EP1434617A2 - Catheter with retractable perforating or piercing end tool - Google Patents

Catheter with retractable perforating or piercing end tool

Info

Publication number
EP1434617A2
EP1434617A2 EP02800639A EP02800639A EP1434617A2 EP 1434617 A2 EP1434617 A2 EP 1434617A2 EP 02800639 A EP02800639 A EP 02800639A EP 02800639 A EP02800639 A EP 02800639A EP 1434617 A2 EP1434617 A2 EP 1434617A2
Authority
EP
European Patent Office
Prior art keywords
catheter
catheter according
needle
liquid
slide
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Withdrawn
Application number
EP02800639A
Other languages
German (de)
French (fr)
Inventor
Bertrand Gonon
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Eschmann Holdings Ltd
Original Assignee
Eschmann Holdings Ltd
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Eschmann Holdings Ltd filed Critical Eschmann Holdings Ltd
Publication of EP1434617A2 publication Critical patent/EP1434617A2/en
Withdrawn legal-status Critical Current

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00—Catheters; Hollow probes
    • A61M25/0067—Catheters; Hollow probes characterised by the distal end, e.g. tips
    • A61M25/0082—Catheter tip comprising a tool
    • A61M25/0084—Catheter tip comprising a tool being one or more injection needles
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00—Catheters; Hollow probes
    • A61M25/0067—Catheters; Hollow probes characterised by the distal end, e.g. tips
    • A61M25/0082—Catheter tip comprising a tool
    • A61M25/0084—Catheter tip comprising a tool being one or more injection needles
    • A61M2025/0089—Single injection needle protruding axially, i.e. along the longitudinal axis of the catheter, from the distal tip

Definitions

  • the present invention relates to an improved catheter with retractable tip tool for puncture or puncture work.
  • an active agent for example a medicament, a product useful for surgical intervention or a diagnostic product, directly in contact with the diseased or to be treated area, which is located most of the time inside the human body, in an organ, or in its tissue.
  • an injection catheter is used for this, which is inserted and pushed along a vessel inside the patient's body until its distal end, pierced with one or more orifices, is as close as possible to the area to be treated. Then the active agent is injected into the area to be treated through the opening (s) of the end of the injection catheter.
  • the active product For the treatment to be effective, the active product must be applied for a long period or several times, which lengthens the patient's hospital stay and increases the risk. infections or complications related to the procedure. In addition, since the active product is often relatively expensive, the cost of treatment is considerably increased. In addition, the active product which is useful and beneficial in the targeted area can be harmful or even toxic if it is applied to other organs of the patient not affected by the treatment. This is particularly the case with the increasing development of gene therapies, during which it is possible, for example, to administer genes, cells, nucleic acids or genetically modified proteins to the target organ, applied in isolation or by means of 'a vector for example a virus. It is therefore very important that the administered product, developed for a specific application, remain localized at the site of its injection. However, with the conventional device described above, the active agent is carried away from the treatment site by the flow of the blood circulation and can therefore inadvertently lead to other organs not targeted.
  • catheters comprising at their distal end an injection needle device have been developed.
  • the needle enters the targeted tissue and the active agent is injected through this needle directly into the heart of the tissue to be treated.
  • the active agent is much more effective. Indeed, all of the agent injected can act and is much less likely to be involuntarily trained towards other non-target organs. In addition the fabric is treated in depth and no longer just on the surface.
  • injection catheters comprising at their distal end a retractable needle have been proposed in the prior art.
  • the exit of the needle prior to injection and then the re-entry of the latter inside the catheter are controlled manually by the user.
  • One of the objectives of the invention is to meet this need.
  • the catheter according to the invention is of the injection catheter type, that is to say a flexible adjustable conduit intended to inject into an organ or into the tissue of an organ an active product. It has at its distal end a retractable puncture or puncture tool making it possible to perform a puncture work and to inject a product directly into the tissue of an organ.
  • the catheter device provides greatly improved security by eliminating the risk previously mentioned.
  • the position of the retractable end tool is controlled automatically, its output only taking place when a liquid under sufficient pressure is sent to be delivered by the catheter.
  • the tool In the absence of liquid or if the pressure thereof is below a threshold value, the tool is automatically returned to the retracted safety position inside the catheter. Before and after injection, the tool is therefore in the retracted position without the user having to intervene. Any risk of involuntary damage is thus avoided.
  • the work of the pressurized jet makes it possible to produce a conduit in the tissue or the organ to be treated, into which an active, treatment, growth or other liquid is injected or introduced.
  • the working liquid is also the active liquid or a mixture.
  • the active product sent inside the conduit dug by the working liquid under pressure is thus administered to the heart of the tissue to be treated.
  • the end of the conduit being open the active agent tends to come out of the conduit and to be quickly evacuated from the treatment site. We then find us in the disadvantageous situation previously mentioned.
  • the pressure jet working longitudinally, the concentration of the liquid takes place at the blind end of the duct.
  • the area of the open end and the walls of the beginning of the conduit receive very little active liquid when this end also needs it.
  • the inventive solution described below overcomes this drawback.
  • the device according to the invention makes it possible to combine the benefits of the jet of liquid under pressure with those of needle catheters.
  • the invention enables the first part of an injection pipe to be produced mechanically by a perforating or puncturing tool, while diffusing the active product in a layer located near the surface.
  • the catheter according to the invention has a retractable end tool, preferably a retractable needle, which can be used as an outlet nozzle for a pressurized liquid, the work of which consists in digging a conduit in the layer of tissue against which the front wall catheter is affixed.
  • the active liquid or a part of it is also used as working liquid for the diffusion of the liquid along the conduit.
  • the catheter according to the invention is in the form of a flexible conduit with a steerable end by known means, comprising a retractable end tool of the puncturing or pricking type, movable between a working out position and a retracted safety position. inside the catheter, allowing the injection of a liquid under pressure.
  • the exit from the end tool is automatic and caused by the pressure of the liquid escaping from the catheter.
  • the end tool is automatically retracted inside the catheter in the absence of liquid or if the pressure of the latter is below a threshold value.
  • Figure 1 is a sectional view of the end of an embodiment of the catheter according to the invention, the needle-nozzle being in the retracted position of rest; .
  • Figure 2 is a sectional view of the end of an embodiment of the catheter according to the invention, the needle-nozzle being in the out position for injecting liquid; .
  • Figure 3 is a sectional perspective view of the end of a variant of the catheter according to the invention comprising a suction means, the needle-nozzle being in the retracted position; .
  • Figure 4 is a schematic sectional view of the end of the suction variant of the catheter according to the invention, positioned in contact with the wall of an organ, the needle-nozzle being in the retracted position; .
  • FIG. 5 is a schematic sectional view of the end of the suction variant of the catheter according to the invention, positioned in contact with the wall of an organ, the needle-nozzle being in the outgoing injection position for liquid ; .
  • FIG. 6 is a more general simplified explanatory diagram, illustrating a possible application of the catheter according to the invention to a dissection apparatus with jets pulsed with liquid under pressure.
  • the catheter according to the present invention will now be described in detail with reference to Figures 1 to 6.
  • the equivalent elements shown in the different figures will have the same reference numerals.
  • the catheter 1 is conventionally in the form of a flexible conduit 2 in which an active liquid 3 can flow, for example a working liquid, a therapeutic, surgical or diagnostic product. It comprises a proximal end 4 manipulated by the surgeon and a distal end 5 introduced inside the patient's body.
  • the distal end 5 includes known navigation and orientation means which have not been shown in the figures because they are not part of the invention.
  • the catheter ends at its distal end with a front end wall 6 pierced with an orifice 7, preferably central, through which the active liquid 3 can flow or be ejected.
  • this end 5 of the catheter can optionally be protected by a removable closure piece, for example a screw cap. In this case, it has an external thread 8.
