DEVICE AND METHOD FOR ENDOSCOPIC VASCULAR SURGERY

Abstract: A site is prepared along a wall of a receiving blood vessel for connecting a prospective blood vessel thereto without interrupting the flow of blood through the receiving blood vessel. A device for the preparation comprises an elongated member and a sealing means. The device has a head portion to which the elongated member is connected, and a cutting means provided at a distal part of the head portion for making an initial opening in the receiving blood vessel. The sealing means is provided on the head portion proximally of the cutting means.

Description: DEVICE AND METHOD FOR ENDOSCOPIC VASCULAR SURGERY Technical Field of the Invention The present invention relates to a device and a method for preparing a site along a wall of a receiving blood vessel for connecting a prospective blood vessel thereto without interrupting the flow of blood through the receiving blood vessel. The device comprises an elongated member and a sealing means. Background Art Currently, the standard treatment of narrow and blocked arteries is to bypass the narrow part of the vessel with an additional vessel. When such an operation is to be performed the blood flow at the site where che additional vessel should be connected has to be excluded co prohibit bleeding. To exclude the blood flow, clamps normally are applied to the vessel which is to be connected to the additional vessel, either on one or both sides of the connection site. This can also be achieved by means of a side-clamp that excludes a part of the lumen around the intended opening. Today, surgery is heading towards endoscopic surgery, also called key-hole surgery. To apply clamps on arteries through endoscopic ports is very demanding and sometimes impossible, especially on the aorta. Ono way αf reducing the prcblorπs described, above is by using the device described in WO 98/52475. However, the preparation of a site for connecting a prospective blood vessel using this device is complicated and time- consuming. This results in the fact that the time for sealing is long and thus blood will be leaking out of the receiving blood vessel. Further, the device in WO 98/52475 is complicated because of its design, which makes it difficult to maintain, sterilise, and manufacture . Summary of the Invention It is an object of the present invention to provide a device and a method for preparing a site along a wall of a receiving blood vessel for connecting a prospective blood vessel thereto without interrupting the flow of blood through the receiving blood vessel, and further to achieve this preparation by endoscopic surgery. Another object of the present invention is to provide a device and a method that will facilitate fast sealing of the receiving blood vessel for minimising the amount of blood leaking out before the prospective blood vessel is connected. These objects are achieved by a device according to claim 1 and by a method according to claim 11. Preferred embodiments of the present invention are defined in the dependent claims. A device according to the invention comprises an elongated member and a sealing means and is characterised by a head portion to which the elongated member is connected, and a cutting means provided at a distal part of the head portion for making an initial opening in the receiving blood vessel, the sealing means being provided on the head portion proximally of the cutting means. An advantage of providing a cutting means and a sealing means like this is that the initial opening that is made by the cutting means may be sealed very fast by the sealinσ means, because both are arranged in the same device as mentioned above. The fast sealing of the initial opening results in a minimum of bleeding through this opening. Further advantages are that a hole for connecting a prospective blood vessel may be made without the use of clamps and thus very few instruments are required, which makes t easier to prepare said site. In a preferred embodiment of the invention, a needle is provided on the head portion distally of the cutting means for penetrating the wall of the receiving blood vessel before the initial opening is made by the cutting means . By having the needle penetrate the wall of the receiving blood vessel at the site before any cutting or sealing is performed, the initial opening can be posi- tioned with great accuracy. Further, the risk of the cutting means drifting away from a predestined position is minimised. In another preferred emoodiment of the invention, the cutting means comprises at least one cutting edge provided distally of the head portion. This facilitates the preparation of said site by making it possible for a user to botn cut and seal during a single advancement of the device. Thus, the time between cutting an initial opening and sealing the same can be reduced to a very short time Further, the head portion preferably tapers distally to facilitate the cutting of the initial opening and the advancement of the device through said opening. In yet another preferred embodiment, the sealing means is a flexible disc extending radially outwards from the head portion in a relaxed state. As a result, the sealing means does not require any mechanical controlling means for sealing the opening in the blood vessel . In yet another preferred embodiment, the flexible disc is flexible in a way that makes it bend backwards along the elongated member as a result of the flexible disc making