US 20050149079 A1
A method for implementing vascular anastomosis in the attachment of a graft vessel to a target vessel such as a coronary artery, and subsequently creating a passageway between the vessels in order to establish fluid flow communication therebetween. Further is to the provision of novel devices which are utilized in implementing the steps of attaching a graft vessel to a target vessel such as a coronary artery through vascular anastomosis, and thereafter creating a fluid flow passageway therebetween.
1. An arrangement for implementing a vascular anastomosis between a graft vessel and a target vessel and subsequently creating a fluid flow passageway between said vessels, the arrangement comprising:
a wire having one end inserted into said target vessel by puncturinga wall of said target vessel and exiting said target vessel by puncturing the wall thereof at a spaced location therefrom, thereby defining a region of contact between said target vessel and said graft vessel, the graft vessel being positioned adjacent said target vessel;
an attachment between said target vessel and said graft vessel; and
a fluid flow passageway provided between lumens of said target vessel and said graft vessel through the region of contact.
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19. A method for implementing a vascular anastomosis between a graft vessel and a target vessel and creating a fluid flow passageway therebetween, said method comprising:
inserting a wire with one end into a target vessel by puncturing a wall of said target vessel and exiting said target vessel by puncturing the wall thereof a spaced location therefrom, thereby defining a region of contact between said target vessel and a graft vessel, the graft vessel being positioned adjacent to the target vessel and the wire puncturing walls of the graft vessel;
attaching said target vessel with said graft vessel; and
providing a fluid flow passageway between the lumens of the target vessel and the graft vessel through the region of contact.
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The present application is a continuation application of application Ser. No, 09/966,971 filed on Sep. 28, 2001.
1. Field of the Invention
The present invention relates to a method for implementing vascular anastomosis in the attachment of a graft vessel to a target vessel such as a coronary artery, and subsequently creating a passageway between the vessels in order to establish fluid flow communication therebetween. The invention is further directed to the provision of novel devices which are utilized in implementing the steps of attaching a graft vessel to a target vessel such as a coronary artery through vascular anastomosis, and thereafter creating a fluid flow passageway therebetween.
The concept of anastomosis in implementing the attachment of target vessels, for instance, such as coronary arteries and other body vessels which are subjected to a fluid flow, such as blood to a graft vessel which is intended to be placed in fluid flow communication with the target vessel is well known in the medical technology.
Quite frequently, the attachment or anastomosis of the vessels is implemented through the intermediary of hand suturing of the graft vessel to the target vessel, in effect the coronary artery, necessitating the carrying out of extremely difficult and highly dangerous surgical procedures.
Generally a surgeon will perform an arteriotomy on the coronary artery at a location which is downstream from a blockage; however some flow of blood may still be present in the diseased artery. Occasionally the blood flow through the artery is temporarily occluded by means of a clamp in order to be able to incise the coronary and then perform the anastomosis with a minimal blood leakage. Nevertheless, the occluding of the artery occasionally dislocates plaque which lines the intima of the diseased coronary artery, enabling the plaque particles to migrate downstream, and thereby creating a scenario for the propagation of subsequent complications over time which may be readily life threatening to a patient. Even in the event that the coronary artery is occluded prior to the arteriotomy, it is usually necessary to manage any blood leakage which may be encountered by means of a CO2 blower. Thus, it may be advantageous to be able to perform the anastomosis of the graft vessel to the coronary artery or any target vessel without first having to implement an arteriotomy on the target vessel or coronary artery.
Moreover, the cardiac surgeon must exercise considerable care in order to stitch the intima of the graft vessel to the intima of the coronary artery in order to promote healing at the location of the passage way which has been created between the newly joined graft vessel and the coronary artery. In an ideal situation, the cardiac surgeon intends that the edges of the incision of one vessel are to be perfectly aligned with the mating or opposite edges of the incision of the other vessel, enabling endothelial tissue to quickly form a smooth seam joining the vessels with a minimum build-up of intraluminal tissue mass which may conceivably restrict blood flow subsequent to the joining of the vessels. A conventional stitching method using a running suture also may result in so-called purse stringing or bunching of tissue at various locations along the perimeter of the anastomosis, with the resulting potential of creating subsequent occlusions at those locations. In addition to the foregoing, cardiac surgeons presently slice the coronary artery with a small scalpel, at times utilizing a large number of strokes in order to cut through layers of the interior walls of the artery, and by approximating the length of the incision required based on the size of the graft vessel. This necessitates extreme care to be exercised in order to avoid cutting the posterior wall of the artery.
Consequently, it is imperative that methods and apparatus be developed for forming an anastomosis of a graft vessel to a coronary artery or similar target vessel without first having to create an arteriotomy on the target vessel or artery. Moreover, also desirable is to be able to join the vessels in an anastomosis prior to creating a passageway facilitating fluid flow therebetween in order to ensure that the opposing edges of the incisions in the graft and target vessels are perfectly aligned and stabilized, and with the avoidance of any purse stringing or bunching of the tissues along the anastomosis perimeter. It is also necessary that a method be developed for incising the artery without the possibility of such posterior wall cuts having to be implemented, and with only a minimal chance of rendering the incisions to be either too lengthy or too short at the location of the anastomosis.
