WO2006013234A1 - Vascular prosthesis for adapting diameter differences between two ends of a replaceable blood vessel segment - Google Patents

Vascular prosthesis for adapting diameter differences between two ends of a replaceable blood vessel segment Download PDF

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Publication number
WO2006013234A1
WO2006013234A1 PCT/FR2004/001713 FR2004001713W WO2006013234A1 WO 2006013234 A1 WO2006013234 A1 WO 2006013234A1 FR 2004001713 W FR2004001713 W FR 2004001713W WO 2006013234 A1 WO2006013234 A1 WO 2006013234A1
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Prior art keywords
vascular prosthesis
collar
diameter
prosthesis according
prosthesis
Prior art date
Application number
PCT/FR2004/001713
Other languages
French (fr)
Inventor
Daniel Roux
Original Assignee
Daniel Roux
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Application filed by Daniel Roux filed Critical Daniel Roux
Priority to PCT/FR2004/001713 priority Critical patent/WO2006013234A1/en
Publication of WO2006013234A1 publication Critical patent/WO2006013234A1/en

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/04—Hollow or tubular parts of organs, e.g. bladders, tracheae, bronchi or bile ducts
    • A61F2/06—Blood vessels
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/04—Hollow or tubular parts of organs, e.g. bladders, tracheae, bronchi or bile ducts
    • A61F2/06—Blood vessels
    • A61F2/064—Blood vessels with special features to facilitate anastomotic coupling
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/24—Heart valves ; Vascular valves, e.g. venous valves; Heart implants, e.g. passive devices for improving the function of the native valve or the heart muscle; Transmyocardial revascularisation [TMR] devices; Valves implantable in the body
    • A61F2/2412—Heart valves ; Vascular valves, e.g. venous valves; Heart implants, e.g. passive devices for improving the function of the native valve or the heart muscle; Transmyocardial revascularisation [TMR] devices; Valves implantable in the body with soft flexible valve members, e.g. tissue valves shaped like natural valves
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/04—Hollow or tubular parts of organs, e.g. bladders, tracheae, bronchi or bile ducts
    • A61F2/06—Blood vessels
    • A61F2002/061—Blood vessels provided with means for allowing access to secondary lumens
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/04—Hollow or tubular parts of organs, e.g. bladders, tracheae, bronchi or bile ducts
    • A61F2/06—Blood vessels
    • A61F2002/065—Y-shaped blood vessels
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2250/00—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2250/0014—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof having different values of a given property or geometrical feature, e.g. mechanical property or material property, at different locations within the same prosthesis
    • A61F2250/0039—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof having different values of a given property or geometrical feature, e.g. mechanical property or material property, at different locations within the same prosthesis differing in diameter

Definitions

  • the present invention relates to a vascular prosthesis allowing adaptation to differences in diameter between the two ends of a segment of blood vessel to be replaced.
  • It relates generally to the field of vascular surgery and in particular to interventions to replace with a prosthesis a part or all of the aorta.
  • the device according to the present invention aims to remedy this state of affairs. It allows the surgeon, when there is a segment of blood vessel to be replaced with a difference in diameter upstream and downstream, to save time significantly, while making perfectly tight sutures at both ends of the implant. It consists of a prosthetic tube equipped at the periphery of one of its ends with a collar of the same nature as the prosthesis and of a relatively large diameter relative to that of the prosthetic tube, so as to obtain a prosthesis whose one end has a diameter perfectly adaptable to that of the blood vessel, the collar can be resized by the surgeon as he wishes.
  • Figure 1 shows in perspective a vascular prosthesis according to the invention before implantation
  • Figure 2 shows the same prosthesis after establishment
  • Figures 3 to 6 illustrate the use of the vascular prosthesis on an aorta
  • Figure 7 shows a replacement vascular prosthesis of the abdominal portion of the aorta and Figures 8 and 9 show a descending aortic prosthesis. associated with a heart valve, respectively before and after assembly of the prosthesis and the valve.
  • FIGS. 1 to 9 is formed of a prosthetic tube 1 comprising at one of its ends, or near this end, a collar 2 extending around the periphery of the prosthetic tube in a plane substantially perpendicular to the axis of it.