contact with the receiving blood vessel during the advancement of the head portion through the initial opening of the receiving blood vessel and makes the flexible disc resume its relaxed state when the disc has passed through the initial opening for sealing the initial opening from inside the receiving blood vessel. By designing the sealing means like this, the operation of cutting an initial opening and sealing it can be performed oy involving very few and simple operations. It is even possible to perform the cutting and sealing by just advancing the device through the wall of a receiving blood vessel . Brief Description of the Drawings The invention will now be described in more detail with reference to the accompanying drawings, in which Fi - 1 shows a device according to one embodiment of the invention from the side, Fig. 2 shows the device according to Fig. 1 from its distal end, Fig. 3a shows the device according to Figs 1 and 2 when the sealing means is bent back during advancement through the wall of a receiving blood vessel, Fig. 3b shows the device according to Figs 1 and 2 when the sealing means is bent back by means of a ring, Fig. 4 shows an introducer tube for guiding and initially operating the device according to the invention, Fig. 5 shows the device according to Figs 1 and 2 in combination with the introducer tube according to Fig. 4, Fig. 6 shows the device according to Figs 1 and 2 being guided towards a receiving blood vessel, Fig. 7 shows the device according to Figs 1 and 2 having its needle penetrating the receiving blood vessel, Fig. 8 shows the device according to Figs 1 and 2 passing through an initial opening made by the device. Fig. 9 shows the device according to Figs 1 and 2 sealing the initial opening from inside the receiving blood vessel . Fig. 10 shows a punching device being guided to the site by means of the elongated member of the device in Figs 1 and 2, Fig. 11 shows a prospective blood vessel connected to the receiving blood vessel and shows the device according to Figs 1 and 2 having been retracted from its sealing position inside the receiving blood vessel through a newly created opening in the wall of the receiving blood vessel and then beemg retracted through the lumen cf the newly connecteα prospective blooα vessel , Fig. 12 shows a second cutting device, and Fig. 13 shows the second cutting device cf Fig. 12 when it is guided to the receiving blood vessel. Deta led Desc iption cf Preferred Embodimen s cf he Inven on Figs 1 and 2 illustrate a cutting and sealing device 1 according to a preferred emrjodiment . The device 1 essentially comprises a head portion 10, sealing means 12, and an elongated member 14. The sealing means 12 and the elongated memoer 14 are connected to the head portion 10. The nead portion 10 is preferably made of a narα material, e.g. metal or a harα synthetic material sucn as plastic, PVC, delπn, or any other synthetic material. Further, it is preferably oval in shape when viewed in a direction parallel to the direction of movement during use , see Fig . 2. A distal part 22 of the head portion 10, in the preferred embodiment, tapers distally to facilitate the advancement of the head portion 10 through an initial opening in a receiving blood vessel at a site where a prospective blood vessel is to be connected. At the distal part 22 of the head portion 10 there is provided a cutting means 18 for cutting the initial opening m the blood vessel. In tne preferred errLoodimen , the cutting means 18 is a cutting edge arranged at the surface of the distally tapered distal part 22 of the head portion 1C. The cutting edge is arranged along an axis 26 that is the longest central axis of the oval shape cf tne head portion 10. However, the cutting means 18 could be a cutting edge of any shape as long as it creates an initial opening during the advancement of the cutting means 18 through tne wall cf the blood vessel . In the prefεrreα emoodiment, a needle S is arranged at the distal part 22 of the nead portion 10 to facilitate and ensure that the penetration and the cutting is made at exactly the right position. In a proximal part 20 of the head portion 10 a protrusion 24 is arranged for connecting the elongated member 14 to the head portion 10. Preferably, the protrusion 24 tapers proximally, and even more preferably it tapers proximally and has a concave surface . The elongated memoer 14 is connected to the proximal part 20 of the heaα portion 10 for the purpose of keeping the device 1 in place when sealing the opening and withdrawing the device when it is not needed any more. The eiongateα member 14 may also be used to guide other equipment to the site. For example, equipment could be slidmgly attacneα to the elongated member 14 and thus be transported along the elongated member 14 to the site. The elongated memoer may be a wire made of synthetic material, e.g. PTFE, polyethylene, PDS , etc, or a metal. The sealing means 12 is arranged on the head portion 10 for the purpose of sealing the opening in the receiving blood vessel from inside the blood vessel. Thus, bleeding through the opening is prevented. The sealing means 12 is preferably a soft, bendable, circular disc, and is for example made of a synthetic material such as polyethylene, polyurethane, PVC, silicone, or PTFE. The disc is so soft and bendable that it is able to bend back along the elongated member 14 during advancement through the initial opening in the receiving blood vessel, see