U.S. patent number 3,853,126 [Application Number 05/416,033] was granted by the patent office on 1974-12-10 for artery-to-vein shunt.
This patent grant is currently assigned to Heyer-Schulte Corporation. Invention is credited to Rudolf R. Schulte.
United States Patent |
3,853,126 |
Schulte |
December 10, 1974 |
ARTERY-TO-VEIN SHUNT
Abstract
An artery-to-vein shunt for long-term implantation in a human
body to give external access to the arterial and venous system. The
shunt includes a first and a second button adapted to be engaged in
an aperture through the skin. A peripheral groove in a peripheral
wall of each button receives an adjacent edge of the skin and may
include seal means to act as a fluid seal and as a stop for
infection. A first and a second shunt tube respectively pass
through the first and second buttons and include a connector
portion adapted to be connected to a vein or an artery, and a
coupler portion adapted to be connected to a third shunt tube which
interconnects the first and second shunt tubes. A fixation cuff may
be provided on the outer wall of each connector portion adjacent to
the respective free end. The fixation cuff and the stabilizer means
comprise a material with openings into which tissue can penetrate,
for example, a velour fabric. A pair of couplings is adapted
detachably to join respective free ends of the third shunt tube to
respective free ends of one of the coupler portions so as to
interconnect the flow conduits of the first and second shunt tubes
through the flow conduit of the third shunt tube.
Inventors: |
Schulte; Rudolf R. (Goleta,
CA) |
Assignee: |
Heyer-Schulte Corporation
(Goleta, CA)
|
Family
ID: |
23648247 |
Appl.
No.: |
05/416,033 |
Filed: |
November 15, 1973 |
Current U.S.
Class: |
604/8;
604/175 |
Current CPC
Class: |
A61M
1/3655 (20130101); A61M 39/0247 (20130101); A61M
2039/0258 (20130101) |
Current International
Class: |
A61M
1/00 (20060101); A61M 39/10 (20060101); A61M
39/00 (20060101); A61M 1/36 (20060101); A61m
005/00 (); A61m 025/00 () |
Field of
Search: |
;128/214R,334C,348,350,1R ;3/1 |
References Cited
[Referenced By]
U.S. Patent Documents
Primary Examiner: Truluck; Dalton L.
Attorney, Agent or Firm: Mon; Donald D.
Claims
I claim:
1. An artery-to-vein shunt for long-term implantation in a human
body to give external access to the arterial and venous system,
comprising: a first and a second button, each button comprising a
body member having a top and a bottom surface, a peripheral wall
extending around the body and interconnecting said top and bottom
surfaces, a peripheral groove in said peripheral wall, and
peripheral button-sealing means in said peripheral groove; a first
and a second shunt tube, respectively attached to and passing
through the first and second buttons, each of said first and second
shunt tubes having an inner and outer wall, and a flow conduit
defined by the respective inner wall, each of said shunt tubes
forming a coupler portion adjacent to and extending from the top
surface of the button, and a connector portion adjacent to and
extending from the bottom surface of the body, each said portion
having a free end spaced from the button, the free end of the
connector portion being intended for long-term attachment to a
respective artery or vein; a fixation cuff on the outer wall of
each connector portion adjacent to the respective free end; shunt
tube stabilizer means extending peripherally around the outer wall
of the connector portions of the first and second shunt tubes,
adjacent to the bottom surface of the respective button, the
fixation cuff and the shunt tube stabilizer means comprising a
material with openings into which tissue can penetrate; a third
shunt tube having a flow conduit and a pair of free ends; and a
pair of couplings, each detachably joined to a respective free end
of the third shunt tube to a respective free end of one of the
coupler portions so as to interconnect the flow conduits of the
first and second shunt tubes through the flow conduit of the third
shunt tube when they are joined by the couplings.
2. An artery-to-vein shunt according to claim 1 in which said
material is woven.
3. An artery-to-vein shunt according to claim 2 in which said
material is a velour.
4. An artery-to-vein shunt according to claim 1 in which the shunt
tube stabilizer means further includes said material applied to
said bottom surface of the button.
5. An artery-to-vein shunt according to claim 1 in which the
peripheral groove is ovular in plan.
6. An artery-to-vein shunt according to claim 1 in which a flexible
and resilient coil spring is formed between the inner and outer
walls of the connector portions adjacent to the free end
thereof.
