DE10042493A1 - System for treating varicose veins - Google Patents

Abstract

A system for the application of thermal energy in order to cause permanent contraction of vascular structures comprises a catheter (1) and a control device (2). The catheter (1) is introduceable into a vascular structure and includes at least one lumen having an opening in the distal end region. The control device (2), to which the catheter (1) is connectable via its proximal end region (5), is adapted to provide a liquid, to cause heating of the liquid and to supply the liquid into a lumen of the catheter (1) and to apply a vacuum to a lumen of the catheter (1).

Description

The invention relates to a system for the application of thermal Energy to cause a permanent contraction of vascular structures cause the z. B. used in the treatment of varicose veins can be.

A current, well-established treatment for varicose veins is pulling the saphenous vein, see e.g. BL Johns et al., "Neovascularization is the principal cause of varicose vein recurrence: results of a randomized trial of stripping the long saphenous vein", Eur J Vasc Endovasc Surg 12, 442-445 ( 1996 ); G. Goren, AE Yellin, "Minimally invasive sur gery for primary varicose veins: limited invaginated axial stripping and tributary (hook) stab avulsion", Ann Vasc Surg 9 ( 4 ), 401-414 ( 1995 ); PH Rutgers, PJ Kitslaar, "Randomized trial for stripping versus high ligation combined with sclero therapy in the treatment of the incompetent greater saphenous vein", Am J Surg 168, 311-315 ( 1994 ); S. Sarm et. al., "Strip ping of the long saphenous vein in the treatment of primary varicose veins", Br J Surg 81, 1455-1458 ( 1994 ).

On the ankle and in the groin area of the patient cuts made. The saphenous vein is identified, tanned the and shared. A flexible strip is created at the ankle incision inserted into the saphenous vein and through the proximal vein painterly direction until it through the groin incision exposed. The stripper is at its distal end large end piece attached; some strippers are with a one constructed "olive" shaped distal end. The vena saphena is in turn tied to the distal end of the stripper and then by quickly pulling the stripper through the Groin incision removed.  

This surgical technique eliminates the varicosity Return path and the blood source. However, she achieves this with considerable morbidity. The pulling procedure tears the vena saphena from collateral vessels, and additionally generate the large end piece and the growing drawn part of the vena saphena a large subcutaneous residual canal within the leg after removal of the vein. These factors lead to one Bleeding and a hematoma inside the leg, a pain adhere and slowly healing state, in a protracted Recovery phase results. This trauma also leads to harm on the nerves near the saphenous vein. Furthermore, the cosmetic results of this operation due to thresholds, Crushing and discoloration bad.

Other clinical techniques have been developed to treat varicose veins, trying to limit the morbidity associated with pulling. The ligamentation of the vena saphe na to the femoral vein connection (L. Jones et al., "Neo vascularization is the principal cause of varicose vein recur rence: results of a randomized trial of stripping the long saphenous vein", Eur J Vasc Endovasc Surg 12 , 442-445 ( 1996 ); S. Sarm et. Al., "Stripping of the long saphenous vein in the treatment of primary varicose veins", Br J Surg 81, 1455-1458 ( 1994 )) and compression sclerotherapy (K. Biegeleisen , RD Nielsen, "Failure of angioscopically guided sclerotherapy to permanently obliterate greater saphenous varicosity", Phlebology 9, 21-24 ( 1994 ); G. Goren, "Injection sclerotherapy for varicose veins: History and effectiveness", Phlebology 6, 7-11 ( 1991 ); PH Rutgers, PJ Kitslaar, "Randomized trial for stripping versus high ligation combined with sclerotherapy in the treat ment of the incompetent greater saphenous vein", Am J Surg 168, 311-315 ( 1994 )) are two alternative varicose vein treatments. The goal of tying the saphenous vein to the femoral junction is to eliminate the major return path to the saphenous vein. The procedure is performed using a groin incision. The sapheno-femoral connection and all other local bypasses of the saphenous vein are identified, isolated, ligated and divided. In compression sclerotherapy, a hardening agent is injected into the diseased vein to be treated. The agent acts as an irritant, causing damage to the endothelial lining and edema of the vascular wall. A compression bandage is used as an integral part of the treatment. The external force compresses the damaged endothelial layers of the vessel. Over time, the walls of the vessels weld together due to fibrosis and the vessel is closed. However, the two methods described above have high clinical relapse rates and are not considered optimal treatments.

