RU2252719C1 - Method and device for building vascular anastomosis on aorta - Google Patents

Abstract

FIELD: medicine; medical engineering.

SUBSTANCE: device has body manufactured as cap. The cap has circular cross-section and skirt deviating aside from its edge. Radial slits are produced on the cap and skirt. The slits do not reach skirt edge and divide device body into sectors equal in size. The slits have dilated segments. Method involves setting the device in the aorta in a way that the cap is positioned inside of the aorta and the skirt is superimposed over its external surface around the opening. Auto vein edges are joined to aorta edges via the dilated segments of the device superimposed over the aorta.

EFFECT: simplified method for building anastomosis on working heart.

8 CL, 4 dwg

Description

The group of inventions relates to medical surgical equipment, and in particular to a method and device for forming proximal anastomoses of an autologous vein with an aorta without its lateral squeezing and application of vascular anastomoses of other locations in cardiovascular surgery.

Currently, such manipulations are carried out mainly by the lateral aortic squeezing method, which is not always convenient when applying proximal anastomoses to the aorta.

In addition, with lateral squeezing of the aorta with a clamp, in case of pronounced calcification, a material embolism (with calcium) is not excluded, and blood flow is started by all applied shunts simultaneously after removing the clamp from the aorta, which is not always desirable.

It is possible to impose proximal anastomoses on the aorta without its lateral extraction using a metal suture (clips) using mechanical “staples”. However, this technique has a significant drawback, consisting in the low quality of the suture, in which the risk of anastomotic thrombosis is not excluded.

As the closest analogue of the proposed device and method, the selected device and method for connecting vessels, described in A.S. SU 835430, class A 61 B 17/11, 08/13/1981.

A disadvantage of the closest analogue is that the connection of vessels in the implementation of the known method and the known device provide for connection to a vacuum system, which complicates both the method and the device intended for its implementation.

The proposed method allows to eliminate the above-mentioned disadvantages, namely: to facilitate the application of proximal anastomoses to the ascending aorta, to exclude the possibility of material embolism, to ensure the start of blood flow through shunts as they are applied, which is especially important when performing operations on a working heart, and much more.

The proposed device is convenient for use both in primary and, in particular, in repeated operations of coronary artery bypass grafting (CABG), when existing functioning shunts interfere with adequate lateral aortic extraction.

The proposed device is also suitable for applying proximal anastomoses of atypical localization, for example, to the descending aorta, including during interventions on the arteries of the lower extremities and during the application of distal anastomoses, including using artificial vessels.

The device is convenient for emergency CABG operations conducted against a background of cardiogenic shock.

The device also allows you to alter a failed superimposed proximal anastomosis without repeated lateral aortic extraction.

The above advantages of the proposed technical solution for the object “device” are implemented using the following set of features.

A device for applying a vascular, for example, proximal anastomosis to the aorta contains a body in the form of a cap with a skirt made in one piece with it and extending from its edge. Radial slots passing from the cap to the skirt are made on the cap and skirt, some ends of which are connected at one point in the center of the bottom of the cap, while others are made not reaching the edge of the skirt.

The cap at any level has a round cross section and a rounded bottom, while the skirt of the device body is located in a plane perpendicular to the axis of the cap. The cap is made tapering to the bottom.

In the portion of the cap conjugated with the skirt, and in the portion of the cap or in the portion conjugated with the cap, the slots are made widened, i.e. their edges are open. In the remaining sections of the skirt and cap, the edges of the slots are adjacent to each other. Slots divide the device case into 8-10 identical sectors in terms of area (by the number of seam stitches).

To ensure the tightness of the device during its use (sewing of the anastomosis), a hemo-insulating coating, for example, based on gelatin, is applied to the inner surface of the cap and the part of the surface of the skirt associated with it.

On the outer surface of the cap intended for contact with the aortic wall, fixing corrugations are made near the skirt, which have, for example, a wavy shape. The corrugations should prevent the cap from being ejected from the aorta under the pressure of the blood in it.

To facilitate the stitching of the vessel into the aortic wall, the device can be made of a transparent material.

The above advantages of the proposed technical solution for the object “method” are implemented using the following set of features.

The method of applying a vascular, for example, proximal anastomosis to the aorta consists in forming holes in the aortic wall, followed by placing a device in the hole, the construction of which is described in detail above. The cap of the device is inserted into the aortic lumen, and its skirt is located on the outer surface of the aortic wall around (around the circumference) of the hole. After that, using a standard atraumatic thread, the edges of the autovein are sutured with the edges of the hole formed in the aortic wall by sequentially passing the needle with the thread through the autogenous wall, a layer of gelatin, a slot in the cap, the wall of the aorta and a cut in the skirt. Then traction (tension) is carried out at both ends of the thread without finally tying it, and the remaining uncut sections of the skirt that are located between the ends of the slots and the edge of the skirt are cut (notched), and then the elements of the device formed by the notch in the form of petals (slices) are removed. When all elements of the device are removed, both ends of the thread are additionally pulled and form a knot.

The operation of applying the anastomosis to the aorta is completed.

The proposal is illustrated in the drawing, in Fig.1 which shows a device for applying a vascular anastomosis to the aorta (general view); figure 2 is a section aa in figure 1; figure 3 is a view along arrow B in figure 1; figure 4 - schematically shows the process of applying a proximal anastomosis to the aorta during CABG surgery.

1-3, the device for facilitating the connection of the proximal anastomosis with the aorta is made in the form of a transparent polymer cap 1 with a skirt 2. The surface of the cap and skirt is made with radial slots 3, one end of which is located in the center of the narrowed and rounded bottom 4 of the cap, and the other 5 does not reach the edge of the skirt by about 2-3 mm.