  • the prosthetic tube 1, made of biocompatible material such as "Dacron” or “Goretex” is the standard type currently used in the replacement of segments of blood vessels 3, 3 '.
  • the flange 2 is a plane or conical element, of the same material as the prosthetic tube 1, of circular or semicircular shape and having an opening whose edge is perfectly sealed to the wall of the tube.
  • the diameter of the collar 2 will be much larger than that of the prosthetic tube 1 so as to be able to cope with all the cases that may arise, for example for a prosthetic aortic diameter 4 cm greater than that of the prosthesis .
  • the vascular prosthesis according to the invention is particularly suitable, in the case of interventions on the aorta 4 and makes it possible to intervene under very satisfactory conditions to treat particular situations such as those which are the subject of the following examples:
  • FIG. 3 and 4 show respectively the ascending part of an aorta 4 (heart side 6) sectioned before installation of the prosthesis and after establishment of the latter.
  • the prosthesis comprises not only an infusion line 5 but also branches 8 allowing connection with the branches 9 constituting the brachiocephalic arterial trunk, the left carotid and the left subclavian (FIG. 5).
  • the invention allows a two-step operation.
  • First step replacement of the aortic arch 10
  • Second step replacing the aorta thoracic 7 descending ( Figure 6).
  • Aneurysm of the abdominal aorta 11 when the aneurysm concerns the abdominal aorta and the iliac arteries, the surgeon uses a bifurcated prosthesis here, the invention can be adapted to the bifurcated prosthesis 12 so as to fix it on the Abdominal aorta ( Figure 7).
  • aortic heart valve leakage When aortic heart valve leakage is associated with a pathological ascending aorta (aneurysm), the valve should be changed and the ascending aorta replaced with a vascular prosthesis. There are mechanical valves sutured on vascular prostheses. On the other hand, this device does not exist for biological valves 13 (based on pig or calf tissues). Indeed, the biological valves are kept in a liquid product called glutamaldehyde which would alter the vascular prosthesis, that is why there is no valve tube with a bioprosthesis.
  • the vascular prosthesis according to the invention makes it possible to produce a valve-tube at the time of the operation by the surgeon.
  • the prosthetic tube 1 is capped on the biological valve 13 and the flange 2 is applied to the suture cushion 14 of the valve consists of a ring "dacron" ( Figures 8 and 9).
  • the collar can measure for example 1 cm wide.
  • the device according to the invention can be put in place on any vascular prosthesis so that the surgeon uses it if need be otherwise, does not use it. Indeed, this device does not interfere with the use of the prosthesis in a conventional way.

Abstract

The invention relates to a vascular prosthesis which makes it possible to adapt diameter differences between two ends of a replaceable blood vessel. The inventive prosthesis consists of a prosthetic tube (1) provided with a flange (2) which is arranged on the end thereof, made of the material used for the prosthesis and whose diameter relatively greater than the diameter of the prosthetic tube in such a way that the prosthesis whose one end is perfectly adaptable to the blood vessel (3, 3') diameter is obtainable, wherein the flange is reshapable by a surgeon according to the need thereof. Said invention generally relates to vascular surgery and, in particular, to operations for replacing a part of aorta or an entire aorta by a prosthesis.

Description

PROTHÈSE VASCULAIRE PERMETTANT UNE ADAPTATION AUX VASCULAR PROSTHESIS FOR ADAPTATION TO
DIFFÉRENCES DE DIAMÈTRE ENTRE LES DEUX EXTRÉMITÉS D'UNDIAMETER DIFFERENCES BETWEEN BOTH END OF A
SEGMENT DE VAISSEAU SANGUIN A REMPLACERSEGMENT OF BLOOD VESSEL TO BE REPLACED
La présente invention a pour objet une prothèse vasculaire permettant une adaptation aux différences de diamètre entre les deux extrémités d'un segment de vaisseau sanguin à remplacer.The present invention relates to a vascular prosthesis allowing adaptation to differences in diameter between the two ends of a segment of blood vessel to be replaced.