  • the distal end of the catheter according to the invention contains a retractable end tool 9 movable between a retracted safety position inside the catheter, illustrated in FIGS. 1, 3, 4 and 6, and an extended position. work, illustrated in Figures 2 and 5.
  • the end tool 9 makes it possible to carry out perforating or puncturing work.
  • it comprises a slide 10 and a base 11 carrying a needle-nozzle 12.
  • the slide 10 is preferably in the form of a substantially cylindrical hollow part or pierced with a through channel 13. Its outside diameter is slightly smaller than the inside diameter of the pipe 2 so that it can slide inside the latter. However, the clearance between the duct 2 and the slide 10 remains minimal in order to ensure sealing despite this freedom of sliding.
  • the internal wall 14 of the conduit 2 and the parts of the slide in contact with the latter are lined with a Teflon-based coating ensuring sealing even at high pressure, while promoting sliding.
  • all the sliding parts of the end tool 9 in contact with the internal wall 14 of the conduit 2 are preferably provided with a coating based on Teflon.
  • the slide 10 is integral or capable of pushing the needle holder base 11 in order to drive it in its sliding movement. According to an alternative embodiment shown in Figures 4 and 5, the slide 10 and the base 11 can be made in one piece.
  • the needle holder base 11 comprises a plate 15 preferably substantially circular and with a diameter less than the internal diameter of the conduit 2 so as to be able to slide inside the latter.
  • the parts of the needle holder base 11 in contact with the internal wall 14 of the conduit 2 are also provided with a coating based on Teflon.
  • the needle 12 is connected to the plate 15 by a base 16 and ends with a tip 17 capable perform perforation or puncture work.
  • the internal channel 18 of the needle has a substantially conical shape narrowing in the direction of the ejection orifice 19 so as to be able to act as a nozzle.
  • the needle 12 also has a substantially conical external shape. This form is not, however, limiting. Indeed, the length and the shape of the needle 12 can be optimized according to the application envisaged for the catheter according to the invention. Thus, the needle 12 can for example be pointed, rounded or bevelled.
  • the outer surface of the needle is not necessarily smooth. It may include reliefs, such as for example one or more twist (s), notches, hooks or retaining pins, in order to improve the anchoring and the attachment of the needle into the fabric.
  • reliefs such as for example one or more twist (s), notches, hooks or retaining pins, in order to improve the anchoring and the attachment of the needle into the fabric.
  • the plate 15 is also pierced with a through channel 20, the ends of which are in fluid communication for one with the end of the channel 13 of the slide 10 and for the other with the internal channel 18 of the needle 12.
  • the tip 17 of the needle 12 is located opposite the orifice 7 of the front wall 6 of the catheter end, so as to be able to project out of the catheter through this orifice when the needle 12 is in the out position. job ( Figures 2 and 5).
  • an elastic restoring force recalls the slide-needle assembly in the retracted position of rest, that is to say in the retracted safety position inside the catheter.
  • This restoring force can be exerted by a spring 21, preferably disposed between the plate 15 of the needle holder base 11 and the end end wall 6 of the catheter.
  • the spring 21 exerts an elastic return force on the needle holder base 11, which keeps the needle 12 in the retracted position of rest.
  • the slider 10 slides inside the conduit 2 in the direction of the distal end 5 of the catheter, driving with it the needle holder base 11 and compressing the return spring 21.
  • the movement of the base 11 causes the tip 17 of the needle 12 to exit the catheter through the orifice 7 of the front end wall 6.
  • the needle 12 is then in the working output position ( Figures 2 and 5).
  • the fluid is ejected from the catheter 1 through the orifice 19 of the needle-nozzle 12 in the form of a jet 24.
  • the return spring 21 decompresses and pushes the plate 15 which causes the sliding of the needle holder base 11 as well as that of the slide 10 in the direction of the proximal end 4 of the catheter.
  • the needle 12 then returns to its retracted rest position.
  • the exit and re-entry of the needle take place automatically and without direct intervention by the user, depending on the pressure of the fluid flowing into the catheter.
  • the surgeon controls only the start and / or stop of the flow of liquid, the position of the needle being automatically and almost immediately adapted to the situation.
  • the fluid To bring out the needle 12, the fluid must have sufficient pressure to succeed in compressing the spring 21. There therefore exists for the fluid a limit pressure or threshold pressure, corresponding to the equilibrium pressure with the elastic force of reminder, below which the needle exit does not take place.
  • This threshold pressure is, in this embodiment, fixed by construction and depends on the stiffness constant of the return spring 21. It is preferably close to five bars.
  • the catheter according to the invention makes it possible to achieve this objective satisfactorily.
  • the catheter according to the present invention may further comprise a suction means opening out near the intervention zone, which makes it possible to aspirate the working fluid, body fluids and small debris, thus improving the efficiency of the 'intervention and visibility of the treated area for the surgeon.
  • a suction means opening out near the intervention zone which makes it possible to aspirate the working fluid, body fluids and small debris, thus improving the efficiency of the 'intervention and visibility of the treated area for the surgeon.
  • FIGS. 3 to 6 A variant of this type has been shown in FIGS. 3 to 6.
  • the catheter 1 comprises a suction duct 25, for example of generally cylindrical shape and surrounding the duct 2 preferably concentrically.
  • the suction duct 25 widens at the distal end 5 of the catheter until it forms a skirt 26.
  • the catheter according to the invention may include an additional anchoring system in order to ensure immobilization of its active end during the firing of liquid under pressure, thus improving the precision of the interventions.
  • FIGS. 4 and 5 An example of use of the catheter according to the invention has been shown diagrammatically in FIGS. 4 and 5.
  • the surgeon introduces the distal end of the catheter into the body of the patient and guides it along an appropriate vessel until it comes close to an organ or tissue 27 to be treated.
  • a wall area 28 suitable for treatment After having identified, by means of location not shown, a wall area 28 suitable for treatment, it positions the front end wall 6 of the catheter as close as possible to the targeted area of the wall 28 by means of means of orientation and articulation also not represented.
  • the point 17 of the needle passes through the wall 28 and penetrates into the tissue 27.
  • the maximum depth of penetration into the fabric 27 depends on the maximum length of the stroke of the slide 10 and therefore on the possible compression of the spring 21. It is preferably about 2 mm.
  • the pressurized liquid passes through the channel 13 of the slide 10, the channel 20 of the base 11 and the channel 18 of the needle 12 which acts as a nozzle. It is then ejected at high speed through the orifice 19 of the needle into the tissue 27 where it digs a conduit 29.
  • the needle 12 which, by its mechanical penetration, initiates the digging work of the duct 29.
  • This advantageous characteristic makes it possible to reduce the pressure of the working liquid and / or the number of shots necessary to dig the duct 29.
  • This characteristic is particularly interesting when the target organ is surrounded by a membrane or an external wall more resistant than its internal tissue.
  • the needle 12 passes through the external wall and the pressurized liquid can then easily dig into the softer internal tissue.
  • the surgeon can then initiate the injection into line 29 of an active, treatment, growth, diagnostic or other agent.
  • the working liquid is also the active liquid or a mixture containing the active agent.
  • the active product sent inside the conduit 29 hollowed out by the working liquid under pressure is thus administered to the heart of the tissue to be treated.
  • the dissection apparatus 31 makes it possible to send one or more jets 24 of sterile liquid under pressure for example against a fabric to be cut or a material to be disaggregated.
  • This device comprises a generator of pressurized liquid 32 connected to a reserve 33 of working liquid.
  • the pressure of the jet of liquid generated can be adjustable in order to adapt it to the needs.
  • the working liquid used is preferably sterile physiological serum.
  • other sterile liquids can obviously be used as working fluid, for example a saline solution, a glucose solution, a Ringer-lactate solution, a hydroxy-ethyl starch solution or a mixture of these solutions.
  • the sterile working liquid is brought to a handpiece 34 allowing the surgeon performing the intervention to control the triggering of the working liquid jet and to direct it.
