WO2000025679A1

WO2000025679A1 - Rigid circular implant that is used as an external stent in vascular anastomoses

Info

Publication number: WO2000025679A1
Application number: PCT/TR1999/000003
Authority: WO
Inventors: Sebat KARAMÜRSEL
Original assignee: Karamuersel Sebat
Priority date: 1998-11-04
Filing date: 1999-02-02
Publication date: 2000-05-11
Also published as: AU2556299A

Abstract

We report on a new microvascular anastomosis technique utilizing a rigid circle around the anastomotic circumference. The circle is made from a round bodied rigid wire made of metal and 0,1-0,2 milimeters thickness having internal diameter of 0,5 to 5 milimeters or higher. Sutures are first passed inside the circle and tied outside and over the circle so as to stretch open the anastomotic side. By retraction of vessel ends the circle is totally exteriorised and thus there is no contact with the blood. The rigid circle proves to be superior over the conventional anastomoses both in speed of execution and patency rates of anastomoses.

Description

DESCRIPTION

Rigid circular implant that is used as an external stent in vascular anastomoses

This invention is about a rigid circular implant incorporated around the anastomotic circumference. The circle is made from a round bodied rigid wire made of metal and of 0.1-0,2 milimeters thickness having internal diameter of 0,5 up to 5 milimeters , according to the diameter of the vessels to be anastomosed. The circle is incorporated at the anastomotic circumference without any effort to slip it over the cut end of vessel.

Anastomosis of small vessels remains one of the most precise and technically sensitive aspects of replantation surgery and free tissue transfers. Experience is most important for the anastomotic patency and thus tissue survival. Anastomotic narrowing secondary to inadvertantly placed sutures or total lumen obstruction by a back wall bite, especially in inexperienced hands are the limiting factors of conventional suture aanastomosis. To facilitate these time consuming and difficult anastomosis these techniques, various techniques and devices have been introduced so far. Non-suture external cuff techniques. Payr being the inventor, external ring technique, anastomotic staplers, everting ring-pin devices are all the results of search for an anastomotic method that either supplanted sutures or made their use easier and safer. Despite the existence of different non-suture anastomotic techniques and continuing tremendous interest and search on the subject, none of them proved to be superior over conventional methods. Under experimental conditions, coupling devices provide a rapid leakproof anastomosis for small vessels. However, these devices are complex aand cumbercome, shorten the vessel, heve limited availability and are rigid foreign bodies enclosing a dynamic dilating structure and inapplicable for significant size discrepancies or in end to side anastomoses. The external ring technique of einrib employed an outer ring of plastic tube that had an inner diameter of 1,5 to 2 times greater than the outer diameter of the vessel and 3 to 4 sutures were used in this technique. After the sutures were tied over the vessel, additional effort was spent to tie the suture ends again but over the plastic circle. The ring functioned only to stretch open the anastomotic site. With only 3-4 sutures, leakage was prevented by extreme stretching and pulling tight of the vessel ends, which made knot tying difficult. Another disadventage was that the cross section of the anastomotic line was rectangular or triangular, which might cause turbulence.

The rigid circular implant that is described is a very fine apparatus that has very limited thickness and length in comparison to its diameter, whereas all the rings described previously in the literature were short pipes which had unnecessary thickness and length that made incorporation into anastomotic line impossible. As the rigid circle retracts the free edges of the vessel without the need of an assistant for traction, the surgeon can safely and easily pass the needle, sure that he is not picking up the opposite wall. The aim of this invention is to perform vascular anastomoses faster, easier and safer than the other anastomosis techniques. The technique of vascular anastomoses using rigid circular implant is described in drawings.

Fig 1 Rigid circular implant

Fig 2 The first guide suture is placed passing inside the circle

Fig 3 The first guide suture tied over the circle Fig 4 Second guide suture placed again passing inside the circle and tied

Fig 5 The appeaarance after all sutures passed and tied

Claims

Rigid circle that is made of round rigid wire having thickness of 0.1 to 0.2 n ilimeters and internal diameter ranging from 0,5 to 5 milimeters. Rigid circle that has a highly polished surface allowing gliding of knots.

Inert rigid circle that causes no reaction in human body made of titanium, stainless steel, etc.