Therefore, less invasive and less traumatic procedures for treating venous disorders have been investigated. In general, the use of intraluminal energy in the field is known to contract, damage and close vessels (W. Gorisch et al., "Heat-induced contraction of blood ves sels", Lasers Surg Med 2 ( 1 ), 1-13 ( 1982 ); GT Watt, "Endovenous diathermy destruction of internal saphenous", British Medical Journal, 53 (Oct. 7, 1972); K. O'Reilly, "Endovenous dia-thermy sclerosis of varicose veins", The Australian, New Zealand Journal of Surgery 47 (No. 3), 393-395 (June 1977); Cragg, et al. "Endovascular diathermic vessel occlusion", Diagnostic Radiology 144 , 303-308 (July 1982)).

US 6 014 589, WO 99/03413 and WO 99/12489 disclose a method and apparatus for treating cramp veins in which the permanent occlusion of the saphenous vein occurs the intraluminal application of radio frequency (RF) energy be will work. The energy causes a contraction and eventually a closure of the vessels. The energy is through a kathe ter with an expandable electrode tip. This The advantage of this procedure is that it is less traumatic than vein pulling. A major disadvantage, however, is the cost and complexity of the catheter treatment system. The challenge The change in this design is that the catheter is small enough to be inserted into the saphenous vein while  at the same time the ability to treat large vessels Diameter must exist. This is done with an expandable Electrode arrangement reached at the tip of the catheter. A disadvantage is the use of many small, moving components what is expensive and tends to be less reliable. Furthermore, the use of small electrodes leads to blood interact within the vascular lumen, also leading to an impurity cleaning tip.

Another method and another permanent device vascular occlusion, the various means of mechanical Collapse of the vessel and the application of energy closes, is known from US 5,709,224 and WO 96/39961. Body lumens like blood vessels become selective by mechanical Collapse of the blood vessel closed, e.g. B. by using negative pressure, and then applying RF Energy via one or more electrodes inside or in the Near the collapsed area.

US 5 273 524 discloses an endoscopic instrument an electrosurgical end tool. The main function is a tissue ablation with a monopolar radio frequency elec trode located at the distal tip of the instrument is. A secondary function of tissue removal is through successive rinsing with a fluid and suction on the Operation site reached. The construction of the device has a handle with a solid metallic tube. The tubular structure contains the treatment electrode on it distal end together with a single suction / irrigation lumen inside the tube.

It is an object of the present invention to provide a way Cause a permanent contraction of vascular structures create that efficiently, inexpensively and for the patient is less stressful.  

This task is solved by a system for the application of thermal energy to create a permanent contraction of the vessel to effect structures with the features of claim 1. An saying 15 is directed to a catheter which is a component of such a system, and claim 17 to a tax device which is another component of such a system is. Advantageous refinements of the invention result from the dependent claims.

The system according to the invention for the application of thermal energy, to cause a permanent contraction of vascular structures, has a catheter that can be inserted into a vascular structure and at least one lumen with an opening in the distal end area has. Another component of the system is one Control device with which the catheter over its proximal End area is connectable. The control device is turned on aimed to provide a liquid, heating the Induce fluid and the fluid into a lumen of the Delivery catheter and a vacuum to a lumen of the Ka theters. The control device is preferably for this purpose set up the liquid to a preselected temperature warm up and the warmed liquid to a lumen of the kathe to deliver. Alternatively or additionally, an elec trical heating device for heating the liquid in the distal End region of the catheter can be arranged; in this case is the control device is set up to this heater to control.

