NL8700667A - ENDOVASCULAR CONNECTOR. - Google Patents

Description

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875019 / Ti / MB

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Short designation: Endovascular connector.

The invention relates to a device for connecting the spaces of blood vessels and / or grafts (artificial blood vessels). Such a device will hereinafter be referred to as an "endovascular connector", or connector.

Despite the spectacular improvement in surgical techniques since the 1950s, many reconstructions fail in current vascular surgery. In such procedures, vessels - either natural vessels or natural vessels on the one hand and artificial vessels (grafts) on the other - are joined together by sutures extending through the vessel walls.

At the bonding site, forces occur with a complicated interrelation. On the one hand, there are forces directed in the vascular longitudinal direction and, on the other hand, circular forces arise as a result of the expansion of the vessel caused by the passing blood wave. In addition, radially directed forces also occur. These forces are thought to cause hyperplasia (a reactive thickening of the vessel wall that reduces the free passage of the vessel). It is clear that this considerably increases the chance of failure of the reconstruction.

When connecting a graft with a natural vessel, there is of course a difference in stiffness (referred to in the Anglo-Saxon literature as "compliance mismatch") between the graft and the natural vessel, which in particular leads to a shock load in case of a distal anastomosis. on the transition between graft and blood vessel.

Regardless of the type of anastomosis, it is furthermore very desirable that there is practically no diameter variation between the supplying blood vessel, anastomosis and the discharging blood vessel. However, this is virtually impossible to achieve with known techniques.

The object of the invention is to provide a solution to the problems described above, and is based on the insight that 8/00667 + - 2 - f ** this is possible when the two vessels are connected to each other by means of a connector which is designed in such a way that optimal for both vessels adhesion resp. connection points with the respective vessel can be realized. Thus, the place of fixation - which corresponds to the place of reactive thickening of the vessel wall - is separated from the place where the lumens of the vessels (graft) merge, and this transition can also be almost isometric. This keeps the occurrence of turbulences to a minimum.

The invention thus proposes the use of a tubular coupling member with a first end arranged to be inserted into the open end of the body vessel and a second end adapted to receive the open end of the other vessel.

On the one hand, this connector must have sufficient strength and on the other hand keep the lumen as large as possible; these requirements can be met with the usual materials known per se and already used for grafts (such as, for example, known from Dutch patents 164470 and 165647), in particular with regard to the choice of mesh size for optimum incorporation. Preferred embodiments are described in the following claims.

The forces described above are taken up where the ligature is applied; if reactive vessel wall thickening already occurs, it is thus at a distance from the end of the insertion part, so that the free cross-section of the blood vessel will not be affected thereby. Furthermore, there will be ingrowth at both ends of the connector, which improves attachment and sealing.

The connector according to the invention represents a considerable simplification of the anastomosis technique, which can therefore also be used by non-vascular surgeons. This is particularly important when treating patients with serious injuries due to calamities and accidents; the arterial and / or venous circulation 67 0 0 66 7 - 3 - * r can be quickly repaired, which considerably shortens the ischemia time and thus greatly reduces the chance of permanent damage to organs or body parts.

If necessary, a final reconstruction can be carried out later.

Other applications are the use with arterio-venous fistulas for hemodialysis which can be used shortly after application and the use with arterio-venous shunts that can be easily replaced (in whole or in part) when using the connector according to the invention.

Furthermore, it can be envisaged for use in organ transplants and reconstructive surgery of the veins.

The invention is elucidated with reference to the drawing. Herein is:

Figure 1a is a perspective view of a first embodiment according to the invention, intended for connecting vessels and / or grafts with mutually different diameters.

Figure 1b is a longitudinal section through this embodiment.

Figure 2a is a perspective view of a second embodiment according to the invention, also intended for connecting vessels and / or grafts with mutually different diameters.

Figure 2b is a longitudinal section through this embodiment.

Figure 3 is a longitudinal section through a third embodiment intended for interconnecting vessels and / or grafts of substantially equal diameter.

Figure 4 is a longitudinal section through a fourth embodiment, also intended for interconnecting vessels and / or grafts of substantially equal diameter.

Figure 5a is a perspective view of a fifth embodiment intended to make a branch on a vessel.

Figure 5b is a longitudinal section through this embodiment.

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The device according to the invention will hereinafter be referred to as an "endovascular connector", or connector.

The embodiment of this connector shown in Figure 1a is indicated in its entirety by the reference numeral 1.

