WO1988005290A1 - Regulation de l'irrigation sanguine du foie - Google Patents

Regulation de l'irrigation sanguine du foie Download PDF

Info

Publication number
WO1988005290A1
WO1988005290A1 PCT/AU1988/000008 AU8800008W WO8805290A1 WO 1988005290 A1 WO1988005290 A1 WO 1988005290A1 AU 8800008 W AU8800008 W AU 8800008W WO 8805290 A1 WO8805290 A1 WO 8805290A1
Authority
WO
WIPO (PCT)
Prior art keywords
shunt
flow control
blood
blood flow
control means
Prior art date
Application number
PCT/AU1988/000008
Other languages
English (en)
Inventor
Rodney James Lane
Peter Spencer
Original Assignee
Vaso Products Australia Pty. Limited
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Vaso Products Australia Pty. Limited filed Critical Vaso Products Australia Pty. Limited
Publication of WO1988005290A1 publication Critical patent/WO1988005290A1/fr

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/0004—Closure means for urethra or rectum, i.e. anti-incontinence devices or support slings against pelvic prolapse
    • A61F2/0031—Closure means for urethra or rectum, i.e. anti-incontinence devices or support slings against pelvic prolapse for constricting the lumen; Support slings for the urethra
    • A61F2/0036—Closure means for urethra or rectum, i.e. anti-incontinence devices or support slings against pelvic prolapse for constricting the lumen; Support slings for the urethra implantable
    • A61F2/004—Closure means for urethra or rectum, i.e. anti-incontinence devices or support slings against pelvic prolapse for constricting the lumen; Support slings for the urethra implantable inflatable

