RU2245109C1 - Method and device for preventing aneurysm occurrence in repairing aorta and large arteries - Google Patents

Abstract

FIELD: medicine; medical engineering.

SUBSTANCE: method involves creating central end-to-end anastomosis of blood vessel and synthetic prosthesis. Porous titanium nickelide device of 50-65% porosity and pore size of 50-200 mcm, is conducted through peripheral vascular prosthesis end. The cylindrical device is not shorter as 25 mm and has longitudinal slit. The device is set in a way that the slit and anastomosis line are overlapped with the cylinder at distance not shorter than by 5 mm and aorta segment adjacent to the prosthesis at 25 mm long distance. The longitudinal slit is arranged on blood vessel wall with slightest deviation and fixed on both sides with 2-3 sutures.

EFFECT: accelerated operation time; reduced risk of traumatic complications.

2 cl, 2 dwg

Description

The invention relates to medicine, vascular surgery and can be used in the surgical treatment of diseases of the aorta and large main arteries.

There is a method of treating aortic diseases, which consists in the fact that after stitching the prosthesis, a circular wrapping of the anastomoses is carried out with strips of synthetic tissue identical to the prosthesis used (a.s. SU 1690707 A1, A 61 B 17/12. A method for treating diseases of the descending thoracic aorta / A .V. Pokrovsky, P.O. Kazanchyan. - Notified March 21, 89. Publish. November 15, 91, Bull. No. 42). The disadvantages of the proposed method include:

1) the increase in the operation time required for cutting out strips of tissue and their thorough fixation to the anastomosis and vessel, since the tissue can curl up in the form of a tourniquet under the influence of a pulse wave;

2) the strengthened vessel is delimited by a dense synthetic material from paravasal tissues, which prevents adequate blood supply to the vessel;

3) in the distant period, the created rigid framework made of synthetic materials itself can contribute to the formation of aneurysm (the phenomenon of hydrodynamic shock at the border of an arterial vessel - a synthetic explant is not eliminated).

A new technical challenge is to reduce the number of complications, reduce the time of surgery and expand the scope.

The problem is solved by the use of a new method for the prevention of aneurysms during reconstructions of the aorta and the main arteries, which consists in conducting an aneurysmectomy and the subsequent application of an anastomosis between the vessel and the vascular prosthesis, and after the stage of applying the central anastomosis, the end of the vessel — at the end of the synthetic prosthesis, passes the device through p. 2 and set it so that the seam line of the anastomosis and the prosthesis are covered with it at a distance of at least 5 mm, and an approximate the segment of the vessel to the prosthesis is not less than 20-25 mm, while the longitudinal slot of the device is oriented to the vessel wall with the least changes, after which it is fixed on both sides with 2-3 seams.

Also, the device for the prevention of aneurysms during reconstruction of the aorta and main arteries is made in the form of a cylinder equipped with a longitudinal slot made of porous titanium nickelide with porosity of 50-65%, pore size in the range of 50-200 microns and wall thickness 400-500 microns.

The method is as follows: after completing the stage of applying a central anastomosis, the end of the vessel is at the end of the synthetic prosthesis, a device made of porous titanium nickelide is passed through the peripheral end of the vascular prosthesis. Device 1 (Fig. 1) is installed in such a way that the seam line of the anastomosis 3 and part of the prosthesis 2 are covered at a distance of at least 5 mm, and the vessel is proximal to the anastomosis 4, in a section close to the prosthesis of at least 20-25 mm. The slot line of the cylinder is oriented towards the vessel wall with the least changes. It is sufficient to fix the design to the synthetic prosthesis and the vessel with 2-3 sutures 5. The device shown in FIG. 2 represents a cylinder 1 equipped with a longitudinal slot 2, at least 25 mm long, made of porous titanium nickelide with a porosity of 50-65%, size then in the range of 50-200 microns and a wall thickness of 400-500 microns.

The device is cylindrical in shape to create the best conditions when placed on a vessel and prosthesis. The presence of a longitudinal slot allows you to increase the elastic properties necessary to suppress the pulse wave and ensure the versatility of the device when used on vessels of different diameters.

The technical characteristics of the titanium nickelide material are selected on the basis of experimental studies and are optimal for fixing on a vessel and vascular prosthesis, providing the ability to self-fix due to surface irregularities, mechanically strengthening the altered vascular wall and suture line of the anastomosis, ensuring the subsequent germination of connective tissue, vessels and nerve fibers. The properties of titanium nickelide are known: shape memory, biochemical, biomechanical compatibility with tissues, corrosion resistance, inertness (Medical materials and implants with shape memory / V.E. Gunter, Dambaev G.Ts., Sysolyatin P.G., Ziganshin R.V. . et al. - Tomsk: Publishing House of Tomsk University, 1998. - 488 p.)

