US3503398A - Atraumatic clamp for vascular surgery - Google Patents

Description

March 31, 1970 T. J. FOGARTY ET AL 3,

ATRAUMATIC CLAMP FOR VASCULAR SURGERY 2 Sheets-Sheet 1 Filed Sept. 10, 1965 INVENTORS THOMAS J. FOGARTY DONALD A. RAIBLE BY GEORGE G. SIPOSS Attorney March 31, 1970 T. J. FOGARTY ETAL 3,503,398

ATRAUMATIC CLAMP FOR VASCULAR SURGERY Filed Sept. 10, 1965 2 Sheets-Sheet 2 5a 52 53 --&W&\\\\ W 57 5O J INVENTORS 1 THOMAS J. FOGARTY T DONALD A. RAIBLE I 1- BY GEORGE e. SIPOSS IO 54/ .i 4 Attorney United States Patent ATRAUMATIC CLAMP FOR VASCULAR SURGERY Thomas J. Fogarty, Bethesda, Md., and Donald A. Raible, Corona, and George G. Siposs, Garden Grove, Califi; said Raible and said Siposs assignors, by mesne assignments, to American Hospital Supply Corporation,

Evanston, 11]., a corporation of Illinois Filed Sept. 10, 1965, Ser. No. 486,266 Int. Cl. A61b 17/12, 17/28 US. Cl. 128346 19 Claims ABSTRACT OF THE DISCLOSURE Two types of removable and interchangeable jaw inserts are provided for the clamp. One is a hydraulic jack comprising a closed chamber filled with liquid, the jacket being resiliently deformable under applied pressure on a clamped object. The other type of insert is a tooth bar wherein the tooth points are directed parallel with the clamping plane so as to be capable of applying traction but being non-penetrating by clamping pressure alone.

This invention relates to a surgical clamp for clamping and holding an artery or vein or other body tissue.

Certain disadvantages exist with presently available hard clamps used for occluding the vascular system. The inner surface of blood vessels consists of a very smooth lining called endothelium. This lining is subject to damage by external forces. A relatively normal artery can tolerate this damage without serious consequences but arteries diseased by atherosclerosis, and the venous system, will not tolerate appreciable external forces without significant residual effects. Among the immediate results which may occur when occluding an atherosclerotic artery is 2 dislodgment or cracking of the atherosclerotic material. In the venous system where the flow of blood is slow, there is a more pronounced tendency toward thrombosis at sites of previous endothelial trauma and immediate thrombosis may occur with occlusion of the vein and possible pul monary embolization.

The long-term residual effects of clamping arteries by presently available rigid instruments leads to a progressive narrowing of the lumen of the artery. There is an initial deposition of microthrombi which is followed by the development of an endothelial cushion and subsequently an area which is indistinguishable from atherosclerotic plaque. The use of clamps on vessels which are of very small diameter, that is, less than one centimeter, becomes very critical since the small size of the lumen of these vessels does not allow for appreciable encroachment without marked diminution in flow. A traumatic instrument which would not cause damage to these areas would be advantageous.

Rubber-faced clamp jaws previously proposed do not solve the problem because they still apply the greatest pressure at the point of greatest thickness of the vessel and do not distribute the clamping pressure uniformly over a vessel having a cross section of varying thickness.

The general object of the present invention is, therefore, to provide an improved surgical clamp. More specific objects are to provide an improved soft jaw clamp, to provide a clamp having a flexible hydraulic jacket on at least one of a pair of opposed clamp jaw surfaces, to provide a clamp of the type described having removable and interchangeable soft jaw and toothed jaw elements, to provide an improved arrangement of the teeth on the toothed jaw of a clamp, and to provide means for supporting the clamp so that it will not dangle from the clamped vessel.

The present clamp allows total occlusion of vessels without immediate or later developing residual damage.

3,503,398 Patented Mar. 31, 1970 The clamp also offers the utility of being able to occlude a vessel over intraluminal objects Without undue trauma. These advantages flow from two novel and important features. One of these features comprises a removable hydraulic jacket on the gripping face of one of the clamp jaws. As clamping pressure is applied to a vessel between the jaws, there is fluid displacement in the jacket allowing the jacket to conform to the irregular shape of the vessel and exert uniform clamping pressure in a plurality of different directions normal to the surface of the vessel. In

this way, the necessary clamping force can be exerted with a minimum of injury to the vessel. The other primary feature of novelty resides in the shape and distribution of the exposed teeth on the toothed jaw opposite the soft jaw. Another novel feature involves supporting means embodied in the handles of the clamp.