7. An artery-to-vein shunt according to claim 1 in which each of
said couplings comprises a shoulder on the respective coupler
portions, adjacent its free end, a shoulder adjacent to each free
end of the third shunt tube, and a clamp for engaging the said
shoulders and restraining them against separation.
8. An artery-to-vein shunt according to claim 7 in which seal means
seals the assembled three shunt tubes against leakage at the said
free ends of the coupler portions.
9. An artery-to-vein shunt according to claim 8 in which said seal
means comprises a peripheral sealing surface on each of said shunt
tubes.
10. An artery-to-vein shunt according to claim 9 in which one of
said sealing surfaces at each joinder of the third shunt tube with
another shunt tube is resiliently deformable.
11. An artery-to-vein shunt according to claim 10 in which said
resiliently deformable surface is part of one of said shunt tubes,
and in which the clamp draws the shunt tubes together to cause said
deformation.
12. An artery-to-vein shunt according to claim 1 in which said
third shunt tube is cuttable, and in which adapter means is
provided to make a fluid connection with two cut ends of the third
shunt tube.
13. An artery-to-vein shunt according to claim 1 in which the first
and second shunt tubes are mirror images of one another, and the
third shunt tube is U-shaped.
14. An artery-to-vein shunt according to claim 13 in which the said
portions lie primarily in planes which are spaced apart from one
another on opposite sides of the buttons, and which planes lie
substantially parallel to the plane of the peripheral groove in the
button.
15. An implant for long-term implantation in a human body to give
external access to an artery or a vein, comprising: a button
comprising a body member having a top and a bottom surface, a
peripheral wall extending around the body and interconnecting said
top and bottom surfaces, a peripheral groove in said peripheral
wall, and peripheral button-sealing means in said peripheral
groove; a shunt tube attached to and passing through the button,
said shunt tube having an inner and outer wall, and a flow conduit
defined by the inner wall, the said shunt tube forming a coupler
portion adjacent to and extending from the top surface of the
button, and a connector portion adjacent to and extending from the
bottom surface of the body, each said portion having a free end
spaced from the button, the free end of the connector portion being
intended for long-term attachment to a respective artery or vein; a
fixation cuff on the outer wall of the connector portion adjacent
to the free end; shunt tube stabilizer means extending peripherally
around the outer wall of the connector portion of the shunt tube,
adjacent to the bottom surface of the button, the fixation cuff and
the shunt tube stabilizer means comprising a material with openings
into which tissue can penetrate, whereby a third shunt tube having
a flow conduit and a pair of free ends, and a pair of couplings
each adapted detachably to join a respective free end of the third
shunt tube to a respective free end of the coupler portion, and
also the coupler portion of the second shunt tube of another
implant is adapted to interconnect the flow conduits of the first
and second shunt tubes through the flow conduit of the third shunt
tube when they are joined by the couplings.
16. An implant according to claim 15 in which said material is
woven.
17. An implant according to claim 16 in which said material is a
velour.
18. An implant according to claim 15 in which the shunt tube
stabilizer means further includes said material applied to said
bottom surface of the button.
19. An implant according to claim 15 in which the peripheral groove
is ovular in plan.
20. An implant according to claim 15 in which a flexible and
resilient coil spring is formed between the inner and outer walls
of the connector portions adjacent to the free end thereof.
Description
This invention relates to an artery-to-vein shunt for long-term
implantation in a human body to give external access to the
arterial and venous system.
A serious problem faced by persons who require periodic treatment
of their blood, such as by dialysis as a consequence of kidney
malfunction, is that each time they are connected to the dialysis
machine, a new incision must be made in a vein and an artery. This
is a source of considerable pain and discomfort, and further, after
many incisions are made, the person begins to run out of locations
where a connection can be made. In fact, the problem of connecting
the dialysis machine to the patient periodically over an extended
period of time is one of the most severe problems faced by the
patient.
Furthermore, the presently-known means for connecting dialysis
devices to patients simply utilizes a trochar needle which
penetrates the wall of the respective vein or artery. The needle is
strapped to the body during treatment. Motion of the arm or other
body member soon constitutes a source of exquisite pain for the
patient, and should be avoided if possible.
It is an object of this invention to provide an artery-to-vein
shunt which can surgically be implanted for long-term access to the
arterial and venous systems so that connections and re-connections
are done on articles which are physically separate from the human
body. If re-implantation is necessary, it is an infrequent, rather
than a frequent matter, and a single invasion of a vein and artery
lasts for many treatments.