Elle se rapporte d'une manière générale au domaine de la chirurgie vasculaire et en particulier aux interventions visant au remplacement par une prothèse d'une partie ou de la totalité de l'aorte.It relates generally to the field of vascular surgery and in particular to interventions to replace with a prosthesis a part or all of the aorta.
Les prothèses vasculairés actuelles sont réalisées en textile synthétique à base de polyester "Dacron" tissé ou tricoté, ou en "Goretex", matériau inerte souple à base de polytétra-fluoro-éthylène, totalement compatible avec les tissus biologiques et utilisé pour la chirurgie (vaisseaux et ligaments) et pour l'esthétique.Current vascular prostheses are made of synthetic textile based on woven or knitted "Dacron" polyester, or "Goretex", a flexible inert material based on polytetrafluoroethylene, totally compatible with biological tissues and used for surgery ( vessels and ligaments) and for aesthetics.
Leur diamètre varie de 4 mm à 40 mm et toutes les prothèses connues sont cylindriques. Or, dans de nombreux cas, le diamètre du vaisseau sanguin n'est pas identique d'un point à un autre. Si cette différence de diamètre est peu sensible dans les petits diamètres, elle peut devenir importante pour des vaisseaux sanguins de grand diamètre comme l'aorte par exemple.Their diameter varies from 4 mm to 40 mm and all the known prostheses are cylindrical. However, in many cases, the diameter of the blood vessel is not identical from one point to another. If this difference in diameter is not very sensitive in small diameters, it may become important for large diameter blood vessels such as the aorta for example.
Cet état de fait engendre une difficulté pour le chirurgien. Il devra choisir en effet une prothèse dont le diamètre est une moyenne entre la grande section et la petite section du vaisseau sanguin où il va l'interposer. Puis, il devra suturer en fronçant de façon à compenser la différence de diamètre. Il va s'en suivre, une perte de temps un risque de fuite.This state of affairs creates a difficulty for the surgeon. He must choose a prosthesis whose diameter is an average between the large section and the small section of the blood vessel where he will interpose. Then, he will suture by frowning to compensate for the difference in diameter. It will follow, a loss of time a risk of flight.
Le dispositif selon la présente invention a pour objectif de remédier à cet état de choses. Il permet en effet au chirurgien, lorsqu'il y a un segment de vaisseau sanguin à remplacer avec une différence de diamètre d'amont et d'aval, de gagner du temps de façon sensible, tout en réalisant des sutures parfaitement étanches aux deux extrémités de l'implant. II est constitué d'un tube prothétique équipé à la périphérie de l'une de ses extrémités d'une collerette de même nature que la prothèse et d'un diamètre relativement important par rapport à celui du tube prothétique, de manière à obtenir une prothèse dont l'une des extrémités a un diamètre parfaitement adaptable à celui du vaisseau sanguin, la collerette pouvant être retaillée par le chirurgien comme il le désire.The device according to the present invention aims to remedy this state of affairs. It allows the surgeon, when there is a segment of blood vessel to be replaced with a difference in diameter upstream and downstream, to save time significantly, while making perfectly tight sutures at both ends of the implant. It consists of a prosthetic tube equipped at the periphery of one of its ends with a collar of the same nature as the prosthesis and of a relatively large diameter relative to that of the prosthetic tube, so as to obtain a prosthesis whose one end has a diameter perfectly adaptable to that of the blood vessel, the collar can be resized by the surgeon as he wishes.
Sur les dessins annexés, donnés à titre d'exemples non limitatifs de formes de réalisation conformes à la présente demande : la figure 1 représente en perspective une prothèse vasculaire selon l'invention avant implantation, la figure 2 montre la même prothèse après mise en place, les figures 3 à 6 illustrent l'utilisation de la prothèse vasculaire sur une aorte,In the accompanying drawings, given by way of nonlimiting examples of embodiments according to the present application: Figure 1 shows in perspective a vascular prosthesis according to the invention before implantation, Figure 2 shows the same prosthesis after establishment , Figures 3 to 6 illustrate the use of the vascular prosthesis on an aorta,
La figure 7 représente une prothèse vasculaire de remplacement de la partie abdominale de l'aorte et les figures 8 et 9 montrent une prothèse d'aorte descendante . associée à une valvule cardiaque, respectivement avant et après assemblage de la prothèse et de la valvule.Figure 7 shows a replacement vascular prosthesis of the abdominal portion of the aorta and Figures 8 and 9 show a descending aortic prosthesis. associated with a heart valve, respectively before and after assembly of the prosthesis and the valve.