The foregoing and additional objects and advantages will become apparent and the invention will be better understood from the following detailed description of the preferred embodiment illustrated on the accompanying drawing. Various changes may be made, however, in the details of construction and arrangement of parts and certain features may be used without others. All such modifications within the scope of the appended claims are included in the invention. While the invention is illustrated and described in connection with the occlusion of a diseased artery, the clamp is also useful on other tissues in the body.

In the drawing:

FIGURE 1 is a perspective view of a surgical clamp embodying the features of the invention;

FIGURE 2 is a side elevation view of the clamp in reduced scale;

FIGURE 3 is a view on the line 33 of FIGURE 1;

FIGURE 4 is an enlarged view on the line 44 of FIGURE 5 showing both jaws of the clamp, the upper jaw containing a soft jaw insert and the lower jaw containing a tridirectional hard jaw insert;

FIGURE 5 is a fragmentary sectional view taken approximately on the line 5-5 in FIGURE 4;

FIGURE 5A is a fragmentary perspective view of the hard jaw insert in FIGURES 4 and 5;

FIGURE 6 is a fragmentary side elevation View of a bidirectional hard jaw insert;

FIGURE 7 is a perspective view of the jaw insert in FIGURE 6;

FIGURE 8 is a cross sectional view of a diseased artery;

FIGURE 9 is a fragmentary view showing the action of the hydraulic jacket as the clamp is closed on a diseased artery;

FIGURE 10 is a similar view illustrating complete occlusion over an intraluminal object;

FIGURE 11 is a side elevation view with parts broken away, showing a modification of the soft jaw insert; and

FIGURE 12 is a fragmentary perspective view of the insert in FIGURE 11.

The clamp has a pair of straight, elongated jaw members l0 and 11 which are pivotally interconnected at 12 and provided with extending handle portions 14 and 15 in the general arrangement of a pair of pliers. Preferably, the jaws are bent at 13 at a considerable angle to the hinge and handle portions. The extremity of each handle portion carries a finger loop 16 and the handle portions are equipped with conventional locking lugs 17 having interengageable ratchet teeth. The finger loops are bent at 18 at a small angle to the handle portions. The loops are somewhat resilient or springy and are split at '20 for a purpose which will presently appear.

The two jaws 10 and 11 are identical, each having a longitudinal keyhole slot with an enlarged bottom portion 25 and a reduced neck portion 26 which opens into the surface 27 that faces the opposite jaw. These surface portions 27 on opposite sides of the slot are preferably inclined at a small angle to each other to form a V-shaped seating surface for soft jaw and hard jaw inserts which will now be described.

As shown in FIGURE 4, the soft jaw insert 30 comprises a flexible rubber tube containing a closed chamber 31 filled with a suitable liquid such as glycerin. This tube forms a hydraulic jacket which is generally rectangular in cross section and preferably has the particular configuration shown. The clamping wall 32 is arched outwardly and the opposite side walls 33 are arched inwardly. The back wall 34 is in V-shape to fit the angle of jaw surfaces 27.

Integral with the back wall 34 is a longitudinal tongue having an enlarged edge portion 35 for reception in the enlarged portion 25 of the jaw slot and a reduced neck portion 36 for reception in the narrow portion 26 of the slot. In order to facilitate insertion and removal of the soft jaw, and to re-enforce and stiffen the soft rubber tongue, the enlarged portion 35 of the tongue preferably has bonded to it a relatively rigid metallic or non-metallic sleeve 40 which has a sliding fit in slot portion 25.

The insertable hard jaw element comprises a tooth bar of metal or hard non-metallic material which may take different forms. A tri-directional tooth bar 50 is shown in FIGURES 4, and 5A. Extending along the back side of the tooth bar 50 is an integral tongue 51 having a keyhole shape to fit the wide and narrow slot portions 25 and 26 of the jaw 10. The face of the tooth bar has a centerrow of teeth 52 and two side rows of teeth 53.