It has also been ascertained that bio-adhesives may be utilized in the joining together or anastomosis of blood vessels; however, in the event that an arteriotomy is implemented prior to adherence between the vessels, it is a possibility that the surgeon may inadvertently apply adhesive material onto the intima of the vessels which are to be joined, thereby impeding the appropriate healing of the joined vessels. Thus, there is a need for a method which will alleviate this potential danger to the patient in being able to join the vessels without exposing the intima of either vessel to the bio-adhesive.
2. Discussion of the Prior Art
Although numerous publications are currently available which to varying degrees concern themselves with this particular technology, none of them clearly or satisfactorily provide teachings regarding vascular anastomosis methods or devices which will provide for the joining of a target vessel, such as a coronary artery, to a graft vessel prior to the cutting of a fluid flow passageway between the graft vessel and the target vessel so as to generally, to a considerable degree, alleviate the difficulties and shortcomings encountered in the medical technology.
Nobles et al. U.S. Pat. No. 5,944,730 discloses a device and method for assisting in end-to-side anastomosis wherein a sealing device pierces the one vessel and then forms a inner seal around an inner wall of an incision in an arterial blood flow or target vessel. Thereafter, a graft vessel is attached to the target vessel or artery, and appropriate suturing implemented, whereupon the seal is then withdrawn through the graft vessel providing for fluid or blood flow communication between the coronary artery and the graft vessel.
Stefanchik et al. U.S. Pat. No. 6,015,416 discloses an end-to-side anastomosis between two vessels, wherein a passageway is initially created between the vessels and thereafter a plow structure of a surgical anastomosis instrument is withdrawn subsequent to effectuating anastomosis therebetween.
Troutman U.S. Pat. No. 5,041,127 discloses an offset point surgical needle adapted to pierce through the walls of a vessel which is to be subjected to anastomosis with another vessel.
Whitehall et al. U.S. Pat. No. 3,019,789 discloses an anastomosis clamp for the intimal-to-intimal anastomosis of two vessels, and wherein sutures are to be applied to the location of the anastomosis subsequent to the formation of a flow passageway between the vessels.
The foregoing publications all entail the forming of passageways which permit blood flow between a coronary artery or target vessel and a graft vessel prior to anastomosis, and which are subject to the drawbacks and disadvantages described hereinabove.
Other publications also concern themselves with different types of devices and methods for performing anastomosis between blood vessels or graft vessels.
Bolduc et al. U.S. Pat. No. 5,976,159 discloses a surgical clip and method for tissue approximation, which enable the end-to-end anastomosis and method for tissue approximation, and which also enable the end to the side anastomosis between a coronary artery and a graft vessel subsequent to the forming of a flow passageway therebetween.
LeMole U.S. Pat. No. 5,893,369 describes a procedure for bypassing an occlusion in a blood vessel wherein an end-to-side anastomosis is performed between two vessels and wherein a graft vessel initially has a seal element punch a passageway through the target vessel or artery. Thereafter the graft vessel is attached thereto by means of suitable clamps, whereupon subsequent to suturing the seal element is withdrawn through the graft vessel.
Walsh et al. U.S. Pat. No. 4,657,019 describes an anastomosis device wherein forceps are adapted to engage ring shaped anastomosis elements in order to perform end-to-end anastomosis between a, artery or target vessel and a graft vessel. This also entails the formation of a flow passageway prior to carry out the anastomosis.
Gifford, III et al. U.S. Pat. No. 5,695,504 describes various methods and apparatus for performing anastomosis in an end-to-end and side vascular surgery, particularly coronary artery bypass surgery. In this instance, a passageway is formed in a target vessel or coronary artery wherein ring shaped anastomotic couplers are introduced through an incision formed therein and then connected to a graft vessel. This also entails forming a blood flow passageway between the vessels prior to the anastomosis thereof.
Similarly, Gifford, III et al. U.S. Pat. No. 5,817,113 discloses the formation of a flow communication in a target vessel, such as coronary artery, prior to anastomosis with a graft vessel.
Kaster U.S. Pat. No. 4,368,736 describes an anastomotic fitting for performing an end-to-side anastomosis between a target vessel, such as an aorta or coronary vessel, and a graft vessel. In that instance a passageway facilitating blood flow between the vessels is formed prior to the anastomosis which is implemented by way of surgical clips engaging the tissue of the target vessel.
Spence et al. U.S. Pat. No. 5,868,763 discloses an apparatus and method adapted to perform anastomosis, wherein side-to-side anastomosis between two vessels is implemented subsequent to the forming of a passageway between the vessels, which enables blood flow through the vessels prior to completing the anastomosis.
