JP2798173B2 - Bifurcated vascular graft - Google Patents

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a branch artificial blood vessel,
In particular, it relates to an improved bifurcated vascular graft used to replace lesions in the aortic arch.

[0002]

2. Description of the Related Art Blood pumped from the heart is pumped through the aortic valve of the heart and guided to the whole body through the aorta. The aorta ascends to the right behind the pulmonary trunk and enters the ascending aorta, which forms an arc (this portion is called the aortic arch) and moves posteriorly past the left pulmonary root. It passes immediately to the left of the thoracic vertebra, then to the descending aorta, which runs down the front of the spine, and to the arteries throughout the body. (See Fig. 1) This aortic arch is the main part that sends blood to the whole body. The branch of this part is the common carotid artery (two right and left) leading to the head and the subclavian artery (two right and left) leading to the arm. Branch to In a living body, there are three direct branches from the aortic arch. When a lesion occurs in the vicinity of the bifurcation, treatment is performed by replacing the bifurcation of the intricately bifurcated living blood vessel with an artificial blood vessel. At this time, a blood vessel that matches the biological structure is considered to be good.

[0003] In an operation using an artificial blood vessel, it is important to secure circulating blood throughout the patient in order to maintain the life of the patient during the operation. If this is insufficient, the patient's life cannot be sustained intraoperatively, with serious consequences. Particularly in the replacement of arteries, especially the aorta, it is particularly important to ensure circulating blood flow, since the aorta is the starting point for blood circulation throughout the body. This securing of circulating blood can be broadly divided into two. One is securing blood flow to the head and the brain, and the other is securing blood flow to the whole body below the neck.

Conventionally, in an operation for replacing a lesion in the aorta, it is necessary to cut off blood flow around the lesion, so that blood flow to the brain and blood flow to the whole body below the neck are secured. Is to separately collect the blood clapping from the patient's heart, create a separate blood circuit using a pump, and resect the lesion while securing blood flow to the brain and the whole body. A method has been adopted in which an artificial blood vessel is replaced and anastomosis is performed, and when the replacement is completed, the blood circuit used so far is removed. This is because, in a narrow surgical field, performing a procedure using a cannula or a tube while securing blood flow is quite impossible in terms of space, and often hinders the execution of an anastomosis. It was a problem.

The inventor of the present invention has been studying a method for securing blood flow circulation to the brain by using an improved artificial blood vessel for interpreting this problem. In order to realize this function, we will introduce a new surgical technique by adding a unique improvement to the artificial blood vessel with a side tube for aortic replacement and adding a new side tube for blood introduction. In addition, a new artificial blood vessel for aortic replacement for the purpose has been found, and the present invention has been achieved.

[0006]

FIG. 2 shows an example of replacement of an artificial blood vessel using an aortic aneurysm as an example. The practitioner excises the lesion of the living blood vessel, stitches the artificial blood vessel, replaces the lesion with the artificial blood vessel, and completes the operation. On the other hand, when the lesion further extends to the bifurcation, that is, as shown in FIG. 3, if a pre-branched artificial blood vessel can be obtained, the power of the operation can be reduced and the operation time can be shortened. Thoracotomy is extremely dangerous, and even a highly skilled practitioner can exert an outstanding effect on this kind of surgery, which is extremely difficult. The present invention further improves this, and performs a branch artificial blood vessel having a function of securing blood flow to the brain at the time of interrupting blood flow by forceps of a host blood vessel at the time of replacement surgery. To provide.

[0007] As shown in FIGS. 2 and 3, the branch vascular prosthesis replaces the lesion and normalizes the blood flow. The lesion and post-operative condition are now easily understood. The present invention provides a bifurcated vascular prosthesis having means for providing a function of ensuring blood flow that has been cut off during surgery, in addition to the function of simply providing a replacement material for a lesion, to the bifurcated vascular prosthesis.

