US 3040748 A
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Description (OCR text may contain errors)
June 26, 1962 G. J. KLEiN ETAL vAscuLAR PosITIoNING METHOD AND DEVICE:
Filed Sept. 14, 1959 United dtates 3,040,743 VASCULAR PUSITIONING METHOD AND DEVICE George .1. Klein, Ottawa, Ontario, Christoph L. Fischer,
Eastview, Ontario, and Ernest S. Turner, Ottawa, Ontario, Canada, assignors to National Research Council, Ottawa, Ontario, Canada, a corporation of Canada Filed Sept. 14, 1959, Ser. No. 839,638 4 Claims. (Cl. 12S- 334) This invention relates to a vascular positioning method and device.
In the use of vascular suturing apparatus, such as described in copending application, Serial No. 717,656, filed February 26, 1958, now Patent No. 2,940,451, it is necessary to thread each severed end portion `of a blood vessel through a bushing and then to evert such end portion over the end of the bushing. The everted ends, held in appropriate position by the bushings and associated holders, are then joined together by means of clips.
It Will be apparent that the steps of threading the vessel through a bushing and then turning the vessel inside out over the end of the bushing are of exacting nature and very diilcult to perform, particularly in respect of small vessels such as those of 4 mm. or less in diameter.
-It is an object of this invention to provide a method and device of simple structure which may be employed to eiect with convenience and facility the threading and,
everting steps mentioned above in respect of very small as well as large sizes of blood vessels.
The invention will be described with reference to the accompanying drawings, in which ARIGURE 1 is a sectional side elevation of a device in accordance with the invention, showing one position thereof with associated parts of a suturing apparatus.
FIGURE 2 is a sectional side elevation of the device, showing another position thereof, and
FIGURE 3 is a sectional side elevation of parts of the suturing apparatus with associated means for threading the vessel through the bushing.
In the drawing, 1 is a bushing, 2 a bushing holder, and 3 a hemostatic clamp, all being parts of a suturing apparatus. The end portion of a severed blood vessel, which it is desired to position on the bushing, is indicated at 4.
The step of threading the blood vessel portion 4 through the bushing 1 will rst be described with particular reference to FIGURE 3. A flexible tube 5 of suitable plastic composition has one end placed loosely over the end of the bushing and its other end connected to a moderately high volume suction air pump, such as that of a domestic vacuum cleaner. The other end of the bushing is applied to the free end portion of the blood vessel 4 and the flow of airthrough the bushing draws the vessel through the bushing without causing injury to the blood vessel. In this connection, the pressure difference through the suction pump at zero air flow should not be greater than normal blood pressure or about 2 pounds per square inch.
As shown, on completion of the threading operation, the hemostatic clamp 3 engages the holder Zand may be locked thereto. Y
A vascular everting dev-ice in accordance with the invention is generally indicated at 6, and comprises a cylindrical body or cylinder 7 having a cylindrical bore 8. The cylinder has a rearward end closure plate 9, the forward end thereof lbeing open. Preferably, the forward end edge 9a of the cylinder is of reduced thickness, as provided by the outer bevelled surface 10 and is of rounded contour. A piston 11 is reciprocally mounted in the cylinder and has a forwardly extending nose 12 the end of which is tapered substantially to an apex, as shown, and through which extends a restricted orifice 13, thus providing a nozzle 14. 'Ilhe piston has a rearwardly extendling rod 15 which extends through closure plate 9. The piston has a longitudinal interior passage 17 which extends through the nose 12 and rod 15 and with which the nozzle orice 13 communicates. YThe rearward end of passage 17\is closed by a screw 18, the head 18a of which seats upon the closure plate 9 in one position of the piston and acts as `a stop to deine such position. In such position, the ypiston is located closely adjacent the forward end of the cylinder with the nose 12 projecting forwardly `of the cylinder. Since the rod 15 is of less diameter than the piston, an annular space 19 is formed between the rod and the interior wall of the cylinder. Space 19 communicates with the passage 17 in the piston by means of holes 20 extending through the piston.
The cylinder 7 is provi-ded with a stem 21 mounted on the rearward end thereof and having a longitudinal passage 22 therein communicating with space 19 through an aligned hole 23. A conduit 24 is removably connecte-d to stem 21 for admitting fluid under pressure to the passage 22. The conduit 24 may be part of a syringe (not shown) or other source `of iluid under pressure. The iiow of uid supplied through conduit 24 is controlled by operation `of the syringe, when such is employed, or by a valve '24a when the conduit is connected to other source of uid under pressure.
A flexible ring or collar 25 of soft rubber or like material is arranged to be applied to the nose 12. The ring 25 has a tubular sleeve or neck 26 adapted to be seated on the nose 12 which preferably is provided with a recess 27, a radial annular tlange 2S projecting outwardly from the neck, and a peripheral rib 29 adapted to seat on 'the forward outer surface of the cylindrical body 7.