Finally, International Publication WO 99/37218 (PCT/US99/01182) provides a system for performing vascular anastomosis in which an opening is formed in a target vessel, such as a coronary artery, and subsequently an anastomosis is performed in the attachment of a graft vessel thereto.
All of the foregoing publications require the termination of blood flow through the target vessel during implementing of the foregoing procedures, or necessitate lengthy surgical procedures which includes considerable risk to patients and which are subject to high degrees of morbidity and potential mortality while necessitating lengthy hospital stays for the patient.
According to the present invention, the foregoing drawbacks and disadvantages are clearly obviated in that novel methods and devices for anastomosis between a coronary artery or target vessel and a graft vessel are implemented prior to the formation of a fluid flow passageway between the vessels, thereby enabling the maintaining of a continued blood flow during the anastomosis.
Pursuant to one aspect of the invention, the anastomosis is performed by inserting a suture wire through one wall of the target vessel or coronary artery, and then passing out the suture wire from that wall at a predetermined distance from the point of insertion, passing the opposite outwardly extending ends of the wire through a second vessel, such as graft vessel, positioning the graft vessel in close proximity to the coronary artery or target vessel and adhering the graft vessel to the target vessel at that particular location through diverse means. Prior to the formation of the fluid flow passageway between the two vessels, attachment is implemented at that location intermediate the wire ends by either the application of an adhesive, suturing, or a combination of adhesive and sutures, and thereafter withdrawing the wires while cutting a passageway therewith between the graft vessel and the target vessel or coronary artery within the confines of the anastomosis area, and thereafter removing the wire.
The foregoing passageway forming method for interconnecting the vessels in fluid flow communication may be implemented by the suture wire in that the wire is longitudinally reciprocated so as to form a kind of cutting blade in the form of a so-called “cheese cutter”, or alternatively, the wire may have electrical energy applied thereto in a region defined by the juncture or anastomosis of the vessels, so as to essentially melt through the vessel tissues to thereby produce the passageway.
Accordingly, it is a primary object of the present invention to provide a novel method of implementing anastomosis between two body vessels prior to the formation of a fluid flow passage way therebetween at the location of the anastomosis.
Another object of the present invention is to provide a suitable suture wire extending through the location of the proposed anastomosis between two vessels, such as a graft vessel and a target vessel consisting of a coronary artery, whereby anastomosis is implemented and thereafter the suture wire is manipulated to cut through the vessels at the site of the anastomosis in order to form a blood flow passageway therebetween, and the effectuating removal of the suture wire.
Another object resides in the provision of an arrangement for implementing anastomosis between two body vessels which are in a generally side-to-side orientation, through the interposition of a suture wire extending into the vessels, and subsequently applying electrical energy or radio frequency energy to the wire so as to serve through the tissues separating the vessels at the location of the anastomosis, thereby forming a blood flow passageway between the vessels, and thereafter removing the suture wire.
Other objects and advantages of the invention and novel features thereof may be readily ascertained from the following detailed description of the invention, taken in conjunction with the accompanying drawings; wherein:
Referring now to a first embodiment of the anastomosis device and flow passage producing method, as indicated schematically in
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A tool 24 which may be the leading end of a rod-like member is inserted into an open end 24A of the graft vessel 12, as shown in
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Subsequent to completing the forming of the flow passageway 30, the suture wire 14 may be withdrawn from the graft vessel 12, leaving only tiny punctures which will readily seal themselves due to normal body mechanisms once blood flow is established in both of the graft and target or coronary vessels.
Pursuant to modified embodiments, as shown in various of the drawing figures, a graft vessel 40 may be attached to the target vessel or coronary artery 10 through an end-to-side anastomosis.
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The two wires are electrically insulated from each other through the application of lacquer, polymers or other insulations, in combination with the bi-polar energy.
Utilizing a special two bipolar tweezer to supply an entry to the wire and to manipulate the wires during anastomosis enables the exposed metal wire portions which are formed by the overlapped wire portions, which have any insulation scraped off after dipping in insulating material etc., and bonding together, as shown in
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As an alternative to the hooked needle 110, there can be also provided an L-shaped needle 120 as shown in FIGS. 31 to 33, wherein the needle has a length L and is adapted to be pulled upwardly so as to pierce the coronary artery wall at locations equal to the length of the intended passageway portion L which is to form the opening in fluid flow communication with the graft vessel 40. This is similar to the function of the needle structure described with regard to FIGS. 27 to 29, and the attachment of the graft vessel 40 to the coronary artery 10 may then be implemented in any manner as described hereinbefore. The foregoing clearly provides unique methods and apparatus for attaching a graft vessel to a target vessel such as a coronary artery while permitting a continuous blood flow through the latter and then enabling the anastomosis of the vessels prior to the formation of the fluid flow passageway therebetween.
While the invention has been particularly shown and described with respect to preferred embodiments thereof, it will be understood by those skilled in the art that the foregoing and other changes in form and details may be made therein without departing from the spirit and scope of the invention.