The present invention is accomplished through intraluminal application of thermal energy the clinical goal, a vessel, e.g. B. the vena saphena to contract or close. The heat is on the vascular structure in question via a heated liquid transferred, preferably a physiological treatment fluid. This concept enables a simplified, less expensive ge and robust construction of the components of the system, ins special of the catheter.  

The system has the advantage of being a disposable catheter component can be constructed, which is set up to the heat transfer fluid to a local treatment to deliver area within the lumen of a vessel and from it due. The complexity and cost of the system shifted from the catheter to the control device. before preferably the control device is a reusable pre direction constructed outside the sterile chi rurgisches Feld to be used. It preferably contains all or most of the components and control units for. Heating, delivery and return of the liquid.

The method using the system according to the invention is similar to current processes, but offers many advantages. The catheter is placed in the vessel to be treated used and led to the end of the treatment section. The Blood can be drawn from the vessel to be treated by methods such as An lifting, roller cuff, compression bandage or direct use pressure can be emptied. Then the system is activated fourth. The one sent through the catheter to the treatment site Liquid is warmed up, fills the treatment area and gently delt, d. H. warmed, the vessel wall in a homogeneous manner. The rivers liquid is then applied to the catheter by means of a vacuum returned, preferably to a collection container, which is in the control device is located or connected to it. This Treatment cycle continues when the catheter is off the Vessel is withdrawn, making a longitudinal section of the vessel is treated.

The system according to the invention enables a less invasive and less traumatic treatment than current methods, eli mines hematomas, swelling and bruising and reduces Pain and the time associated with recovery. The treatment time is comparable to the current methods. A efficient catheter design enables lower costs, so that the catheter can be provided as a disposable item. It also allows the use of a heated liquid or  of a heated physiological treatment fluid is homogeneous and even treatment of the vascular wall, what the application avoids excessive heat in certain places and generally enables shorter treatment times, with thermal effects be reduced to the surrounding structures.

The physiological treatment fluid is preferably a salt solution. It can also contain typical sclerotic agents, to support the treatment of the vessel.

In an advantageous embodiment of the invention, the Catheter at least two lumens, each with an opening in the has distal end portion, and the catheter and control device device are set up to the liquid and the negative pressure to deliver or create to different lumens. Preferably runs a lumen in the inner region of the catheter, whereby a such lumen is set up to lie the liquid remote. In this case, the catheter can be generally circular cross-sectional shape and a coaxial arrangement of the lumens have, the lumen for supplying the liquid in general runs along the central axis of the catheter. This arrangement has many advantages, especially if the liquid from the Control device is heated. First, it is efficient Arrangement within a prescribed outer envelope, which has a maximum cross-section of the lumen for improved lie Fer and backflows enabled. Second, this arrangement thermally efficient. A heat loss along the length of the Catheter is reduced because the central lumen for the delivery the liquid through two wall thicknesses of the catheter material as and through the reflux lumen or the reflux lumens (from which the negative pressure is applied) is isolated. A loss of heat is also reduced by the heat transfer area of the liquid delivered to the treatment site on the Central lumen diameter is minimized. In this way the temperature loss to the distal end of the Ka theters delivered fluid minimized while the catheter along its length on the outer surface where it is in contact with  the vessel wall comes, maintains a lower temperature. This avoids inadvertent thermal treatment of the vessel prior to controlled treatment at the tip of the catheter, d. H. in its distal end region.

If the catheter has at least two lumens, the distal end region of the catheter preferably at least one Delivery opening and at least one vacuum opening. This public can be used for optimal delivery and removal of the Liquid can be constructed as below using specific Exemplary embodiments explained.

If the catheter has at least two lumens, it can also the control device can be set up to hold the liquid and the vacuum simultaneously to respective separate lumens of the Deliver or apply catheters. That way he will warmed liquid to the vessel wall at the treatment site delivered, and at the same time used liquid is dispensed sucks what a steady flow and even and before allows defined treatment conditions.