The used device made of porous titanium nickelide is characterized by high elastic properties, which allows it to oscillate together with the aortic wall and good wettability - an important property that allows tissue fluid and blood to penetrate the pores with the formation of blood clots, fibrin filaments and, subsequently, form connective tissue. Vascular, nerve fibers sprout through the pores, providing adequate nutrition for the strengthened vessel. After tissue formation in the pores, the device is a functioning composite implant + tissue conglomerate. The superimposed device proximal to the suture line by 20–25 mm provides not only the mechanical strengthening of the weakened vessel wall, but also the smooth repayment of the “hydrodynamic shock” along the most loaded part of the vascular structure - the suture line. Covering the line of sutures with the site of the vascular prosthesis at a distance of at least 5 mm, provides additional mechanical reinforcement of the anastomosis.

Clinical example. Patient X., was admitted to the Department of Vascular Surgery of the Design Bureau of the city of Tomsk with a diagnosis of atherosclerosis of the abdominal aorta, arteries of the lower extremities, aneurysm of the infrarenal abdominal aorta, occlusion of the iliac arteries on both sides, chronic limb ischemia of st. Operation: median laparatomy, aneurysmectomy, bifurcation aortic femoral prosthetics. The abdominal aorta was mobilized for the operation, proximal to the aneurysm, 5 × 8 cm in size. Clamps were placed on the iliac arteries and the aorta. Aneurysm is dissected, thrombotic masses are removed, the inferior mesenteric artery flowing into the cavity of the aneurysm is obliterated. When performing intrafine bifurcation prosthetics, the posterolateral wall of the aorta erupted. The aorta is crossed proximal, its walls are thinned due to pronounced atheromatous decay, and degenerative changes extend proximal to the level of renal artery discharge. Anastomosis is laid on the end of the infrarenal aorta - at the end of the synthetic prosthesis with a 3-00 proline thread. The area of the anastomosis and the underlying segment of the aorta with degenerative changes is additionally strengthened according to the proposed method with a device made of porous titanium nickelide. The branches of the prosthesis are removed into the inguinal wounds and distal anastomoses with femoral arteries are superimposed. Wounds are sutured in layers. Restored blood flow with a distinct pulsation of arteries at all levels. The postoperative period is smooth. 10 days after the operation, abdominal radiography was performed, ultrasound duplex scanning of the abdominal aorta and vessels of n / extremities, computed tomography. During the examination after 2 years: no complaints, pulsation of the arteries of the n / a is distinct at all levels, ischemia of the fineness - 0. In dynamics, all examinations performed in the early postoperative period were performed: the device from titanium nickelide was clearly contrasted, its migration was not. There are no changes in the size of the ports both at the level and proximal to the device. The implanted porous-permeable structure into systole and diastole changes diameter up to 2.5 mm (with duplex examination).

In the clinic, the proposed method and device was used in 9 patients. The follow-up period after operations is up to 3 years. The formation of aneurysms of the anastomoses and the underlying segments of the aorta after using the described device was not detected.

Thus, the proposed method using a device made of porous titanium nickelide, in cases of a high risk of the formation of postoperative aneurysms (pronounced degenerative changes in blood vessels, repeated reconstructions, extensive deobliterations and endarterectomies), can prevent this complication by ensuring smooth repayment of the “hydrodynamic shock” line of anastomosis, adequate nutrition of the vascular wall from paravasal tissues.

Claims (2)

1. A method for the prevention of aneurysms during reconstructions of the aorta and major arteries, which consists in conducting an aneurysmectomy and subsequent application of an anastomosis between the vessel and the vascular prosthesis, characterized in that after the stage of applying the central anastomosis, the end of the vessel to the end of the synthetic prosthesis passes through the peripheral end of the vascular prosthesis a device made from porous titanium nickelide in the form of a cylinder with a slot, and set so that the prosthesis and the anastomosis line overlap them at a distance of not m it is 5 mm, and the approximate aortic segment of the prosthesis to 25 mm, and the longitudinal slot on the device oriented container wall with minimal changes, and then fixed on both sides 2-3 sutures. 2. Device for preventing aneurysms during reconstruction of the aorta and great arteries, characterized in that it is made in the form of a cylinder with a length of at least 25 mm, equipped with a longitudinal slot made of porous titanium nickelide with a porosity of 50-65%, pore size of 50-200 microns and wall thickness 400-500 microns.

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