Patent Publication Number: US-6221079-B1

Title: Method and apparatus for vessel repair in a patient

Description:
FIELD OF THE INVENTION 
     The present invention is related to minimally invasive thorascopically assisted replacement of the aorta. More specifically, the present invention is related to minimally invasive thorascopically assisted replacement of the descending thoracic aorta, or the abdominal portion of the aorta, utilizing a sutureless aortic graft. 
     BACKGROUND OF THE INVENTION 
     Minimal access surgical approaches to diseases of the cardiovascular system are becoming increasingly common. Traditional techniques of cardiovascular surgery are massively intrusive to the patient and induce severe trauma to the patient simply by the patient having to experience his or her chest being opened to access the heart. Furthermore, there is always the concern for blood loss in any surgery, especially heart surgery and vascular surgery. In many instances, such as the repair of an aneurysm, if angioplasty is not indicated, the cure could almost be as bad as the disease. 
     The present invention provides for minimally invasive surgical techniques that can quickly and simply repair a vessel, such as the aorta, so there is minimal loss of blood and minimal trauma to the patient. 
     SUMMARY OF THE INVENTION 
     The present invention pertains to an apparatus for repairing a vessel in a patient. The apparatus comprises a graft. The apparatus comprises a mechanism for compressing the vessel to the graft and holding the vessel to the graft. 
     The present invention pertains to a method of repairing a vessel of a patient. The method comprises the steps of placing a first end of a graft in contact with a first side of the vessel. Then there is the step of placing a second side of the graft in contact with the second side of the vessel. Next there is the step of compressing the first side of the vessel against the first end. Then there is the step of compressing the second side of the vessel against the second end. 
    
    
     BRIEF DESCRIPTION OF THE DRAWINGS 
     In the accompanying drawings, the preferred embodiment of the invention and preferred methods of practicing the invention are illustrated in which: 
     FIG. 1 is a schematic representation of a graft of an apparatus for repairing a vessel in a patient of the present invention. 
     FIG. 2 is a schematic representation of the graft of the apparatus for repairing a vessel between the thoracic aorta. 
     FIG. 3 is a schematic representation of the graft of the apparatus for repairing a vessel between the thoracic aorta with a first and second strip about the first and second sides of the aorta and the first and second ends of the graft, respectively. 
     FIG. 4 is a schematic representation of the graft of the apparatus for repairing a vessel between the thoracic aorta with the first and second strips in place with first and second ties about the first and second sides of the aorta and the first and second ends of the graft, respectively. 
    