Le dispositif, figures 1 à 9, est formé d'un tube prothétique 1 comportant à l'une de ses extrémités, ou près de cette extrémité, une collerette 2 s'étendant autour de la périphérie du tube prothétique dans un plan sensiblement perpendiculaire à l'axe de celui-ci.The device, FIGS. 1 to 9, is formed of a prosthetic tube 1 comprising at one of its ends, or near this end, a collar 2 extending around the periphery of the prosthetic tube in a plane substantially perpendicular to the axis of it.
Le tube prothétique 1 , réalisé en matériau biocompatible tel que "Dacron" ou "Goretex", est du type standard actuellement utilisé dans le remplacement de segments de vaisseaux sanguins 3, 3'.The prosthetic tube 1, made of biocompatible material such as "Dacron" or "Goretex" is the standard type currently used in the replacement of segments of blood vessels 3, 3 '.
La collerette 2 est un élément plan ou conique, du même matériau que le tube prothétique 1 , de forme circulaire ou semi-circulaire et comportant une ouverture dont le bord est joint de façon parfaitement étanche à la paroi du tube. Le diamètre de la collerette 2 sera nettement plus important que celui du-tube prothétique 1 de façon à pouvoir faire face à tous les cas pouvant se présenter, par exemple pour une prothèse aortique d'un diamètre de 4 cm supérieur à celui de la prothèse.The flange 2 is a plane or conical element, of the same material as the prosthetic tube 1, of circular or semicircular shape and having an opening whose edge is perfectly sealed to the wall of the tube. The diameter of the collar 2 will be much larger than that of the prosthetic tube 1 so as to be able to cope with all the cases that may arise, for example for a prosthetic aortic diameter 4 cm greater than that of the prosthesis .
Ainsi lorsqu'il y a un segment de vaisseau sanguin 3, 3' à remplacer avec une différence de diamètre d'amont et d'aval, le chirurgien choisit le diamètre de la prothèse égal au petit diamètre du vaisseau. Il réalise alors la suture bout à bout de façon parfaitement congruente puisque les diamètres du vaisseau et de la prothèse sont identiques.Thus when there is a blood vessel segment 3, 3 'to be replaced with a difference in diameter upstream and downstream, the surgeon chooses the diameter of the prosthesis equal to the small diameter of the vessel. He then makes the suture end to end in a perfectly congruent way since the diameters of the vessel and the prosthesis are identical.
Par contre pour le grand diamètre, il va suturer la collerette si son diamètre est adapté sinon, il peut la retailler au ciseau de façon à lui donner un diamètre exactement adapté à celui du vaisseau sanguin 3, 3' (figure 2). Le chirurgien va ainsi gagner du temps et Ia suture sera plus facile et étanche. Ce dispositif permet de s'adapter aisément à la forme du vaisseau; en effet, s'il n'est pas parfaitement cylindrique comme cela est souvent le cas, la collerette* sera découpée à la forme de la section du vaisseau.On the other hand, for the large diameter, it will suture the collar if its diameter is adapted otherwise it can resize the chisel so as to give it a diameter exactly adapted to that of the blood vessel 3, 3 '(Figure 2). The surgeon will save time and the suture will be easier and more watertight. This device makes it easy to adapt to the shape of the vessel; indeed, if it is not perfectly cylindrical as is often the case, the collar * will be cut to the shape of the section of the vessel.