Slots 6 on the skirt predominantly along their entire length or on a shorter portion and the portion of the cap mating with the skirt are made wider to facilitate insertion of the needle.

The cap 1 in its middle part has a cylindrical surface, and closer to the bottom has a conical surface or can be rounded.

The skirt 2 is bent and is located transversely relative to the surface of the cap 1.

Slots 3 divide the casing of the device into 8-10 equal sectors 8 (Fig.3).

On the outer surface of the cap 1 near the skirt 2, fixing corrugations are formed, for example, in the form of wave-shaped protrusions 7 (Fig. 2).

The inner surface 9 of the cap and the surface 10 of the skirt are provided with a hemo-insulating coating (FIG. 2).

The device is characterized by the following dimensions. The height of the cap is about 10 mm, the width of its inner cavity is from 4 to 6 mm for different sizes of the holes in the aorta. The distance from the edge of the skirt to the cavity of the cap is about 6-7 mm. The lengths of the slots formed on the skirt and the widened slots on the cap are 4 mm. The width of the outer surface of the cap on which the corrugations are made is about 3-4 mm. The wall thickness of the device is 0.1-0.3 mm.

It is necessary to have several sizes of caps for holes in the aorta of different diameters.

The elastic properties of the material of the device make it possible, as shown in FIG. 4, to easily insert the cap 1 into the aortic opening 11 formed by the cutter and tightly fix it in it, since the width of the cap is greater than the width of the aortic opening. In addition, the corrugations formed outside the cap, interacting with the aortic wall, prevent it from being pushed out.

The places of possible penetration into the blood cap (in the area of the slots and especially the slots widened in width) are treated with a hemo-insulating composition that forms a film, which, due to its elasticity, is subsequently cut with a thread when removing the petals.

All this significantly reduces blood loss during surgery, creating the necessary obstructive effect.

During the implementation of the method (Fig. 4), the edges of the wall of the autovein 12 used to superimpose the proximal anastomosis on the aorta are connected by means of a standard atraumatic thread 13 with the edges of the hole formed in the wall of the aorta 11 through the expanded slots 6 formed in the device, while the edge of the autovenous is captured at a minimum distance, and the stitch on the aortic wall is made wider.

After the formation of anastomosis 12, the surgeon traces at both ends of the specified thread without tying it. The assistant cuts the jumpers on the skirt, as a result of which the elements of the device in the form of petals (lobules) lose contact with each other, and are removed one by one. After this, the surgeon additionally tightens the threads until the anastomosis is sealed and binds them.

The method is illustrated by specific examples.

Example 1

In the cardiac surgery department of the clinical hospital, CABG surgery was performed on patient B., 54 years old. Before the operation, according to ECHO-KG data, coarse aortic calcification was detected in its ascending section. When trying to apply a L-shaped clamp for lateral aortic squeezing, a crunch of calcium was heard, for fear of causing the separation of calcium masses from the aortic wall and embolism of the internal organs (brain), lateral squeezing was stopped. The only soft, calcium-free area of the aorta defined by palpation was located so that it was not possible to squeeze it with a clamp, an area of 1.5 × 2 cm, where two proximal anastomoses were applied using the proposed device. Blood flow through shunts. The patient was discharged in satisfactory condition.

Example 2

In the cardiac surgery department of the clinical hospital, CABG surgery was performed for a 60-year-old patient. 10 years ago, he underwent surgery for CABG in another medical institution. He felt good for 9 years, after a worsening of the condition, caronoventriculography was performed, which revealed the occlusion of 2 out of 4 previously applied shunts. 2 shunts functioned satisfactorily. The second operation was performed on a working heart. 2 distal anastomoses were formed. When attempting lateral aortic squeezing to apply 2 proximal anastomoses, one functioning shunt was clamped, which caused an immediate cardiac arrest. The clamp from the aorta is removed. Repeated defibrillation, cardiac activity restored. On a small area of the aorta, between the existing shunts, the cutter made 2 holes of different diameters (according to the diameter of the autovein), into which 2 proposed devices with different diameters of the caps were inserted, 2 proximal anastomoses were formed. The patient was discharged in satisfactory condition.

Claims (8)

1. A device for applying a vascular anastomosis to the aorta, comprising a body with slots, characterized in that the body is in the form of a cap with a skirt that extends from the edge of the body, while the slots are located on the cap and on the skirt, pass from the cap to the skirt and not reach the edge of the skirt, and the inner surface of the cap and part of the surface of the skirt have a hemo-insulating coating. 2. The device according to claim 1, characterized in that the cap has a circular cross section and is made tapering to the bottom, and the skirt is located in a plane perpendicular to the axis of the cap. 3. The device according to any one of claims 1 and 2, characterized in that the slots on the skirt and the portion of the cap associated with it are made widened. 4. The device according to claim 1, characterized in that the slots divide the housing into 8-10 sectors. 5. The device according to claim 1, characterized in that the hemo-insulating coating is made on the basis of gelatin. 6. The device according to claim 1, characterized in that on the outer surface of the cap near the skirt, fixing corrugations are made. 7. The device according to claim 1, characterized in that its housing is made of a transparent polymer material. 8. The method of applying a vascular anastomosis to the aorta, including the formation of an opening in the aortic wall and placement in the device opening, characterized in that the device according to any one of claims 1 to 7 is placed in the hole so that the cap of the device is located inside the aorta and its skirt is superimposed on the outer surface around the hole, then the edges of the autovein are seamed with the edges of the hole in the aortic wall by sequentially passing the filament through the autogenous wall, the cap of the cap, the aortic wall and the skirt of the skirt, after which traction at both ends of the thread, without tying it, and cut the sections of the skirt between the ends of the slots and its edge, then remove the formed elements of the device, additionally pull both ends of the thread and form a knot.

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