  • the handpiece 34 comprises an ergonomic body 35, allowing easy gripping and handling and which may have control members such as, for example, push buttons 36.
  • the handpiece 34 is extended by the catheter 1 according to the invention delivering the jet of sterile liquid under pressure in order to perform surgical work of cutting, dissection or disintegration.
  • the surgical device 31 preferably comprises a suction system 37 connected to a vacuum source 38, for example the general vacuum circuit of the hospital.
  • the suction system ends with the suction duct 25, concentric with the duct 2 and emerging at the level of the skirt 26.
  • the surgical device 31 is preferably a pulsed jet device sending the liquid under pressure by a shot in the form of a discontinuous train of pulses constituting elementary jets of liquid under pressure.
  • the surgical apparatus 31 includes a sequencer 39 allowing the formation of the pulsed jet and controlling its parameters.
  • the dissection apparatus further comprises a reserve 40 of treatment product.
  • the treatment product is preferably in a liquid form or sufficiently fluid to be applied by means of the surgical device 31. It may be a single active agent or a mixture of several of them, in a form, for example fluid and preferably liquid, pure or in solution or suspension in any solvent or in the form of an emulsion, a foam or a gel.
  • FIG. 6 the working liquid has been symbolized by a thick black line and the treatment fluid by a thick gray line.
  • the dissection apparatus may include, for example, upstream of the catheter 1, a switching allowing the surgeon practicing the intervention to trigger the choice of firing a jet of working liquid or a jet of treatment product.
  • the device may also include, in place of the switching member, a mixing member allowing the surgeon to produce, at the appropriate time, a mixture of working liquid and treatment product.
  • the surgical device 31 delivers a pulsed jet of pressurized liquid, it may further comprise a multiplexer 41 making it possible to combine pulses of working liquid and treatment product within the discontinuous train of pulses constituting the pulsed jet.
  • the parameters of the different pulses, their nature and their succession can be modified and programmed according to the needs of the surgeon, the patient and the type of intervention performed, in order to optimize the result of the intervention.
  • the catheter according to the invention is obviously not limited to an application on a surgical device as previously described. It is possible to imagine many other surgical, therapeutic or diagnostic devices to which it can be adapted.
  • the catheter according to the invention is particularly suitable for performing interventions of the type of transmyocardial or myocardial revascularization, consisting in digging a plurality of revascularization conduits in an ischemic zone of the wall of the myocardium.
  • its use is not limited to cardiac intervention. It is possible to imagine multiple applications of the catheter according to the invention for procedures on any type of organ or tissue of the human or animal body.

Abstract

The invention concerns a catheter (1) comprising an end tool (9) with retractable needle (12) in the form of a slide (10) integral with a needle base (11) or pushing the latter under the effect of a continuous or pulsed pressurized fluid pressure. An elastic return force, preferably exerted by a spring (21) arranged between the needle-holder base (11) and the front end wall (6) of the catheter, returns the slide-needle assembly in inactive retracted position. The invention is of interest to manufacturers and users of catheters for surgical, therapeutic or diagnostic purposes.

Description

Cathéter à outil d'extrémité perforant ou piquant rétractable. Catheter with retractable puncture or puncture tip tool.
La présente invention se rapporte à un cathéter amélioré à outil d'extrémité rétractable en vue d'un travail perforant ou de piqûre.The present invention relates to an improved catheter with retractable tip tool for puncture or puncture work.
Dans le cadre d'un traitement médical, au cours d'une intervention chirurgicale ou d'une action de diagnostic, il est souvent avantageux d'administrer un agent actif, par exemple un médicament, un produit utile à l'intervention chirurgicale ou un produit de diagnostic, directement au contact de la zone malade ou à traiter qui se situe la plupart du temps à l'intérieur du corps humain, dans un organe ou dans le tissu de celui-ci.In the context of medical treatment, during a surgical intervention or a diagnostic action, it is often advantageous to administer an active agent, for example a medicament, a product useful for surgical intervention or a diagnostic product, directly in contact with the diseased or to be treated area, which is located most of the time inside the human body, in an organ, or in its tissue.
De façon classique, on utilise pour cela un cathéter d'injection que l'on introduit et que l'on pousse le long d'un vaisseau à l'intérieur du corps du patient jusqu'à ce que son extrémité distale, percée d'un ou de plusieurs orifices, se trouve le plus près possible de la zone à traiter. Puis on injecte l'agent actif sur la zone à traiter à travers le ou les orifices de l'extrémité du cathéter d'injection.Conventionally, an injection catheter is used for this, which is inserted and pushed along a vessel inside the patient's body until its distal end, pierced with one or more orifices, is as close as possible to the area to be treated. Then the active agent is injected into the area to be treated through the opening (s) of the end of the injection catheter.
Malheureusement avec ce dispositif classique, l'agent injecté n'est appliqué qu'à la surface de l'organe concerné. De ce fait il se dissipe très rapidement et ne permet pas de réaliser un traitement en profondeur ou de longue durée de cet organe.Unfortunately with this conventional device, the injected agent is only applied to the surface of the organ concerned. Therefore it dissipates very quickly and does not allow for a deep or long-term treatment of this organ.
Pour que le traitement soit efficace, le produit actif doit être appliqué pendant une longue durée ou plusieurs fois ce qui allonge la durée d'hospitalisation du patient et accroît le risque d'infections ou de complications liées à l'intervention. En outre, le produit actif étant souvent relativement cher, le coût du traitement se trouve considérablement augmenté. Par ailleurs, le produit actif utile et bénéfique sur la zone ciblée peut être néfaste, voire toxique s'il est appliqué à d'autres organes du patient non concernés par le traitement. C'est notamment le cas avec le développement croissant des thérapies géniques, au cours desquelles on peut par exemple administrer à l'organe cible des gènes, des cellules, des acides nucléiques ou des protéines génétiquement modifiés, appliqués de façon isolée ou au moyen d'un vecteur par exemple un virus. II est ainsi très important que le produit administré, développé pour une application spécifique, reste localisé sur le site de son injection. Or avec le dispositif classique précédemment décrit, l'agent actif est emporté hors du site de traitement par le flux de la circulation sanguine et peut ainsi aboutir malencontreusement à d'autres organes non visés.For the treatment to be effective, the active product must be applied for a long period or several times, which lengthens the patient's hospital stay and increases the risk. infections or complications related to the procedure. In addition, since the active product is often relatively expensive, the cost of treatment is considerably increased. In addition, the active product which is useful and beneficial in the targeted area can be harmful or even toxic if it is applied to other organs of the patient not affected by the treatment. This is particularly the case with the increasing development of gene therapies, during which it is possible, for example, to administer genes, cells, nucleic acids or genetically modified proteins to the target organ, applied in isolation or by means of 'a vector for example a virus. It is therefore very important that the administered product, developed for a specific application, remain localized at the site of its injection. However, with the conventional device described above, the active agent is carried away from the treatment site by the flow of the blood circulation and can therefore inadvertently lead to other organs not targeted.
Pour remédier à ce problème, des cathéters comportant à leur extrémité distale un dispositif d'aiguille d'injection ont été développés. L'aiguille pénètre dans le tissu ciblé et l'agent actif est injecté à travers cette aiguille directement au cεur du tissu à traiter.To remedy this problem, catheters comprising at their distal end an injection needle device have been developed. The needle enters the targeted tissue and the active agent is injected through this needle directly into the heart of the tissue to be treated.
De cette manière, l'agent actif est beaucoup plus efficace. En effet, la totalité de l'agent injecté peut agir et a beaucoup moins de chance d'être entraîné de manière involontaire vers d'autres organes non ciblés. De plus le tissu est traité en profondeur et non plus simplement en surface.In this way, the active agent is much more effective. Indeed, all of the agent injected can act and is much less likely to be involuntarily trained towards other non-target organs. In addition the fabric is treated in depth and no longer just on the surface.
