Sutureless Percutaneous Anastamosis Device Steve Chen Jamal Siddiqui

Advisor Dr. Raul Guzman Assistant Professor of Surgery and Cell Biology, Vanderbilt University Division of Vascular Surgery Vanderbilt University Medical Center

Peripheral Arterial Disease Narrowing of the arteries that supply the legs with blood. 8-12 million affected Risk factors Symptoms: Leg/Buttock pain and numbness Claudication Stroke Heart Attack How many actually get surgery or need it? 8.6 million of these people are without symptoms PAD is a narrowing of the arteries that supply the legs with blood. The arteries can fill up with plaque or calcium and other kinds of things that will narrow the arteries in the legs. ANNOUNCER:  This narrowing of the arteries in the legs leads to inadequate blood flow. (leads to atherosclerosis: hardening of arteries due to calcium deposition) This atherosclerotic blockage, by itself, is usually considered to be irreversible, but the rate at which it develops can be markedly blocked by a good, healthy lifestyle and by the use of medications that lower the importance of these risk factors. These risk factors include smoking, diabetes, high blood pressure and high blood cholesterol. Claudication is a discomfort that is sometimes described as a fatigue, a numbness, a cramping, or may actually be a severe pain that occurs in these muscles with walking and that is relieved when the patient stops to rest.  Unfortunately, when the patient begins to walk again, claudication reappears and limits the patient's ability to perform their activities of daily living. Symptoms are hard to find.

Alternative Methods Healthy Diet Refrain from smoking Regular exercise Angioplasty

Problem Current aortobifemoral bypass surgeries are invasive and require long recovery periods. Say how our device itself is not going to cut down recovery time, but it’ll make it easier for laparoscopy, which is the ultimate goal, to cut down on recovery time.

Current Method Incision, expose artery, clamp, suture, close up

Problems with Current Method Invasive Long Recovery Time in Hospital 5 - 7 days Bedrest 2 - 4 Long Recovery Time outside Hospital Prominent Scarring Risk of infection

Solution To create a sutureless percutaneous anastomosis device to allow the aortobifemoral bypass surgery to be performed laparoscopically.

Laparoscopic Method Anesthesia Insufflation w/ CO2 ~15mmHg Camera and 2-3 trocars inserted Corrections made Sew back up Don’t have to separate skin from muscle tissue Suflation to 15mmHg

Design Constraints Tube inside diameter 6mm Account for variety of thicknesses of vessel wall Biocompatible Very stable Safe shape

2003-2004 Project Infrarenal Aorta Plastic tubing Anchor Proximal Balloon Distal Balloon Infrarenal Aorta

Design Stages Head piece: nitinol Plastic tubing Anchor piece Infrarenal Aorta

Market 26,200 surgeries per year Only severely diseased need surgery Men/Women over 50 Diabetics Smokers High cholesterol High blood pressure

Future Applications Microlaparoscopy Computer Motion Robotic surgery Minimally invasive Accurate dissection Laparoscope 10-12mm down to 3mm, also trocars are smaller.

References http://www.lapsurgery.net/how_lapsurg.asp http://www.vascularlaparoscopy.org/ilvc_techniques.html http://my.webmd.com/hw/health_guide_atoz/aa118239.asp http://computermotion.wwwa.com/clinicalapplications/publications/vascular_abstracts.cfm http://www.understandingpad.com/webcast_transcript.asp?f=pad_comprehend&b=understandingpad&c=cardio_padaware&transcript=yes&spg=VID http://www.nlm.nih.gov/medlineplus/tutorials/aortobifemoralbypass/vs019101.html www.laparoscopy.com