Method and apparatus for implanting a graft prosthesis in the body of a patient

• US 5,304,220 A
• Filed: 05/03/1993
• Issued: 04/19/1994
• Est. Priority Date: 07/03/1991
• Status: Expired due to Term

• Current Assignee: Lifeshield Sciences LLC (Acacia Research Corporation)
• Original Assignee: Thomas J. Maginot
• Inventors: Maginot, Thomas J.
• Primary Examiner(s): Green, Randall L.
• Assistant Examiner(s): BURKE, ELIZABETH
• Application Number:
  US08/056,371
• Time in Patent Office: 351 Days
• Field of Search: 606/153, 606/155, 606/159, 623/1, 623/12, 600/29, 600/30, 128/898
• US Class Current: 128/898
• CPC Class Codes: A61B 17/11 for performing anastomosis; Buttons for anastomosis
• CPC Class Codes: A61B 2017/1107 for blood vessels
• CPC Class Codes: A61F 2/06 Blood vessels
• CPC Class Codes: A61F 2/064 with special features to facilitate anastomotic coupling anastomosis of natural blood vessels A61B17/11
• CPC Class Codes: A61F 2/07 Stent-grafts
• CPC Class Codes: A61F 2/856 Single tubular stent with a side portal passage
• CPC Class Codes: A61F 2/88 the wire-like elements formed as helical or spiral coils forming a net-like or mesh-like structure A61F2/90
• CPC Class Codes: A61F 2/90 characterised by a net-like or mesh-like structure
• CPC Class Codes: A61F 2/954 for placing stents or stent-grafts in a bifurcation
• CPC Class Codes: A61F 2/958 Inflatable balloons for placing stents or stent-grafts
• CPC Class Codes: A61F 2002/065 Y-shaped blood vessels
• CPC Class Codes: A61F 2002/075 the stent being loosely attached to the graft material, e.g. by stitching
• CPC Class Codes: A61F 2002/821 Ostial stents
• CPC Class Codes: A61F 2220/0075 sutured, ligatured or stitched, retained or tied with a rope, string, thread, wire or cable
• CPC Class Codes: Y10S 623/902 Method of implanting
• CPC Class Codes: Y10S 623/903 Blood vessel

Abstract

A method of implanting a graft in a patient'"'"'s body is disclosed. According to the method, a first end of the graft is anastomosed to the blood vessel at a first location which is covered by a substantially intact portion of the epidermis of the body, and a second end of the graft is anastomosed to the blood vessel at a second location which is visually exposed through a gaping surgical incision. The first end of the graft includes a flanged end portion which is guided into the blood vessel through an arteriotomy defined therein near the first location so as to be positioned substantially adjacent a portion of a sidewall of the blood vessel which substantially surrounds the arteriotomy. An expandable stent is then placed within the blood vessel and in contact with the flanged end portion so as to secure the flanged end portion of the graft between the sidewall of the blood vessel and the stent thereby securing the graft to the blood vessel. The graft is further secured to the blood vessel by suturing the flanged end portion and the stent to the sidewall of the blood vessel. The second end of the graft is secured to the blood vessel at the second location by standard surgical techniques.

Claims

1. A method of implanting a graft prosthesis in the body of a patient to bypass a segment of a blood vessel, comprising the steps of:

making an incision in the body;

positioning a graft so that one end of the graft is located substantially adjacent the blood vessel at a site upstream of the segment and a second end of the graft is located substantially adjacent the blood vessel at a site downstream of the segment, wherein the positioning step includes the step of placing the graft into the body through the incision, and further wherein the positioning step is performed while the upstream site is covered by a substantially intact portion of the epidermis of the body;

isolating a region of the area within the blood vessel substantially adjacent the upstream site from fluid communication with the rest of the area within the blood vessel, wherein the upstream isolating step is performed while the upstream site is covered by the substantially intact portion of the epidermis of the body;

making an arteriotomy in a sidewall of the blood vessel substantially adjacent the upstream site to create a communicating aperture between the upstream isolated region and an area outside of the blood vessel, wherein the upstream arteriotomy making step is performed while the upstream site is covered by the substantially intact portion of the epidermis of the body;

forming an anastomosis between the one end of the graft and the blood vessel substantially adjacent the upstream site, wherein the upstream anastomosis forming step is performed while the upstream site is covered by the substantially intact portion of the epidermis of the body, and further wherein the upstream anastomosis forming step includes the step of suturing the one end of the graft to the blood vessel;

isolating a region of the area within the blood vessel substantially adjacent the downstream site from fluid communication with the rest of the area in the blood vessel;

making an arteriotomy in the sidewall of the blood vessel substantially adjacent the downstream site to create a communicating aperture between the downstream isolated region and the area outside of the blood vessel; and

forming an anastomosis between the second end of the graft and the blood vessel substantially adjacent the downstream site.

2. The method of claim 1, wherein the one end of the graft includes an outwardly extending flanged end portion which is sutured to the sidewall of the blood vessel.

3. The method of claim 2, wherein the step of suturing the one end of the graft to the blood vessel includes the step of suturing the outwardly extending flanged end portion of the graft to an interior portion of the blood vessel.

4. The method of claim 2, wherein the step of suturing the one end of the graft to the blood vessel includes the step of suturing the outwardly extending flanged end portion of the graft to an exterior portion of the blood vessel.

5. The method of claim 1, wherein the downstream isolating step, the downstream arteriotomy making step and the downstream anastomosis forming step are each performed while a portion of the blood vessel substantially adjacent the downstream site is exposed through the incision.

6. The method of claim 1, wherein the positioning step includes the step of advancing the one end of the graft within the body to the upstream site with a medical instrument.

7. The method of claim 1, wherein the upstream anastomosis forming step further includes the step of securing the one end of the graft to the blood vessel with an expandable stent.

8. A method for implanting an end portion of a graft within the body of a patient during a bypass grafting procedure, comprising the steps of:

making an incision in the body at a first location;

isolating a region of the area within a blood vessel of the body substantially adjacent a second location from fluid communication with the rest of the area within the blood vessel, wherein the first location is remote from the second location, and further wherein the isolating step is performed while the second location is covered by a substantially intact portion of the epidermis of the body;

making an arteriotomy in the sidewall of the blood vessel substantially adjacent the second location to create a communicating aperture between the isolated region and the outside of the blood vessel, wherein the arteriotomy making step is performed while the second location is covered by the substantially intact portion of the epidermis of the body;

advancing the end portion of the graft through the incision to the second location, wherein the advancing step is performed while the second location is covered by the substantially intact portion of the epidermis of the body; and

forming an anastomosis between the end portion of the graft and the blood vessel substantially adjacent the second location, wherein the anastomosis forming step is performed while the second location is covered by the substantially intact portion of the epidermis of the body, and further wherein the anastomosis forming step includes the step of suturing the end portion of the graft to the blood vessel.

9. The method of claim 8, wherein the end portion of the graft includes an outwardly extending flange which is sutured to the sidewall of the blood vessel.

10. The method of claim 9, wherein the step of suturing the end portion of the graft to the blood vessel includes the step of suturing the outwardly extending flange to an interior portion of the blood vessel.

11. The method of claim 9, wherein the step of suturing the end portion of the graft to the blood vessel includes the step of suturing the outwardly extending flange to an exterior portion of the blood vessel.

12. The method of claim 8, wherein the step of advancing the end portion of the graft through the incision to the second location includes the step of advancing the end portion of the graft within the body to the second location with a medical instrument.

13. The method of claim 8, wherein the anastomosis forming step further includes the step of securing the end portion of the graft to the blood vessel with an expandable stent.