Néanmoins, ce genre de cathéter est pour des raisons de sécurité très difficile à manipuler. En effet, sa mise en place jusqu'au contact du tissu à traiter puis son retrait sont rendus très délicat par la présence de l'aiguille d'extrémité.However, this type of catheter is for safety reasons very difficult to handle. Indeed, its installation until contact with the tissue to be treated and its removal are made very delicate by the presence of the end needle.
Pour remédier à cet inconvénient, des cathéters d'injection comportant à leur extrémité distale une aiguille rétractable ont été proposés dans l'art antérieur. Dans ces dispositifs connus, la sortie de l'aiguille préalable à l'injection puis la rentrée de celle-ci à l'intérieur du cathéter sont commandées manuellement par l'utilisateur.To overcome this drawback, injection catheters comprising at their distal end a retractable needle have been proposed in the prior art. In these known devices, the exit of the needle prior to injection and then the re-entry of the latter inside the catheter are controlled manually by the user.
Cette commande manuelle de la position de l'aiguille n'est pas encore satisfaisante au point de vue de la sécurité. En effet, si l'aiguille est oubliée en position sortie lors de l'insertion et de la mise en place du cathéter ou lors du retrait de celui-ci, elle risque de provoquer de graves dégâts dans le corps du patient.This manual control of the needle position is not yet satisfactory from the point of view of safety. In fact, if the needle is forgotten in the extended position during the insertion and placement of the catheter or when it is withdrawn, it risks causing serious damage in the patient's body.
Il existe donc un grand besoin pour un cathéter d'injection à aiguille, plus sûr. L'un des objectifs de l'invention est de répondre à ce besoin.There is therefore a great need for a safer needle injection catheter. One of the objectives of the invention is to meet this need.
Le cathéter selon l'invention est du type cathéter d'injection, c'est-à-dire un conduit souple orientable destiné à injecter dans un organe ou dans le tissu d'un organe un produit actif. Il comporte à son extrémité distale un outil perforant ou piquant rétractable permettant de réaliser un travail de piqûre et d'injecter un produit directement au cεur du tissu d'un organe.The catheter according to the invention is of the injection catheter type, that is to say a flexible adjustable conduit intended to inject into an organ or into the tissue of an organ an active product. It has at its distal end a retractable puncture or puncture tool making it possible to perform a puncture work and to inject a product directly into the tissue of an organ.
Le dispositif de cathéter selon l'invention assure une sécurité grandement améliorée en éliminant le risque précédemment évoqué. En effet, la position de l'outil rétractable d'extrémité est commandée automatiquement, sa sortie n'ayant lieu que lorsqu'un liquide sous pression suffisante est envoyé pour être délivré par le cathéter. En l'absence de liquide ou si la pression de celui-ci est inférieure à une valeur de seuil, l'outil est automatiquement ramené en position rétractée de sécurité à l'intérieur du cathéter. Avant et après l'injection, l'outil se trouve donc en position rentrée sans que l'utilisateur n'ait à intervenir. Tout risque de dégât involontaire est ainsi évité.The catheter device according to the invention provides greatly improved security by eliminating the risk previously mentioned. In fact, the position of the retractable end tool is controlled automatically, its output only taking place when a liquid under sufficient pressure is sent to be delivered by the catheter. In the absence of liquid or if the pressure thereof is below a threshold value, the tool is automatically returned to the retracted safety position inside the catheter. Before and after injection, the tool is therefore in the retracted position without the user having to intervene. Any risk of involuntary damage is thus avoided.
Dans l'art antérieur, on connaît également un autre type de dispositif permettant d'injecter et de diffuser des liquides à l'intérieur des tissus d'un organe du corps humain, par exemple du cεur. Ce dispositif, décrit dans la demande de brevet WO 00/56232 au nom de SAPHIR MEDICAL PRODUCTS GMBH, utilise le travail d'un jet puisé d'un fluide sous pression délivré par une buse.In the prior art, another type of device is also known which makes it possible to inject and diffuse liquids inside the tissues of an organ of the human body, for example of the heart. This device, described in patent application WO 00/56232 in the name of SAPHIR MEDICAL PRODUCTS GMBH, uses the work of a jet drawn from a pressurized fluid delivered by a nozzle.
Le travail du jet sous pression permet de réaliser un conduit dans le tissu ou l'organe à traiter, dans lequel on injecte ou on introduit un liquide actif, de traitement, de croissance ou autre.The work of the pressurized jet makes it possible to produce a conduit in the tissue or the organ to be treated, into which an active, treatment, growth or other liquid is injected or introduced.
De façon efficace, le liquide de travail est aussi le liquide actif ou un mélange.Effectively, the working liquid is also the active liquid or a mixture.
Le produit actif envoyé à l'intérieur du conduit creusé par le liquide de travail sous pression est ainsi administré au cεur du tissu à traiter. Cependant l'extrémité du conduit étant ouverte, l'agent actif a tendance à ressortir du conduit et à être rapidement évacué hors du site de traitement. On se retrouve alors dans la situation désavantageuse précédemment évoquée.The active product sent inside the conduit dug by the working liquid under pressure is thus administered to the heart of the tissue to be treated. However, the end of the conduit being open, the active agent tends to come out of the conduit and to be quickly evacuated from the treatment site. We then find ourselves in the disadvantageous situation previously mentioned.
Ce phénomène est encore aggravé lorsque l'organe traité est en mouvement, ce qui est par exemple le cas du cεur. L'évacuation du produit actif est accrue par le mouvement métabolique de l'organe.This phenomenon is further aggravated when the organ being treated is in motion, which is for example the case with the heart. The evacuation of the active product is increased by the metabolic movement of the organ.
En outre le jet sous pression travaillant longitudinalement, la concentration du liquide s'effectue à l'extrémité borgne du conduit. La zone de l'extrémité ouverte et les parois du début du conduit ne reçoivent que très peu de liquide actif alors que cette extrémité en a également besoin. La solution inventive décrite ci-après remédie à cet inconvénient. Le dispositif selon l'invention permet de combiner les bénéfices du jet de liquide sous pression avec ceux des cathéters à aiguille.In addition, the pressure jet working longitudinally, the concentration of the liquid takes place at the blind end of the duct. The area of the open end and the walls of the beginning of the conduit receive very little active liquid when this end also needs it. The inventive solution described below overcomes this drawback. The device according to the invention makes it possible to combine the benefits of the jet of liquid under pressure with those of needle catheters.
L'invention permet de réaliser de façon mécanique par un outil perforant ou de piqûre la première partie d'un conduit d'injection, tout en diffusant le produit actif dans une couche située près de la surface.The invention enables the first part of an injection pipe to be produced mechanically by a perforating or puncturing tool, while diffusing the active product in a layer located near the surface.
Le cathéter selon l'invention présente un outil rétractable d'extrémité, préférentiellement une aiguille rétractable, pouvant être utilisé comme buse de sortie d'un liquide sous pression dont le travail consiste à creuser un conduit dans la couche de tissu contre laquelle la paroi frontale du cathéter est apposée. De préférence, le liquide actif ou une partie de celui-ci est utilisé aussi comme liquide travail pour la diffusion du liquide le long du conduit. A la fin de l'injection sous pression ou par une autre quantité envoyée ultérieurement avec une pression plus faible, on arrive à diffuser le liquide actif dans la zone de tissu située au voisinage de l'extrémité de l'aigui le, cette zone n'étant pas ou faiblement atteinte précédemment par le liquide actif.The catheter according to the invention has a retractable end tool, preferably a retractable needle, which can be used as an outlet nozzle for a pressurized liquid, the work of which consists in digging a conduit in the layer of tissue against which the front wall catheter is affixed. Preferably, the active liquid or a part of it is also used as working liquid for the diffusion of the liquid along the conduit. To the end of the injection under pressure or by another quantity sent subsequently with a lower pressure, we manage to diffuse the active liquid in the tissue area located near the end of the needle, this area not being not or only slightly reached previously by the active liquid.