Definitions

  • This invention relates to the control of blood flow to the liver.
  • the vessels connected to the liver include the hepatic artery, the portal vein and the hepatic veins.
  • Normal liver tissue derives its blood supply principally from the portal vein but also to a certain extent from the hepatic artery.
  • the hepatic veins convey the blood from the liver. There are three such veins which converge towards the posterior surface of the liver and open into the inferior vena cava.
  • a portacaval shunt between the inferior vena cava and the portal vein to lower portal hypertension.
  • a difficulty with the insertion of a portacaval shunt is that the diameter of the fistula between the veins (which constitutes the shunt) largely determines the amount of portal vein decompression and the amount of blood diverted from the liver.
  • the diameter of the fistula is too large, blood can tend to flow away from the liver (retrograde flow), down the fistula from the portal vein and cause a large increase in toxins in the blood stream resulting in porta systemic (or post-operative) encephalopathy. Also, a decreased flow renders the hepatic cells ischaemic.
  • a blood flow control system for controlling the flow of blood from the portal vein to the liver, said system comprising a shunt between the portal venous drainage system and the systemic venous system, flow control means engaged with the shunt and means for actuating the flow control means so as to regulate the flow of blood through the shunt to the systemic venous system.
  • the term "portal venous drainage system" as used in this specification embraces the portal vein, the splenic vein, the mesenteric vein and any branches or tributaries of the aforementioned veins.
  • the blood flow control system of the invention could include a portacaval shunt, a mesocaval shunt, a mesorenal shunt or splenorenal shunt.
  • the shunt may be in the form of a graft (fistula) or side-to-side anastomosis.
  • the blood flow rate along the shunt can be infinitely controlled from a maximum when the flow control means does not restrict the diameter of the shunt to zero when the flow control means occludes the shunt.
  • the flow control means consists of a cuff placed around the shunt and the actuating means which is operated transcutaneously inflates the cuff to change the internal cross-sectional area of the shunt to regulate the flow between the portal venous drainage system and the systemic venous system.
  • the actuation means is a manually compressible reservoir balloon located beneath the skin but easily operated by externally applied pressure.
  • a release valve which prevents fluid back-flow into the reservoir balloon is located adjacent to the reservoir balloon and is also operated and opened by externally applied pressure.
  • the reservoir balloon is connected to the cuff around the shunt by a thin tube so that compression of the reservoir balloon causes inflation of the cuff around the shunt thereby occluding or partly occluding the shunt.
  • Activation of the release valve allows immediate reflux of the fluid into the reservoir balloon beneath the skin and deflation of the cuff inserted around the shunt.
  • the fluid is forced back into the reservoir balloon by the blood pressure acting on the cuff through the shunt and due to the suction caused by the elastic recoil force of the compressible reservoir balloon.
  • Fig. 1 is a schematic diagram of the portal venous drainage system and the systemic venous system incorporating four different shunts in accordance with the principles of the invention
  • Fig. 2 is a schematic view of a blood flow control system according to one embodiment of the invention
  • Fig. 3 is a perspective view of an implantable device for controlling the flow of blood through one of the shunts shown in Fig. 1
  • Fig. 4 is a cross-sectional view of the implantable device shown in Fig. 3.
  • the tissue of the liver Referring initially to Fig. 1, the tissue of the liver
  • the portal venous drainage system embraces the portal vein 13, the splenic vein 14 and the superior mesenteric vein 15 together with any branches or tributaries of the aforementioned veins.
  • the systemic venous system embraces the inferior vena cava 10 and the renal vein 16 leading to the kidney 12.
  • the blood flow control system of the invention includes a shunt between the portal venous drainage system and the systemic venous system which permits portal vein decompression and diversion of blood flow from the liver.
  • a shunt between the portal venous drainage system and the systemic venous system which permits portal vein decompression and diversion of blood flow from the liver.
  • four such shunts are identified: the porta caval shunt 17, the splenorenal shunt 18, the mesorenal shunt 19 and the mesocaval shunt 20.
  • the shunts could be formed by side-to-side anastomosis.
  • the schematic blood flow control system of the embodiment of the invention shown in Fig. 2 includes a porta caval shunt 17 between the portal vein 13 and the inferior vena cava 10. Flow of blood through the shunt 17 is controlled by an inflatable cuff 21 secured around the shunt 17. Inflation of the cuff 21 is effected by squeezing the deformable reservoir 22 to force fluid down the fluid line 23 to the cuff 21.
  • the cuff 21 consists of an inflatable balloon 24 mounted on a balloon connector 25- having a passageway in communication with the interior of the balloon 24 and the first fluid line 23a.
  • a strap 26 is connected by one end to the balloon connector 25 above the balloon 24 and has an aperture 27 at its other end which is passed over the fluid line 23a and the balloon connector 25 to encircle the inflatable cuff around the shunt 17 (see Fig. 4).
  • a coupling 36 connects fluid line 23a to fluid line 23b connected to the reservoir 22.
  • the reservoir 22 has a valve body 28 which defines a valve chamber as shown in Fig. 4.
  • the valve chamber has an inlet 29 and an outlet 30.
  • Within the valve chamber there is a valve seat 31 having a passageway 32 in communication with the inlet 29.
  • a support member 33 having perforations 34 supports a valve plunger 35 normally biased to close the passageway 32.
  • the valve body When the cuff 24 is to be deflated, the valve body is squeezed in the direction of arrows A whereupon the valve seat 31 is distorted away from the plunger 35 to allow the fluid to return to the reservoir 22 under the influence of the blood pressure in the shunt 17 acting on the cuff 24 and the suction caused by the elastic recoil of the reservoir 22.
  • the implantable device is made of a bio-compatible material such as Silicone.
  • Table 1 gives an outline of the patients and their treatment.

Landscapes

  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Vascular Medicine (AREA)
  • Veterinary Medicine (AREA)
  • Urology & Nephrology (AREA)
  • Public Health (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Cardiology (AREA)
  • Reproductive Health (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Transplantation (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • External Artificial Organs (AREA)

Abstract

Système de régulation de l'irrigation sanguine du foie destiné à moduler le flux sanguin provenant de la veine porte (13) qui irrigue le foie (non indiqué sur la figure), ledit système de régulation de l'irrigation sanguine comprenant un pontage (17) entre le système de drainage composé de la veine porte (13) et le système veineux général (10), un appareil régulateur de flux (21) placé sur le pontage (17) et un dispositif (22) permettant d'agir sur l'appareil de régulation de flux (21) de manière à régler le flux sanguin dans le pontage jusqu'au système veineux général (10).
PCT/AU1988/000008 1987-01-16 1988-01-15 Regulation de l'irrigation sanguine du foie WO1988005290A1 (fr)

Applications Claiming Priority (4)

Application Number Priority Date Filing Date Title
AUPH9905 1987-01-16
AU990587 1987-01-16
AU518587 1987-11-02
AUPI5185 1987-11-02

Publications (1)

Publication Number Publication Date
WO1988005290A1 true WO1988005290A1 (fr) 1988-07-28

Family

ID=25611142

Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/AU1988/000008 WO1988005290A1 (fr) 1987-01-16 1988-01-15 Regulation de l'irrigation sanguine du foie

Country Status (1)