[0008]

SUMMARY OF THE INVENTION The present invention is a bifurcated vascular prosthesis derived from four side tubes, of which three side tubes form a group, and one side tube deviates from this group to form one group. The present invention relates to a branch vascular prosthesis in which a side tube is provided. Furthermore, three side tubes are arranged side by side in a group along the length direction of the main portion of the branch artificial blood vessel or on a straight line having an angle of 30 ° or less with the length direction, or two side tubes are arranged adjacent to each other. Side pipes are arranged in the length direction, and the other one is arranged so as to be deviated from a straight line connecting to the two side pipes to form a group, and further includes one side pipe (a fourth side pipe). The fourth side pipe is disposed within a range obtained by adding L / 2 to both sides of the width (L) occupied in the length direction of the group of three side pipes or by separating this range in the length direction. A side tube having a larger inner diameter than one of the other two adjacent side tubes in a group of three side tubes. In the section of the main part of the branched vascular prosthesis viewed from the side, the fourth side pipe is clockwise (clockwise) based on the side pipe located at the center of the three side pipes forming the group. At an angle within 180 ° in spite) about branch vascular prosthesis comprising disposed on said branch artificial blood vessel main portion on. Further, the present invention is directed to a longitudinal direction on the main portion of the branched vascular prosthesis, which passes through the fourth side tube or between any side tube of the group of three side tubes and the fourth side tube. And a branched artificial blood vessel having a linear marker.

[0009] More specifically, the position of the above-described fourth side tube in the branch main part of the artificial blood vessel (hereinafter referred to as the main part of the artificial blood vessel) is as shown in FIGS. 4 (a) and 4 (b). A cross-sectional view in a direction perpendicular to the longitudinal direction of the main portion of the artificial blood vessel is shown by F− when viewed from the side of the relatively thick side tube A of the three side tube groups forming the group.
On a sectional view F (hereinafter referred to as a front sectional view), a fourth side of the three side pipes forming the group is clockwise (clockwise) from the center point X of the joint of the side pipe B located at the center. Tube D
And the angle θ formed between the center point of the connecting portion of these side tubes, X and Y, and the center point P of the main portion of the artificial blood vessel (hereinafter referred to as the fourth side tube angle). But 0 ° -180
°, that is, 0 ° ≦ θ ≦ 180 °.

[0010] The range restricted here is that if this angle is formed counterclockwise, the fourth side tube faces the back side of the patient's body as viewed from the operator, and no surgical operation is possible. Becomes It is essential for the operation that the side tube is facing the surgeon. Preferred fourth tube angle θ
Is between 60 ° and 160 °, with 90 ° being most preferred for use. In addition, as a reason for limiting to the above range, the position of the fourth side tube is related to the difficulty of the surgical operation of the operator, depending on various conditions of the patient, and the operator secures a wide operating field, This is because it is necessary to determine the position of the most convenient fourth side tube. Such a branched artificial blood vessel having the fourth side tube can be used for maintaining blood flow to the brain when performing a replacement operation on a lesion of the aorta.

That is, arterial blood pumped from the patient's heart is sent from the fourth side tube, and is used for circulating blood flow to the brain using two of the other three side tubes forming a group. Others can be interrupted by forceps to perform anastomosis surgery in a conventional manner. That is, the replacement artificial blood vessel itself can be used as a blood circuit for securing a circulating blood flow to the brain.

[0012] In this way, a circuit that has been used to secure circulating blood flow to the brain by using a separate circuit is no longer required, so that the operative field is widened, and a complicated surgical operation is required. It can be largely omitted, greatly reducing the operation and labor of the practitioner, shortening the operation time, and also reducing the physical burden on the patient, which is also effective for quick recovery of the patient Naturally, patients with severe illness will have good results such as reduced mortality.

After the operation, the unnecessary fourth side tube is sutured in the vicinity of the main portion of the artificial blood vessel, and then cut, thereby completing the operation. As described in detail above, the present invention greatly improves the conventional aortic replacement technique, and contributes to improvement of many surgical methods such as simplification of operation and reduction of operation time. In the present invention, the inside diameter of the portion forming the main portion of the artificial blood vessel is between 10 mm and 45 mm. This is to match the size of the inner diameter of the human aorta, even in children, it is rarely less than 10 mm and never more than 45 mm. Usually 15mm-4
It is usually between 0 mm and even between 20 mm and 36 mm.

