US 3155095 A
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Description (OCR text may contain errors)
Nov. 3, 1964 A. M. BROWN 3,155,095
v. ANASTOMOSIS METHOD AND MEANS Filed Feb. 7, 1961 INV EN TOR.
add uh Erown United States Patent 3,155,095 ANASTGMOSIS METHOD AND MEANS Adolph M. Brown, 9735 Wilshire Blvd., Beverly Hills, Calif.
Filed Feb. 7, 1961, Ser. No. 87,636 11 Claims. (Cl. 128-334) This invention relates to the anastomosis of blood vessels and more particularly to the anastomosis of arterial vessels which have been cut, intentionally or otherwise.
As used herein, the term anastomisis means the rejoinder of blood vessels or arteries after they have been cut and it includes the completion of the arterial passage not only by joinder but also by replacement of a length of vessel when removed or otherwise when a deficiency exists, as by a grafting operation to complete the length of the artery for restoration of normal blood flow.
Present day surgical techniques for the joinder of such tissues involves a suturing operation. Generally, the ends of the artery or other blood vessel are clamped to seal off the flow of blood to the region for anastomosis. The adjacent free ends of the vessels are then joined, as by a stitching operation, using silk thread or fine gut adapted to hold the ends together until epithelialization occurs. It will be apparent from the foregoing that considerable time and effort are required to effect the desired anastomosis with a consequent danger that the organ or limb which the vessel supplies may become necrotic and/or gangrenous if the blood supply is cut off for too long a period of time. Thus the possible loss of the organ limb or life is involved or else damage thereto. It is an important object of this invention to provide a safe and elficient method and means for anastomosis of blood vessels and it is a related object to provide an anastomosis method and means which is safe and effective and which can be practiced in a fraction of the time heretofore required for conventional techniques thereby greatly to reduce the time that the blood flow is stopped and consequently greatly to enchance the health of the life, limbs and organs of the body.
More specifically, it is an object of this invention to provide a method and means for the anastomosis. of blood vessels and arteries whereby anastomosis can be effected easily, safely and quickly; whereby the vessel can be returned for normal blood flow in minimum time; whereby anastomosis can be effected without injury to the vessel; whereby anastomosis can be effected without the need to stretch the vessel in the lengthwise direction for joinder; whereby anastomosis can be effected without reentry for the removal of elements otherwise used to seal the ends of the vessels together until epithelialization; whereby linking lengths of preserved artery can be grafted in a safe and efficient manner.for replacement of lengths removed, and which is flexible in manner of operation for use with blood vessels of various dimensions and cross sections within the human system. These and other objects and advantages of this invention will hereinafter appear and for purposes of illustration but not of limitation an embodiment of the invention is shown in the accompanying drawing in which:
FIGURE 1 is a perspective elevational view of one of the elements employed in the practice of this invention;
FIGURE 2 is a perspective elevational view of the other of the combination of elements used in connection with the element of FIGURE 1 in the anastomosis process embodying the practice of this invention;
FIGURE 3 is a sectional view along the line 33 of FIGURE 2;
FIGURE 4 is a perspective elevational view showing 2,155,095 Patented Nov. 3, 1964 the element 1 in position of use with one end of a blood vessel in position thereon;
FIGURE 5 is a perspective view similar to that of FIGURE 4 with the other end of the blood vessel in position of use thereon;
FIGURE 6 is an elevational view of a completed assembly for anastomosis in accordance with the practice of this invention; and
FIGURE 7 is an elevational view partially in section showing the practice of this invention in grafting a length of blood vessel into the arterial system. i
The invention will be described initially. by reference to the elements employed in the practice thereof and then by the method of use of such elements for rapid and safe anastomosis of blood vessels.
