Patent Application
20120277849
The present invention generally relates to an artificial blood vessel to be used to cure an aorta or the like.
A common way of curing aortic diseases, such as aortic aneurysm and aortic dissection, is by surgery involving replacement of the aortic arch with an artificial blood vessel. There have been developed various artificial blood vessels for this purpose, an example of which is disclosed in U.S. Pat. No. 6,770,090.
The surgery mentioned above requires a heart-lung machine for extracorporeal circulation. Surgery that ranges from the ascending aorta or aortic arch to the descending aorta is highly invasive, imposing a large burden on the patient, because of its extended incision.
There have been proposed various techniques to supersede the above-mentioned surgery involving replacement. One of them is intended to insert a stent graft into the aorta by partially clamping the ascending aorta, connecting an artificial blood vessel that bypasses the right brachiocephalic arterial trunk or left common carotid artery branching from the aortic arch, and finally closing the branching part of the aortic arch.
To reduce the burden and invasiveness on the patient, the foregoing technique should permit relatively easy and smooth insertion of intravascular curing devices (e.g., a delivery system for placement of a stent graft and a contrast catheter to ensure the state of placement of the stent graft) into the aorta.
Disclosed here is an artificial blood vessel that permits relatively easy and smooth insertion of intravascular curing devices, with more reduced burden and invasion on the patient.
The artificial blood vessel includes one proximal-end, at least one distal-end communicating with the proximal-end, and an inserting port positioned between the proximal-end and the distal-end, wherein the inserting port is provided with a check valve that permits an intravascular curing device to pass through up to the proximal-end and also prevents body fluid from flowing out from the artificial blood vessel.
An advantage of this construction is that the blood vessel branching from the aortic arch can be bypassed while the heart is beating, without the necessity of extracorporeal circulation through a heart-lung machine, by connecting the proximal-end to the ascending aorta, which is partially clamped, and connecting the distal-end to the blood vessel branching from the aortic arch. This leads to a reduced burden on the patient. Another advantage is that the inserting port permits relatively smooth insertion and advance of a stent graft into the aortic arch. In this way it is possible to insert an intravascular curing device, such as delivery catheter, more easily and smoothly than inserting it from the groin of the thigh.
One way of inserting a stent graft into the aortic arch, with the artificial blood vessel attached to the aorta and the blood vessel branching from the aortic arch closed, is accomplished by suturing the proximal-end of the artificial blood vessel to the ascending aorta, which is partially clamped while the heart is beating, dissecting the blood vessel, such as right brachiocephalic arterial trunk, branching from the aortic arch and suturing the distal-end of the artificial blood vessel to the dissected blood vessel, thereby closing the dissected blood vessel branching from the aortic arch, inserting a delivery catheter from the inserting port such that the delivery catheter passes through the proximal-end and advances to the aortic arch, which is the object position, thereby inserting the stent graft into the aortic arch, and removing the delivery catheter from the inserting port, followed by cutting off the inserting port and closing the cut part.
The distal-end of the artificial blood vessel may have a branched structure or three-forked structure, so that it may be sutured to more than one blood vessel. This makes the artificial blood vessel more compatible with the living body.
The inserting port mentioned above is preferably positioned between the proximal-end and the branching distal-end. This helps facilitate insertion of an intravascular curing device into the aorta or other blood vessels through the proximal-end.
The check valve mentioned above should preferably be composed of first and second valve components, the first valve component preventing body fluid from flowing out while the intravascular curing device is inserted into the inserting port, and the second valve component preventing body fluid from flowing out while the intravascular curing device is not yet inserted into the inserting port. The check valve in this structure helps ensure good sealing performance regardless of whether or not the intravascular curing device is inserted into the inserting port.
The check valve composed of two components should be constructed as follows. The second valve component is positioned closer to the front side for insertion of the intravascular curing device than the first valve component. The first valve component has a hole permitting the intravascular curing device to be smoothly inserted and to come into close contact with the external surface of the intravascular curing device which has been inserted. The second valve component has a pair of walls inclined toward the direction in which the intravascular curing device is inserted into the inserting port. Adjacent ends of the inclined walls come close each other and separate from each other so that the intravascular curing device passes through the space between the inclined walls. The thus constructed check valve is relatively simple in construction, but is capable of a relatively tight sealing regardless of whether or not the intravascular curing device is inserted into the inserting port.
The artificial blood vessel may be constructed such that the proximal-end is capable of connection to the ascending aorta and the distal-end is capable of connection to at least one of the right brachiocephalic arterial trunk, left common carotid artery, and left subclavian artery.