The inner diameter of the fourth side pipe of the present invention is 5 mm to 15 m.
m, preferably 6 to 12 mm, more preferably 8 m
m to 10 mm. When the inside diameter is smaller than 5 mm, a sufficient blood flow cannot be secured, and when the inside diameter is larger than 15 mm, it becomes an obstacle to the operation field and the operation becomes difficult. The most preferred inner diameter is between 8 mm and 10 mm. The length of the fourth side pipe is 1
It is preferably between 00 mm and 300 mm, more preferably between 100 mm and 250 mm, even more preferably between 120 mm and
mm to 230 mm. If this length is too short, it will not be possible to accommodate a wide variety of patient conditions, and 30
If the length is longer than 0 mm, an extra conduit is randomly present in the surgical field, which is not preferable.

In the present invention, the relatively thick side tube A among the three side tubes forming a group of the branch artificial blood vessels has an inner diameter of 9 mm to 1 mm.
2 mm, which is the other two adjacent side tubes B and C
Is larger than the inner diameter (7 mm to 9 mm). The arrangement of the three side tubes in a group is shown in FIGS.
(A), FIG. 7 (a), FIG. 9 (a), FIG. 10 (a), FIG.
1 (b), 12 (a) and 13 (a), they are arranged on a straight line in the length direction of the main part of the artificial blood vessel, or artificial as shown in FIG. 5 (a). It is arranged on the length direction q of the main blood vessel or on a straight line having an angle φ with respect to the length direction q, and the inclination φ is 30 ° or less, preferably 5 ° or more.
30 °, more preferably 5 ° to 20 °, or two adjacent side tubes B, C as illustrated in FIG.
Are arranged in the length direction q of the main portion of the artificial blood vessel, and the other one side tube A
Are displaced from the straight line connecting the side pipes B and C. Further, the straight line connecting the side tubes B and C is not limited to the straight line in the length direction q.

The bifurcated vascular prosthesis of the present invention may further pass through the fourth side pipe or between any of the three side pipes forming a group and the fourth side pipe, and the bifurcated vascular prosthesis may be used. A linear marker in the length direction on the part (the line is at least one line, and the line type such as the line thickness, color, solid line, broken line, etc. can be arbitrarily selected within a visible range) , Whereby the operation can be easily performed. During the operation, the artificial blood vessel is stained red with the blood of the patient, and even if the artificial blood vessel is abnormally twisted, the operator cannot easily grasp the state and the anastomosis may be performed while the blood vessel is twisted. In such a case, the distortion of this torsion develops over time after the operation, which may cause a kink (a state in which a blood vessel is broken), which may have serious consequences. To avoid this, the practitioner performs the operation with great care by carefully grinding the nerves, but if an easy-to-see line is provided along the length of the main part of the artificial blood vessel, the operator can The twist of the artificial blood vessel can be sufficiently corrected, and the operation can be performed with confidence. Also, with this marker of the present invention, it is possible to see the marker in the most visible position for the practitioner,
Surgery can be performed safely.

In view of the essence of the present invention, the present invention relates to an artificial blood vessel made of a polyester artificial blood vessel stretched and focused resin, and the like.
Naturally, it can be applied to an artificial blood vessel made of any material, and is a modified version of the above artificial blood vessel, that is, a so-called zero-porosity artificial blood vessel or the like, which is treated with gelatin or collagen to prevent plasma leakage. Of course also apply.

[0018]

Industrial Applicability The present invention relates to an artificial blood vessel for aorta, which is a bifurcated artificial blood vessel used for replacement of the aortic arch, which is derived from four side vessels and has a marker in the main part of the artificial blood vessel. It exerts its power in accuracy, shortens the operation time, contributes to proper blood circulation of the patient after the operation, and brings the gospel to the patient and the practitioner.