La prothèse vasculaire selon l'invention est particulièrement adaptée , dans le cas d'interventions sur l'aorte 4 et permet d'intervenir dans des conditions très satisfaisantes pour traiter des situations particulières telles que celles faisant l'objet des exemples suivants:The vascular prosthesis according to the invention is particularly suitable, in the case of interventions on the aorta 4 and makes it possible to intervene under very satisfactory conditions to treat particular situations such as those which are the subject of the following examples:
- Dissection aortique, la prothèse comportant avantageusement un conduit de perfusion 5 permettant la connexion rapide avec la circulation extra-corporelle (cf brevet N° FR 01 12 642 déposé par l'auteur de la présente demande). Les figures 3 et 4 montrent respectivement la partie ascendante d'une aorte 4 (côté coeur 6) sectionnée avant pose de la prothèse et après mise en place de cette dernière.- Aortic dissection, the prosthesis advantageously comprising an infusion line 5 for rapid connection with the extracorporeal circulation (see patent No. FR 01 12 642 filed by the author of the present application). Figures 3 and 4 show respectively the ascending part of an aorta 4 (heart side 6) sectioned before installation of the prosthesis and after establishment of the latter.
- Anévrysme de l'aorte thoracique 7: la prothèse comporte non seulement un conduit de perfusion 5 mais également des branches 8 permettant une connexion avec les dérivations 9 constituant le tronc artériel brachio-céphalique, la carotide gauche et la sous clavière gauche, (figure 5).Aneurysm of the thoracic aorta 7: the prosthesis comprises not only an infusion line 5 but also branches 8 allowing connection with the branches 9 constituting the brachiocephalic arterial trunk, the left carotid and the left subclavian (FIG. 5).
L'invention permet une opération en deux temps. Premier temps : remplacement de la crosse aortique 10 ; Deuxième temps : remplacement de l'aorte thoracique 7 descendante (figure 6).The invention allows a two-step operation. First step: replacement of the aortic arch 10; Second step: replacing the aorta thoracic 7 descending (Figure 6).
- Anévrysme de l'aorte abdominale 11 : quand l'anévrysme intéresse l'aorte abdominale et les artères iliaques, le chirurgien utilise une prothèse bifurquée ici, l'invention pourra être adaptée à la prothèse bifurquée 12 de façon à effectuer sa fixation sur l'aorte abdominale (Figure 7).- Aneurysm of the abdominal aorta 11: when the aneurysm concerns the abdominal aorta and the iliac arteries, the surgeon uses a bifurcated prosthesis here, the invention can be adapted to the bifurcated prosthesis 12 so as to fix it on the Abdominal aorta (Figure 7).
Lorsqu'une fuite de la valvule cardiaque aortique est associée à une aorte ascendante pathologique (anévrisme), il faut changer la valvule et remplacer l'aorte ascendante par une prothèse vasculaire. II existe des valves mécaniques suturées sur des prothèses vasculaires. Par contre ce dispositif n'existe pas pour les valvules biologiques 13 (à base de tissus de porc ou de veau). En effet, les valvules biologiques sont conservées dans un produit liquide appelé glutamaldehyde qui altérerait la prothèse vasculaire, c'est pourquoi il n'existe pas de tube valvule avec une bioprothèse.When aortic heart valve leakage is associated with a pathological ascending aorta (aneurysm), the valve should be changed and the ascending aorta replaced with a vascular prosthesis. There are mechanical valves sutured on vascular prostheses. On the other hand, this device does not exist for biological valves 13 (based on pig or calf tissues). Indeed, the biological valves are kept in a liquid product called glutamaldehyde which would alter the vascular prosthesis, that is why there is no valve tube with a bioprosthesis.
La prothèse vasculaire selon l'invention permet de réaliser un tube- valvule au moment de l'opération par le chirurgien.The vascular prosthesis according to the invention makes it possible to produce a valve-tube at the time of the operation by the surgeon.
