US 3411505 A
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Description (OCR text may contain errors)
Nov. 19, 1968 P. D. NOBIS 3,411,505
DEVICE FOR INTERRUPTING ARTERIAL FLOW Filed Dec. 15, 1965 INVENTOR.
' PAUL D. NOBIS BY $2M a/W ATTORNEYS United States Patent 3,411,505 DEVICE FOR INTERRUPTING ARTERIAL FLOW Paul D. Nobis, 490 Post St., SanFrancisco, Calif.
Filed Dec. 15, 1965, Ser. No. 514,040 8 Claims. (Cl. 128-325) ABSTRACT OF THE DISCLOSURE holding member facilitates the application of hand pressure to the link.
This invention relates to a surgical instrument adapted for stopping blood flow through an artery of a human or other animal. More particularly, it relates to a handactuated instrument which can' be applied quickly to the exterior surfaces of an artery and the blood flowing past the point of application stopped by pinching the interior walls of the artery into sealing engagement through the application of pressure to the instrument.
During cardio-vascular surgery, it frequently becomes necessary 'to stop blood flow through a particular artery so that repair, removal of clots, and similar manipulations can be accomplished downstream from the point of closure of the artery. Closing of the artery at a given point by compressing or pinching the walls thereof into a sealed relationship requires considerable pressure because of the forces which build up at the constriction by blood being pumped from the heart.
When closure of the artery must be maintained for some period of time to permit completion of surgical manipulations, the pressure must be applied over a long and sustained period'of time. Intermittent opening and closure can not be tolerated or profuse bleeding and loss of blood quickly results through the portion of the artery undergoing surgery. For this reason, closure of an artery by .simply pinching it between the fingers is not feasible. The muscles in the fingers soo'n fatigue under the pressures and forces encountered, if a complete closure can be accomplished at all.
Consequently, it has been the practice to utilize several aids along the lines of a rigid member with fabric, or the like, at one end which is placed in contact with the artery at the desired point of constriction and pressure .applied. Another type of unit is a rigid member which hasa configuration analagous to a shufile board paddle. It is used byplacing the artery in the curved end of the paddle and forces are then applied with the elongate handle. Unfortunately, these types of devices are not completely efficient in that the user tends to become fatigued because of a lack of a comfortable surface upon which to apply the considerable hand pressure required over a prolonged period of time. In addition, the devices are not designed for adaption to the varying physiological characteristics of the arteries and parts of the body in which the artery is located. For example, the arteries are not uniformly compressible due to deposits within the arteries and/or non-uniformities of the surrounding body tissues against which the artery is pressed.
The present invention provides a device that has overcome all of these deficiencies of prior techniques and instruments. The new device provides a convenient surface for receiving hand pressure that is comfortable and which provides a maximum maneuverability for the user, en-
abling the application of large amounts of pressure for sustained periods of time with a minimum of fatigue. Of even more importance, the new instrument provides a portion for engaging the artery that adapts to the condition of the artery and its environment so that a total and complete closure is readily accomplished with a minimum of mechanical damage to the tissues.
In a preferred embodiment, the new device is formed with a main body member having an X configuration. A substantially straight beam which serves as a handle is attached across two adjacent ends of the X. At the other end of the X, opposed to the handle, a link is connected between the other two legs of the X. The link is formed from a-material sufiiciently resilient to conform to the surface of an artery during application of pressure to the handle while being sufficiently rigid to compress the walls of the artery and close arterial flow therebetween.
In the accompanying drawing:
FIG. 1 shows in side elevation a surgical device in accordance with the present invention.
FIG. 2 shows in perspective the manner of using the device of FIG. 1 to constrict an artery for purposes of closing flow therethrough.
FIG. 3 shows in side elevation an alternate embodinientof the device of the present invention.
More particularly, with respect to FIG. 1, the preferred device is formed with a furcated member 10 which may be viewed as the main 'body. Member 10 is preferably in the form of an X. Onepair of adjacent ends 11 and 12 of member '10 are joined to a handle 13 which may take the form of a substantially straight beam. Handle 13 is most advantageously selected so that the palm of a human hand can conveniently rest upon it in comfort so that substantial downward pressure can be applied over a long period of time with a minimum of fatigue.
The X configuration of member 10, together with the straight beam handle 13 offer an optimum configuration for this purpose. Thus, a hand can conveniently rest upon the top of beam 13 with the fingers extending therearound, underneath, and between ends 11 and 12 of member 10. In this way, there is no interfering parts of member 10 which must fit between the fingers and which could lead to early fatigue.
The bifurcated configuration of member 10 in which ends 11 and 12 are attached to handle 13 at spaced apart locations near the ends of handle 13 contributes to a high degree of control during use of the instrument. With this configuration, it is possible to exert more pressure on one side or the other as required by the characteristics of the artery and itslocation without losing a grip on the unit and without opening the artery to undesired flow.
Member 10, due to its X configuration, also includes an opposite pair of spaced apart legs 14 and 15. A link 16 is connected between legs 14 and 15 to form a loop therewith. Connection between link 16 and the ends of legs 14 and 15 may be accomplished in any suitable manner. It is convenient to accomplish the connection by forming ling 16 with at least its ends being hollow so that the ends of legs 14 and 15 can be inserted within the hollow ends of link 16. In this way, link 16 can be quickly replaced in the event it has lost its necessary physical properties to be described or has otherwise been rendered not suitable for further use.