One of the elements essential to the combination employed in the practice of this invention comprises a bridging member 10 in the form of a relatively firm but flexible, elongate tubular member 10 formed of a material which is slowly absorbable into the body fluids, such as may be fabricated of a material like collagen. The tubular bridging member 10 is fabricated with a glazed or smooth inner surface 14 to permit free and complete flow of blood therethrough without possible clot formation and it is dimensioned to have a length preferably two or more time the diameter with an inner wall-to-wall dimension corresponding somewhat to the lumen or diameter of the passage of the blood vessels to be joined so as to avoid any restriction to the free flow of blood through the joined vessels. The outer surface 16 of the bridging member 10 is formed with a roughness, such as a knurled surface or with ribs or crosshatching, to enable a stronger gripping relationship to be established between the end portions of the blood vessels and the portion of the bridging member inserted into the vessel for joinder. It is dimensioned to have an outer wall-to-wall dimension which is greater than the lumen or passage through the blood vessel so that the vessel will have to be stretched to grip the roughened surface of the bridging member telescoped therein. The bridging members may be formed with square ends, but it is preferred to form the ends with a slope or taper, as illustrated in the drawings, to facilitate insertion of the bridging member into the open ends of the blood vessel for displacement to the desired position for use. 7
For use in combination with the described bridging member 10, there is provided a cufi 20 or clamping member shaped in cross section to correspond with the cross section at the central portion of the bridging member to effect a gripping relationship therebetween when the bridging member is encircled by the cuff. The cuff member is also adapted to be characterized by stiffness and resiliency and it is preferably formed of a slowly absorbable material, such as collagen.
The cuff can be in the form of a'continuous cylindrical section but it is preferred to make use of a cylindrical cuff which is formed with a longitudinal slot 22 for enabling the adjacent edges to be spread thereby to facilitate insertion into position of'use and to impartresiliency to the cuff. In the preferred practice, it is desired to form the cuff with an internal wall-to-wall dimension or diameter which is about the same or slightly less than the external wall-to-wall dimension or diameter of the central portion of the bridging member so that the cuff will resiliently grip the bridging member firmly to engage any element that is disposed therebetween. As on the'outside surface 16 of the bridging member 10, the inner surface 24 of the cuff is preferably formed with a degree of roughness for establishing a better gripping relationship with elements in surface contact and'resiliently engaged by the inner surface thereof. For this purpose, the inner surface may be crosshatched, knurled, etc., but it is preferred to form the cuff with ribs 26 extending longitudinally thereof in closely spaced apart relation. While the cuff can be formed with straight or square edges, it is preferred to form the edges with alternating peaks 28 and valleys 30 and more preferably with the peaks on one edge being aligned with the correspondingly shaped valleys on the other edge, etc., so as to enable the cuffs to be out without excessive waste, from lengths of tubular material and also to provide an interfitting relationship between the cuffs in use.
Both the tubular bridging member and the cuffs are made of a material which is capable of being slowly absorbed by the body fluids or disintegrated slowly over a period of time so that elements arranged in gripping relationship one with the other can hold the vascular segments together until epithelialization occurs. Thereafter the foreign matter can be eventually dissolved or otherwise eliminated leaving an anastomosis connection without any stitches or other unnatural disturbances. In brief, it is desirable for at least the bridging member to retain its shape even while being slowly eliminated so as to support the vessels without collapse during epithelialization. A suitable material for these elements is represented by reconstituted collagen, which is a pulp-like maceration of bovine or similar intestinal tissues. he collagen is preferably hardened by chromicizing and the absorption time of the tubular bridging member and/or cuffs can be regulated by the amount of tanning or chromicizing that it receives. Use can also be made of gelatin plasticized with a material such as dibutyl phthalate or a the like. Other materials suitable for use in the preparation of the described elements include oxidized cellulose, compressed dried blood, glucose and mixtures thereof.
In the practice of the invention in anastomosis, the arterial or the like vessels to be joined are first clamped by conventional means a short distance from their cut ends. Then one end of the bridging member is inserted through the open end of one of the vessels for displacement to about the center of the tubular bridging member. Then the free end is inserted into the open end 32 of the other vessel which is displaced until the ends of the respective vessels are in substantially abutting relationship at about the center of the bridging member Where they are held for eventual epithelialization. Next, the cuff 20", which has previously been positioned about one or the other of the vessels, is displaced axially and slipped over the abutting ends of the blood vessels telescoped onto the bridging member firmly to clamp the abutting edges between the internal tubular bridging member and outer cuff to militate against separation until epithelialization has been completed. A preferable arrangement involves the use of at least two cuffs, the serrations of which interdigitate more effectively to clamp the ends of the blood vessels about the bridging member but without shutting off the abutting edges entirely or placing too much pressure thereon thereby to facilitate epithelialization without injury or pain. Such procedure provides less localized pressure at the abutting junction per se and thus results in better circulation and eventual healing together at the end segments. The serrations and the corrugations contribute mutually to a minimum of contact between the various parts and the dangers of ichemia and necrosis for the anastomized joinder by virtue of excessive constriction of the blood vessel are thereby obviated.