Country Link
WO (1) WO1988005290A1 (fr)

Cited By (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP0650703A1 (fr) * 1993-07-06 1995-05-03 Antoine Jean Henri Robert Sphincter périuréthral réglable
FR2856582A1 (fr) * 2003-06-24 2004-12-31 Emmanuel Delorme Sphincter artificiel pour le traitement de l'incontinence urinaire, tant masculine que feminine
GB2545667A (en) * 2015-12-21 2017-06-28 Balatech Ltd Flow control valves
WO2019012331A1 (fr) * 2017-07-12 2019-01-17 Medical Innovation Developpement Anneau vasculaire ajustable et kit implantable comprenant un tel anneau
RU2789284C1 (ru) * 2022-07-15 2023-02-01 Федеральное государственное автономное образовательное учреждение высшего образования "Российский национальный исследовательский медицинский университет имени Н.И. Пирогова" Министерства здравоохранения Российской Федерации (ФГАОУ ВО РНИМУ им. Н.И. Пирогова Минздрава России) Способ лечения осложнений, обусловленных тотальным сбросом крови из портальной системы в нижнюю полую вену, у детей, перенесших спленоренальное шунтирование "бок-в-бок" или спленосупренальное шунтирование по поводу портальной гипертензии

Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US3744063A (en) * 1971-10-12 1973-07-10 Kendall & Co Artifical sphincter for controlling urinary incontinence
US4256093A (en) * 1978-10-12 1981-03-17 The United States Of America As Represented By The Administrator Of The National Aeronautics And Space Administration Prosthetic urinary sphincter
AU1277083A (en) * 1982-04-23 1983-10-27 United States Of America As Represented By The Administrator Of The National Aeronautics And Space Administration, The Prosthetic occlusive device
US4501263A (en) * 1982-03-31 1985-02-26 Harbuck Stanley C Method for reducing hypertension of a liver
WO1986001395A1 (fr) * 1984-09-05 1986-03-13 Intra Optics Laboratories Pty. Ltd. Regulation d'un ecoulement de sang

Patent Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US3744063A (en) * 1971-10-12 1973-07-10 Kendall & Co Artifical sphincter for controlling urinary incontinence
US4256093A (en) * 1978-10-12 1981-03-17 The United States Of America As Represented By The Administrator Of The National Aeronautics And Space Administration Prosthetic urinary sphincter
US4501263A (en) * 1982-03-31 1985-02-26 Harbuck Stanley C Method for reducing hypertension of a liver
AU1277083A (en) * 1982-04-23 1983-10-27 United States Of America As Represented By The Administrator Of The National Aeronautics And Space Administration, The Prosthetic occlusive device
WO1986001395A1 (fr) * 1984-09-05 1986-03-13 Intra Optics Laboratories Pty. Ltd. Regulation d'un ecoulement de sang

Cited By (8)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP0650703A1 (fr) * 1993-07-06 1995-05-03 Antoine Jean Henri Robert Sphincter périuréthral réglable
FR2856582A1 (fr) * 2003-06-24 2004-12-31 Emmanuel Delorme Sphincter artificiel pour le traitement de l'incontinence urinaire, tant masculine que feminine
WO2005009293A1 (fr) * 2003-06-24 2005-02-03 Emmanuel Delorme Sphincter artificiel pour le traitement de l'incontinence urinaire
GB2545667A (en) * 2015-12-21 2017-06-28 Balatech Ltd Flow control valves
WO2019012331A1 (fr) * 2017-07-12 2019-01-17 Medical Innovation Developpement Anneau vasculaire ajustable et kit implantable comprenant un tel anneau
CN111050695A (zh) * 2017-07-12 2020-04-21 医疗创新发展公司 可调节的血管环和包括该环的可植入套件
US11666340B2 (en) 2017-07-12 2023-06-06 Medical Innovation Developpement Adjustable vascular ring and implantable kit comprising such a ring
RU2789284C1 (ru) * 2022-07-15 2023-02-01 Федеральное государственное автономное образовательное учреждение высшего образования "Российский национальный исследовательский медицинский университет имени Н.И. Пирогова" Министерства здравоохранения Российской Федерации (ФГАОУ ВО РНИМУ им. Н.И. Пирогова Минздрава России) Способ лечения осложнений, обусловленных тотальным сбросом крови из портальной системы в нижнюю полую вену, у детей, перенесших спленоренальное шунтирование "бок-в-бок" или спленосупренальное шунтирование по поводу портальной гипертензии

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