DE202008015879U1 - Catheter cannula system for reentry from the subintimal space into the true vessel lumen - Google Patents

Abstract

Catheter and cannula system for the sounding the true vessel lumen behind a closed vessel section, characterized in that it consists of three coaxially guided parts consists of: an outer plastic catheter, a blunt cannula Made of elastic steel and a sharply ground cannula also made of elastic steel.

Description

A the best ways to make a closed artery functional again is the so-called subintimal recanalization.

Beginning In the 1990s, A. Bolia convincingly demonstrated to a large group of treated patients that reopening occluded sections of the great thigh arteries, too outside the true lumen can take place. Similar to spontaneous aortic dissection, one creates a "false" lumen between the intima and media with exit in front of (or in) the closure segment and a Re-entry into the true lumen behind the clasp. This wrong one Lumen lets to stabilize by balloon dilation so that, as a rule Stents are not required. Since there is no in the wrong lumen arteriosclerotic wall changes There is a tendency for recurrent occlusion here is particularly low.

Of the Entry of guidewire and catheter in the subintimal space often occurs spontaneously in the attempt of sounding a shutter.

you But it can also be the entry into the subintimal space before the closed Section looking to the new lumen completely outside the arteriosclerotic changed To place area.

to Creation of the new path in the vascular wall is preceded by a sliding wire the top of the leader Catheter a U-shaped Loop formed by the catheter to the end of the catheter Lock segment slides.

Then you pull the wire back and try with the short curved tip, the intima towards the vessel lumen to perforate, show off the wire there and then the catheter to follow. Often these are curved catheters and different ones wires necessary. The conclusion is always the dilation of the new path and not infrequently the implantation of stents.

critical is that immediately distal to the occlusion reentry is found in the normal lumen, which can be very tedious and also at greater Experience only succeeds in about 80% of cases.

In about 20% of the cases So it succeeds with the usual Catheters and guidewires not, behind the closure, the way back to the normal vessel lumen Find.

since A few years ago there are special catheters on the market, which are the allow targeted puncture of the intima with a curved sharp cannula, through then a thin one Wire pushed back to the true lumen to secure the way becomes.

These complex Systems (outback from Cordis and Pioneer from Medtronic) have the Disadvantage of very high costs.

The Here presented invention is intended for well-accessible arteries such as the Thigh or pelvis the same goal with much simpler Means possible and reduce the cost per application to a fraction.

• 1. einem Kunststoff-Katheter (1a)
• 2. einer stumpfen dünnwandigen Kanüle aus elastischem Stahl, die in den Katheter passt und, vollständig eingeführt, die Katheterspitze mit dem Ansatz einer Krümmung überragt. (1b). An ihrem hinteren (äußeren) Ende ist die Kanüle mit einer Markierung versehen, welche die Richtung ihrer Endkrümmung anzeigt.
• 3. einer schräg angeschliffenen im Spitzenbereich gebogenen Kanüle aus elastischem Stahl, die in die unter 2 beschriebene Kanüle passt und, vollständig eingeführt, die andere Kanüle und den Katheter um etwa 15–20 mm überragt. An ihrem hinteren (äußeren) Ende ist die Kanüle mit einer Markierung versehen, welche die Richtung ihrer Endkrümmung anzeigt (1c).

The system consists of three parts:

• 1. a plastic catheter ( 1a )
• 2. a blunt thin-walled elastic steel cannula that fits into the catheter and, when fully inserted, projects beyond the catheter tip with the lug of a curve. ( 1b ). At its rear (outer) end, the cannula is provided with a mark indicating the direction of its end curvature.
• 3. An obliquely ground tip steel cannula made of elastic steel which fits into the cannula described in 2 and, when fully inserted, projects beyond the other cannula and catheter by about 15-20 mm. At its rear (outer) end, the cannula is provided with a mark indicating the direction of its end curvature ( 1c ).

The Starting situation is such that over one so-called lock in the inguinal artery a catheter and a so-called guidewire is introduced into the femoral or pelvic artery and in height of the sealed section into a gap between inner and middle wall layer of the artery lies.

