Enzler M A
Helv Chir Acta. 1989 Jun;56(1-2):279-83.
When autologous veins or vascular prostheses are implanted for bypass operations or hemodialysis shunts, the use of an appropriate tunneling device is recommended. In order to avoid perigraft hemorrhage and allow undelayed graft incorporation, the tunneler should match the diameter of the implant. Interchangeable shafts with various lengths and blunt tips of various diameters are prerequisites for versatile applicability. The tunneling instrument designed by Kelly and Wick was until now the most versatile on the market. Its main drawback is a handle that is welded to one end of the shaft thus preventing "bi-directional" use. We therefore developed a modified "Bi-directional Tunneler". Its handle can be attached to both ends of the shaft and allow at the same time torsional rigidity for directional guiding. Thus, e.g. in a femoro-popliteal bypass, the distal anastomosis can be accomplished first, followed by the introduction of the "Bi-directional Tunneler" from the knee to the groin. In a further step the tip and handle are interchanged and the graft is also passed from the knee to the groin. Thus, the "Bi-directional Tunneler" offers hitherto unknown versatility in bypass as well as in hemodialysis shunt surgery.
当植入自体静脉或血管假体进行搭桥手术或血液透析分流时，建议使用合适的隧道装置。为避免移植血管周围出血并使移植血管能及时融合，隧道器应与植入物的直径相匹配。具有不同长度的可互换轴以及不同直径的钝头是实现广泛适用性的前提条件。凯利和威克设计的隧道器械是目前市场上通用性最强的。其主要缺点是手柄焊接在轴的一端，因此无法“双向”使用。因此，我们开发了一种改良的“双向隧道器”。其手柄可连接在轴的两端，同时具备用于定向引导的扭转刚度。例如，在股腘动脉搭桥手术中，可先完成远端吻合，然后将“双向隧道器”从膝盖向腹股沟引入。下一步，将尖端和手柄互换，移植血管也从膝盖向腹股沟穿过。因此，“双向隧道器”在搭桥手术以及血液透析分流手术中提供了前所未有的通用性。