In an alternative embodiment of the invention, the Catheter only one lumen, and the control device is one directed, alternating fluid to the lumen of the catheter deliver and apply a negative pressure to the lumen of the catheter lay. In this case, the construction of the catheter is special simple, but during the heat treatment is a steady one Liquid flow not possible. The latter is ever but not a disadvantage if the vessel z. B. along sections its length is treated. For this purpose, a given Section of a vessel wall using a certain amount Liquid can be heated for a certain period. Then it will be this liquid is aspirated and the catheter is pulled back to the next section of the vessel wall to be treated expose, etc.  

The catheter preferably has an atraumatic shape distal end region. The catheter can also be set up for this purpose be inserted into a vascular structure by means of a guide wire to be put. For this purpose, the guide wire can be in one of the lumens considered above or in an additional one for which Guide wire provided lumens are guided.

As already mentioned, the control device is preferably for this purpose set up the liquid to a preselected temperature warm up and the warmed liquid to a lumen of the kathe to deliver. In this case, the construction of the Kathe ters be particularly simple since they do not have a heating device closes.

It is also possible to have an electric heater in front is preferably designed as a resistance heating device, for heating the fluid in the distal end of the cathe To arrange, wherein the control device is set up is to control this heater. This concept allows even heat transfer from the heat source to the vessel wall if that provided by the control device Liquid flows around the electric heater and up this way is heated while the electric heater device does not come into direct contact with the vessel wall. virtue There is a temperature sensor that is electrically connected to the Control device is connected near the electrical Heater to monitor the temperature of the liquid and to support the control of the heating device. The elec trical heater can be the only heat source for heating men of the liquid supplied by the control device ver be used or as an additional facility, e.g. B. for Fine adjustment of the temperature of a liquid by the Control device is preheated. It is advantageous that the electric heating device a better fine control of the tempe rature of the liquid can allow, but on the other hand ent holds a catheter with an electric heater larger number of components and is more expensive.  

As already mentioned, the control device is preferably as reusable component designed outside of the sterile field is used. It preferably contains one electrical supply for the entire system, a standard ver binding to supply the liquid (treatment fluid) and / or optionally a reservoir for fresh liquid, a pump for delivering the liquid to the catheter, optional a heater for heating the liquid, a sub pressure pump for applying the vacuum and suctioning the ver needed liquid, optionally a container to collect the used liquid, a connection for the Catheter (which is preferably connected to an integral connector its proximal end for quick connection to the Connection terminal of the control device is provided) and all sensors and control devices for operating the system.

In the following, the invention is illustrated by means of exemplary embodiments explained in more detail. The drawings show in

Fig. 1 is a view of an embodiment of the erfindungsge MAESSEN system with a control device and a control device connected to the catheter,

Fig. 2 is a schematic illustration of the use of the system to bring about a permanent contraction of vascular structures, wherein in part (a) the catheter is inserted into a vessel before the application of thermal energy and in part (b) the vessel after Application of thermal energy is contracted

Fig. 3 in part (a) is a side view of the distal portion of the catheter of FIG. 1 and in part (b) shows a longitudinal section of the distal portion of this catheter,

Fig. 4 in part (a) a cross section of the catheter of Fig. 3 along the line III-III of Fig. 3 (a), in part (b) a similar cross section of a second embodiment of the catheter and in part (c) one Similar cross section of a third embodiment of the catheter,

Fig. 5 in part (a) a side view of the distal region of a fourth embodiment of the catheter, in part (b) a longitudinal section of this embodiment along the axis VV from part (a) and in part (c) an end view of this embodiment and

Fig. 6 in part (a) is a side view of the distal portion of a fifth embodiment of the catheter, in part (b) shows a longitudinal section of this embodiment taken along the axis VI-VI of part (a) and in part (c) is an end view of this embodiment.