Of the Catheter is removed and in its place over the wire the outer catheter of the system described here. After removal of the wire push the two long cannulas together (pushed together) and locks that sharp point of the inner cannula through the outer cannula is protected) in the catheter. The joint insertion of both cannula reduced the risk of kinking! In case of a stronger bending of the system at the access point in the bar is also recommended the Insert a wire into the inner cannula

Then, the fluoroscopic unit is rotated so that the catheter and vessel lumen are displayed side by side, as accurately as possible so that the planned path from the catheter into the vessel is parallel to the image plane (if necessary control with fluoroscopy in a direction changed by 90 °, in which then catheter and vessel on each other adorn). Subsequently, contrast representation of the vessel lumen, preferably with so-called roadmapping. (The contrast image of the vessel remains in the fluoroscopic image).

Then Become the blunt and sharp cannula by the directional mark turned so that the still hidden in the blunt cannula end curvature on directed the vessel lumen is a contrast agent syringe placed on the outer end of the sharp cannula and the lock between the two cannulas solved.

Now push the sharp cannula under roadmapping control until its tip after the fluoroscopic image lies in the free lumen of the artery ( 2 ), controls the position by a small injection of contrast agent, secures the position of the sharp cannula by tightening the locking screw and pushes a matching guide wire (0.45 or 0.35 mm [0.018 or 0.014 inch] diameter) through the inner cannula into the vessel ( 2 ).

If the wire with its stiff shaft lies securely in the vessel lumen, becomes the sharp cannula retreated to the dull and both cannulas together removed with the catheter.

On the Wire can then be inserted the appropriate catheter, with which you can newly created vascular lumens and the two transitions to the original Lumen expands. If necessary, insertion of stents.

a

Plastic catheter

b

Dull cannula made of elastic steel

c

sharp curved cannula made of elastic steel

d

Thin guidewire

e

Set screw (Protection claim 10)

f

Mark, which indicates the orientation of the end hole or the bend.

Claims (10)

A catheter-cannula system for probing the true vessel lumen behind a closed vessel section, characterized in that it consists of three coaxially guided parts: an outer plastic catheter, a blunt cannula made of elastic steel and a sharpened cannula extending therein, also made of elastic steel. Catheter and cannula system for the Probing the true vessel lumen behind a closed vessel section according to claim 1, characterized in that the blunt cannula made of elastic Steel, when complete introduced is, the catheter tip surmounted by a few millimeters. Catheter and cannula system for the Probing the true vessel lumen behind a closed vessel section according to the preceding claims characterized in that the blunt cannula so bent at its tip and cut off that its opening is directed to one side. Catheter and cannula system for the Probing the true vessel lumen behind a closed vessel section according to the preceding claims characterized in that the blunt cannula at its rear end with a mark is provided which the orientation of the end hole displays. Catheter and cannula system for the Probing the true vessel lumen behind a closed vessel section according to the preceding claims characterized in that catheter and blunt cannula fixed can be connected to each other, z. B. with a luer mechanism. Catheter and cannula system for the Probing the true vessel lumen behind a closed vessel section according to the preceding claims characterized in that the tip of the inner cannula, when this fully introduced is the tip of the blunt cannula surmounted by about 15 to 20 mm. Catheter and cannula system for the Probing the true vessel lumen behind a closed vessel section according to the preceding claims characterized in that the inner cannula in the section containing the dull cannula protrudes, has a bend. Catheter and cannula system for the Probing the true vessel lumen behind a closed vessel section according to the preceding claims characterized in that the orientation of the bend of the inner cannula by a mark on the outer end is shown. Catheter and cannula system for the Probing the true vessel lumen behind a closed vessel section according to the preceding claims characterized in that the inner cannula sharpened at its tip is. A catheter-cannula system for probing the true vessel lumen behind a sealed vessel portion according to the preceding claims, characterized in that the position of the inner sharp cannula within the outer vessel Blunt cannula can be fixed by a screw.