According to another aspect, an artificial blood vessel that is attachable to an aorta includes: a trunk tube terminating at a proximal-end configured to be sutured to the ascending aorta; a plurality of spaced apart branch tubes each fixed to the trunk tube so that the trunk tube and the branch tubes communicate with one another, with the branch tubes each terminating in a respective distal-end communicating with the proximal-end; and an inserting port fixed to the trunk portion and communicating with both the proximal-end and each of the distal-ends. The inserting port includes a check valve adapted to receive an intravascular curing device, with the check valve being configured to prevent flow of body fluid out of the inserting portion by way of the check valve when the intravascular curing device is not received in the check valve, and the check valve also being configured to prevent flow of body fluid out of the inserting portion by way of the check valve when the intravascular curing device is received in the check valve.
Another aspect involves a method of using an artificial blood vessel comprising: fixing a proximal-end of an artificial blood vessel to an ascending aorta of an aorta, the artificial blood vessel also comprising at least one distal-end communicating with the proximal-end, and an inserting port including a check valve; inserting an intravascular curing device into the inserting port; and advancing the intravascular curing device through the check valve and through the proximal-end to position the intravascular curing device in an aortic arch of the aorta while also preventing body fluid from flowing out from the artificial blood vessel.
Set forth below with reference to the accompanying drawings is a detailed description of an example of one embodiment of the artificial blood vessel disclosed here. The artificial blood vessel 10 disclosed here is used to cure a blood vessel of the living body, such as the aortic arch 12a of the aorta 12, by insertion and placement of the stent graft 13 in the aortic arch. The artificial blood vessel 10 may also be used to cure (replace) other parts of the living body, as a matter of course.
As shown in
As shown in
The inserting port 22 is composed of the port tube 26 and the check valve 28. The port tube 26 is connected to that part (or the trunk tube 18 in this case) between the proximal-end 14 and each of the distal-ends 16a, 16b. The check valve 28 is attached to that part of the port tube 26 which is opposite to that part of the port tube 26 which is connected to the trunk tube 18. The port tube 26 may be formed from the same material as used for the trunk tube 18 and the branch tubes 20a and 20b. It may have an outside diameter of about 6 mm to 16 mm, a wall thickness of about 0.1 mm to 1 mm, and a length of about 10 mm to 150 mm.
The check valve (or hemostatic valve) 28, shown in
The first valve component 32 is an annular-shaped discoid member having a hole 32a at its center. It is made of an elastic material such as rubber, so that it fluid-tightly fits to the inner wall of the housing 30. The hole 32a has an inside diameter large enough for the delivery catheter 36 (as an intravascular curing device) to pass through and tightly hold (tightly contact) the delivery catheter 36 passing through it. The delivery catheter 36 is intended to deliver the balloon catheter or the stent graft 13 as generally shown in
The first valve component 32 is an ordinary rubber stopper and hence the hole 32a remains open while the delivery catheter 36 does not pass through it. Therefore, it cannot prevent body fluid (blood) from flowing out from the port tube 26 (or the aorta 12).
The second valve component 34 is arranged in the housing 30 axially adjacent to the first valve component 32 in the direction in which the delivery catheter 36 is inserted. The second valve component 34 consists of a discoid section 34a, a cylindrical section 34b, and a pair of inclined walls 34c, 34c. The discoid section 34a is fluid-tightly fixed to the inner wall of the housing 30. The cylindrical section 34b joins together the discoid section 34a and the inclined walls 34c, 34c. The inclined walls 34c, 34c are inclined toward the direction in which the delivery catheter 36 is inserted. These parts (i.e., the sections 34a, 34b and the inclined walls 34c, 34c) are formed from an elastic material such as rubber. It is also possible to configure the second valve component 34 to omit the cylindrical section 34b.
As shown in
The second valve component 34 is a type of valve referred to as a so-called duckbill valve. Therefore, it functions as a check valve that prevents body fluid from flowing out from the port tube 26 while the delivery catheter 36 is not inserted, as shown in
As mentioned above, the check valve 28 has the first valve component 32 at its proximal-end from which the delivery catheter 36 is inserted and the second valve component 34 in front of the first valve component 32. The first valve component 32 tightly seals while the delivery catheter 36 is inserted into the inserting port 22 (or the check valve 28), and the second valve component 34 tightly seals while the delivery catheter 36 is not inserted. This structure effectively prevents body fluid from flowing out regardless of whether or not the delivery catheter 36 is inserted.