Il faut une prothèse vasculaire dont le diamètre du tube prothétique 1 soit légèrement supérieur à celui de la valvule biologique (à titre indicatif, il faut une prothèse vasculaire de 26 mm de diamètre pour une valvule de 23 mm de diamètre.) Ainsi le tube prothétique 1 se coiffe sur la valvule biologique 13 et la collerette 2 vient s'appliquer sur le coussin de suture 14 de la valvule constitué d'un anneau en "dacron" (figures 8 et 9).It requires a vascular prosthesis whose diameter of the prosthetic tube 1 is slightly greater than that of the biological valve (as an indication, a vascular prosthesis of 26 mm in diameter is required for a valve of 23 mm in diameter.) Thus the prosthetic tube 1 is capped on the biological valve 13 and the flange 2 is applied to the suture cushion 14 of the valve consists of a ring "dacron" (Figures 8 and 9).
Il ne reste plus au chirurgien qu'à suturer cet ensemble. II y aura donc un conditionnement séparé de la valvule et de la prothèse à collerette, un assemblage au moment de l'opération.It only remains for the surgeon to suture this set. There will therefore be separate conditioning of the valve and the flange prosthesis, an assembly at the time of the operation.
La collerette pourra mesurer par exemple 1 cm de large. Après assemblage du tube et de la valvule 13, la suture sur le coeur 6 est effectuée de façon à ce que la collerette 2 de la prothèse vasculaire et le coussin de suture 14 de la valvule biologique 13 soient solidarisés lorsque les fils sont noués.The collar can measure for example 1 cm wide. After assembly of the tube and the valve 13, the suture on the heart 6 is performed so that the collar 2 of the vascular prosthesis and the suture cushion 14 of the biological valve 13 are secured when the son are knotted.
D'une manière générale, le dispositif selon l'invention peut être mis en place sur toute prothèse vasculaire de façon à ce que le chirurgien l'utilise si besoin est sinon, ne l'utilise pas. En effet, ce dispositif ne gène en rien l'utilisation de la prothèse de façon conventionnelle.In general, the device according to the invention can be put in place on any vascular prosthesis so that the surgeon uses it if need be otherwise, does not use it. Indeed, this device does not interfere with the use of the prosthesis in a conventional way.
Le positionnement des divers éléments constitutifs donne à l'objet de l'invention un maximum d'effets utiles qui n'avaient pas été, à ce jour, obtenus par des dispositifs similaires. The positioning of the various constituent elements gives the object of the invention a maximum of useful effects that had not been obtained so far by similar devices.

Claims

REVENDICATIONS
1 °. Prothèse vasculaire permettant une adaptation aux différences de diamètre entre les deux extrémités d'un segment de vaisseau sanguin à remplacer, destinée en particulier aux interventions visant au remplacement par une prothèse d'une partie ou de la totalité de l'aorte, caractérisé par la combinaison d'un tube prothétique (1) et d'une collerette (2) du même matériau s'étendant autour de la périphérie du dit tube prothétique dans un plan sensiblement perpendiculaire à l'axe de celui-ci, la collerette étant d'un diamètre relativement important par rapport à celui du tube prothétique (1) et comportant une ouverture dont le bord est joint de façon parfaitement étanche à la paroi du tube, à l'une des extrémités de celui-ci ou près de cette extrémité, de façon à obtenir une prothèse vasculaire dont l'une des extrémités a un diamètre parfaitement adaptable à ceiui du vaisseau sanguin (3, 3'), la collerette pouvant être retaillée^aux ciseaux par le chirurgien.1 °. A vascular prosthesis for adapting to differences in diameter between the two ends of a segment of the blood vessel to be replaced, in particular for interventions to replace a prosthesis with part or all of the aorta, characterized by the combination of a prosthetic tube (1) and a collar (2) of the same material extending around the periphery of said prosthetic tube in a plane substantially perpendicular to the axis thereof, the collar being a relatively large diameter relative to that of the prosthetic tube (1) and having an opening whose edge is sealingly sealed to the wall of the tube, at one end thereof or near this end, in order to obtain a vascular prosthesis, one end of which has a perfectly adaptable diameter to that of the blood vessel (3, 3 '), the collar being able to be resized by chirping by chirp urgien.
2°. Prothèse vasculaire selon la revendication 1 , se caractérisant par le fait que la collerette (2) est un élément plan.2 °. Vascular prosthesis according to claim 1, characterized in that the collar (2) is a planar element.
