RU2626595C1 - Instrument for forming spiral venous grafts - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: instrument has a body-tube length 272 mm and inner diameter 25 mm. The proximal and distal ends of the tube are provided with corrugated thickenings. A telescopic system of thin-walled tubes 210 mm with an outer diameter from 14 to 25 mm and with a diameter step in 1 mm. Each tube protrudes from the tube of the previous one - a larger diameter 10 mm. The protruding ends of the tubes are rated. The proximal ends of the tubes are expanded into 0.1 mm. A plug with a grooved working surface is screwed into the proximal end of the body. All parts are made of bioinert steel. The tool makes it possible to form both cylindrical and conical spiral venous grafts with a diameter from 15 to 25 mm With a diameter step in 1 mm, which corresponds to the diameter of large vessels (aorta, major arteries, upper and lower vena cava), and as a consequence, reduces the risk of stenosis, thrombosis and other Intra- and postoperative complications for the patient.

EFFECT: device allows for easy assembly and disassembly of the tool, which simplifies and improves the quality of sterilisation.

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Description

The present invention relates to medicine, namely to vascular surgery, and can be used in surgery of the aorta, large main arteries, superior and inferior vena cava, in particular for prosthetics and bypass vascular bypass surgery for aneurysms and stenosis.

In 1974, an article was published that first described the technique for the formation of spiral venous grafts ¹ . The essence of the technique is as follows: at the first stage, an autobot (external jugular, large subcutaneous, etc.) is isolated, its tributaries are ligated throughout and taken, and then the vein lumen is opened longitudinally, forming a venous “ribbon” that is spirally wrapped around a cylindrical matrix the required diameter, after which the adjacent edges of the coils are sewn with a continuous twisting seam, thereby completing the formation of a graft, which is used for prosthetics or shunting of the vessel. The authors report successful experimental prosthetics of the superior vena cava of dogs using this technique. The article also gives a formula for calculating the length of a section of a donor vein: l = R / r * L; where: l is the length of the donor vessel, R is the radius of the recipient vessel, r is the radius of the donor vessel, L is the length of the prosthetic site.

For the first time, this technique was used in clinical practice in 1976 by Doty DB, Baker WH et al. ² for the treatment of a patient with superior vena cava syndrome. They performed a roundabout shunting of the superior vena cava (the unnamed vein - the right atrium) with a spiral venous graft. The material for the graft was an autologous large saphenous vein. Later, Doty JR, Flores JH, Doty DB ³ published long-term treatment results for 23 patients. The mean follow-up period was 10.9 years (1 month - 23 years and 8 months). All patients underwent surgery and were discharged from the clinic. Three of them died during the first year, in the remaining patients on control CT studies grafts are passable and not dilated.

There is also evidence of the successful use of spiral venous grafts for prosthetics of the superficial femoral artery ⁴ , subclavian and axillary arteries ⁵ , thoracic aorta ⁶ , abdominal aorta ^7-9 , portal vein ¹⁰ , superficial femoral vein ⁴ and iliac-femoral bypass ⁴ .

This technique provides the opportunity to form a vascular prosthesis or shunt of the required diameter, using the patient’s own tissues. This allows you to achieve an exact match between the diameters of the prosthesis and the prosthetic vessel. In addition, in some cases, for example, in the treatment of infected aneurysms ^7–9 , vascular injuries ⁴ and infection of vascular prostheses ^4,6 , the use of autologous tissues demonstrates better treatment results compared to synthetic prostheses.

As a matrix for the formation of spiral venous grafts using:

1. Double-lumen venous cannula for heart-lung machine ¹¹ , which is a hollow tube, with an outer diameter of from 8 to 17 mm;

2. Thoracic drainage tube ² with an outer diameter of 6.7 to 11.3 mm;

3. Bougie (expanders, dilators) Geghara ⁵ - a set of medical instruments for expanding tubular organs, which are a metal rod of different outer diameters from 1.5 to 15 mm with a gradual increase in diameter by 0.33-0.66 mm.