The center teeth are inclined away from the ends of the jaws and the side teeth are inclined outwardly at angles of approximately 45 from the general plane of the clamping face of the tooth bar. The center teeth 52 present relatively blunt surfaces in an upward direction under direct clamping pressure but have points which are in a position to penetrate a clamped object when traction is applied to the object longitudinally of the jaws in a direction away from pivot 12. The side teeth 53 present relatively blunt surfaces in an upward direction under direct clamping pressure but have sharp points which are in a position to penetrate a clamped object when traction is applied in either direction transversely of the jaws.

Suitable locking devices are provided for releasably retaining the hard paw inserts in the slots. In FIGURE 4 and 5 there is shown a spring finger 54 on the outer end of tongue 51 which has a projection 55 to snap into a hole 56 in the jaw 10. Sleeve 40 on the soft jaw may be equipped with a similar locking projection. These projections are tapered so that the inserts may readily be removed when desired. When pressure is applied to the inner end of the insert adjacent pivot 12 to remove the insert, the projection 55 will cam itself out of hole 56. An upset 57 on the outer end of the tongue 51 forms an enlargement to prevent this end of the insert from entering the slot 25. This prevents wrong end insertion of the tooth bar in the slot.

A bi-directional tooth bar 50a is shown in FIGURES 6 and 7. This tooth bar has only the side teeth 53 with an open trough-shaped space extending along the center of the bar. This makes the bar effective to exert traction primarily in opposite directions transversely of the jaws. The configuration of the two rows of teeth may be identical or different to provide traction also in a direction parallel with the jaws as well as in a transverse direction. The concave space between the two rows of teeth stabilizes and supports the convex clamping surface of the rubber soft jaw element when the jaws are clamped together.

Since the finger loops 16 are inclined at a slight angle to the handle portions 14 and 15, the clamp would normally be grasped in such position that one of the jaws or 11 would be a bottom jaw and the other jaw would be a top jaw. The easy removability and interchangeability of the soft and hard jaw inserts permits either one of them to be placed in the top or bottom jaw as desired.

Also, soft jaw inserts 30 may be placed in both jaws 10 and 11 or hard jaw inserts 50 or 50a may be placed in both jaws 10 and 11, if desired. The tooth bar inserts may be made inexpensively of a hard plastic which is autoclavable for re-use if desired or they may be employed as disposable elements which are discarded after a single use.

FIGURE 8 shows a typical cross section of a diseased artery A wherein the lumen is reduced by a hard plaque 60 of therosclerotic material. This material forms a protrusion or lump in one side of the inner wall of the artery. Such a plaque frequently occurs in a region of the artery which must be clamped. The surgeon can readily detect with his fingers the existence of the plaque and determine on which side of the artery it is located. He places the side of the artery containing the plaque against the hard jaw and tightens the soft jaw against the opposite side as shown in FIGURE 9. This compresses and flattens the artery until the normal upper side closes down against the plaque but the artery is not occluded and blood still flows through the restricted lumen.

When both paws of the clamp are conventional hard jaws, the surgeon has no alternative but to apply greater pressure as may be necessary to completely occlude the lumen and stop the flow of blood. If the plaque material is hard and brittle, it will crack and pieces of it will break off and wash away with the blood stream either immediately or later when the clamp is released. This often results in severe injury to the patient when the broken off plaque material finally lodges in and blocks a smaller artery which nourishes a vital function of the body such as the brain. Conventional rubber jaw members are not substantially better than hard jaws because they, too, apply the greatest pressure to the area of greatest thickness, causing the plaque material to break or crack.

Such a condition is avoided by the present clamp as shown in FIGURE 10. The soft jaw insert 30 readily yields to conform to the shape of the plaque and effects complete occlusion of the lumen without breaking or dis- 4 lodging the plaque. The hydrostatic jacket of the soft jaw insert applies uniform clamping pressure perpendicular to the surface of the artery at all points of contact and does not apply any greater pressure to the thickest portion of a plaque than is applied to any other part of the artery. When the clamp is released, the plaque is not broken or dislodged to migrate with the blood stream.