This somewhat funnel-shaped connector is designed with an insertion end 2 intended to be inserted into a blood vessel 3, which insertion end 2 merges into a body part 4 which widens from the insertion end 2, the wall of which is thinner over part 6 near the mouth 5 so that an internal shoulder 7 is formed. This shoulder 7 serves as a stop for the end edge 8 of a second vessel 9 to be inserted in the mouth 5. This connector is intended to be used for establishing an endovascular connection in which the blood flows in the direction of the arrow 10 .

The vessel 3 is secured with a ligature 11 to the spigot 2 and a circumferential groove 12 formed at the transition between the spigot 2 and the body portion 4 improves the attachment obtained with this ligature.

An annular thickening, not shown in the figure, may optionally be formed next to this groove. The embodiment shown in Figures 1a and 1b is intended to be used where the diameters of the vessels between which a connection is to be made differ.

The connector 16 according to Figs. 2a and 2b is intended to be used in the case where the blood flows from the insertion end to the other end, i.e. in the direction of the arrow 15. In these figures, parts corresponding to Figs. 1a and 1b are corresponding parts indicated by like, but accentuated, reference numerals.

In the embodiment according to Figs. 2a and 2b, the vessel 9 'is slid over the mouth 5', for which purpose the end zone 17 of the body part 4 'has a somewhat smaller diameter, so that an external shoulder 18 is created which at BHu reef; 7.

The application of the vessel 9 'serves as a stop for the end edge 8' of the latter.

The embodiment according to Figure 3 substantially corresponds to that according to Figures 1a and 1b, with the difference, however, that the diameter of the connector indicated in its entirety with the reference 20 is substantially the same over the entire length; here the insertion end 21 which is inserted into the vessel 22 is also provided with the circumferential groove 23 for locating the ligature 24, while the accommodation end 25 has a smaller diameter over a part of the length so that also here the shoulder 26 is formed forms a stop for the end edge 27 of the vessel 28 to be inserted.

This embodiment is for those applications in which the blood flows in the direction of the arrow 29.

The embodiment of figure 4 substantially corresponds to that of figure 3; corresponding parts are also indicated here with the same reference numerals, but with an accent.

This connector, denoted in its entirety by the reference numeral 30, is intended for use in the case where the blood flows in the direction of the arrow 31 and for this purpose the receptacle end 32 for the vessel 33 is formed with a portion 34 of smaller diameter so that an external shoulder 35 is formed which serves as a stop for the end 36 of the vessel 33.

The embodiment of Figures 5a and 5b is for making a branch on a blood vessel; the latter is indicated in figure 5a with reference numeral 40.

The connector, designated in its entirety by reference numeral 41, consists of a tubular part 42 with two insertion ends 43 and 44, each provided with a circumferential groove 45, respectively. 46 and a branch 47, the narrowed end 48 of which passes via the shoulder 49 into the part 47 is intended to receive the vessel 50.

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Figure 5a shows the use of this connector; a longitudinal cut 51 is formed in the vessel 40 of such a length that the tubular part 42 can be inserted therein, for example by first inserting this part and moving it completely to the right until the left end can be inserted into the vessel via the incision and the then slide to the left until branch 47 is in the center of the cut; with ligatures 52 and 53, the. connector then be tightened.

The vessel 50 is slid over the receiving end 48.

With regard to the connection between the ends of the respective connectors indicated in the figures with reference numerals 6, 17, 25, 34 and 48, it should also be noted that these vessels can be fixed with an appropriate number of sutures with the sutures can be laid so that they remain completely outside the lumen.

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Claims (7)

Device for connecting the spaces of blood vessels and / or grafts, characterized by a tubular coupling part with a first end, arranged to be inserted into the body vessel and a second end, adapted to receive the open end of the other vessel. 2. Device as claimed in claim 1, characterized in that the second end is provided with an external stop for the end edge of a vessel to be arranged over this end, which is spaced from the end edge thereof. Device according to claim 2, characterized in that this stop is formed by the stepped transition from the outer wall of the narrowed end zone to the wider outer periphery of the coupling part. 3 fc - 7 - Device as claimed in claim 1, characterized in that the second end is provided with an internal stop for the end edge of a vessel to be inserted in this end, which is spaced from the end edge thereof. Device according to claim 4, characterized in that this stop is formed by the stepped transition from the inner wall of the flared end zone to the narrower inner bore of the coupling part. 6. Device as claimed in claims 1-4, characterized in that the coupling part is provided with a tubular branch, which communicates with the space within it, intended to be inserted into, or to receive, a third vessel. Device according to claims 1-6, characterized in that a circumferential groove and / or ring is formed in the outer wall of the spigot. 87 0 0 6 6 7