U.S. patent number 3,823,705 [Application Number 05/318,130] was granted by the patent office on 1974-07-16 for blood vessel bridging device.
This patent grant is currently assigned to Dow Corning Corporation. Invention is credited to Cleve Trimble.
United States Patent |
3,823,705 |
Trimble |
July 16, 1974 |
BLOOD VESSEL BRIDGING DEVICE
Abstract
A blood vessel bridging device to be surgically implanted
between two blood vessels to prevent partial occlusion of one by
the other. The device comprises a generally U-shaped molded body
of, e.g., Dacron reinforced silicone rubber having flattened
bearing portions at both ends thereof and a generally U-shaped
cross-section at its mid portion to cradle the overlying blood
vessel.
Inventors: |
Trimble; Cleve (Denver,
CO) |
Assignee: |
Dow Corning Corporation
(Midland, MI)
|
Family
ID: |
23236790 |
Appl.
No.: |
05/318,130 |
Filed: |
December 26, 1972 |
Current U.S.
Class: |
600/37 |
Current CPC
Class: |
C08L
83/04 (20130101); A61F 2/06 (20130101); A61L
27/18 (20130101); A61L 27/18 (20130101); A61B
90/00 (20160201); A61B 2090/0816 (20160201); A61B
2090/0815 (20160201) |
Current International
Class: |
A61B
19/00 (20060101); A61F 2/06 (20060101); A61L
27/18 (20060101); A61L 27/00 (20060101); A61b
019/00 () |
Field of
Search: |
;128/1R,214R,132R
;3/1 |
References Cited
[Referenced By]
U.S. Patent Documents
Primary Examiner: Medbery; Aldrich F.
Attorney, Agent or Firm: Needleman; Gordon Hermann; Howard
W.
Claims
That which is claimed is:
1. A blood vessel bridging device for surgical implantation between
a juxtaposed pair of blood vessels to prevent compression of one of
said vessles by the other, comprising a molded body of semi-rigid
material substantially inert to the animal body having a generally
U-shaped configuration along the longitudinal axis thereof with a
flattened bearing portion at both ends thereof; the center portion
of said body being also generally U-shaped in a cross-section taken
perpendicular to the longitudinal axis of said body to thereby
cradle the overlying blood vessel and prevent contact between said
pair of vessels.
2. A blood vessel bridging device as defined in claim 1 wherein
both of said bearing portions are of substantially the same width
as the remainder of said device.
3. A blood vessel bridging device as defined in claim 2 wherein
said device is fabric reinforced silicone rubber.
4. A blood vessel bridging device as defined in claim 3 wherein a
stripe of radiopaque material is molded integrally therewith along
the length thereof.
5. A blood vessel bridging device as defined in claim 1 wherein at
least one of said bearing portions is substantially wider than the
remainder of said body.
6. A blood vessel bridging device as defined in claim 5 wherein
said device is fabric reinforced silicone rubber.
7. A blood vessel bridging device as defined in claim 6 wherein a
stripe of radiopaque material is molded integrally therewith along
the length thereof.
8. The combination of a pair of juxtaposed blood vessels in an
animal body, the blood vessels comprising a first vessel and a
second vessel and a blood vessel bridging device to be implanted
between the first and second vessel, the device comprising a molded
body of semi-rigid material substantially inert to said body having
a generally U-shaped configuration along the longitudinal axis
thereof with a flattened bearing portion at both ends thereof; the
center portion of said body being also generally U-shaped in a
cross-section taken perpendicular to the portion of the
longitudinal configuration along the longitudinal axis abutting the
first vessel and spaced from the second vessel thereby to cradle
the first vessel and preventing contact between said pair of
vessels.
Description
BACKGROUND OF THE INVENTION
The present invention relates to surgical devices and more
particularly to a device for surgical implantation for prevention
of partial occlusion of blood vessels at points where one crosses
over another.
In a study of thrombotic and static venous diseases of the lower
extremities it has been found that a preponderance of problems
occur on the left side and it has been observed that many of these
are apparently caused by venous adhesions and outflow obstruction
produced by compression of the left common iliac vein at the point
where the right common iliac artery crosses over it. The
statistical significance of primary disease occuring in the left
leg is overwhelming, with thrombophlebitis occuring twice as
frequently on the left, ileofemoral thrombosis having a similar
predominance, and lymphedema praecox having a 80 percent occurence
on the left. This juncture of stasis has also been implicated as a
frequent source for pulmonary emboli. These diseases, of course,
take a fantastic toll in clinical morbidity and mortality.
Dissections in unselected autopsies show an average adult incidence
of 24 percent of intimal bands or adhesions at this point. Yet, in
fetal and new born dissections virtually no such adhesions exist.
It has, therefore, been theorized that the pulsating artery lying
in substantial contact with the vein induces an intimal thickening
and thrombosis and surgery has in the past been utilized to attempt
to correct such problems. Up until the present invention, however,
surgeons have suffered from an inability to prevent recurrent
arterial compression following an initial restoration by surgery.
It is toward that problem that the present invention is
directed.
SUMMARY OF THE INVENTION
It is a primary object of the present invention to provide a
surgically implantable device which will prevent recurrence of
venous stasis at the point where the right common iliac artery
crosses over the left common iliac vein. The present invention
provides a device which is a generally U-shaped molded body of
semi-rigid material having a flattened bearing portion at both ends
thereof. The center portion of the body is also generally U-shaped
in cross-section taken perpendicular to the longitudinal axis of
the body and acts to cradle the overlying blood vessel and prevents
contact between the pair of vessels. The bearing portions of the
device serve to support the overlying blood vessel and prevent
pressure from being exerted on any confined area of the underlying
vessel by the overlying one. The device has been designed
specifically for the point at which the right common iliac artery
crosses over the left common iliac vein. Clinical evidence
indicates efficacy of the device for the purpose for which it was
designed.
