Surgery – Instruments – Surgical mesh – connector – clip – clamp or band
Reexamination Certificate
2001-10-16
2004-06-08
Milano, Michael J. (Department: 3731)
Surgery
Instruments
Surgical mesh, connector, clip, clamp or band
C606S140000
Reexamination Certificate
active
06746459
ABSTRACT:
BACKGROUND OF THE INVENTION
1. Field of the Invention
The present invention relates to a method of anastomosis of blood vessels, more particularly to a method of an end-to-side anastomosis of an end portion of one blood vessel to a side portion of another blood vessel and instruments used for this anastomosis method. Also, the present invention relates to a method of connection of a medical device constituting an extracorporeal circulation circuit, such as a pump-oxygenator, a dialyser for blood or body fluid, at a side portion of a blood vessel.
2. Description of the Related Art
In operations, an end-to-side anastomosis by connection of an end portion of a blood vessel with a side portion of another blood vessel to communicate the blood vessels with each other is sometimes carried out. For example, in coronary artery bypass graft (CABG) for the therapy of angina pectoris, cardiac infarction, arrythmia and so forth caused by insufficient circulation to the cardiac muscle due to the constriction of coronary artery, an end portion of internal thoracic artery or great saphenous vein, for example, is anastomosed (connected) to a side portion of coronary artery on its peripheral side with respect to the constricted site.
The end-to-side blood vessel anastomosis method is carried out usually by partially dissecting a side portion of one blood vessel to form an opening having a peripheral portion and suturing the peripheral portion with an end portion of another blood vessel with a needle and a suture. Such a technique requires a considerably high level skill. In particular, anastomosis of coronary artery bypass graft, which is carried out on blood vessels that are very thin and under a narrow field of vision, is very difficult to carry out.
In end-to-side anastomosis method for blood vessels, it is particularly important to maintain the opening formed on the side portion of one blood vessel to have a sufficient size for it to be anastomosed with the end portion of another blood vessel when the blood vessels are sutured with each other. In this respect, a conventional method as disclosed in U.S. Pat. No. 2,453,056 has been carried out as follows. That is, the peripheral portion of the opening attached to the side portion of a blood vessel is clipped with a plurality of tweezers to retain the opening at the side portion of the blood vessel in an expanded state sufficient for the end portion of another blood vessel to be anastomosed thereto and then the peripheral portion of the opening at the side portion of one blood vessel and the end portion of another blood vessel are connected to each other. However, the blood vessel of which anastomosis is needed usually is hardened and very brittle because of calcification or the like so that there is the fear that the blood vessel when clipped with tweezers or the like could be torn at the dissected portion.
Also, coronary artery bypass graft has been conventionally carried out in a cardiac arrest state using a pump-oxygenator. However, use of a pump-oxygenator gives much stress on patients. Accordingly, in recent years, low stress coronary artery bypass graft carried out in a state where the heart beats (under heart beating) (hereinafter referred to as “bypass graft under heart beating”) has been carried out in order to alleviate load to the body of a patient, shorten the time required for curing and reduce medical expenses to be paid by the patient.
In the bypass graft under heart beating, the surface of the heart moves due to the heartbeat, which makes the blood vessel anastomosis more difficult.
In this regard, a method of connection between a peripheral portion of an opening at the side portion of one blood vessel and an end portion of another blood vessel by using a special instrument is disclosed in U.S. Pat. No. 4,787,386, for example. The special instrument has an annular shape provided with an opening in the center with a plurality of protrusions provided on an outer periphery of the annular portion. The protrusion of the instrument are pierced into the peripheral portion of the opening attached to the side portion of one blood vessel to retain the opening at the side portion of the blood vessel in an expanded state having a desired size. Then, the peripheral portion of the opening at the side portion of the blood vessel is connected to the end portion of another blood vessel.
However, in this connection method, it is necessary to retain the opening of a blood vessel in an expanded state with the tweezers or the like so as to have a sufficient size for the attachment of the instrument when the protrusions of the instrument thereto are pierced into the peripheral portion of the opening. This procedure itself is difficult as described above. Also, after the anastomosis, the protrusions of the instrument exist exposed in the passage of blood in the blood vessel. When they are in contact with the blood flow, they are recognized as foreign matter, leading to the possibility of thrombus formation.
SUMMARY OF THE INVENTION
An object of the present invention is to provide a method of end-to-side anastomosis of blood vessel that facilitates expansion of an opening provided on a side portion of a blood vessel to a desired size and enables retention of the opening in that state when a blood vessel is subjected to end-to-side anastomosis, and in which no foreign matter is present in the passage of blood in the blood vessel after completion of anastomosis.
Another object of the present invention is to provide an instrument for use in the method of end-to-side blood vessel anastomosis and more particularly to provide a blood vessel connecting instrument, a blood vessel supporting instrument or a surgical instrument.
Still another object of the present invention is to provide a method of connection of a medical device constituting an extracorporeal circulation circuit, such as a pump-oxygenator, a dialyser for blood or body fluid, with a side portion of a blood vessel.
The above objects have been achieved by the following items (1) to (34) according to the present invention.
(1) A method of end-to-side anastomosis of blood vessels for connecting a side portion of a first blood vessel to an end portion of a second blood vessel, comprising the steps of:
holding a first site on the side portion of the first blood vessel located in the vicinity of a peripheral portion of an opening formed on the side portion of the first blood vessel using a holder, and partially elevating the side portion of the first blood vessel;
superimposing a second site on the side portion of the first blood vessel that is more distant from the peripheral portion of the opening formed on the side portion of the first blood vessel than that from the first site and the end portion of the second blood vessel on each other and fixing them with a ring-shaped fixing member to each other; and
detaching the holder from the first blood vessel when they are fixed using the fixing member or after they are fixed.
(2) A blood vessel connecting instrument for connecting to an opening formed on a side portion of a first blood vessel an end portion of a second blood vessel, comprising:
at least one engaging member having an engaging portion for enabling engagement in the vicinity of a peripheral portion of an opening formed on the first blood vessel from inside thereof; and
a holding means for holding the state of engagement of the engaging portion in the vicinity of the peripheral portion of the opening in the first blood vessel.
(3) A blood vessel connecting instrument according to the item (2) above, wherein the holding means is a holding member having a clipping portion that can clip a part of the first blood vessel in the vicinity of the opening in the first blood vessel between it and the engaging portion.
(4) A blood vessel connecting instrument according to the item (2) or (3) above, wherein the engaging member is arranged in the holding member movable in a longitudinal direction thereof.
(5) A blood vessel connecting instrument according to any one of the items (2) to (4) above, compr
Burns Doane Swecker & Mathis L.L.P.
Milano Michael J.
Pantuck Bradford C
Terumo Kabushiki Kaisha
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