Fig. 3a. On the other hand, the disk is so rigid that it will not be pusned out of the initial opening or an enlarged opening in the wall cf the receiving blood vessel by the blood pressure . When the disc has passed the wall of the receiving blood vessel, it returns to its relaxed state for sealing the opening. Referring to Figs 3a and 3b, the disc is bent backwards during the penetration by forces from the edges of the initial opening, but optionally t can initially be fixed m the backwardly bent position by, for example, a synthetic ring 28 or a tape, which is released during the advancement of the disc througn the initial opening. Referring to Fig. 5, the device is shown together with an introducer tube 50, shown in Fig. 4, for guiding and initially controlling the device. The introducer tube 50 may be made of metal or any synthetic material. Further, it may be non-bendable , partially bendable or bendable in its full length, depending on the requirements of bending the tube in order to direct the head portion of the device 1 to the site. The tube 50 surrounds the elongated member 14 of the device and is smaller in diameter than the nead portion 10 of the device 1. The smaller diameter cf the introducer tube makes it possible to exert force on the head portion 10 and make t penetrate the receiving blood vessel. Referring to Figs 12 and 13, an embodiment of the present invention comprises a second cutting device 74, e.g. a punching device or a biting device. The cutting device 74 is preferably a punching device and is designed to be guided by the elongated member to the site where a hole is to be cut. In a preferred embodiment the punching device comprises a central channel 80, a punching mechanism 82 in a distal end of the punching device 74, manoeuvring means 84 in a proximal end of the punching device 74, and an elongated body 86. The puncning mechanism 82 is arranged to be controlled cy the manoeuvring means 84 from outside a boαy 88. Thus, a hole is puncheα inside the body 88 by means of the punching mecnanism 82 by manoeuvring the manoeuvring means 84 being positioned outside the body 88. The manoeuvring means 84 can be formed with a scissor-grip or just as two rods. To guide the punching device 74 to said site the central channel 80 is arranged for sliding the punching device 74 on the elongated memoer 14. The elongated body 86 is preferably a tube surrounding the central channel 80, which tube is flexible in order to follow bends of the elongated member 14. Now referring to Fig. 6, in a preferred method according to the invention, the cutting and sealing device 1 is guided to the site of a receiving blood vessel 70, e.g. an artery, where a prospective blood vessel is to be connected. The means used for guiding and initial operation of the device 1 is preferably the introducer tube 50, but could be any other means that are able to guide and initially operate the device. The advantage of using an introducer tube is that it is a non-compleκ device, as explained. Now referring to Fig. 7, when the device 1 is positioned at the site, the needle 16 adjacent to the head portion 10 is easily directed to the exact location for the operation and pushed into the blood vessel 70 by means of the introducer tube 50. Now referring to Fig. 8, the device 1 is further advanced so that the cutting means 18 is cutting an initial opening 72 in the wall of the receiving blood vessel 70 simultaneously as it is advanced through the same. The device 1 is further advanced and the sealing means 12 is bent back along the tube 50 by forces from the edges of the initial opening 72. The device is further advanced uncil the sealing means 12 has passed the wall of the receiving blood vessel 70 totally. Alternatively, the sealing means could initially be arranged in a backwardZy bent pos-c-on by means of a synthetic ring or a tape, which is released during the passage of the sealing means through the wall of the receiving blood vessel 70. Now referring to Fig. 9, when the sealing means 12 has passed the wall of the receiving blood vessel 70, it resumes its relaxed state and covers the initial opening 72. To ensure that the sealing means keeps its sealing position, a slight traction may be applied to the elongated member 14. Now referring to Figs 10 and 11, a second cutting device 74, e.g. a punching device or biting device, is arranged to be guided by the elongated memoer 14 to the site for cutting a final larger opening 76 in the wall of the receiving blooα vessel . The elongated member 14 is preferably running tnrough the second cutting device 74, which will thus be able to cut the final larger opening 76 at the location of the initial opening 72. When the second cutting device 74 is in position at the initial opening 72 it is operated to cut or punch a round hole, i.e. the final opening 76, in the receiving blood vessel 70. The sealing means 12 is also sealing the final opening 76 When the final opening 76 is made, the second cutting device 74 is retracteα and the material that has been removed by means of the second cutting device 74 is discarded when the second cutting device 74 is outside the body Then the prospective blood vessel 78 is attached to the receiving blood vessel 70 at the final opening 76 by means of suturing or anastomotic devices. Finally, when the prospective blood vessel 78 is attached and the connection is sealed, the cutting and sealing device 1 is retracted through this newly attached blood vessel 78.