BRIEF DESCRIPTION OF DRAWINGS
The invention will be better understood by reference to the
following detailed description when read in connection with the
accompanying drawings wherein:
FIG. 1 is a view in prespective of a bridging device made in
accordance with the present invention;
FIG. 2 is a side elevational view of the device shown in FIG.
1;
FIG. 3 is an end view in elevation of the device shown in FIGS. 1
and 2;
FIG. 4 is a vertical cross-sectional view of the device shown in
FIGS. 1-3 taken along the line 4--4 of FIG. 2;
FIG. 5 is an anatomical sketch showing positioning of the device of
FIGS. 1-4 within a human body;
FIG. 6 is a view in perspective of a modified form of the device,
and
FIG. 7 is an anatomical sketch showing positioning of the device of
FIG. 6 within a human body.
DESCRIPTION OF PREFERRED EMBODIMENTS
Referring now to the drawings wherein like reference characters
designate like or corresponding parts throughout the figures
thereof there is shown in FIGS. 1-4 a molded body of semi-rigid
material which constitutes the present invention. The term
"semi-rigid" as used herein means a material of sufficient rigidity
to retain its shape under stress from the pulsing of arteries into
which it is to be placed in contact but capable of flexing to
prevent anatomical damage to portions of the body adjacent to the
device in the event of severe stresses. The material, of course,
must be substantially inert with respect to the body in which it is
being implanted. A preferred material is Dacron fabric reinforced
silicone rubber.
As may be seen from FIGS. 1-4 the body has a generally U-shaped
configuration along its longitudinal axis and in addition has a
generally U-shaped configuration in its midsection as may be seen
more clearly from the cross-section in FIG. 4. The opposite ends of
the body are flattened to provide footplates or bearing portions 11
and 12 and preferably an elongated stripe 13 of radio-paque
material is provided along the length of the device to allow visual
inspection by X-ray of placement of the device subsequent to
surgery.
The anatomical sketch shown in FIG. 5 shows placement of the device
as shown in FIGS. 1-4. The aorta is indicated by the numeral 14 and
branches into right and left iliac arteries 15 and 16,
respectively. The vena cava 17 is similarly fed by the right and
left iliac veins 18 and 19, respectively. Since the aorta lies to
the left of the vena cava the right iliac artery 15 must cross over
the left iliac vein 19. Iliac venous compression is caused by
pressure exerted by the artery 15 on the vein 19. The body 20 of
the present invention is interposed between the artery and vein at
that point. The bearing portions 11 and 12 of the device are
sutured to the prevertebral fascia at the iliac venous crotch and
the left superior iliocaval border. The right iliac artery is
cradled between the upturned edges of the center portion of the
device to thereby hold it in position. The longitudinal U-shaped of
the center portion of the device serves as a bridge over the left
iliac vein to thereby eliminate pressure on the vein by the artery.
The device also acts as a spacer to prevent any adhesion between
the vein and the artery. The inherent rigidity of the device
provided, for example, by the silicone rubber and the fabric
reinforcement thereof from which the device is preferably
manufactured, serves to maintain the relationship.
In about 20 percent of the cases in which iliac venous compression
occurs the right iliac artery tends to run parallel to the right
iliac vein at the iliac venous crotch thus preventing placement of
the bearing portion on the prevertebral fascia in the crotch. In
such instances it is preferable to have a device shaped such as the
modification 20' shown in FIG. 6 in which the bearing portion 11'
at one end of the device is made substantially wider than the body
of the device instead of substantially the same width of the device
as is shown in FIGS. 1-4. Placement of the device 20' in a human
body is shown in the anatomical sketch of FIG. 7. The wide bearing
portion 11' can then overly the right iliac vein and bear on fascia
at both sides thereof or at least spread any pressure exerted on
the device by the right iliac artery over a much wider area thereby
preventing adhesions. Obviously it is desirable for the widened
bearing portion 11' to have a curvature corresponding to the
curvature of the right iliac vein to minimize pressure on the right
iliac vein and flattened footplates provided at each end of the
bearing portion 11'.
In the preferred operative technique for implanting the device of
the present invention the aortic bifurcation is exposed through a
midline transabdominal incision. The distal aorta and the right
common iliac artery are mobilized and retracted to the left.
Elevation of the artery permits lysis of fibrous adhesions
surrounding the left iliac vein and characteristically allows the
previously flattened vein to assume a substantially circular
configuration. Minimal posterior dissection is required. The
prevertebral fascia at the iliac venous crotch and the left
superior ileocaval border is then exposed and the device is
temporarily positioned with its footplates on these cleared areas
to allow ajustments to insure gentle arterial bridging. When
alignment is deemed proper sutures are placed into the fascia with
the device removed and the free suture ends are then passed through
each respective footplate. After the device is securely positioned
the peritoneum is closed over the vessels and the abdomen is
closed.
It should be realized that although the description of a preferred
embodiments refers only to a device for bridging the left iliac
vein, similar devices utilizing the same principles may be used in
other portions of the human body or in animal bodies if similar
conditions exist. It will also be obvious to those skilled in the
art that some modifications and variations of the device may be
made without departing from the spirit and scope of the invention;
therefore, it is to be understood that within the scope of the
amended claims the invention may be practiced otherwise than as
specifically described.
* * * * *