Instead of making use of a pair of cuffs, the desired stabilization effect can be secured with but a single cuff of the type described by positioning the cuff to overlap the adjacent edge portions of the blood vessels effectively to grip each of the edge portions for holding the edges in abutting relationship. Under such circumstances, best use is made of a cuff having valleys in one edge, the base of which extends beyond the base of the valleys from the opposite edge, so that portions of the abutting edges of the clamped vessels will be free of the cuff member for fuller access of the body fluids to carry away contamination and to expedite healing.
operation heretofore employed. After the necessary num- 7 her of cuffs 20 have been positioned about the vessel 42, one end of the bridging member 10 is inserted into the end 30 of one of the vessels while the other is inserted into one end of the linking artery 40 until the edges are in abutting relation. Thereafter, cuffs 20 can be slipped over the abutting edge portions to establish the described gripping relation. In the same fashion, one end of another bridging member 10 can be inserted into the end 32 of the other vessel and the other edge of the bridging member inserted into the free end of the linking artery 46 until the edges are in abutting relationship. Thereafter the remaining cuffs can he slipped over the abutting edges to establish the desired assembled relationship, as illustrated in FIGURE 7.
After the desired joint or joints have been effected,
the clamps are removed and normal blood flow is allowed to take place through the synthesized vascular channel. It will be noted that the lumen or internal diameter is relatively unaifected by the presence of the anastomosized assembly. After a period of time, about two weeks with chromicized collagen, the bridging members and cuffs will be eliminated by solution or absorption in the body fluids and the epithelialization will be found to have been successfully completed. It will be found also that the vessels stretched over the bridging members will recede upon elimination thereof to result in a uniform lumen between the joined vessels.
The bridging members and clamping cuff elements can be provided in a variety of sizes and shapes according to the dimensions of the various blood vessels. By Way of example, bridging members can be made available with bores extending Lherethrough having a diameter ranging from 10, of an inch up to /2 inch or more. Thus specific units can be made available for use with blood vessels of small dimension while others can be made available for use with arteries or other blood vessels of large dimension with correspondingly dimensioned cuffs for uses in combination therewith.
While the drawings illustrate the bridging members as being formed of cylindrical sections of uniform diameter throughout the lengths thereof, it will be understood that they may be formed of other contours in cross section, as desired. It will be apparent from the foregoing that I have provided a simple and efiicient means for anastomosis in a manner which completely obviates the exacting and time-consuming stitching techniques heretofore employed. By way of review, it will be apparent that I have provided a method and means of anastomosis which enjoys many desirable attributes, namely:
(1) A process for anastomosis which is extremely rapid, requiring only about 10 percent of the time necessary to perform an anastomosis by processes which have previously been employed such as by sewing or stapling the vessels together.
(2) The described anastomosis procedure can be carried out without sacrifice of the size of the lumen or of the inside diameter of the repaired blood vessel thereby to permit continued flow without interruption and without restriction.
(3') The described process for anastomosis permits grafting of lengths of blood vessels independently of the length or amount and without loss of time so essential to the free flow of blood for safety of life and and avoidance of necrotic or gangrenous conditions.
(4) The described process for anastomosis also permits joinder of extremely small blood vessels not heretofore attempted by conventional procedures.
(5) The process described is free of the insertion of foreign elements which remain in position of use, such as the tbimbles heretofore emplo 'ed in the practice of processes adopted both in the United States and in Russia for such purpose.
(6) The process described can be employed to anastomose not only host artery to host artery but also to anasto-m-ose preserved arteries to host artery in a grafting operation for replacement of removed arterial segments.
It will be apparent also that the lo-ngitudi .al slit extending through a wall of the cuff permits a cult of smaller diameter to be used, that is a cuff having the same or lesser diameter than the outside diameter of the bridging member, since the slit permits the edges of the end to be spread to conform the cuff diameter of the cylinder and the blood vessel telescoped thereon while permitting resilient engagement. The slit also permits a cult to be spread sul'ficient for application onto the bridging member after the blood vessel has been telescoped thereon. It is preferred, though not essential, to have the cuff substantially completely encircle the bridging member, ex-
ept for the spacing between the slit edges.