The applicants did not identify tools designed to solve the tasks set in this application, since all of the above devices have a number of disadvantages. Firstly, the diameter of large vessels, such as the aorta, the superior and inferior vena cava, can normally reach 25 mm, and none of these devices can form a spiral venous graft of this diameter. The diameter of the graft formed on these analogues may not correspond to the prosthetic vessel, which increases the likelihood of stenosis in the area of the anastomosis and, as a result, leads to ischemia of distally located organs and tissues. Secondly, when prosthetics of a large part of a vessel, it is preferable to use a cone-shaped prosthesis for a more accurate comparison of the prosthetic vessel with a prosthesis in the proximal and distal anastomoses, which is impossible when using the above devices. When a cylindrical graft is formed with a diameter equal to the proximal end of the vessel, an excess of the diameter of the spiral structure is inevitable in the region of the distal anastomosis, as a result of which, when two ends are sutured, festoons and pockets are formed, through which blood leakage and the formation of parietal blood clots are possible. As a result, the risk of developing dissection of the aortic wall and its thrombosis increases.

Tasks:

1. To expand the ability of the tool to perform grafts of any diameter;

2. To create the possibility of the formation of conical spiral venous grafts;

3. Create the usability of the tool;

4. Reduce intra- and postoperative complications.

SUMMARY OF THE INVENTION

A tool for forming spiral venous grafts, characterized in that it has a body - a tube 272 mm long and an inner diameter of 25 mm, the proximal and distal ends of which are equipped with corrugated thickenings; a telescopic system of thin-walled tubes with a length of 210 mm with an outer diameter of 14 to 25 mm and a pitch of 1 mm is mounted in the housing, with each tube protruding from the tube of the previous, larger diameter by 10 mm, the protruding ends of the tubes are tariffed, and the proximal ones are flared 0.1 mm; a plug with a corrugated working surface is screwed into the proximal end of the body, all parts are made of bioinert steel.

The technical result is: the ability to form both cylindrical and cone-shaped spiral venous grafts with a diameter of 15 to 25 mm with a pitch of 1 mm in diameter, which corresponds to the diameters of large vessels (aorta, large major arteries, superior and inferior vena cava), and, as consequence, a decrease in the risk of developing stenosis, thrombosis and other intra- and postoperative complications for the patient. Also, the device allows you to easily assemble and disassemble the instrument, which simplifies and improves the quality of sterilization.

The device for a better understanding is schematically shown in figure 1, where 1 is the body, 2 is the proximal end of the body, 3 is a plug with a grooved surface, 4 is the distal end of the body, 5 is a system of thin-walled tubes with a diameter of 14-25 mm, respectively, 6 is a shank with corrugated surface.

The device is used as follows: after the autovein has been taken and the diameters of the proximal and distal ends of the prosthetic section of the vessel have been determined, the tube of the required diameter is pulled out, pulling the protruding end of the tube. If you want to form a spiral venous graft of constant diameter (for example, 21 mm throughout), then use only one tube (5) of the desired diameter. If it is necessary to form a cylindrical spiral venous graft (for example, a proximal diameter of 21 mm, a distal one - 19 mm), then it is necessary to alternately place one after the other tubes (5) (with a diameter of 21 mm, then 20 mm and 19 mm) to the required length ( depending on the length of the prosthetic section of the vessel). After that, the venous “tape” is spirally wound onto the tube (s) (5) and its edges adjacent to each other are sutured with a continuous twisting seam. The formed venous graft is removed from the instrument in the distal direction. To sterilize the instrument, unscrew the plug (3) and remove all tubes (5). After sterilization, the instrument is assembled in the reverse order. The housing (1) accommodates a system of thin-walled tubes (5) and is attached to the stand. A shank (6) is also required to secure the tool to the stand. The corrugation at the plug (3), proximal (2) and distal (4) ends of the body prevents hands from slipping when the plug is loosened.