Le cathéter selon 1 ' invention se présente sous la forme d'un conduit souple à extrémité orientable par des moyens connus, comportant un outil d'extrémité rétractable du type perforant ou piquant, mobile entre une position sortie de travail et une position rentrée de sécurité à l'intérieur du cathéter, permettant l'injection d'un liquide sous pression.The catheter according to the invention is in the form of a flexible conduit with a steerable end by known means, comprising a retractable end tool of the puncturing or pricking type, movable between a working out position and a retracted safety position. inside the catheter, allowing the injection of a liquid under pressure.
Selon une caractéristique essentielle du cathéter selon l'invention, la sortie de l'outil d'extrémité est automatique et provoquée par la pression du liquide s 'échappant du cathéter.According to an essential characteristic of the catheter according to the invention, the exit from the end tool is automatic and caused by the pressure of the liquid escaping from the catheter.
Selon une autre caractéristique, l'outil d'extrémité est automatiquement rétracté à l'intérieur du cathéter en l'absence de liquide ou si la pression de celui-ci est inférieure à une valeur de seuil.According to another characteristic, the end tool is automatically retracted inside the catheter in the absence of liquid or if the pressure of the latter is below a threshold value.
On décrira ci-après un mode de réalisation et quelques variantes qui doivent être considérés comme de simples exemples . D'autres caractéristiques et avantages de l'invention apparaîtront à la lecture de la description détaillée qui va suivre, description faite en référence aux dessins annexés, dans lesquels :An embodiment and a few variants which will be considered as simple examples will be described below. Other characteristics and advantages of the invention will appear on reading the detailed description which follows, description made with reference to the appended drawings, in which:
. la figure 1 est une vue en coupe de l'extrémité d'un mode de réalisation du cathéter selon l'invention, l'aiguille-buse étant en position rentrée de repos ; . la figure 2 est une vue en coupe de l'extrémité d'un mode de réalisation du cathéter selon l'invention, l'aiguille-buse étant en position sortie d'injection de liquide ; . la figure 3 est une vue en coupe et en perspective de l'extrémité d'une variante du cathéter selon l'invention comportant un moyen d'aspiration, l'aiguille-buse étant en position rentrée ; . la figure 4 est une vue schématique en coupe de l'extrémité de la variante à aspiration du cathéter selon l'invention, positionnée au contact de la paroi d'un organe, l'aiguille-buse étant en position rentrée ; . la figure 5 est une vue schématique en coupe de l'extrémité de la variante à aspiration du cathéter selon l'invention, positionnée au contact de la paroi d'un organe, l'aiguille-buse étant en position sortie d'injection de liquide ; . la figure 6 est un schéma explicatif simplifié plus global, illustrant une application possible du cathéter selon l'invention à un appareil de dissection à jets puisés de liquide sous pression. Le cathéter selon la présente invention va maintenant être décrit de façon détaillée en référence aux figures 1 à 6. Les éléments équivalents représentés sur les différentes figures porteront les mêmes références numériques .. Figure 1 is a sectional view of the end of an embodiment of the catheter according to the invention, the needle-nozzle being in the retracted position of rest; . Figure 2 is a sectional view of the end of an embodiment of the catheter according to the invention, the needle-nozzle being in the out position for injecting liquid; . Figure 3 is a sectional perspective view of the end of a variant of the catheter according to the invention comprising a suction means, the needle-nozzle being in the retracted position; . Figure 4 is a schematic sectional view of the end of the suction variant of the catheter according to the invention, positioned in contact with the wall of an organ, the needle-nozzle being in the retracted position; . Figure 5 is a schematic sectional view of the end of the suction variant of the catheter according to the invention, positioned in contact with the wall of an organ, the needle-nozzle being in the outgoing injection position for liquid ; . FIG. 6 is a more general simplified explanatory diagram, illustrating a possible application of the catheter according to the invention to a dissection apparatus with jets pulsed with liquid under pressure. The catheter according to the present invention will now be described in detail with reference to Figures 1 to 6. The equivalent elements shown in the different figures will have the same reference numerals.
Le cathéter 1 selon l'invention se présente de façon classique sous la forme d'un conduit souple 2 dans lequel peut s'écouler un liquide actif 3, par exemple un liquide de travail, un produit thérapeutique, chirurgical ou de diagnostic. Il comprend une extrémité proximale 4 manipulée par le chirurgien et une extrémité distale 5 introduite à l'intérieur du corps du patient.The catheter 1 according to the invention is conventionally in the form of a flexible conduit 2 in which an active liquid 3 can flow, for example a working liquid, a therapeutic, surgical or diagnostic product. It comprises a proximal end 4 manipulated by the surgeon and a distal end 5 introduced inside the patient's body.
L'extrémité distale 5 comporte des moyens de navigation et d'orientation connus qui n'ont pas été représentés sur les figures car ils ne font pas partie de l'invention.The distal end 5 includes known navigation and orientation means which have not been shown in the figures because they are not part of the invention.
Le cathéter se termine au niveau de son extrémité distale par une paroi frontale d'extrémité 6 percée d'un orifice 7, de préférence central, par lequel le liquide actif 3 peut s'écouler ou être éjecté.The catheter ends at its distal end with a front end wall 6 pierced with an orifice 7, preferably central, through which the active liquid 3 can flow or be ejected.
Avant l'intervention chirurgicale, cette extrémité 5 du cathéter peut éventuellement être protégée par une pièce d'obturation amovible, par exemple un bouchon vissé. Dans ce cas, elle comporte un filetage extérieur 8.Before the surgical intervention, this end 5 of the catheter can optionally be protected by a removable closure piece, for example a screw cap. In this case, it has an external thread 8.
L'extrémité distale du cathéter selon l'invention renferme un outil d'extrémité 9 rétractable, mobile entre une position rentrée de sécurité à l'intérieur du cathéter, illustrée sur les figures 1, 3, 4 et 6, et une position sortie de travail, illustrée sur les figures 2 et 5.The distal end of the catheter according to the invention contains a retractable end tool 9 movable between a retracted safety position inside the catheter, illustrated in FIGS. 1, 3, 4 and 6, and an extended position. work, illustrated in Figures 2 and 5.
L'outil d'extrémité 9 permet de réaliser un travail perforant ou de piqûre.The end tool 9 makes it possible to carry out perforating or puncturing work.
Selon un mode de réalisation préférentiel, il comprend un coulisseau 10 et une embase 11 portant une aiguille-buse 12.According to a preferred embodiment, it comprises a slide 10 and a base 11 carrying a needle-nozzle 12.
Le coulisseau 10 se présente préférentiellement sous la forme d'une pièce sensiblement cylindrique creuse ou percée d'un canal traversant 13. Son diamètre extérieur est légèrement inférieur au diamètre interne du conduit 2 de manière à pouvoir coulisser à l'intérieur de celui-ci. Cependant, le jeu entre le conduit 2 et le coulisseau 10 reste minime afin d'assurer l'étanchéité malgré cette liberté de coulissement.The slide 10 is preferably in the form of a substantially cylindrical hollow part or pierced with a through channel 13. Its outside diameter is slightly smaller than the inside diameter of the pipe 2 so that it can slide inside the latter. However, the clearance between the duct 2 and the slide 10 remains minimal in order to ensure sealing despite this freedom of sliding.
Préférentiellement, la paroi interne 14 du conduit 2 et les parties du coulisseau en contact avec celle-ci sont garnies d'un revêtement à base de téflon assurant une étanchéité même à haute pression, tout en favorisant le coulissement.Preferably, the internal wall 14 of the conduit 2 and the parts of the slide in contact with the latter are lined with a Teflon-based coating ensuring sealing even at high pressure, while promoting sliding.
De la même façon, toutes les parties coulissantes de l'outil d'extrémité 9 en contact avec la paroi interne 14 du conduit 2 sont de préférence garnies d'un revêtement à base de téflon.In the same way, all the sliding parts of the end tool 9 in contact with the internal wall 14 of the conduit 2 are preferably provided with a coating based on Teflon.
