WO2014170512A1 - Method and device for suturing blood vessels - Google Patents

Method and device for suturing blood vessels Download PDF

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Publication number
WO2014170512A1
WO2014170512A1 PCT/ES2014/070136 ES2014070136W WO2014170512A1 WO 2014170512 A1 WO2014170512 A1 WO 2014170512A1 ES 2014070136 W ES2014070136 W ES 2014070136W WO 2014170512 A1 WO2014170512 A1 WO 2014170512A1
Authority
WO
WIPO (PCT)
Prior art keywords
device
suture
blood vessels
blood
suturing
Prior art date
Application number
PCT/ES2014/070136
Other languages
Spanish (es)
French (fr)
Inventor
Andrés MARTÍNEZ GARRIDO
Original Assignee
Martínez Garrido Andrés
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
Priority to ES201330541A priority Critical patent/ES2522941B1/en
Priority to ESP201330541 priority
Application filed by Martínez Garrido Andrés filed Critical Martínez Garrido Andrés
Publication of WO2014170512A1 publication Critical patent/WO2014170512A1/en

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Classifications

    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/11Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/11Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
    • A61B2017/1107Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis for blood vessels
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/11Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
    • A61B2017/1132End-to-end connections

Abstract

The invention relates to a method and a device for suturing blood vessels, taking two ends of the blood vessel to be sutured, said device having an annular form which adjusts to the diameter of the end of the blood vessel that has a larger diameter. Said device also has at least two through-openings on the side faces thereof through which the corresponding suture points are passed in such a way that the side faces of the device are attached to the inner surface of the endothelium of the blood vessels.

Description

METHOD AND DEVICE FOR BLOOD VESSELS Suture

Object of the Invention The present invention describes a method and a device for suturing blood vessels. The method and device described herein are intermediate between the stapling and the traditional manual suturing. This novel invention ensures that no transfixing points given (points catch the rear wall of the blood vessel), which is the main problem of the traditional suturing manually and moreover, can be used in all types of blood vessels, which is the stapling limitation. More particularly it relates to a method and a device for use in surgical procedures.

The present invention relates to the field of biomedical engineering and biomedicine. Background

Vascular microsurgery is an art recognized worldwide, which is the union of two vascular ends, in order to re-establish vascular flow through these. Considering the blood vessels (veins and arteries and lymph vessels), such as pipes, it would be to splice two ends to pass blood inside. This technique is known as anastomosis.

The anastomosis of large vessels such as the renal vessels in kidney transplants, or liver transplants in homonyms, are difficult and fine technique. In the case of small vessels also it requires the use of optical systems magnification, which adds complexity and technical difficulty case. Examples anastomosis smaller caliber vessels, would be reimplants members or maxillofacial reconstruction cancer. The main problem in these cases lies in simply prevent the suture vessel clogging and prevent the passage of blood (thrombus). In these cases, graft loss occurs in almost all cases with serious damage this entails. Sometimes the suture has permeability problems that may appear at the time of suturing or deferred occur almost always so that the aggregation and coagulation systems produce a thrombus. The occurrence of delayed thrombosis suture is associated with the existence of a blood flow it is not constant and laminar (sudden changes in blood pressure) or that turbulence occurs in the flow (discrepancy in the size of the vessels ), or because the technique is not sufficiently purified.

Handsewn in expert hands has proven to be a reliable technique with over 90% success rate in almost all series of scientific papers. However, it lacks sufficient reliability at the beginning of the learning curve and it is sometimes difficult when the glass quality is not good.

Therefore, attempts have been searching for the ideal mechanical suture. 1842495 describes EP method and device most currently employed in the prior art. Commercially it is known as GEM Coupler® of Synovis house). It is used especially in venous sutures, requiring a certain elasticity of the vessel wall. It is a fixture where the vessel wall is passed into a ring with spikes, and standing out fixing in these and everting the endothelium. At the other extreme we proceed similarly and then both rings are closed by a closing system. The problem is that this is a complex technique, especially in more consistent walls, like those of the arteries. In addition it requires an instrument specifically designed for placement of the vessel in the ring. Enhancers other prior art are for example those shown in ES2346144 patent documents, WO2011042508 and US4055186. Specifically, the device shown in ES2346144 relates to a device for the surgical joining of two tubular structures where said device comprises two rings are inserted into each of the tubular structures, adjusting its perimeter, and subsequently closed by a mechanism pressure . The problems associated with this type of inventions is similar to that mentioned for the GEM Coupler®.

The invention described in WO2011042508 relates to a suture ring having a plurality of spikes on both sides which once introduced into the blood vessel is attached to the two ends of the joining them vessels. Such inventions show a pressure fixing type that is unreliable in terms of durability and also results in an obstacle to the passage of fluids which can lead to the appearance of thrombi.

The invention shown in US4055186 shows an anastomosis button that has two elements axially coupled complementary fastening. Said fastening elements are introduced into the interior of the two vessel sections to be sutured so greatly affect the passage section of the vessel favoring thrombi again.