    
     DETAILED DESCRIPTION 
     Referring now to the drawings wherein like reference numerals refer to similar or identical parts throughout the several views, and more specifically to figure thereof, there is shown an apparatus  10  for repairing a vessel  12  in a patient. The apparatus  10  comprises a graft  14 . The apparatus  10  comprises a mechanism  16  for compressing the vessel  12  to the graft  14  and holding the vessel  12  to the graft  14 . 
     Preferably, the graft  14  has a first portion  18  with a flow channel  20  extending through it, and a second portion  22  connected to the first portion  18  against which the compressing mechanism comprises the graft  14 . The first portion  18  is preferably flexible and can expand and contract and has an 18-25 millimeter inside diameter for placement into the thoracic artery and a 12-20 millimeter inside diameter for placement in the abdominal portion of the aorta. Preferably, the first portion  18  has a first end  24  and a second end  26  and the second portion  22  comprises a first element  23  and a second element  25 . The first element  23  is disposed in proximity to the first end  24 . The second element  25  is disposed in proximity to the second end. 
     The first end  24  preferably extends through the first element  23  and the second end  26  preferably extends through the second element  25 . Preferably, the first end  24  and second end  26  are glued with adhesive to the first element  23  and second element  25 , respectively. The compressing mechanism can include a first strip  28  and a second strip  30  used to compress the vessel  12  against the first element  23  and second element  25 , respectively, although it is not necessary. 
     Preferably, the compressing mechanism includes a first tie  32  and a second tie  34  disposed about the first strip  28  and the second strip  30 , respectively, to compress and hold the vessel  12  to the first end  24  and the second end  26 , respectively. The first end  24  and the second end  26  are knurled or made of a metal mesh. Preferably, the first end  24  and second end  26  are made of stainless steel, and the first strip  28  and second strip  30  are made of Teflon and the first tie  32  and second tie  34  are made of plastic. 
     The present invention pertains to a method of repairing a vessel  12  of a patient. The method comprises the steps of placing a first end  24  of a graft  14  in contact with a first side of the vessel  12 . Then there is the step of placing a second side of the graft  14  in contact with the second side of the vessel  12 . Next there is the step of compressing the first side of the vessel  12  against the first end  24 . Then there is the step of compressing the second side of the vessel  12  against the second end  26 . 
     Preferably, after the first side compressing step, there is the step of securing the first side of the vessel  12  to the first end  24 ; and after the second side compressing step there is the step of securing the second side of the vessel  12  to the second end  26 . The steps of placing the first end  24 , placing the second end  26 , compressing the first side, compressing the second side, securing the first side and securing the second side preferably occur within four minutes. 
     Preferably, the first end  24  placing step includes the step of placing the first end  24  into the first side of the vessel  12 ; and the second end  26  placing step includes the step of placing the second end  26  into the second side of the vessel  12 . The graft  14  preferably has a first element  23  disposed about the first end  24 , and the graft  14  has a second element  25  disposed about the second end  26 . The first element  23  and second element  25  are made of a hard, flexible but not compressible metal mesh, which provides a complex, high-friction surface for interface with the vessel wall, and the compressing the first side step includes the step of compressing the first side against the mesh surface of the first element  23  by tightening a first strip  28  about the first side and the first element  23 ; and the compressing the second side step includes the step of compressing the second side against the mesh surface of the second element  25  by tightening a second strip  30  about the second side and the second element  25 . 
     Preferably, the securing step includes the step of tying the first strip  28  with a first tie  32 , and the securing the second side step includes the step of tying the second strip  30  with a second tie  34 . The vessel  12  is preferably an aorta. Preferably, before the placing step there is the step of making an incision less than three inches long in the patient; and inserting the graft  14  through the incision to access the vessel  12 . 
     In the operation of the preferred embodiment, an apparatus  10  is used to repair a vessel  12 , such as a thoracic or abdominal aorta. The apparatus  10  comprises a graft  14 , as shown in FIG.  1 . The graft  14  has a first portion  18  which is flexible and can expand and contract with the pressure variation in the blood flow due to the pumping of the heart. The first portion  18  is made of Dacron or PTFE. At the first end  24  of the first portion  18  and the second end  26  of the first portion  18  is disposed a first element  23  and a second element  25 , respectively, of a second portion  22 . The first end  24  and second end  26  are made of stainless steel mesh and have a complex surface which provides a high friction contact. The first portion  18  has a flow channel  20  extending through it which allows blood to travel through the apparatus  10 . The first element  23  aligns with the first end  24  of the first portion  18  so the first portion  18  extends completely through the first element  23 , and the second end  26  of the first portion  18  extends completely through the second element  25 , so there are minimal edges to minimize the possibility of clotting of the blood passing through the graft  14 . In fact, the blood flow is at such a high rate, that there does not seem same to be any concern at all of blood clotting or any stagnation areas about the edges of the first portion  18  to allow for clotting to occur. The first element  23  and the second element  25  are glued to the first end  24  and second and, respectively, with adhesive or sutured. 
     The damaged vessel  12 , either having been cut for a specific medical purpose, or having a section removed that was damaged due to, for instance an aneurysm, quickly has the first element  23  inserted into one side of the vessel  12  and the second element  25  inserted into the second side of the vessel  12 . Speed is of the essence since blood is flowing out of the cut vessel  12  and is being lost. The graft  14  is inserted through an incision about three inches long in the chest wall without the need of a sternotomy, thoracotomy or laparotomy. 
     While the incision is large enough to introduce the graft  14  to the vessel  12 , there is little room or space for elaborate procedures. Once the first element  23  and second element  25  of the graft  14  are in place inside the vessel  12 , as shown in FIG. 2, a first strip  28  is inserted into the incision, behind the graft  14  and back towards the incision so the first strip  28  is positioned about the vessel  12  and the first element  23 . Similarly, a second strip  30  is positioned about the vessel  12  and the second element  25 , as shown in FIG.  3 . Alternatively, a soft backing is placed against the plastic tie-wrap, to pad the interface between the plastic tie and the aorta. The tie wrap can have teflon bonded to it which is 3-4 millimeters wide bonded to it. 
     After the first strip  28  and second strip  30  are in place, a first plastic tie and a second plastic tie are positioned about the first strip  28  and second strip  30  and tightened so the vessel  12  is compressed and secured in place against the first element  23  and second element  25 , as shown in FIG.  4 . The first tie  32  and second tie  34  are well known in the art and have a first end  24  that slides through a lock mechanism which prevents the first end  24  from slipping back through the lock after it is pulled through. Alternatively, the first and second strips can have hook and loop fasteners on opposing ends so when the first and second strips are tightened, the vessel  12  is compressed against the respective first element  23  and second element  25  and secured in place when the hook and loop fasteners are closed together. The mesh surface of the first element  23  and the second element  25  prevents the vessel  12  from sliding about the first and second elements. The procedure to implace the apparatus  10  can occur within 10 minutes. 
     Although the invention has been described in detail in the foregoing embodiments for the purpose of illustration, it is to be understood that such detail is solely for that purpose and that variations can be made therein by those skilled in the art without departing from the spirit and scope of the invention except as it may be described by the following claims.