
1. Tube 2. Slit 3. Film10. Aorta 11. Opening 12. Suture 14. Suture needle 15. Graft for bypass

Claims (3)

A vascular treatment device comprising a tube having a plurality of slits in a length direction and a film covering an upper surface of the slit, wherein the film is torn in the slit direction. 2. The vascular treatment device according to claim 1, wherein the film is stretched at least in a slit direction and is made of a polymer material in which molecules are oriented. 3. The vascular treatment device according to claim 1, wherein a cut is made in the film in advance.

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