Fig. 1 illustrates an embodiment of the system for the application of thermal energy to cause a permanent contraction of vascular structures. This system has a catheter 1 and a control device 2 . The catheter 1 is in a vascular structure, for. B. the saphenous vein or another vein, insertable via its distal end 4 . At its proximal end 5 , the catheter 1 contains an integral connection 6 which fits into a connection provided on the control device 2 .

The main function of the catheter 1 is to deliver a physiological fluid (which in the exemplary embodiment is heated by the control device 2 ) to a treatment site in the vascular structure in which the catheter 1 has been inserted and the used physiological fluid from the treatment site recirculate. For this purpose, the catheter 1 has at least one lumen which has an opening in the region of its distal end 4 . The catheter 1 must be able to be easily inserted into the lumen of the vascular structure or vessel and then guided to the initial treatment site. It can be constructed from a biocompatible polymer such as polytetrafluoroethylene (PTFE), polyurethane, polyethylene or polyvinyl chloride. The catheter 1 is preferably constructed from PTFE. PTFE offers the advantages of biocompatibility, chemical inertness, dimensional stability, thermal insulation and a smooth surface finish. More specifically, when it comes to insertion and guiding, the catheter must have the appropriate stiffness. This can be achieved through an appropriate balance of material properties and lumen dimensions, or a design that allows the use of a guidewire through a lumen. Preferably the tip or distal end portion of the catheter is of an ergonomic shape to allow easy insertion.

In order to be inserted into the vessel to be treated, the outside diameter of the catheter should be in the range from 1 mm to 5 mm, preferably around 3 mm. For the treatment of long vessels within the body of a patient, the catheter 1 should have a length of 50 cm to 150 cm, preferably around 100 cm.

In the exemplary embodiment, the control device 2 contains a standard connection to a separate container for the physiological treatment fluid and an electric pump for supplying the physiological fluid from this container to a lumen of the catheter 1 . In the control device 2 , the physiological fluid is heated to a preselected temperature before it is delivered to the catheter 1 . Furthermore, the Steuerervor device 2 has a vacuum pump for applying a vacuum to a lumen of the catheter. By means of this negative pressure, used treatment fluid is collected and fed to a reservoir, which is located outside of the control device 2 . The control device 2 also contains the electrical supply devices, sensors and control devices (preferably with a microprocessor) for operating the system.

Figure 2 illustrates the concept of using the system. In Fig. 2 (a), the distal end 4 of the catheter 1 has been guided within the lumen of a vessel 8 to a predetermined position, ie the treatment site where the vessel 8 is to be contracted, e.g. B. for the treatment of varicose veins. In this position of the catheter 1 , the control device 2 is operated to deliver physiological fluid heated via the catheter 1 to the treatment site, where the physiological fluid leaves the lumen of the catheter 1 and warms the wall of the vessel 8 . This causes a contraction of the wall, which results in a contracted area 9 . Preferably, the temperature of the physiological fluid is about 80 ° C to 90 ° C when it leaves the catheter 1 . The spent physiological fluid is extracted by means of the voltage applied to the catheter 1 under pressure via the catheter 1, in combination with any other liquids or solid particles at the treatment site (such as blood, emboli, etc.).

In the exemplary embodiment, the catheter 1 has two lumens. The physiological fluid is delivered through one lumen, while the negative pressure is simultaneously applied to the other lumen. This enables the system to operate continuously and the catheter 1 can be slowly pulled to the left (as shown in Figure 2 (b)) to cause the vessel 8 to contract along a portion.

Alternatively, the delivery of the physiological fluid is interrupted after a certain amount has been delivered, whereupon the used physiological fluid is aspirated. Thereafter, the catheter 1 is moved a preselected distance to the left (as shown in FIG. 2 (b)), and then a further amount of heated physiological fluid is supplied, etc.

The physiological treatment fluid is preferably a salt solution. It can also contain typical sclerotic agents, to support the treatment of the vessel. Usually is the contraction induced by the heat treatment is permanent.  