Le coulisseau 10 est solidaire ou susceptible de pousser l'embase porte-aiguille 11 afin de l'entraîner dans son mouvement de coulissement. Selon une variante de réalisation représentée sur les figures 4 et 5, le coulisseau 10 et l'embase 11 peuvent être réalisés d'une seule pièce.The slide 10 is integral or capable of pushing the needle holder base 11 in order to drive it in its sliding movement. According to an alternative embodiment shown in Figures 4 and 5, the slide 10 and the base 11 can be made in one piece.
L'embase porte-aiguille 11 comporte une platine 15 de préférence sensiblement circulaire et de diamètre inférieur au diamètre interne du conduit 2 de manière à pouvoir coulisser à l'intérieur de celui-ci.The needle holder base 11 comprises a plate 15 preferably substantially circular and with a diameter less than the internal diameter of the conduit 2 so as to be able to slide inside the latter.
De cette platine 15 s'élève l'aiguille 12.From this plate 15 rises the needle 12.
De préférence, les parties de l'embase porte- aiguille 11 en contact avec la paroi interne 14 du conduit 2 sont également garnies d'un revêtement à base de téflon.Preferably, the parts of the needle holder base 11 in contact with the internal wall 14 of the conduit 2 are also provided with a coating based on Teflon.
L'aiguille 12 est reliée à la platine 15 par une base 16 et se termine par une pointe 17 susceptible de réaliser un travail de perforation ou de piqûre.The needle 12 is connected to the plate 15 by a base 16 and ends with a tip 17 capable perform perforation or puncture work.
Elle est traversée par un canal interne 18 débouchant à l'extrémité de la pointe 17 par un orifice d'éjectionIt is crossed by an internal channel 18 opening at the end of the tip 17 by an ejection orifice
19. De préférence, le canal interne 18 de l'aiguille présente une forme sensiblement conique se rétrécissant en direction de l'orifice d'éjection 19 de manière à pouvoir jouer un rôle de buse.19. Preferably, the internal channel 18 of the needle has a substantially conical shape narrowing in the direction of the ejection orifice 19 so as to be able to act as a nozzle.
Sur les modes de réalisation représentés, l'aiguille 12 présente également une forme externe sensiblement conique. Cette forme n'est cependant pas limitative. En effet, la longueur et la forme de l'aiguille 12 peuvent être optimisées en fonction de l'application envisagée pour le cathéter selon l'invention. Ainsi, l'aiguille 12 peut par exemple être pointue, arrondie ou biseautée.In the embodiments shown, the needle 12 also has a substantially conical external shape. This form is not, however, limiting. Indeed, the length and the shape of the needle 12 can be optimized according to the application envisaged for the catheter according to the invention. Thus, the needle 12 can for example be pointed, rounded or bevelled.
En outre, la surface externe de l'aiguille n'est pas forcément lisse. Elle peut comporter des reliefs, tels que par exemple une ou plusieurs torsade(s), des crans, des crochets ou des picots de retenue, afin d'améliorer l'ancrage et l'accrochage de l'aiguille dans le tissu.In addition, the outer surface of the needle is not necessarily smooth. It may include reliefs, such as for example one or more twist (s), notches, hooks or retaining pins, in order to improve the anchoring and the attachment of the needle into the fabric.
La platine 15 est également percée d'un canal traversant 20 dont les extrémités sont en communication fluidique pour l'une avec l'extrémité du canal 13 du coulisseau 10 et pour l'autre avec le canal interne 18 de l'aiguille 12.The plate 15 is also pierced with a through channel 20, the ends of which are in fluid communication for one with the end of the channel 13 of the slide 10 and for the other with the internal channel 18 of the needle 12.
La pointe 17 de l'aiguille 12 est située en regard de l'orifice 7 de la paroi frontale 6 d'extrémité du cathéter, de manière à pouvoir faire saillie hors du cathéter par cet orifice lorsque l'aiguille 12 est en position sortie de travail (figures 2 et 5) .The tip 17 of the needle 12 is located opposite the orifice 7 of the front wall 6 of the catheter end, so as to be able to project out of the catheter through this orifice when the needle 12 is in the out position. job (Figures 2 and 5).
Lorsque l'aiguille est en position rétractée de sécurité (figures 1, 3, 4 et 6), un liquide traversant le canal interne 18 de l'aiguille peut également s'écouler hors du cathéter par cet orifice 7.When the needle is in the retracted safety position (Figures 1, 3, 4 and 6), a liquid passing through the internal channel 18 of the needle can also flow out of the catheter through this orifice 7.
Selon une caractéristique essentielle du dispositif selon l'invention, une force de rappel élastique rappelle l'ensemble coulisseau-aiguille en position rétractée de repos, c'est-à-dire en position rentrée de sécurité à l'intérieur du cathéter.According to an essential characteristic of the device according to the invention, an elastic restoring force recalls the slide-needle assembly in the retracted position of rest, that is to say in the retracted safety position inside the catheter.
Cette force de rappel peut être exercée par un ressort 21, de préférence disposé entre la platine 15 de l'embase porte-aiguille 11 et la paroi frontale d'extrémité 6 du cathéter. Le fonctionnement du dispositif selon l'invention découle de manière évidente de la description précédente.This restoring force can be exerted by a spring 21, preferably disposed between the plate 15 of the needle holder base 11 and the end end wall 6 of the catheter. The operation of the device according to the invention follows clearly from the preceding description.
En l'absence de fluide dans le conduit 2In the absence of fluid in line 2
(figures 1, 3 et 4), le ressort 21 exerce une force élastique de rappel sur l'embase porte-aiguille 11, ce qui maintient l'aiguille 12 en position rétractée de repos .(Figures 1, 3 and 4), the spring 21 exerts an elastic return force on the needle holder base 11, which keeps the needle 12 in the retracted position of rest.
Lorsqu'un fluide est envoyé sous pression dans le conduit 2 en direction de l'extrémité distale 5 du cathéter, il pousse sur la face frontale arrière 22 du coulisseau 10. La pression exercée par le fluide a été représentée sur les figures 2 et 5 par des flèches noires 23 en trait épais.When a fluid is sent under pressure in the conduit 2 towards the distal end 5 of the catheter, it pushes on the rear front face 22 of the slide 10. The pressure exerted by the fluid has been shown in FIGS. 2 and 5 by black arrows 23 in thick line.
Si la pression du fluide est suffisante pour compenser la force élastique de rappel du ressort, le coulisseau 10 coulisse à l'intérieur du conduit 2 en direction de l'extrémité distale 5 du cathéter, entraînant avec lui l'embase porte-aiguille 11 et comprimant le ressort de rappel 21.If the fluid pressure is sufficient to compensate for the elastic return force of the spring, the slider 10 slides inside the conduit 2 in the direction of the distal end 5 of the catheter, driving with it the needle holder base 11 and compressing the return spring 21.
Le mouvement de l'embase 11 provoque la sortie de la pointe 17 de l'aiguille 12 hors du cathéter à travers l'orifice 7 de la paroi frontale d'extrémité 6. L'aiguille 12 se trouve alors en position sortie de travail (figures 2 et 5).The movement of the base 11 causes the tip 17 of the needle 12 to exit the catheter through the orifice 7 of the front end wall 6. The needle 12 is then in the working output position ( Figures 2 and 5).
Le fluide est éjecté du cathéter 1 à travers l'orifice 19 de l'aiguille-buse 12 sous la forme d'un jet 24.The fluid is ejected from the catheter 1 through the orifice 19 of the needle-nozzle 12 in the form of a jet 24.