The following is a description of the technique and function in attaching the above-mentioned artificial blood vessel 10 to the aorta 12.
Step S1 in
Step S2 is intended to reconstruct the blood vessels branching from the aortic arch 12a as shown in
The next step, Step S3, involves inserting the delivery catheter 36 from the inserting port 22 and advance the delivery catheter 36 through the port tube 26, the proximal-end tube 18, and the proximal-end 14 until it reaches the aortic arch 12a (the desired position), at which point the stent graft 13 is released there as shown in
Step S4 involves pulling-out the delivery catheter 36 from the inserting port 22, cutting-off the inserting port 22 from the proximal-end tube 18, and suturing and closing the cut part 44 as shown in
As mentioned above, the artificial blood vessel 10 disclosed here is composed of one (only one) proximal-end 14 and three distal-ends 16a, 16b, 16c, each communicating with the proximal-end 14, and the inserting port 22 positioned between the proximal-end 14 and the distal-ends 16a, 16b, 16c, with the inserting port 22 being provided with the check valve 28.
Therefore, the artificial blood vessel 10 permits the blood vessels branching from the aortic arch to be bypassed while the heart is beating without extracorporeal circulation through a heart-lung machine as the result of connecting proximal-end 14 to the ascending aorta 12c, which is partially clamped, and the blood vessels branching from the aortic arch are connected to the distal-ends 16a, 16b, 16c. This procedure can be accomplished with less burden on the patient. Moreover, the artificial blood vessel 10 permits the stent graft 13 to be inserted and advanced to the aortic arch 12 through the inserting port 22. Thus it helps facilitate easy and smooth insertion of the intravascular curing device, such as the delivery catheter 36 (or delivery system) to place the stent graft 13 and the contrast catheter to ensure the placement of the stent graft 13. This leads to a further reduction of burden on the patient.
The artificial blood vessel 10 has at least three-forked distal-ends 16a, 16b, 16c, which facilitates connection with the branching blood vessels. In other words, a distal-end branches into at least three sections so that the distal-end is relatively easily connected to a plurality of branching blood vessels. Because of this structure, the artificial blood vessel 10 is highly compatible with the living body.
The artificial blood vessel 10 has the inserting port 22 between the distal-end (or the distal-ends 16a, 16b, 16c) and the proximal-end 14. The inserting port 22 facilitates insertion of the intravascular curing device into the blood vessel (e.g., aorta) through the proximal-end 14. Moreover, the inserting port 22 is positioned closer to the proximal-end 14 than the branched distal-ends, so that it facilitates insertion of the intravascular curing device into the aorta 12. The inserting port 22 may be positioned at the distal-end tube 20a etc. depending on the technique employed, as a matter of course.
In addition, the inserting port 22 has the check valve 28 which is composed of the first valve component 32 and the second valve component 34, as described above. The inserting port 22 of this structure relatively easily achieves high sealing performance regardless of whether or not the delivery catheter 36 is inserted into the inserting port 22, thereby inhibiting or preventing body fluid from flowing out from the inserting port 22.
The present invention is not restricted to the embodiment and variations described above, as it is possible to introduce modifications and changes in its structure and procedure within the scope of the invention. For example, the number of distal-ends 16a, 16b, 16c may be at least one or more according to the technique employed, and the number of the distal-end tubes 20a, 20b, 20c may be varied accordingly.
The check valve 28 attached to the inserting port 22 is not restricted in structure to the one consisting of the first valve component 32 and the second valve component 34 described above. It may be of any structure so long as it achieves high sealing performance regardless of whether or not the intravascular curing device is inserted into the inserting port 22.
The detailed description above describes features and aspects of one example of an embodiment of an artificial blood vessel. The present invention is not limited, however, to the precise embodiment and variations described. Various changes, modifications and equivalents could be effected by one skilled in the art without departing from the spirit and scope of the invention as defined in the appended claims. It is expressly intended that all such changes, modifications and equivalents which fall within the scope of the claims are embraced by the claims.
| Number | Date | Country | Kind |
|---|---|---|---|
| 2010-047282 | Mar 2010 | JP | national |
This application is a continuation of International Application PCT/JP2011/053916 filed on Feb. 23, 2011, which claims priority to Japanese Patent Application No. 2010-047282 filed in the Japanese Patent Office on Mar. 4, 2010, the entire content of both of which is incorporated herein by reference.
| Number | Date | Country | |
|---|---|---|---|
| Parent | PCT/JP2011/053916 | Feb 2011 | US |
| Child | 13544334 | US |