Claims: CLAIMS 1. A device for preparing a site along a wall of a receiving olooα vessel (70) for connecting a prospective blood vessel (78) thereto without interrupting the flow of blood through the receiving blood vessel (70), said device comprising an elongateα member (14) and a sealing means (12), characterised by a head portion (10) to wnich the elongated member (14) is connected, and a cutting means (18) provided at a distal part of the head portion (10) for making an initial opening (72) in the receiving blood vessel (70) , the sealing means (12) being provideα on the head portion (10) proximally of the cutting means (18) 2. A device according to claim , wherein a needle (16) s provided on the head portion (10) distally of the cutting means (18) for penetrating the wall of the receiving blood vessel (70) before the initial opening (72) is made by the cutting means (18) . 3. A device according to claim l or 2 , wherein the cutting means (18) comprises at least one cutting edge provided distally of the head portion (10) . 4. A device according to any one of the preceding claims, wherein the head portion (10) tapers distally. 5. A device according to any one of the preceding claims, wherein a proximal part (20) of the heaα portion (10) comprises a protrusion (24) to wnicn the elongateα memoer (14) is attacned, the protrusion (24) tapering proximally. 6. A device according to any one of the preceding claims, wherein the head portion (10) is oval in shape when viewed along the direction of operational movement. 7. A device according to any one of the preceding claims, wherein the elongated member (14) is a wire. 8. A device according to any one of the preceding claims, wherein the sealing means (12) is a flexible disc extenαmg radially outwards from the neaα portion (10) in a relaxed state. 9. A device according to claim 8, wherein the flexible disc (12) is flexible m a way that makes it bend bacKwarαs along the elongated member (14) as a result cf the flexible disc (12) making contact with the receiving olood vessel (70) during the aαvancement of the head portion (10) througn the initial opening (72) in the receiving blood vessel (70) , the flexible disc (12) resuming its relaxed state when the disc (12) has passed through the initial opening (72) for sealing the initial opening (72) from inside the receiving blood vessel (70) . 10. A αevice according to claim 8 or 9 , further comprising a tube (50) navmg the nead portion (10) at a distal enα ana enclosing the eiongatea memDer (14) for guiding the head portion (10) towards the receiving blood vessel (70) . 11. A device according to any one of the preceding claims, further comprising a punching device (74) having a central channel (80) for sliding on the elongated member ( 14 ) . 12. A device according to claim 11, wherein the punching device (74) comprises a punching mechanism (82) of cooperating cutting edges controlled by manoeuvring means (84) at proximal end of the punching device (74) outside a body 13. A device according to claim 11 or 12, wnerem the puncning αevice (74) is flexible in order to follow bends wnen sliding on the elongated member (14) . 14. A method for preparing a site along a wall of a receiving blood vessel (70) for connecting a prospective blooα vessel (78) thereto without interrupting the flow of blood through the receiving blood vessel (70) , the method comprising the steps of guiding a cutting and sealing device (1), comprising an elongated member (14), a sealing means (12), a head portion (10) and a cutting means (18), to the site of the receiving blood vessel (70) , cutting an initial opening (72) in the wall of the receiving blood vessel (70) by means of the cutting means (18) of the αevice (1) , and sealing the initial opening (72) of the receiving blocα vessel (70) by aαvancing the sealing means (12) of the device (1) througn the initial opening (72) and making the sealing means (12) seal the initial opening (72) from the inside of the receiving blood vessel (70) . 15. A method according to claim 14, further comprising, before the step of cutting, the step of penetrating the receiving blood vessel (70) with a neeαle (16) provided at a distal part (22) of the neaα portion (10) . 16. A method according to claim 14 or 15, wherein the cutting of the initial opening (72) is performed by advancing the cutting means (18), which is provided with at least one cutting edge, through the wall of the receiving blood vessel (70) . 17. A method according to any one of claims 14-16, wherein a flexible disc is used as the sealing means (12) 18. A method according to claim 17, wherein the flexible disc (12), during the advancement m the sealing seep, is bent backwarαs along the elongated member (14) when advanced through the initial opening (72) ana wherein the flexible disc (12) returns to a relaxed state when it has passed the wall of the receiving blooα vessel (70) completely 19. A method according to any one of claims 14-18, wherein the cutting and sealing device (1) is slightly retracted at the end of the sealing step to keep the sealing means (12) positioned over the initial opening (72) . 20. A method according to any one of claims 14-19, wherein the cutting and sealing device (1) s guided to the site of the receiving blooα vessel (70) by means of a tube (50) . 21. A method according to any one of claims 14-20, further comprising, after the step of sealing, the step of making a final opening (76) in the receiving blood vessel (70) at the sealed site of the receiving blood vessel (70) by means of a second cutting device (74) . 22. A method according to claim 21, wherein the second cutting device (74) is advanced to the site at the blood vessel (70) along the elongated member (14) .

Inventors: SOLEM JAN OTTO, SOLEM, JAN, OTTO
Applicants: SOLEM JAN OTTO, SOLEM, JAN, OTTO
Application year: 2001
Main classification: A61B17
IPC codes: A61B17