It is an object of this invention to provide such a shunt which
enables ready connection to be made to the dialysis device, using
inexpensively replaced throw-away parts.
It is still another object of this invention to provide fixation
means and stabilizer means which will hold the shunt relative to
surrounding tissue so as to minimize movement of the shunt relative
to the vein and thereby decrease the incidence of pain in its
use.
An artery-to-vein shunt according to this invention comprises a
first and a second button, each button having a peripheral groove
and peripheral button-sealing means in the peripheral groove. The
button-sealing means make a fluid seal and a stop for infection at
the skin level. A first and a second shunt tube are respectively
attached to and passed through the first and second buttons, each
of which has a flow conduit, a coupler portion adjacent to and
extending from the surface of the button outside the body, and a
connector portion adjacent to and extending from the other surface
of the body and adapted to be connected to a respective artery or
vein.
A fixation cuff is provided on the outer wall of each connector
portion adjacent to its respective free end, and shunt tube
stabilizer means extends peripherally around the outer wall of the
first and second shunt tubes adjacent to the button so as to
minimize its motion relative to the body. The fixation cuff and the
shunt tube stabilizer means comprise a material with openings into
which tissue can penetrate.
A third shunt tube has a flow conduit and a pair of free ends. A
pair of couplings detachably joins the free ends of the third shunt
tube to respective free ends of the coupler portions so as to
interconnect the flow conduits of the first and second shunt tubes
through the flow conduit of the third shunt tube when they are
joined by the couplings.
According to a preferred but optional feature of the invention, the
material of the fixation cuff and the shunt tube stabilizer means
is woven, and preferably is a velour.
According to another preferred but optional feature of the
invention, a flexible and resilient coil spring is formed between
the inner and outer walls of the connector portions adjacent to
their free ends.
According to yet another preferred but optional feature of the
invention, seal means seals the assembled three shunt tubes against
leakage at the free ends of the coupler portions.
The above and other features of this invention will be fully
understood from the following detailed description and the
accompanying drawings in which:
FIG. 1 is a perspective view of the presently preferred embodiment
of the invention;
FIGS. 2 and 3 are fragmentary perspective views showing the device
of FIG. 1 implanted and in two conditions of use;
FIG. 4 is a longitudinal, fragmentary cross-section showing a
portion of FIG. 1 implanted;
FIG. 5 is a fragmentary axial cross-section showing another portion
of the device of FIG. 1 implanted;
FIG. 6 is a plan view taken at line 6--6 of FIG. 5;
FIG. 7 is an exploded view of parts comprising a portion of FIG.
1;
FIG. 8 shows a portion of FIG. 7 in the operating condition of FIG.
3;
FIG. 9 shows a form of seal means useful with the invention;
and
FIGS. 10 and 11 show a modification of the construction of FIG. 9
with its operational features emphasized.
The presently preferred embodiment of an artery-to-vein shunt 20 is
shown assembled in FIG. 1. It is intended surgically to be
implanted relative to the skin with part of it beneath the skin and
part of it above the skin, such as on an arm or on a leg. The shunt
20 is shown attached to an artery 21 and a vein 22 which lie
beneath skin 23.
The shunt comprises a first and a second button 25, 26. While these
buttons may take a number of shapes, the presently preferred form
is ovular, i.e., relatively elliptical in plan view (FIG. 6). It
has been found that generally elongated form such as this enables
the button to be planted in the skin in a relative long slit and be
accommodated thereby better than when a circular or other shape is
used instead, especially in the arm or leg.
THe buttons are identical, and only button 25 will be described in
detail. The body member is preferably flat with a top surface 27
and a bottom surface 28, the terms "top" and "bottom" referring to
outside and inside the skin level in which the button is placed. A
peripheral wall 29 extends around the body and interconnects the
top and bottom surfaces. A peripheral groove 30, which may have a
relatively sharp apex 31, extends peripherally around the wall. The
skin 23 of the patient will have been cut, and the edges of the cut
will be received in the peripheral groove in a manner yet to be
described.
A first and second shunt tube 35 and 36 are respectively attached
to and pass through the first and second buttons. The constructions
of the first and second shunt tubes are identical, except that they
are mirror images, so that only shunt tube 35 will be described in
detail. Shunt tube 35 has an inner wall 37, an outer wall 38, and a
flow conduit 39 passing therethrough.