Lorsque la pression du fluide diminue à la fin de l'injection, le ressort de rappel 21 se décomprime et pousse la platine 15 ce qui provoque le coulissement de l'embase porte-aiguille 11 ainsi que celui du coulisseau 10 en direction de l'extrémité proximale 4 du cathéter. L'aiguille 12 reprend alors sa position rétractée de repos.When the fluid pressure decreases at the end of the injection, the return spring 21 decompresses and pushes the plate 15 which causes the sliding of the needle holder base 11 as well as that of the slide 10 in the direction of the proximal end 4 of the catheter. The needle 12 then returns to its retracted rest position.
Il est à souligner que de façon particulièrement avantageuse dans le dispositif selon l'invention, la sortie et la rentrée de l'aiguille se font de manière automatique et sans intervention directe de l'utilisateur, en fonction de la pression du fluide s 'écoulant dans le cathéter.It should be emphasized that, in a particularly advantageous manner in the device according to the invention, the exit and re-entry of the needle take place automatically and without direct intervention by the user, depending on the pressure of the fluid flowing into the catheter.
Le chirurgien commande uniquement le départ et/ou l'arrêt de l'écoulement de liquide, la position de l'aiguille étant automatiquement et quasi- immédiatement adaptée à la situation.The surgeon controls only the start and / or stop of the flow of liquid, the position of the needle being automatically and almost immediately adapted to the situation.
Pour faire sortir l'aiguille 12, le fluide doit avoir une pression suffisante pour réussir à comprimer le ressort 21. Il existe donc pour le fluide une pression limite ou pression de seuil, correspondant à la pression d'équilibre avec la force élastique de rappel, en dessous de laquelle la sortie de l'aiguille n'a pas lieu. Cette pression de seuil est, dans ce mode de réalisation, fixée par construction et dépend de la constante de raideur du ressort de rappel 21. Elle est de préférence voisine de cinq bars.To bring out the needle 12, the fluid must have sufficient pressure to succeed in compressing the spring 21. There therefore exists for the fluid a limit pressure or threshold pressure, corresponding to the equilibrium pressure with the elastic force of reminder, below which the needle exit does not take place. This threshold pressure is, in this embodiment, fixed by construction and depends on the stiffness constant of the return spring 21. It is preferably close to five bars.
De manière avantageuse, il est ainsi possible de délivrer un liquide à basse pression sans que l'aiguille ne sorte. On peut ainsi notamment réaliser une purge du cathéter avec du sérum physiologique à basse pression, par exemple à 3 bars, ou utiliser le cathéter selon l'invention pour une fonction de lavage.Advantageously, it is thus possible to deliver a liquid at low pressure without the needle coming out. It is thus possible in particular to purge the catheter with physiological saline at low pressure, for example at 3 bars, or to use the catheter according to the invention for a washing function.
Selon les interventions envisagées, il est souvent particulièrement avantageux de délivrer un jet puisé de liquide sous pression. Le cathéter selon l'invention permet d'atteindre cet objectif de façon satisfaisante.Depending on the interventions envisaged, it is often particularly advantageous to deliver a jet of liquid under pressure. The catheter according to the invention makes it possible to achieve this objective satisfactorily.
En effet, même si l'aiguille se rétracte automatiquement lorsque la pression du liquide diminue, cela se produit avec un léger retard. De ce fait, si les impulsions du jet puisé sont suffisamment rapprochées, l'aiguille n'a pas le temps de se rétracter entre les différentes impulsions d'un même tir. Ainsi, l'aiguille sort à la première impulsion et ne se rétracte qu'après la dernière impulsion d'un même tir puisé de liquide sous pression.Even if the needle retracts automatically when the liquid pressure decreases, this occurs with a slight delay. Therefore, if the pulses of the pulsed jet are close enough, the needle does not have time to retract between the different pulses of the same shot. Thus, the needle comes out at the first pulse and does not retract until after the last pulse of the same shot drawn from liquid under pressure.
Le cathéter selon la présente invention peut comporter en outre un moyen d'aspiration débouchant à proximité de la zone d'intervention, qui permet d'aspirer le liquide de travail, les liquides corporels et les petits débris, améliorant ainsi l'efficacité de l'intervention et la visibilité de la zone traitée pour le chirurgien. Une variante de ce type a été représentée sur les figures 3 à 6. Le cathéter 1 comporte un conduit d'aspiration 25, par exemple de forme générale cylindrique et entourant le conduit 2 de préférence de manière concentrique.The catheter according to the present invention may further comprise a suction means opening out near the intervention zone, which makes it possible to aspirate the working fluid, body fluids and small debris, thus improving the efficiency of the 'intervention and visibility of the treated area for the surgeon. A variant of this type has been shown in FIGS. 3 to 6. The catheter 1 comprises a suction duct 25, for example of generally cylindrical shape and surrounding the duct 2 preferably concentrically.
Préférentiellement, le conduit d'aspiration 25 s'évase au niveau de l'extrémité distale 5 du cathéter jusqu'à former une jupe 26.Preferably, the suction duct 25 widens at the distal end 5 of the catheter until it forms a skirt 26.
Bien que la pénétration de l'aiguille 12 dans le tissu traité procure une certaine stabilité à l'extrémité distale du cathéter pendant l'injection, le cathéter selon l'invention peut comporter un système d'ancrage supplémentaire afin d'assurer l'immobilisation de son l'extrémité active lors des tirs de liquide sous pression, améliorant ainsi la précision des interventions.Although the penetration of needle 12 into the treated tissue provides a certain stability at the distal end of the catheter during injection, the catheter according to the invention may include an additional anchoring system in order to ensure immobilization of its active end during the firing of liquid under pressure, thus improving the precision of the interventions.
Il peut s'agir d'un quelconque moyen d'ancrage mécanique ou d'un moyen utilisant l'aspiration du cathéter et par exemple la jupe 26. Un exemple d'utilisation du cathéter selon l'invention a été schématisé sur les figures 4 et 5.It may be any mechanical anchoring means or a means using the suction of the catheter and for example the skirt 26. An example of use of the catheter according to the invention has been shown diagrammatically in FIGS. 4 and 5.
Le chirurgien introduit l'extrémité distale du cathéter à l'intérieur du corps du patient et la guide le long d'un vaisseau approprié jusqu'à ce qu'elle arrive à proximité d'un organe ou d'un tissu 27 à traiter.The surgeon introduces the distal end of the catheter into the body of the patient and guides it along an appropriate vessel until it comes close to an organ or tissue 27 to be treated.
Après avoir repéré, à l'aide de moyens de repérage non représentés, une zone de paroi 28 convenant pour le traitement, il positionne la paroi frontale d'extrémité 6 du cathéter le plus près possible de la zone ciblée de la paroi 28 grâce à des moyens d'orientation et d'articulation également non représentés .After having identified, by means of location not shown, a wall area 28 suitable for treatment, it positions the front end wall 6 of the catheter as close as possible to the targeted area of the wall 28 by means of means of orientation and articulation also not represented.
Il déclenche alors l'aspiration dans le conduit d'aspiration 25. La portion de paroi 28 du tissu 27 située en regard de l'intérieur de la jupe 26 est alors aspirée et vient se plaquer contre la paroi frontale d'extrémité 6 du cathéter. L'extrémité distale du cathéter est ainsi immobilisée en position de tir telle qu'illustrée sur la figure 4.It then triggers the suction in the suction duct 25. The wall portion 28 of the tissue 27 located opposite the interior of the skirt 26 is then aspirated and comes to rest against the front end wall 6 of the catheter . The distal end of the catheter is thus immobilized in the firing position as illustrated in FIG. 4.
Le chirurgien déclenche alors le jet de liquide de travail sous pression, qui lorsqu'il arrive au niveau de l'extrémité du cathéter provoque automatiquement la sortie de l'aiguille 12 à travers l'orifice 7 de la paroi frontale 6 du cathéter. La pointe 17 de l'aiguille traverse la paroi 28 et pénètre dans le tissu 27.The surgeon then triggers the jet of pressurized working liquid, which when it arrives at the end of the catheter automatically causes the needle 12 to exit through the orifice 7 of the front wall 6 of the catheter. The point 17 of the needle passes through the wall 28 and penetrates into the tissue 27.