Fig. 3 shows the catheter 1 in more detail. The catheter 1 includes a cylindrical outer wall 10 and a cylindrical inner wall 12 in a coaxial arrangement, see also FIG. 4 (a), which shows a cross section through the catheter 1 along the line III-III of FIG. 3 (a) , The inner wall 12 can be held on the outer wall 10 by an open structure, which is not shown in the figures. The inner wall 12 defines the periphery of a first lumen 14 which extends along the central axis of the catheter 1 and at the distal end 4 of the catheter 1 has an opening, which is referred to as a supply port 15th The annular space between the outer wall 10 and the inner wall 12 defines a second lumen 16 , which also has an opening at the distal end 4 of the catheter 1 , which is referred to as a suction opening 17 .

The heated physiological treatment fluid is delivered through the first lumen 14 and through the delivery port 15 , while the used physiological treatment fluid is aspirated through the suction port 17 and returned through the second lumen 16 as indicated by the arrows in Fig. 3 (b). The coaxial arrangement of the lumens 14 and 16 has the advantage that the heated physiological treatment fluid does not come into contact with the outer wall 10 and thus cannot cause any undesirable heat effects before the fluid leaves the catheter 1 at the delivery opening 15 .

The Fig. 4 (b) and Fig. 4 (c) show the cross-sectional shapes of two other embodiments of the catheter. In Fig. 4 (b), a catheter 1 'has a cylindrical outer wall 10 ' that is divided by an inner wall 12 'that extends along the diameter of the catheter 1 ', thereby creating a first lumen 14 'and a second lumen 16 'can be defined.

In Fig. 4 (c), a catheter 1 "has a cylindrical outer wall 10 " and a star-like inner wall 12 "which defines three lumens 14 ", 16 "and 18 ". The lumen 18 "can be used, for example, for a guide wire and / or for the leads to a temperature sensor arranged at the distal end of the catheter 1 " for monitoring and regulating the temperature of the physiological treatment fluid delivered via the delivery opening.

Fig. 5 explains the distal part of a fourth embodiment of the catheter, which is designated 20 here. The distal end region 21 is shaped like a truncated cone. The catheter 20 has an outer wall 22 and an inner wall 23 , which are arranged coaxially, so that the cross section looks similar to FIG. 4 (a). The inner wall 23 defines a first lumen 24 which ends at the delivery opening 25 at the distal end of the catheter 20 . The annular space between the outer wall 22 and the inner wall 23 forms a second lumen 26 which has a total of four openings in the distal end region 21 , ie four suction openings 27 , which can best be seen in the front view according to FIG. 5 (c) ,

This construction allows a particularly efficient suction of used physiological treatment fluid.

The distal region of a fifth embodiment of the catheter, which is designated here by 30, is illustrated in FIG. 6. The distal end region 31 is again frustoconical and thus has an ergonomic and atraumatic shape. The catheter 30 has a cylindrical outer wall 32 and a cylindrical inner wall 33 which are arranged coaxially, resulting in a cross-sectional shape as in Fig. 4 (a). The inner wall 33 defines a first lumen 34 which is connected to the interior of a cross tube 35 which is near the distal end of the inner wall 33 , see Fig. 6 (b). At both ends, the cross tube 35 extends to the outer wall 32 and has openings there, ie the delivery openings 36 . Thus, physiological treatment fluid can be delivered via the first lumen 34 and through the delivery openings 36 to the sides of the catheter 30 , which enables a particularly efficient heat treatment.

A second lumen 38 terminates at a suction port 39 at the distal end of catheter 30 and is used to aspirate the used physiological treatment fluid.