The first and second shunt tubes respectively include coupler
portions 40, 41 which are positioned on the outside of the device
when installed, i.e., above the top surface. They also include
respective connector portions 42, 43 which extend from the bottom
wall and are intended for long-term attachment to a respective vein
22 or artery 21. First and second shunt tubes 35 and 36 have free
ends 46, 47 on the connector portions and free ends 48, 49 on the
coupler portions at the end thereof.
According to a preferred but optional feature of the invention, a
flexible and resilient coil spring 55 is formed between the inner
and outer walls of each of the connector portions adjacent to the
free ends thereof. This spring may readily be molded into the
material of the connector portion at the time it is made. It
provides springy support to maintain the circular shape of the
tubes at the point of attachment to the artery or vein.
A fixation cuff 60, 61 is attached to the shunt tube adjacent to
the respective free ends of 46 and 47 of the connector portions.
They are made of a material yet to be described, and can be
cemented or sewed into place on the outer wall of the respective
conductor portion.
Shunt tube stabilizer means 65 (FIG. 5) is attached to and extends
peripherally around the outer wall of the connector portions of the
first and second shunt tubes adjacent to the bottom surface of the
respective button. It extends axially along the connector portion
as shown. Optionally, the shunt tube stabilizer means may further
include said material applied as a layer 66 to the said bottom
surface of the respective button for purposes yet to be
described.
A third shunt tube 70 is generally U-shaped and has a flow conduit
71 and a pair of free ends 72, 73 respectively adapted to make a
fluid-tight connection with the free ends 48 and 49 of the coupler
portions.
Couplings 75, 76 are provided, one for joining each of the free
ends of the third shunt tube to a respective free end of the
coupler portions of the first and second shunt tubes. These
couplings include shoulders 77, 78 on the coupler portions, and
shoulders 79, 80 on the respective free ends of the third shunt
tube. The free ends are brought together and the shoulders are
engaged by respective clamps 81, 82 which also form a part of the
couplings. Only clamp 82 will be described in detail (see FIG. 7).
Clamp 81 is identical to it. Clamp 82 has a central channel 83 to
pass the connector portion and the third shunt and to receive their
free ends. It also includes a pair of shoulders 84, 85 on the clamp
which can be brought to bear against shoulders 78 and 80 so as to
hold the free ends together in a compressive fit. The material of
the clamp may be inherently springy such that it can be snapped
into place and will retain itself under those circumstances. It can
also readily be removed by reverse motion.
Peripheral button-sealing means 90 are attached to the inside wall
91 of peripheral groove 30. The purpose of this material is to form
a fluid seal and a stop for infection at the point of entry of the
shunt system. Materials suitable for this button-sealing means will
be described below.
Seal means 95 (FIGS. 9-11) may be provided to seal the assembled
three shunt tubes against leakage at the free ends of the coupler
portions. Although relatively complicated conventional fluid-seals
such as O-rings and the like could be used, when relatively
resilient materials such as polyethylene or medical grade silicone
rubber (silicon elastomer) is used as a material of construction, a
satisfactory fluid seal can be obtained by direct
surface-to-surface abutting fit.
For example, in FIG. 9, the seal means 95 comprises peripheral end
surfaces 96, 97 on the coupler portion 41 and on the third shunt
tube 70, respectively. These surfaces are flat annuli and are
brought together against one another at the time the clamp is
applied. The sealing action can be improved by the means shown in
FIGS. 10 and 11 wherein, instead of forming end surfaces 96 and 97
both as inherently deformable flat surfaces, end surface 96 is
formed rounded. When first contact is made between surfaces 96 and
97, the spacing apart L.sub.1 of shoulders 78 and 80 will be as
shown in FIG. 10. When the clamp is applied as in FIG. 11, there
will have been an axial compression along axis 98, causing a
resilient distortion shown as a bulb 99 on the free end of
connector portion 41. The spacing apart of shoulders 78 and 80 is
then L.sub.2 as shown, and a more reliable fluid seal is formed at
this point by the spring-back force of the material forming bulb
99.
The material of which the fixation cuffs 60 and 61, the shunt tube
stabilization means 65, and the peripheral button-sealing means 90
can be made is a material with openings into which tissue can
penetrate, and which is not harmful to or absorbed by body tissue.
