TERUMO CORPORATION Evaluation Center, 1500 Inokuchi, Nakai-machi, Ashigarakami-gun, Kanagawa, 259-0151, Japan.
J Artif Organs. 2023 Mar;26(1):65-72. doi: 10.1007/s10047-022-01333-4. Epub 2022 Apr 28.
Sheath-type tunnelers are frequently used to create vascular access using vascular grafts. However, during vascular access creation, tunnelers damage the surrounding tissues, consequently causing problems, such as swelling, failure to heal, and infection. This study evaluated a novel rod-type tunneler that was designed to prevent tunneler-related tissue damage and its sequelae.
We developed a small-diameter rod-type tunneler that reduces injuries during subcutaneous tunnel creation. The rod diameter of this tunneler is smaller than the vascular graft diameter being implanted. It has a structure in which a vascular graft is implanted at a target site by grasping and pulling the vascular graft. Three dogs were used in the experiment, and arteriovenous grafts were created using a rod-type and a sheath-type tunneler on the left and right thighs, respectively, with a different type of commercially available graft used in each dog. The edema of the tissues surrounding the vascular graft was measured at 11 sites by ultrasonography at prespecified intervals.
Compared with implantation using a sheath-type tunneler, when the self-sealing Rapidax II was implanted using the small-diameter rod-type tunneler, the postimplantation edema (degree of change) decreased by 28-53% and 80-247% in the peri-vascular-graft area and within the loop, respectively. The MAXIFLO and SEALPTFE did not significantly reduce postoperative edema but exhibited a tendency for improved postimplantation tissue healing.
The reduced-diameter rod-type tunneler may be a useful device for vascular graft implantation.
套管式隧道器常用于使用血管移植物建立血管通路。然而，在建立血管通路时，隧道器会损伤周围组织，从而导致肿胀、愈合不良和感染等问题。本研究评估了一种新型的杆式隧道器，旨在防止与隧道器相关的组织损伤及其后遗症。
我们开发了一种小直径杆式隧道器，可减少皮下隧道形成过程中的损伤。该隧道器的杆直径小于植入的血管移植物直径。它的结构是，通过夹持和拉动血管移植物，将血管移植物植入目标部位。在实验中，使用了 3 只狗，在左右大腿上分别使用杆式和套管式隧道器创建动静脉移植物，每只狗使用不同类型的市售移植物。在预设的间隔时间内，通过超声在 11 个部位测量血管移植物周围组织的水肿情况。
与使用套管式隧道器植入相比，当使用小直径杆式隧道器植入自密封 Rapidax II 时，血管移植物周围区域和环内的植入后水肿（变化程度）分别减少了 28-53%和 80-247%。MAXIFLO 和 SEALPTFE 并未显著减少术后水肿，但显示出改善植入后组织愈合的趋势。
小直径杆式隧道器可能是一种有用的血管移植物植入装置。