Claims (18)

1. System for the application of thermal energy to cause a permanent contraction of vascular structures with
a catheter ( 1 ; 20 ; 30 ) which can be inserted into a vascular structure ( 8 ) and at least one lumen ( 14 , 16 ; 24 , 26 ; 34 , 38 ) with an opening ( 15 , 17 ; 25 , 27 ; 36 , 39 ) in the distal end region ( 4 ; 21 ; 31 ), and
a control device ( 2 ) to which the catheter ( 1 ; 20 ; 30 ) can be connected via its proximal end region ( 5 ) and which is set up to provide a liquid, to cause the liquid to heat up and to transfer the liquid to a lumen ( 14 ; 24; 34) of the catheter (1; to create a vacuum 30); 20; supplying 30) and a lumen (16; 26; 38) of the Kathe ters (1; 20th 2. System according to claim 1, characterized in that the catheter ( 1 ; 20 ; 30 ) has at least two lumens ( 14 , 16 ; 24 , 26 ; 34 , 38 ), each of which has an opening ( 15 , 17 ; 25 , 27 ; 36 , 39 ) in the distal end region ( 4 ; 21 ; 31 ), and that the catheter ( 1 ; 20 ; 30 ) and the control device ( 2 ) are set up to separate the liquid and the vacuum from separate lumens ( 14 , 16 ; 24 , 26 ; 34 , 48 ) to deliver or create. 3. System according to claim 2, characterized in that a lumen ( 14 ; 24 ; 34 ) runs in the inner region of the catheter ( 1 ; 20 ; 30 ), such a lumen ( 14 ; 24 ; 34 ) being set up to the Add liquid. 4. System according to claim 3, characterized in that the catheter ( 1 ; 20 ; 30 ) has a generally circular cross-sectional shape and a coaxial arrangement of the lumens ( 14 , 16 ; 24 , 26 ; 34 , 38 ), the lumen ( 14 ; 24 ; 34 ) for supplying the liquid runs generally along the central axis of the catheter ( 1 ; 20 ; 30 ). 5. System according to any one of claims 2 to 4, characterized in that the distal end region ( 4 ; 21 ; 31 ) of the catheter ( 1 ; 20 ; 30 ) at least one delivery opening ( 15 ; 25 ; 36 ) and at least one vacuum opening ( 17 ; 27 ; 39 ). 6. System according to any one of claims 2 to 5, characterized in that the control device ( 2 ) is set up to simultaneously supply liquid and a vacuum to respective separate lumens ( 14 , 16 ; 24 , 26 ; 34 , 38 ) of the catheter ( 1 ; 20 ; 30 ) to deliver or create. 7. System according to claim 1, characterized in that the Catheter has only one lumen and the control device is set up to alternate the lumen of the fluid Feed catheter and a vacuum to the lumen of the Apply catheters. 8. System according to one of claims 1 to 7, characterized in that the catheter ( 20 ; 30 ) has an atraumatically shaped distal end region ( 21 ; 31 ). 9. System according to any one of claims 1 to 8, characterized in that the catheter ( 1 ; 20 ; 30 ) is set up to be inserted into a vascular structure ( 8 ) by means of a guide wire. 10. System according to one of claims 1 to 9, characterized in that the control device ( 2 ) is set up to heat the liquid to a preselected temperature and the heated liquid a lumen ( 14 ; 24 ; 34 ) of the catheter ( 1st ; 20 ; 30 ). 11. System according to any one of claims 1 to 10, characterized records that an electric heater for heating  of fluid in the distal end of the catheter is arranged and that the control device is set up for this is to regulate this heater. 12. System according to claim 11, characterized in that the electric heater as a resistance heater direction is constructed. 13. System according to any one of claims 1 to 12, characterized in that the control device ( 2 ) contains a pump for supplying the liquid. 14. System according to any one of claims 1 to 13, characterized in that the control device ( 2 ) has a vacuum pump for applying the vacuum. 15. Catheter intended for use in an An saying 1 is set up. 16. Catheter according to claim 15, characterized by the features of the catheter in a system according to one of claims 1 until 14. 17. Control device intended for use in a system Claim 1 is set up. 18. Control device according to claim 17, characterized by the Features of the control device in a system according to a of claims 1 to 14.