[0019]

The present invention will be described in more detail by way of examples.

Embodiment 1 FIG. 4 shows a first embodiment. In this example, the inner diameter of the main portion of the artificial blood vessel is 20 mm, and three side tubes are arranged on a substantially straight line in the length direction of the artificial blood vessel. As shown in the figure, the three side tubes are in a group, and have a relatively large inner tube A (inner diameter 10 mm) and an inner diameter 8 mm from the left side (when replaced, it is closer to the patient's heart). Are sewn, and the interval between the side tubes is 3 mm. Therefore, in this example, the maximum width (L) of the group of side tubes is:
10 + 3 + 8 + 3 + 8 = 32 (mm), and the distance from the fourth side tube D in the length direction of the artificial blood vessel is 10 mm, and this 10 mm is L / 2 = 16 mm or less. Further, as shown in FIG.
The fourth side pipe angle θ is 90 °, and the length of the fourth side pipe is 15
0 mm. With reference to the position where the fourth side tube D and the main part of the artificial blood vessel are sewn, a marker m is arranged in the length direction on the main part of the artificial blood vessel.
The line is attached to facilitate the determination of the position. Although the replacement of the pathological aortic arch was actually performed with this bifurcated vascular graft, the positional compatibility was extremely good, the anastomosis was performed smoothly, and the operation was performed accurately in a shorter time than expected.

Embodiment 2 FIG. 5 shows a second embodiment. In this example, a group of three side tubes A, B, and C (these are referred to as first, second, and third side tubes).
Are arranged on a straight line p having an inclination of φ = 20 ° with respect to the length direction q of the main portion of the artificial blood vessel. The fourth side tube D is disposed at a fourth side tube angle θ of 90 °, and the side tube C and the fourth side tube D
Is 4 mm in the length direction of the main portion of the artificial blood vessel.
In this example, the maximum width (L) of the side tube is 10 + 8 + 8 + 4 +
Since 4 = 34 (mm) and L / 2 = 17 mm, the fourth side tube D falls within the range defined by the present invention for the main portion of the artificial blood vessel. The length of the fourth side pipe is 220 mm.
When the three-dimensional positional relationship of this branched artificial blood vessel was examined in an actual clinical setting, extremely conformity in shape was recognized.

Embodiment 3 FIG. 6 shows a third embodiment of the present invention. The inner diameter of the main part of the artificial blood vessel of this example is 28 mm, and a group of three side tubes (A: inner diameter 10 mm, B, C: inner diameter 8 mm) are arranged substantially linearly in the length direction of the main part of the artificial blood vessel. The distance between the pipes A and B and between the pipes B and C is 10 mm. The fourth side tube is a group of 3
When viewed from the arrangement of the side tubes A, B, and C, the side of the artificial blood vessel opposite to the main portion, in other words, the fourth side tube angle θ of the front section is 18
The position of the fourth side tube in the length direction of the main portion of the artificial blood vessel is 0 mm in view of the positional relationship between the side tube A and the side tube D. It has become.
The length of the side tube D is 200 mm. A marker m was attached in the length direction on the main portion of the artificial blood vessel at an arbitrary position (in this case, substantially at the center) between the fourth side tube D and the group of three side tubes A, B, and C.

Embodiment 4 FIGS. 7A, 7B and 7C show a fourth embodiment of the present invention. In this example, the inside diameter of the main portion of the artificial blood vessel is 32 mm, FIG. 7 (a) is a view of a group of side tubes vertically and viewed from the side, and FIG. (C) is a front sectional view. The inner diameter of a group of three side tubes is A = 10m
m, B = 8 mm, C = 8 mm, and the intervals between A and B and between B and C are arranged on a substantially straight line in the longitudinal direction of the main portion of the artificial blood vessel so that each of them is 10 mm. The fourth side tube is
In the front sectional view (c) of the main portion of the artificial blood vessel, the fourth side tube angle θ is 90 °, and the positional relationship in the length direction of the main portion of the artificial blood vessel is as follows: the distance between the side tubes A and D is 10 mm. And the side tube D
Is 250 mm in length.