As clamp pressure is applied as shown in FIGURE 10, hydraulic fluid is displaced toward opposite ends of chamber 31, causing the end portions of the rubber jacket to dilate. Such distortion of the jacket results in a small bulbous distal end portion at 61 wherein a portion of the hydraulic fluid may become locked if the chamber 31 becomes occluded directly over the artery. The bulbous end portion of the hydraulic jacket resists avulsion of the clamp from the vessel. The purpose of the concave side walls 33 is to avoid bulging when clamping pressure is applied. Increased pressure in the liquid then causes the side walls to straighten out to flat configuration.

The shape and configuration of the teeth on the hard jaw insert 50 assist in preventing the clamp from working loose from the vessel and have other advantages. Conventional clamps have sharp teeth projecting at a angle from the general plane of the jaw. Such teeth pierce the adventitial and sometimes medial coat of the vessel and such penetration is utilized to accomplish traction. The capability of traction is necessary because if dislodgment of the clamp occurs, massive bleeding may ensue. Dislodgment may occur at either of two directions or at an intermediate angle. The clamp may slide off the end of a severed vessel or the vessel may slide out from between the ends of the clamp jaws. In the latter event, the tips of the clamp jaws are the last portions of the jaws to leave the vessel surface. Dislodgment in this direction is prevented by the bulbous end portion 31 of the hydraulic jacket of the soft jaw and by the center row of teeth in the tri-directional tooth bar.

In normal clamping without traction, the present teeth present a relatively flat, non-penetrating surface to the vessel. However, when traction is applied by some external force, which may be an inadvertent movement or intentional shifting of the position of the clamp, the outwardly directed sharp ends of side teeth 53 are then in a position to penetrate the vessel and prevent lengthwise slippage of the vessel through the jaws. Thus, the soft jaw and certain teeth prevent dislodgment in one direction and other teeth, which are normally non-penetrating, become effective to penetrate and prevent dislodgment in the other direction.

In the foregoing description of the clamping action, the clamp jaws are applied transversely of the vessel as shown in FIGURES 9 and 10*. The bend in the jaws at 13 provides an additional clamping position wherein the vessel is disposed parallel with the jaws. This orientation of the clamp may be used to effect partial occlusion of a large vessel which is wider than the jaws, which is sometimes desired. For this purpose, two metal jaw inserts such as tooth bar 50, or tooth bars with a different configuration of teeth, may be used, or one soft jaw and one hard jaw, as desired.

The purpose of the split finger loops 16 is to support the clamp so that it will not hang from the vessel after it has been applied. The portions of the ring on opposite sides of the gap 20 are resilient and can be deflected laterally from the plane of the loop to permit insertion of a fold of the covering sheet on the patient. One of the rings may thus be employed as a spring clip to support the clamp and hold it in a desired position thereby further reducing the tendency of the clamp to pull off a clamped vessel.

FIGURES 11 and 12 show a soft jaw insert A having a different reenforcement means for the supporting tongue. In this modification the tongue is interlocked in a stiffening bead 70 of metal or hard plastic. Bead strip 70 has a longitudinal slot 71 to receive the neck portion 36 of the tongue and transverse holes 72 intersecting the bottom of the slot. Bead strip 70 is placed in the mold for the rubber tube whereby the rubber is caused to flow into slot 71 and holes 72 forming interlocking plugs 73 in the holes. The band strip is dimensioned for a sliding fit in the enlarged portion 25 of the clamp jaw slots. Detent locking means may be provided on the bead strip similar to that shown, for example, on the hard jaw insert in FIGURE 5. Sleeve 40 in FIGURE 4 may be similarly equipped.

Having now described our invention and in what manner the same may be used, what we claim as new and desire to protect by Letters Patent is:

1. A surgical clamp comprising a pair of elongated jaws operatively connected together for movement into and out of gripping relation, a longitudinal slot in each jaw, a soft jaw insert detachably mounted in said slot in one jaw, a tooth bar inserted detachably mounted in said slot in the other jaw, and teeth on said tooth bar having laterally directed points for tractive penetration of a clamped object in opposite directions transversely of the jaws, said teeth presenting relatively blunt clamping surfaces to the clamped object.

2. A clamp as defined in claim 1, said tooth bar also having teeth with points directed longitudinally of the jaws for tractive penetration of the object in a longitudinal direction.