Example

Patient M. was admitted to the Department of Vascular Surgery GBUZ "Research Institute-KKB No. 1 named after prof. S.V. Ochapovsky ", Krasnodar, with complaints of fever t ° = 37.5-38.7 ° C, persisting for a week, progressive pain in the abdomen. A history of transferred linear prosthetics of the infrarenal aorta regarding aortic aneurysm (type II according to A.V. Pokrovsky's classification). Objectively: arterial pressure 105/50 mm Hg, heart rate 107 beats per minute, negative symptoms of peritoneal irritation and the symptom of thrashing. Laboratory indicators: hemoglobin - 52 g / l, white blood cells - 14.3 * 10 ⁹ / l. When computed tomographic examination with intravenous contrasting, foci of para-prosthetic infiltration were identified. A decision was made about an emergency operation, during which the infected prosthesis was resected and the adjacent sections of the aorta, the retroperitoneal space was reconstructed, and the resected section of the aorta was re-prosthetized with a cone-shaped spiral graft (the proximal diameter of the graft is 18 mm, the distal is 16 mm), formed with using the proposed tool for the formation of spiral venous grafts. After 11 days, the patient was discharged in satisfactory condition. After 4 months, on a control computed tomography study with intravenous contrasting, the absence of paraprosthetic infiltrates was noted, the spiral venous graft was passable, hermetic, and not stenotic.

Bibliography

1. Chiu C. J., Terzis J., MacRae M. L. Replacement of superior vena cava with the spiral composite vein graft. A versatile technique. Ann Thorac Surg. 1974 Jun; 17 (6): 555-60.

2. Doty D.B., Baker W.H. Bypass of superior vena cava with spiral vein graft. Ann Thorac Surg. 1976 Nov; 22 (5): 490-3.

3. Doty J.R., Flores J.H., Doty D.B. Superior vena cava obstruction: bypass using spiral vein graft. Ann Thorac Surg. 1999 Apr; 67 (4): 1111-6.

4. Fowl R.J., Martin K.D., Sax H.C., Kempczinski R.F. Use of autologous spiral vein grafts for vascular reconstructions in contaminated fields. J Vase Surg 1988; 8: 442-6.

5. Koga Y., Tomita M., Shibata K., Onitsuka T. An experience using spiral vein graft as arterial substitute. Jpn J Surg 1981; 11: 305-9.

6. Palma J.H., Gomes W.J., Almeida D.R., Carvalho A.C., Brasil L.A., Buffolo E. Replacement of infected thoracic aortic prosthesis with a spiral composite vein graft. Ann Thorac Surg. 1998 Apr; 65 (4): 1135-7.

7. Heikens J.T., Coveliers H.M., Burger D.H., van Berge Henegouwen D.P., Vriens P.W. Saphenous vein spiral graft: successful emergency repair of a mycotic aneurysm with aortoduodenal fistula. Eur J Vase Endovasc Surg 32, 408-410 (2006).

8. Aerts P.D., van Zitteren M., Van Kasteren M.E., Buiting A.G., Heyligers J.M., Vriens P.W. Report of two in situ reconstructions with a saphenous spiral vein graft of Coxiella burnetii-infected aneurysms of the abdominal aorta. J Vase Surg. 2013 Jan; 57 (1): 234-7. doi: 10.1016 / j.jvs.2012.08.08.042. Epub 2012 Nov 20.

9. van Zitteren M., van der Steenhoven T.J., Burger D.H., van Berge Henegouwen D.P., Heyligers J.M., Vriens P.W. Spiral vein reconstruction of the infected abdominal aorta using the greater saphenous vein: preliminary results of the Tilburg experience. Eur J Vase Endovasc Surg. 2011 May; 41 (5): 637-46. doi: 10.1016 / j.ejvs.2011.01.0.020. Epub 2011 Mar 4.

10. Chiu K.M., Chu S.H., Chen J.S., Li S.J., Chan C.Y., Chen K.S. Spiral saphenous vein graft for portal vein reconstruction in pancreatic cancer surgery. Vase Endovascular Surg. 2007 Apr-May; 41 (2): 149-52

11. Thourani V., Long S., Chen E. Spiral vein graft for SVC stenosis. http://www.ctsnet.org/article/spiral-vein-graft-svc-stenosis

Claims (1)

A tool for forming spiral venous grafts containing a body, characterized in that it is made of bioinert steel and includes a telescopic system of tubes mounted in the body 210 mm long with an outer diameter of 14 to 25 mm and with a diameter pitch of 1 mm, each tube protruding from the tube of the previous one — larger diameter by 10 mm, the protruding ends of the tubes are tariffed, and the proximal ends of the tubes are 0.1 mm apart, while the casing is made in the form of a tube 272 mm long and an inner diameter of 25 mm, equipped with corrugations thickening at the proximal end, a corrugated bead at a distal end and a plug with a corrugated working surface, is screwed into the proximal end.

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