Embodiment 5 FIG. 8 shows a fifth embodiment of the present invention. In this example, the inside diameter of the main portion of the artificial blood vessel is 26 mm, and the inside diameters of a group of three side tubes are A = 10 mm, B = 8 mm, and C = 8 mm, and the lengthwise interval between these main portions of the artificial blood vessel. Is 10 mm each. In the present example, of the group of three side tubes, the side tube A having a relatively large inner diameter is in the longitudinal direction of the main portion of the artificial blood vessel, that is, about 3 mm from the straight line connecting the side tubes B and C to the fourth side tube. It is displaced (see FIG. 8B). The fourth side tube is disposed so that the fourth side tube angle θ is 135 ° in the front sectional view (c) of the main portion of the artificial blood vessel, and the side tube A in the length direction of the main portion of the artificial blood vessel. Is 6 mm. The length of the side tube D is 250 mm.

Embodiment 6 FIG. 9 shows a sixth embodiment of the present invention. In this example, the inner diameter of the main part of the artificial blood vessel is 22 mm, and the inner diameters of a group of three side tubes are A = 10 mm, B = 8 mm, and C = 8 mm. 8m each
m, the fourth side tube has a fourth side tube angle θ of 90 °, an inner diameter of the fourth side tube of 8 mm, and a length of 200 mm in the front sectional view (b) of the main portion of the artificial blood vessel. In this example, the fourth
The position of the side tube in the length direction of the main portion of the artificial blood vessel is disposed so as to be located between the side tubes A and B in the side tube group. [See FIG. 9 (a)] A marker m is provided in the length direction on the main portion of the artificial blood vessel at a distance of about 1/3 from the fourth side tube D toward the side tube A or the side tube B.

Embodiment 7 FIG. 10 shows a seventh embodiment of the present invention. In this example, the inside diameter of the artificial blood vessel main part is 24 mm, and a group of three side tubes A, B, and C are arranged substantially linearly in the length direction of the artificial blood vessel main part. The inner diameter of the blood vessel on the side is A = 10 m
m, B = 8 mm, C = 8 mm, and the distance between the side tubes is 8 mm, respectively. The fourth side tube has a fourth side tube angle θ of 80 ° in the front sectional view (b) of the main part of the artificial blood vessel, and the position in the length direction of the main part of the artificial blood vessel is three groups. It is arranged at the same position as the side tube B at the center of the side tube. The length of the fourth side tube D is 200 mm, and the inner diameter is 8 mm. 4th
Based on the position where the side tube D and the main part of the artificial blood vessel are sewn, a line as a marker m is provided in the length direction of the main part of the artificial blood vessel to facilitate the determination of the position.

Embodiment 8 FIG. 11 shows an eighth embodiment of the present invention. In the present example, the fourth side tube D is disposed on the same straight line as the group of three side tubes A, B, and C and the length direction of the branch artificial blood vessel [FIG.
(See (b)), the distance between the fourth side tube D and the adjacent side tube A is 20 mm. In this case, the fourth tube angle θ of the front section is 0 °.

Embodiment 9 FIG. 12 shows a ninth embodiment of the present invention. In this example, the inner diameter of the fourth side pipe D is 10 mm, and the fourth side pipe angle θ of the front section is 90 mm.
°, the distance from the side tube C is 10 mm in the positional relationship in the length direction of the main portion of the artificial blood vessel. [See FIG. 12 (a)] The inner diameter of the main portion of the artificial blood vessel is 28 mm, and the length of the fourth side tube is 20.
0 mm. Based on the position where the fourth side tube D was sutured to the main part of the artificial blood vessel, a thick line as a marker m was attached in the length direction of the main part of the artificial blood vessel to facilitate the discrimination of the position.