Ii. A surgical clamp comprising a pair of elongated jaws operatively connected together for movement into and out of gripping relation, a longitudinal slot in each jaw, a soft jaw insert detachably mounted in said slot in one jaw, and a tooth bar insert detachably mounted in said slot in the other jaw, said jaws being identical to each other for interchangeability of said inserts, each jaw having V-shaped flat seating surfaces for said insert extending on opposite sides of said slot, and each insert having a longitudinal tongue to fit in said slot and V- shaped flat seating surfaces to fit the jaw.

4. A surgical clamp comprising a pair of rigid, unitary jaws operatively connected together for movement into and out of gripping relation with an object to be clamped between said jaws, and a soft jaw gripping element on at least one of said jaws comprising a resilient hydraulic jacket containing a closed chamber permanently filled with a fixed volume of liquid, said jacket having means mounted thereon preventing lateral and vertical displacement from said one jaw when in use.

5. The ,clamp set forth in claim 4 including a handle on said clamp having a split finger loop with a break therein, portions of said loop adjacent said break being resiliently bendable out of the plane of the loop to open a gap for the insertion of cloth through the gap, said adjacent portions of the loop forming, a spring clip for attaching the clamp to said cloth.

6. In a two jaw surgical clamp, a soft jaw element for engaging a clamped object comprising an elongated resilient hydraulic jacket containing a closed chamber permanently filled with a fixed volume of liquid, a relatively stiff base portion extending along one side of said jacket and integral therewith, and means on said base portion for detachably mounting said soft jaw element as an insert on one jaw of the clamp, said jacket having means mounted thereon preventing lateral and vertical displacement from said one jaw when in use.

7. The invention defined in claim 6, said mounting means including interengaging parts on the insert and clamp jaw having snap fit retention.

8. The invention defined in claim 7, one of said interengaging parts comprising a projection and the other comprising means having a hole to receive said projection.

9. A surgical clamp comprising a pair of jaws operatively connected together for movement into and out of gripping relation, and a plurality of curved teeth on at least one of said jaws, the outer surfaces of said teeth which contact a clamped object being substantially parallel with the general clamping surface formed by the teeth to present relatively blunt clamping surfaces to the object and the points of the teeth being directed approximately parallel to said general clamping surface to effect tractive penetration of the object when traction is applied.

10. The invention defined in claim 9, said teeth being incorporated in a tooth bar insert, and means for detachably mounting said insert on a jaw of the clamp.

11. The invention defined in claim 10, said mounting means including interengaging parts on the insert and clamp jaw having snap fit retention.

12. The invention defined in claim 11, one of said interengaging parts comprising a projection and the other comprising means having a hole to receive said projection.

13. In a surgical jaw clamp, detachable tooth bar insert having teeth oriented for tractive penetration of a clamped object, means for mounting the insert on a jaw of the clamp, means for detachably locking the insert on said jaw, and means for preventing wrong end insertion of the insert in said jaw.

14. In a surgical clamp, a tooth bar having side rows of teeth with laterally directed points and a center row of teeth with longitudinally directed points, said teeth presenting relatively blunt clamping surfaces to a clamped object.

15. In a surgical clamp, a detachable tooth bar insert having a plurality of teeth presenting relatively blunt clamping surfaces to a clamped object and having points oriented in different directions for tractive penetration of the object, and a tongue extending along the back side of said bar, said tongue having a reduced neck portion and a thicker edge portion for mounting the insert in the clamp.

16. A tooth bar insert for a jaw of a surgical clamp, means on said insert for detachably mounting the insert on said jaw, and a plurality of curved teeth on said insert, the outer surfaces of said teeth which contact a clamped object being substantially parallel with the general clamping surface formed by the teeth to present relatively blunt clamping surfaces to the object and the points of the teeth being directed approximately parallel to said general clamping surface to efiect tractive penetration of the object when traction is applied.

17. The invention defined in claim 16, said teeth being made of a hard plastic material.

18. The invention defined in claim 16, said teeth being arranged in two rows and said points being oriented outwardly of said rows.

19. The invention defined in claim 18 including a third row of said teeth between said two rows, the tooth points in said third row being oriented longitudinally of the row.

References Cited UNITED STATES PATENTS Greenberg 128-323 Mathison 24-262 X Carlson 30-261 Ziegler 128-346 Schnee 128-346 Weihmann 128-321 X Grieshaber 128-321 Kapp 128-346 Braslow 1.28-327 FOREIGN PATENTS Italy.

US. Cl. X.R.

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