3°. Prothèse vasculaire selon la revendication 1 , se caractérisant par le fait que la collerette (2) est un élément conique.3 °. Vascular prosthesis according to claim 1, characterized in that the flange (2) is a conical element.
4°. Prothèse vasculaire selon l'une quelconque des revendications précédentes, se caractérisant par le fait que la collerette (2) est de forme semi-circulaire.4 °. Vascular prosthesis according to any one of the preceding claims, characterized in that the collar (2) is of semicircular shape.
5°. Prothèse vasculaire selon l'une quelconque des revendications précédentes, se caractérisant par le fait que le tube prothétique (1) et la collerette (2) sont réalisés en matériau biocompatible tel que textile synthétique à base de polyester5 °. Vascular prosthesis according to any one of the preceding claims, characterized in that the prosthetic tube (1) and the collar (2) are made of biocompatible material such as synthetic polyester-based textile
"Dacron" tissé ou tricoté, ou en matériau inerte souple à base de polytétra-fluoro-éthylène ("Goretex"). 6°. Prothèse vasculaire selon l'une quelconque des revendications précédentes, se caractérisant par le fait qu'elle est destinée aux interventions de dissection aortique et qu'elle comporte un conduit de perfusion (5) permettant la connexion rapide avec la circulation extra-corporelle."Dacron" woven or knitted, or flexible inert material based polytetrafluoroethylene ("Goretex"). 6 °. Vascular prosthesis according to any one of the preceding claims, characterized in that it is intended for aortic dissection procedures and comprises an infusion line (5) allowing rapid connection with the extracorporeal circulation.
7°. Prothèse vasculaire selon la revendication 6, se caractérisant par le fait qu'elle comporte des branches (8) permettant une connexion- avec les dérivations (9) constituant le tronc artériel brachio-céphalique, la carotide gauche et la sous clavière gauche.7 °. Vascular prosthesis according to claim 6, characterized in that it comprises branches (8) allowing connection with the branches (9) constituting the brachiocephalic arterial trunk, the left carotid and the left subclavian.
8°. Prothèse vasculaire selon l'une quelconque des revendications 1 à 5, se caractérisant par le fait qu'une de ses extrémités est bifurquée de façon à pouvoir l'utiliser pour relier l'aorte abdominale (11) aux artères iliaques.8 °. Vascular prosthesis according to any one of claims 1 to 5, characterized in that one of its ends is bifurcated so as to be able to use it to connect the abdominal aorta (11) to the iliac arteries.
9°. Prothèse vasculaire selon l'une quelconque des revendications 1 à 5, se caractérisant par le fait qu'elle est associée à une valvule biologique (13) et agencée de manière à permettre d'effectuer en une seule opération le changement de la valvule cardiaque et le remplacement de l'aorte ascendante par une prothèse vasculaire.9 °. Vascular prosthesis according to any one of Claims 1 to 5, characterized in that it is associated with a biological valve (13) and arranged so as to make it possible to perform, in a single operation, the change of the cardiac valve and replacement of the ascending aorta with a vascular prosthesis.
10°. Prothèse vasculaire selon la revendication 9, se caractérisant par le fait que le diamètre du tube prothétique (1) est légèrement supérieur à celui de la valvule biologique (13) et qu'elle est agencée pour coiffer ladite valvule de façon à ce que la collerette (2) vient s'appliquer sur le coussin de suture (14) de la valvule pour permettre de suturer l'ensemble sur le coeur (6) en assurant la solidarisation de ladite collerette et du dit coussin de suture lorsque les fils sont noués. 10 °. Vascular prosthesis according to claim 9, characterized in that the diameter of the prosthetic tube (1) is slightly greater than that of the biological valve (13) and that it is arranged to cap said valve so that the collar (2) is applied on the suture cushion (14) of the valve to allow suturing all on the heart (6) ensuring the fastening of said flange and said suture cushion when the son are knotted.
PCT/FR2004/001713 2004-07-02 2004-07-02 Vascular prosthesis for adapting diameter differences between two ends of a replaceable blood vessel segment WO2006013234A1 (en)

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