Such a material is necessary for the fixation cuffs and shunt tube
stabilizer means, but the button-sealing means may, instead, merely
use compatible resilient material, such as a compressible open or
closed cell silicon elastomer foam or sponge if desired. However,
it is an advantage to utilize the same material in all three
applications. The preferred material is a woven dacron mesh,
preferably in the form of a velour. This cloth construction forms a
group of openings into which tissue can penetrate. This material is
not deleterious to the surrounding tissue, and, after a period of
implantation, it will be noted that tissue has grown into this
material to hold it in place, and as to the botton-sealing means,
prevents leakage of fluid past it and also provides a bar to the
penetration of organisms which might prove to be a source of
infection.
As can be seen in the Figs., the coupler portions and the connector
portions lie primarily in planes which are spaced apart from one
another on opposite sides of the buttons, and the planes lie
substantially parallel to the plane of the peripheral groove in the
button which is, of course, the plane of the skin in which the
button is implanted. The first and second shunt tubes are mirror
images of each other, and the free ends of their connector portions
are generally parallel to one another. The connector portions may
be made U-shaped more conveniently to be connected to the artery or
vein.
The material of which the shunt tubes are made is preferably
slightly resilient, but stiff enough to be shape-retentive.
Polyethylene is a suitable material of construction, as is medical
grade silicone rubber (silicon elastomer). The third shunt tube
should be made of readily cuttable material, such as a realtively
softer polyethylene, in order that it may receive an adapter
110.
When the device is implanted in the patient, and the patient is not
connected to a dialysis machine, the third shunt tube will be in
place as shown in FIG. 1, and flow will be directly from the artery
to the vein. The bypassed regions of the body downstream of the
artery will be supplied by peripheral circulation. When it is
desired to connect tubes 110a and 111 to first and second shunt
tubes, a single cut 112 may be made, and identical adapters 113,
114 are plugged into the stub ends 115, 116 of the U-shaped third
shunt tube. This arrangement is shown in FIG. 3. In FIG. 7 is shown
a situation where two cuts are made in the third shunt tube, and
the bight 117 of the third shunt tube is discarded. It will be
noted now that the dialysis machine has been connected to the
patient without necessity for elaborate sterility precautions and
that the conduitry to the point of attachment is full of blood.
Accordingly, this is a very simple form of attachment, and the
dialysis can proceed. When the dialysis is to be terminated, all
that is necessary is to pinch the tubes going to the dialysis
machine, remove the clamps, and substitute a new U-shaped third
shunt tube (which has been filled with fluid), and connect it as
shown. The individual then resumes his daily work
FIG. 4 illustrates the means of implanting the connector portion in
the human body. It is, of course, a surgical technique. For this
purpose, artery 22 (or vein 21) is cut off to a square face 120
which is brought against the free end of the connector portion of
the first shunt tube. Then it is sutured by sutures 121, 122 in
accordance with known surgical techniques. The sutures preferably
pass through the fixation cuff, and the fixation cuff extends
tubularly over the end of the vein or artery. If desired, the
suture may also be looped through one of the convolutions of the
coil spring, but this is not necessary. After awhile, a layer of
tissue 125 will have grown into the fixation means and also over
the joinder and over the artery, so as to form a more reliable
fluid fit and one which will stabilize the relative positions of
the connector portion and the vein or artery.
Similarly, the shunt tube stabilizer means, i.e., that portion
which extends along the connector portion next to the button and,
when used on the bottom surface of the button, also there, will
enable tissue ingrowth to occur which will stabilize the button
relative to the skin and surrounding structure. The button-sealing
means will prevent the leakage of the fluid and will also further
tend to stabilize the button, particularly against turning,
although the non-circular construction of the button will in itself
aid in resisting that motion.
As a consequence, there is provided an artery-to-vein shunt which
can be implanted for long-term use in the human body and which can
be worn without discomfort. When it is time for it to be used, a
cut or cuts is or are made in the U-shaped third shunt tube, and
the stub ends are connected at the dialysis machine. When the
dialysis procedure is completed, the U-shaped third shunt tube is
replaced. Each time there is used and thrown away only an
inexpensive U-shaped piece of plastic.
The dimensions of the device are arbitrary, and will be suited to
the flow rates and intended locations of implantation. In one
suitable device, the inside diameter of the conduits is 1/8 inch,
and the button is about 1/2 inch by 3/16 inch in its major and
minor dimension. The button is about 3/16 inch thick.
The constructions comprising a button and the first or second shunt
tube is sometimes herein called an "implant."
This invention is not to be limited by the embodiments shown in the
drawings and described in the description, which are given by way
of example and not of limitation, but only in accordance with the
scope of the appended claims.
* * * * *