Tunnelling instruments for vascular grafts: problems and solutions.

Area of Science:

• Vascular Surgery
• Surgical Instrumentation
• Medical Devices

Background:

• Autologous veins and vascular prostheses are crucial for bypass operations and haemodialysis.
• Appropriate tunnelling devices are essential for successful graft implantation, preventing complications like perigraft haemorrhage.
• Existing tunnelling devices often have limitations, such as a fixed handle preventing bidirectional use.

Purpose of the Study:

• To develop a versatile and user-friendly tunnelling device for vascular surgery.
• To overcome the limitations of conventional tunnellers by enabling bidirectional use.
• To improve graft incorporation and reduce complications during bypass and haemodialysis procedures.

Main Methods:

• Development of a modified tunnelling device with a detachable handle that can be attached to either end of the shaft.
• The new tunneller features interchangeable shafts of various lengths and blunt tips of various diameters.
• The connection between the shaft and handle provides torsional rigidity for precise guidance.

Main Results:

• The modified tunneller, named the "Bi-directional Tunneller," can be used effectively in either direction.
• This bidirectional capability allows for flexible surgical approaches, such as completing distal anastomosis first in femoro-popliteal bypass.
• The device facilitates smooth, curved insertion of grafts, particularly beneficial for haemodialysis shunts with PTFE-loops, allowing placement in smaller cavities.

Conclusions:

• The "Bi-directional Tunneller" offers enhanced versatility and ease of use compared to existing devices.
• The design innovation addresses limitations of conventional tunnellers, improving surgical efficiency.
• This device has the potential to optimize outcomes in vascular bypass and haemodialysis procedures.