In operation, the operator applies his thumb to the stop lilato locate the piston in forward position, and a v collar 25 is applied to the nos-e 12, as shown in FIGURE 1. The nozzle 14 is then applied to the mouth of the blood vessel and fluid under pressure is -admitted to passage 22. The uid may be any iluid of sterile nature, such as a low pressure gas or saline solution as commonly used in surgical operations. The uid ows through passage 22, hole 23, space 19, hole or holes 20, passage 17, and emerges as a tine jet through nozzle orifice 13. Since the `diameter of the piston rod 15 is less than the interior diameter of the cylinder, the piston will be held in its forward position under Ili-ght load because of the iluid pressure in space 19.
The issuing tine jet opens the mouth of the vessel. Since the hemostatic clamp` produces a restriction in the blood vessel, further application of fluid under pressure and movement of the nose 12 into the vessel results in a return flow of fluid between the Vessel wall and the piston nose which expands the vessel and permits the end of the vessel to slide over the sleeve 26 of the collar 25. At this point, admission of fluid under pressure is arrested, thus removing pressure on the pist-on and permitting it to move freely. The everting operation is completed by moving the cylinder '7 towards the bushing, which causes the collar v2,5 to be turned inside out by engagement of the end edge 9a with the ange 29S of the collar. This action also everts the overlying portion of the blood vessel, as shown in FIGURE 2.
After the suturingY operation Ihas been completed, the flexible collar 25 is removed by tearing it apart. It will vbe appreciated that `a new collar 25 is employed for each operation.
The everting operation may be performed as described in a very short space of time and in a dependable and positive manner. Excessive pressure on the wall of the vessel between the end of the bushing and the nose of the piston is completely avoided. The everting device described is simple to manufacture, and is subject to convenient and effective washing and sterilization.
the everter will he chosen to correspond with the size of the lbushing employed in the suturing apparatus.
1. A method of positioning the end'of a blood vessel on a suturing apparatus bushing which comprises'applying suction induced air dow to one end of said bushing while applying the other end of said bushing to the end of said blood vessel to draw said hlood Vessel end into said bushing, applying a jet of fluid to the mouth of said lblood vessel While in said bushing to expand said mouth, and while maintaining said mouth in expanded condition turning said end of sai-d blood vessel inside out upon the outside surface of said bushing.
2. A vascular everter comprising a cylinder of uniform inter-nal diameter having a closed end and a free end edge dening an open end, a piston reciprocally mounted in said cylinder and having a nose of smaller diameter than the internal diameter of said cylinder directed towards said open end and having a large` diameter portion engaging said cylinder, said large diameter portion having an end face contiguous with said nose and directed towards said open end, a nozzle axially arranged in said nose, and
a piston rod extending through said closed end, said cylinder having an annular space surrounding said piston rod, said piston rod having a passage therein communicating with said annular space and said nozzle, said nose projecting forwardly of saidcylinder in one position of said piston, means for admitting a controlled supply of` iluid under pressure to said annular space to produce a uid jet through said nozzle, and a flexible collar removably seated on said nose, said collar having a radially extending annular portion of a diameter greater than the internal diameter of said cylinder for engagement by said free end edge of said cylinder to turn said collar inside out on reciprocation of said cylinder relatively to said piston. Y Y
3. A vascular everter comprising a cylinder of uniform internal diameter having a closed end and a free end edge dening an open end, a piston reciproca-Hy mounted in said cylinder and having thereonra rearwardly extending piston rod, said piston having a forwardly projecting nozzle of smaller diameterrthan the internal diameter of said cylinder, and having a large diameter portion engaging said cylinder, said large diameter portion having an end face contiguous with said nozzle and directed towards said open end, a stop on the end of said piston rod engageable with said cylinder closed end to define a forward position of said piston, said nozzle projecting forwardly through said open end of said cylinder `when said piston is in said forward position, said cylinder having an annular space surrounding said piston rod, said piston having a passage therein communicating with said annular space and with said nozzle, means for admitting a controlled supply of fluid under pressure to said annular space and a flexible collar removably seated on said nozzle and having a radially extending annular portion of a diameter greater than the internal diameter of said cylinder for engagement hy said free end edge of said cylinder. 4. A vascular everter comprising ay cylinder of uniform internal diameter having a closed end and a free end edge defining an open end, a piston reciprocally mounted in said cylinder and having thereon a rearwardly extending piston rod, said piston having a forwardly projecting nozzle of smaller diameter than the internal diameter of said cylinder, and having a large diameter portion engaging said cylinder, said large diameter portion having an end face contiguous with said nozzle and directed towards said open end, a stop on the end of said piston rod engagea'ble with said cylinder closed end to define a forward position of said piston, said nozzle projecting forwardly through said open end of said cylinder when said piston is in said forward position, said cylinder having an annular space surrounding said piston rod, said piston having a passage therein communicating with said annular space and with said nozzle, and means for admitting a controlled supply of fluid under pressure to said annular space.
References Cited in the le of this patent UNITED STATES PATENTS 1,151,300 Soresi Aug. 24, 1915 2,399,112 Glover Apr. 23, 1946 4 2,453,056 zack Nev. 2, 194s 2,779,996 Tanis Feb..5, 1957 2,940,452 Smialowski V 4 June 14, 1960