Embodiment 10 FIG. 13 shows a tenth embodiment of the present invention. In this example, the fourth
The side tube D has a fourth side tube angle θ of 90 ° and is disposed at a position corresponding to the side tube C among a group of three side tubes A, B, and C. The inner diameter of the fourth side tube D is 10 mm and the length is 200 mm. The inner diameter of the main part of the artificial blood vessel is 24 mm, and the distance between the side tubes A and B, and B and C is 10 mm.

[Brief description of the drawings]

FIG. 1 shows the location of the aortic arch and associated arteries in the human body.

FIG. 2 shows an example in which an arch aortic aneurysm is replaced with an artificial blood vessel having no branch.

FIG. 3 shows an example in which an arch aortic aneurysm is replaced with a branch vascular prosthesis.

FIG. 4 (a) is a perspective view showing a positional relationship between side tubes of a branch vascular prosthesis of the present invention. (B): FF front sectional view of FIG. 4 (a).

FIG. 5 (a) is a perspective view showing a positional relationship between side tubes of a branch vascular prosthesis of the present invention. (B): GG front sectional view of FIG. 5 (a).

FIG. 6 (a) is a side view showing the positional relationship of the side tube of the branch vascular prosthesis of the present invention. (B): HH front sectional view of FIG. 6 (a).

FIG. 7A is a side view showing the positional relationship of the side tube of the branch artificial blood vessel of the present invention. (B): a view from directly above a group of side tubes. FIG. 7C is a cross-sectional view taken along the line II in FIG.

FIG. 8A is a perspective view showing a positional relationship of a side tube of the branched artificial blood vessel of the present invention. (B): a view from directly above a group of side tubes. (C): JJ front sectional view of FIG. 8 (a).

FIG. 9A is a side view showing the positional relationship of the side tube of the branched artificial blood vessel of the present invention. (B): KK front sectional view of FIG. 9 (a).

FIG. 10 (a) is a side view showing the positional relationship of the side tube of the branched artificial blood vessel of the present invention. (B): RR front sectional view of FIG.

FIG. 11 (a) is a side view showing the positional relationship of the side tube of the branched artificial blood vessel of the present invention. (B): a view from directly above a group of side tubes and a fourth side tube.

FIG. 12 (a) is a side view showing the positional relationship of the side tube of the branch vascular prosthesis of the present invention. (B): MM front sectional view of FIG.

FIG. 13 (a) is a side view showing the positional relationship between the side tubes of the branched artificial blood vessel of the present invention. (B): N-N front sectional view of FIG.

Claims (4)

(57) [Claims] 1. A bifurcated vascular prosthesis having four side tubes derived therefrom, of which three side tubes form a group, and one side tube is displaced from this group. Branch artificial blood vessel. 2. The three side tubes are arranged side by side in a group along the length direction of the main portion of the branch artificial blood vessel or on a straight line having an angle of 30 ° or less with the length direction, or are adjacent to each other. Two side tubes are arranged in the length direction, and the other one is arranged so as to be deviated from a straight line connected to the two side tubes to form a group.
The range in which L / 2 is added to both sides of the width (L) occupied by the three side tubes of the group in the length direction of the group of three side tubes (hereinafter referred to as a fourth side tube) or this range is defined as the length direction. 2. The branched artificial blood vessel according to claim 1, wherein a fourth side tube is disposed at a distance from the second side tube. 3. The branch artificial tube as viewed from the side of the side tube having a larger inside diameter, wherein one side tube of the group of three side tubes has a larger inner diameter than the other two adjacent side tubes. In the cross section of the main part of the blood vessel, the branched artificial blood vessel is rotated clockwise at an angle of 180 ° or less with respect to the side pipe located at the center of the three side pipes in which the fourth side pipe forms the group. 2. The branched artificial blood vessel according to claim 1, which is disposed on the main part. 4. A longitudinal direction passing through a fourth side tube or between an arbitrary side tube of the group of three side tubes and the fourth side tube on the main portion of the branched vascular prosthesis. The branched artificial blood vessel according to claim 1, further comprising a linear marker.