It will be understood that changes may be made in the detail of construction, arrangement and operation without departing from the spirit of the invention, especially as defined in the following claims.
What is claimed is:
1. An absorbable joinder assembly for the anastomosis of vascular vessels consisting essentially of a hollow cylinder and having an outer surface free of obstructions for insertion into the ends of the vascular vessels in a fitting relation therein to bring the ends in abutting relation and an external cylindrical sleeve dimensioned to have an internal diameter adapted for a clamping fit over the abutting end portions of the vascular vessels and contained cylinder, said cylinder and said sleeve being formed of an absorbable material.
2. The assembly of claim 1 in which the hollow cylinder is provided with tapered ends.
3. The assembly of claim 1 in which the external sleeve comprises a serrated and longitudinally split cylindrical member having an internal diameter, slightly greater than the external diameter of the hollow cylinder.
4. The assembly of claim 1 in which the external surface of the hollow cylinder and the internal surface of the sleeve are characterized by surface roughness.
5. The assembly of claim 1 in which the external sleeve comprises a pair of interdigitating serrated cylindrical members.
6. The method of directly anastomosizing two vascular vessels comprising the steps of: (l) restricting the fiow of blood through the two vascular vessels by positioning clamps thereon at a short distance away from the ends thereof; (2) inserting one end of a hollow cylinder of absorbable material into an end of one vascular vessel; (3) inserting the other end of the hollow cylinder into an end of the other vascular vessel so that the respective ends of the vessels abut; (4) positioning a fitting cylindrical sleeve of absorbable material and dimensioned to have a length to overlap the adjacent abutting end portions of the vessels over the abutting junction; and, (5) removing the clamps to allow the normal flow of blood through the anatomosized joint formed thereby.
7. The method of anastomosizing vascular vessels by means of an implanted vessel segment comprising the steps of: (1) restricting the flow of blood through two vascular vessels which are to be joined by positioning clamps thereon at a distance away from the ends thereof; (2) inserting one end of a hollow cylinder of absorbable material into an end of one vascular vessel; (3) inserting the other end of the hollow cylinder into a first end of the interposed vessel segment implant so that the respective ends of the vessels abut; (4) positioning a fitting cylindrical sleeve of absorbable material and dimensioned to have a length to overlap the adjacent abutting end portions of the vessels over the abutting junction; (5) repeating steps (2) through (4) with a second hollow cylinder and external sleeve assembly joining the ends of the second vascular vessel and the other end of the interposed vessel segment in abutting relation; and, (6) removing the clamps to allow the normal flow of blood through the anastomosized joints formed thereby.
8. An absorbable joinder assembly for the anastomosis of vascular vessels including a hollow cylinder formed of absorbable material having an outer surface free of obstructions and being adapted to be inserted into the ends of the vascular vessels in fitting relationship therein to bring the ends of the vessels in abutting end-to-end rela tionship about the cylinder, and further comprising an external sleeve which comprises a serrated and longitudinally slit cylindrical member having an internal diameter that is slightly greater than the external diameter of the hollow cylinder, said sleeve being formed of an absorbable material and having an internal surface characterized by surface roughness, and said sleeve being adapted to clamp the vascular vessel when the sleeve is positioned about the hollow cylinder with the vascular vessel inbetween.
9. A joinder member as claimed in claim 8 in which the external sleeve comprises a pair of interdigitating serrated cylindrical members.
10. A joinder assembly for the anastomosis of vascular vessels comprising a hollow cylinder formed of an absorbable material, said cylinder having an internal diameter substantially corresponding to the internal diameter of the vascular vessels and having tapered ends, the outer surface of said cylinder being free of obstructions whereby the ends thereof can be inserted into the ends of the vascular vessels in fitting relationship therein to bring the ends of said vessels in abutting end-to-end relationship about the cylinder and an elongate sleeve formed of absorbable material and dimensioned internally to grip the vascular vessel when the sleeve is positioned about the hollow cylinder with the vascular vessel inbetween.
11. A joinder member as claimed in claim 10 in which the external surface of the hollow cylinder is formed with surface roughness.
References Cited in the file of this patent UNITED STATES PATENTS