Where this preferred manner of connection between link 16 and legs 14 and 15 is used, it is advantageous to form the ends of legs 14 and 15 with some type of protuberance or other irregularity so that when inserted within the hollow portions of link 16 and pressure applied, link 16 will not slip off legs 14 and 15. In the drawing, the ends of legs 14 and 15 are enlarged and can be seen in 3 dotted lines as a bulge at 17 and 18 interiorly of link 16.
The character of link 16 is most important. It must be sufficiently resilient to conform to the surface of the artery, such as artery 19 shown in FIG. 2. When pressures are applied downwardly on handle 13, link 16 conforms to the exterior surface of artery 19, as well as to the body tissues and adjacent parts such as bone segment 20, which may be present in the vicinity of the particular artery under treatment.
The resiliency will allow for hardening or deposits which may be present within artery 19 which will cause one portion of the artery to yield differently than another adjacent portion of the artery. Also, where the surrounding bone, for example, is irregular, and the artery is compressed against it, the resilient character of link 16 will adapt to and conform with such an environment. A uniform total closure of the artery results, which can be held as long as necessary without leakage.
While being resilient, link 16 must be sufficiently rigid so that the forces applied to handle 13 will result in a collapse and closure of the artery worked upon. This combination of resiliency with the proper amount of rigidity is found in a variety of tubing commonly found in hospital operating rooms. Suitable tubing for use as link 16 which has the requisite physical properties has been found to exist in typical rubber or plastic tubing of an overall outside diameter of about /2 inch and an internal diameter of about inch. Such material has been found to have the proper resiliency, and is rigid enough to cause closure of arterial walls under application of hand pressure. Selection of a proper material for link 16 will be readily accomplished by those skilled in this art who have a knowledge of the physical properties of arteries.
The X configuration of the preferred embodiment is compatible with the practical requirements of the surgeon. Thus, where the operation is performed through a relatively small incision such as at 21, the furcated body member of the present device can be constructed so that the cross-over area 22 lies at a point which will coincide with the location of the incision and will fit through incision 21 as a key through a keyhole. In this regard, it may be desirable to have a plurality of devices of differing sizes on hand during the operation to insure that this relationship will be obtainable.
Preferably, legs 14 and of the device are formed from a material that permits a pro-selected degre of flexing during use. For example, legs formed from stainless steel have been shown to demonstrate this desirable attribute. A relatively small amount of flexing contributes better adaptation to the peculiarities of the artery and its environment and aids in applying a more uniform pressure which will positively close flow through the blood vessel at the time desired.
In the embodiment in FIG. 3, a furcated body member 23 takes the form of an inverted Y with a handle 24 attached to the unitary end of the Y and a resilient link 25 attached to the bifurcated end of the Y. All comments applicable to the embodiment of FIGS. 1 and 2 apply here, except for the fact that the same degree of control over application of pressure to one side or the other is not as readily achieved with the unitary end 26 of member 23 attached centrally to handle 24. In addition, end 26 of member 23 may tend to interfere with the grip of the user about handle 24.
Although the foregoing invention has been described in some detail by way of illustration and example for purposes of clarity of understanding, it is understood that certain changes and modifications may be practiced within the spirit of the invention as limited only by the scope of the appended claims.
What is claimed:
1. A device for interrupting arterial flow comprising: a handle including a surface adapted for receiving pressure applied by the human hand, a furcated member joined in opposition with said handle having first and second spaced apart legs, and a curved link connected at its ends to said first and second legs to form a loop therewith and formed from material sufiiciently resilient to conform to the surface of an artery during application of pressure to said handle while being sufiiciently rigid to compress the walls of an artery and close arterial flow therebetween.
2. A device in accordance with claim 1 wherein said furcated member has the configuration of an X.
3. A device in accordance with claim 1 wherein said furcated member has the configuration of a Y, the handle is attached at the unitary end of the Y, and the link is joined across the bifurcated end of the Y.
4. A device in accordance with claim 1 wherein said link is hollow at least at its ends and is connected with said first and second legs by insertion of the legs within the hollow ends of the link.
5. A device in accordance with claim 4 wherein said first and second legs are formed with protuberances at their ends to secure non-slipping engagement with the interior of the hollow ends of said link.
6. A device in accordance with claim 5 wherein said first and second legs are formed from a material that permits a pre-selected degree of flexing when pressure is applied to compress the walls of an artery.
7. A device for interrupting arterial flow comprising: a handle including a surface adapted for receiving pressure applied by the human hand, a furcated member having the configuration of an X, and provided with first and second spaced apart legs and a link connected between said first and second legs and formed from material sufficiently resilient to conform to the surface of an artery during application of pressure to said handle while being sufficiently rigid to compress the walls of an artery and close arterial flow therebetween, said handle being joined across two ends of the X and said link being joined across the opposite two ends of the X.
8. A device in accordance with claim 7 wherein said handle is a substantially straight beam.
References Cited UNITED STATES PATENTS 788,947 5/1905 Roth 132-91 1,299,860 4/ 1919' Pl-ummer 128-327 2,612,176 9/1952 Sam 13291 2,796,065 6/ 1957 Kapp 128-346 3,126,005 3/ 1964 Smialowski 128--325 FOREIGN PATENTS 15,446 1913 Great Britain.
RICHARD A. GAUDET, Primary Examiner.
M. F. MAJESTIC, Assistant Examiner.