DESCRIPTION OF THE INVENTION

A first object of the present invention is a suturing device of blood vessels, where it has two ends of the blood vessel to be sutured and wherein said device has a ring that fits the diameter of the end of larger diameter form. Also it has at least two through holes in their sides through which are passed the corresponding stitches so that the lateral faces fixing the device to the inner face of the endothelium of blood vessels.

Without being a mechanical suturing, the suturing device object of the present invention facilitates vascular suture. It is a compromise between mechanical and traditional suture. Guaranteed not transfixing points, which is the main problem of manual suturing exist, and moreover, can be used in all types of vessels.

Furthermore it is a suturing device that does not require a specific tool for placement but can be perfectly manipulated by the practitioner in a simple manner, which reduces the cost thereof and surgery.

In a particular embodiment of the invention, the device is made from a compatible material biochemically substances with which it is in contact, for example, muscle, blood and other body fluids and tissues. In another more particular embodiment, the device is made of stainless steel.

In another particular embodiment of the invention, the through holes have a diameter that fits the thickness of the suture needle. This thickness should be slightly larger than the diameter of the needle so that it can pass through it without difficulty.

In a particular embodiment of the invention the suturing device is manufactured in diameters to match the diameters of the most common blood vessels, especially between 1 and 4 mm. In other particular embodiments of the invention, a device 2mm diameter could be placed through holes 6. In 3mm and 4mm devices would consist of eight holes. Also in either case, the thickness of the device may be between 1 and 2 microns. is also provided use of the device described herein for suturing blood vessels of larger caliber such as the coronary arteries, the aorta, vena cava or the renal arteries without further to adapt the device dimensions to the diameter of the blood vessel suture. Obviously suturing a glass of greater diameter have a involve suturing device larger diameter and present a greater number of through holes so that the suture is reliable.

In a more general embodiment of the suture ring, it has at least two holes for passing the traditional point of 8 zeros. A second object of the present invention is a method of suturing blood vessels, more specifically the suture is between a first and a second end of a blood vessel, making use of the device said method described above. The method comprises the following steps: - placing the device in proximity to the first and second out of the blood vessel to be sutured;

- suturing by a plurality of stitches, each stitch is passed from outside in the first place the blood vessel, through one of the holes of the suturing device and inside out by the second out of the blood vessel. Note that usually employ a single stitch for each hole suturing device but there may be applications in which some of said holes are not sutured or that use more than one suture for each hole in order to ensure suture; Y,

- tie each stitch securing the union of both ends with the interposition of the suturing device. Thus, the endothelia of both ends are in contact with the suturing device thus avoiding the adventitia is introduced into the vessel lumen causing the appearance of the thrombus.

Note that when we speak of the suture of a first and a second blood out is not restricting the invention to terminal junctions but also provided for use in sutures end-side. For this type of connections the method is identical for the case of terminal connections although they are technically complex for the surgeon in charge. Thus it is provided the use of the present invention and terminal end-side sutures being the technical stage of this second type of more complex than the first suture. In a particular embodiment of the method, positioning the suturing device in proximity to the ends of the blood vessel phase is performed by a loop of silk of a size that allows to handle the device easily by the practitioner such as a loop of silk four zeros.

In another particular embodiment of the method, as a preliminary to placement of the device in suture proximity to the ends of the vessel comprises removing the adventitia of the blood vessel ends. It has also been foreseen that the suturing device described herein can be employed for suturing anatomical conduits which are not exclusively blood vessels. Examples of such conduits are intestinal loops or urethra. Such passages allow be sutured more easily blood vessels no longer generating thrombi and therefore the problems associated with the introduction of endothelium within the vessel lumen does not exist. However, this device allows the correct suture any type of anatomical conduit simply adapting the dimensions of said device to the ducts which are to be sutured.

DESCRIPTION OF FIGURES

Figure 1 shows a general view of the device of the present invention just before being attached to the two ends of the vessel to be sutured.

Figure 2 shows a view of the device shown in Figure 1 once already joined to both ends of the vessel and thus on the suture.

EXEMPLARY EMBODIMENTS

Then they performed, with an illustrative and nonlimiting character, a description of various embodiments of the invention with reference to the numbering adopted in the figures.

Figure 1 shows an embodiment of the device of the present invention at the time to be suturing of a first place (2) and a second place (3) of a blood vessel. Specifically shows a suture ring (1) with a minimum diameter of 1 mm which matches the diameter of the largest vessel. Note that the ring (1) must have a diameter that fits in each case to the diameter of the largest blood vessel which are to be sutured and also both blood vessels must have a similar dimeter because if submit very unequal diameters blood passing the suture zone can enter turbulence generated thrombi. It is obvious therefore that rings are provided whose diameters conform to the diameters of the existing blood vessels in humans and animals and the suture is place between vessels not necessarily identical diameters but like.

The ring (1) is manufactured in the most common sizes of vessel lumen, ie, between 1 to 4 mm, at intervals of 1 mm. The thickness should be thin, but enough to have rigidity and accommodate the passage openings point.

The ring (1) shown has holes (4) passing along the perimeter, in this case eight, for the passage of traditional stitches (5) of 8 zeros. Note that the type of stitch used in each case depend on the surgical requirements and the size of the ring (1) and therefore the present invention is not limited to a specific point type suture.

The two ends (2,3) of the blood vessel to be sutured been previously manipulated to remove the adventitia (6) exposing the muscle layer adjacent to endothelium (7). Although suturing method that uses the suture ring (1) object of the invention is provided that the adventitia (6) always remains on the outer face of the suture whether previously or removed, if disposed about millimeters therefrom in the suture, it ensures that in any way it is introduced into the vessel lumen causing thrombi.

With this arrangement it is achieved that the endothelium (7) is covering the ring (1) and the adventitia (outer layer) is not inserted into the lumen (inner tunnel of the vessel, where it circulates the blood). Although the ring (1) must have a minimum thickness, the current manufacturing technology suture needles enables the manufacture of needles 12 zeros. The holes (4) of the ring (1) must have a diameter that enables insertion of the needle suture (8).

The ring must be of a suitable diameter and never less than the diameter of the vascular strands thus induce the intrusion of the adventitia, and it would be disastrous. Conversely, if the ring is slightly greater, which is recommended, and evertería extruiría endothelium providing security to the suture.

As the material of manufacture of the ring, this may be the same as suture needles, which is none other than stainless steel.

To facilitate positioning in the surgical field of a device such small dimensions, should be administered with a silk lacing four zeros, which allow its position prior to handling service. Figure 2 shows how the suture is once the ring (1) fixed to the two ends (2,3) of the blood vessel. For this, each stitch (5) is passed from outside to inside of a first place (2) of the vessel, it is subsequently passed through one of the through holes (4) of the ring (1) and finally is removed from the inside out in the second place (3) of the blood vessel. Then knotted at the end portion of the vessel closing the suture.

The vessel wall has three layers: the intima or endothelium (9), which is in contact with the blood and does not induce clotting as is logical. Muscle (7) which it is the intermediate layer and the outer layer or "sheath" (6) is termed adventitia. If poor technique adventitia is introduced into the vessel lumen, it is very inducing thrombus, so usually removed in vascular mm ropes as shown in Figures 1 and 2.

Claims

What is claimed
1. - Device suture (1) of blood vessels characterized by comprising - having an annular fits the diameter of a blood vessel out of the larger diameter of the blood vessels to be sutured form;
- have at least two holes (4) passing on their side faces through which are passed stitches (5) clamping the side faces of the device to the inner surface of the endothelium (9) of blood vessels.
2. - Device suture (1) of blood vessels, according to claim 1, characterized in that it is made of a biochemically compatible material.
3. - Device suture (1) blood vessel according to claim 2, characterized in that it is made of stainless steel.
4. - Device suture (1) blood vessel according to claim 1, wherein the at least two holes (4) passing a diameter that fits the thickness of the suture needle (8).
PCT/ES2014/070136 2013-04-16 2014-02-24 Method and device for suturing blood vessels WO2014170512A1 (en)

Priority Applications (2)

Application Number Priority Date Filing Date Title
ES201330541A ES2522941B1 (en) 2013-04-16 2013-04-16 Method and device suture blood vessels
ESP201330541 2013-04-16

Publications (1)

Publication Number Publication Date
WO2014170512A1 true WO2014170512A1 (en) 2014-10-23

Family

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Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/ES2014/070136 WO2014170512A1 (en) 2013-04-16 2014-02-24 Method and device for suturing blood vessels

Country Status (2)

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ES (1) ES2522941B1 (en)
WO (1) WO2014170512A1 (en)

Citations (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US3254651A (en) * 1962-09-12 1966-06-07 Babies Hospital Surgical anastomosis methods and devices
US3254650A (en) * 1962-03-19 1966-06-07 Michael B Collito Surgical anastomosis methods and devices
US3974835A (en) * 1972-11-30 1976-08-17 Hardy Jr Thomas G Anastomotic apparatus and method
US4553542A (en) * 1982-02-18 1985-11-19 Schenck Robert R Methods and apparatus for joining anatomical structures
WO2000025679A1 (en) * 1998-11-04 2000-05-11 Karamuersel Sebat Rigid circular implant that is used as an external stent in vascular anastomoses
US20070185507A1 (en) * 2005-04-22 2007-08-09 Helmut Schreiber Surgical marker/connector and method of installation

Patent Citations (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US3254650A (en) * 1962-03-19 1966-06-07 Michael B Collito Surgical anastomosis methods and devices
US3254651A (en) * 1962-09-12 1966-06-07 Babies Hospital Surgical anastomosis methods and devices
US3974835A (en) * 1972-11-30 1976-08-17 Hardy Jr Thomas G Anastomotic apparatus and method
US4553542A (en) * 1982-02-18 1985-11-19 Schenck Robert R Methods and apparatus for joining anatomical structures
WO2000025679A1 (en) * 1998-11-04 2000-05-11 Karamuersel Sebat Rigid circular implant that is used as an external stent in vascular anastomoses
US20070185507A1 (en) * 2005-04-22 2007-08-09 Helmut Schreiber Surgical marker/connector and method of installation

Also Published As

Publication number Publication date
ES2522941A1 (en) 2014-11-19
ES2522941B1 (en) 2015-09-08

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