La profondeur maximale de pénétration dans le tissu 27 dépend de la longueur maximale de la course du coulisseau 10 et donc de la possible compression du ressort 21. Elle est préférentiellement d'environ 2 mm. Le liquide sous pression traverse le canal 13 du coulisseau 10, le canal 20 de l'embase 11 et le canal 18 de l'aiguille 12 qui joue le rôle de buse. Il est ensuite éjecté à grande vitesse à travers l'orifice 19 de l'aiguille jusque dans le tissu 27 où il creuse un conduit 29.The maximum depth of penetration into the fabric 27 depends on the maximum length of the stroke of the slide 10 and therefore on the possible compression of the spring 21. It is preferably about 2 mm. The pressurized liquid passes through the channel 13 of the slide 10, the channel 20 of the base 11 and the channel 18 of the needle 12 which acts as a nozzle. It is then ejected at high speed through the orifice 19 of the needle into the tissue 27 where it digs a conduit 29.
Avec le cathéter selon l'invention, c'est l'aiguille 12 qui, par sa pénétration mécanique, amorce le travail de creusement du conduit 29. Cette caractéristique avantageuse permet de réduire la pression du liquide de travail et/ou le nombre de tirs nécessaires pour creuser le conduit 29.With the catheter according to the invention, it is the needle 12 which, by its mechanical penetration, initiates the digging work of the duct 29. This advantageous characteristic makes it possible to reduce the pressure of the working liquid and / or the number of shots necessary to dig the duct 29.
Cette caractéristique est particulièrement intéressante lorsque l'organe visé est entouré d'une membrane ou d'une paroi externe plus résistante que son tissu interne. L'aiguille 12 traverse la paroi externe et le liquide sous pression peut ensuite facilement creuser dans le tissu interne plus tendre.This characteristic is particularly interesting when the target organ is surrounded by a membrane or an external wall more resistant than its internal tissue. The needle 12 passes through the external wall and the pressurized liquid can then easily dig into the softer internal tissue.
Le chirurgien peut alors déclencher l'injection dans le conduit 29 d'un agent actif, de traitement, de croissance, de diagnostic ou autre.The surgeon can then initiate the injection into line 29 of an active, treatment, growth, diagnostic or other agent.
De façon efficace, le liquide de travail est aussi le liquide actif ou un mélange contenant l'agent actif.Effectively, the working liquid is also the active liquid or a mixture containing the active agent.
Le produit actif envoyé à l'intérieur du conduit 29 creusé par le liquide de travail sous pression est ainsi administré au cεur du tissu à traiter.The active product sent inside the conduit 29 hollowed out by the working liquid under pressure is thus administered to the heart of the tissue to be treated.
Il diffuse à travers les parois du conduit 29 et pénètre dans les tissus adjacents à celui-ci qui se comportent comme une éponge. Ces tissus ne subissent pas de dommages car la pression du fluide est très faible perpendiculairement à la direction longitudinale du conduit. Le liquide actif pénètre ainsi dans toutes les veinules et artérioles traversant le conduit. La diffusion du produit actif, représentée par les flèches minces 30 sur la figure 5, se fait à partir des parois du conduit 29 dans toutes les directions.It diffuses through the walls of the duct 29 and enters the tissues adjacent to it which behave like a sponge. These fabrics are not damaged because the fluid pressure is very low perpendicular to the longitudinal direction of the duct. The active liquid thus penetrates into all the venules and arterioles crossing the duct. The diffusion of the active product, represented by the thin arrows 30 in FIG. 5, takes place from the walls of the conduit 29 in all directions.
A la fin de l'injection, la pression du liquide diminue et l'aiguille reprend sa position de repos à l'intérieur du cathéter. Le chirurgien arrête l'aspiration pour décoller l'extrémité du cathéter de la paroi 28 du tissu. Il peut ensuite retirer le cathéter du corps du patient en toute sécurité, l'aiguille étant en position rétractée. Une application possible du cathéter selon l'invention à un appareil 31 de dissection à jets puisés de liquide sous pression a été schématique ent représentée sur la figure 6. L'appareil de dissection 31 permet d'envoyer un ou plusieurs jets 24 de liquide stérile sous pression par exemple contre un tissu à découper ou une matière à désagréger.At the end of the injection, the pressure of the liquid decreases and the needle returns to its rest position inside the catheter. The surgeon stops the suction to detach the end of the catheter from the wall 28 of the tissue. He can then safely withdraw the catheter from the patient's body with the needle in the retracted position. A possible application of the catheter according to the invention to a dissection apparatus 31 with jets drawn from pressurized liquid has been schematically represented in FIG. 6. The dissection apparatus 31 makes it possible to send one or more jets 24 of sterile liquid under pressure for example against a fabric to be cut or a material to be disaggregated.
Cet appareil comporte un générateur de liquide sous pression 32 relié à une réserve 33 de liquide de travail. La pression du jet de liquide généré peut être réglable afin de l'adapter aux besoins.This device comprises a generator of pressurized liquid 32 connected to a reserve 33 of working liquid. The pressure of the jet of liquid generated can be adjustable in order to adapt it to the needs.
Le liquide de travail utilisé est de préférence du sérum physiologique stérile. Mais d'autres liquides stériles peuvent évidemment être utilisés en tant que fluide de travail comme par exemple une solution saline, une solution de glucose, de Ringer-lactate, d'hydroxy-éthyl-amidon ou un mélange de ces solutions.The working liquid used is preferably sterile physiological serum. However, other sterile liquids can obviously be used as working fluid, for example a saline solution, a glucose solution, a Ringer-lactate solution, a hydroxy-ethyl starch solution or a mixture of these solutions.
Le liquide de travail stérile est amené à une pièce à main 34 permettant au chirurgien réalisant l'intervention de commander le déclenchement du jet de liquide de travail et de le diriger. La pièce à main 34 comporte un corps 35 ergonomique, permettant une préhension et un maniement aisés et pouvant présenter des organes de commande tels que par exemple des boutons-poussoirs 36.The sterile working liquid is brought to a handpiece 34 allowing the surgeon performing the intervention to control the triggering of the working liquid jet and to direct it. The handpiece 34 comprises an ergonomic body 35, allowing easy gripping and handling and which may have control members such as, for example, push buttons 36.
La pièce à main 34 est prolongée par le cathéter 1 selon l'invention délivrant le jet de liquide stérile sous pression afin de réaliser un travail chirurgical de découpe, de dissection ou de désagrégation.The handpiece 34 is extended by the catheter 1 according to the invention delivering the jet of sterile liquid under pressure in order to perform surgical work of cutting, dissection or disintegration.
L'appareil chirurgical 31 comporte de préférence un système d'aspiration 37 relié à une source de vide 38, par exemple le circuit général de vide de l'hôpital.The surgical device 31 preferably comprises a suction system 37 connected to a vacuum source 38, for example the general vacuum circuit of the hospital.
Le système d'aspiration se termine par le conduit d'aspiration 25, concentrique au conduit 2 et débouchant au niveau de la jupe 26.The suction system ends with the suction duct 25, concentric with the duct 2 and emerging at the level of the skirt 26.
Pour une meilleure efficacité, l'appareil chirurgical 31 est de préférence un appareil à jet puisé envoyant le liquide sous pression par un tir sous la forme d'un train discontinu d'impulsions constituant des jets élémentaires de liquide sous pression. Pour cela, l'appareil chirurgical 31 comporte un séquenceur 39 permettant la formation du jet puisé et commandant ses paramètres.For better efficiency, the surgical device 31 is preferably a pulsed jet device sending the liquid under pressure by a shot in the form of a discontinuous train of pulses constituting elementary jets of liquid under pressure. For this, the surgical apparatus 31 includes a sequencer 39 allowing the formation of the pulsed jet and controlling its parameters.
Afin de permettre l'application d'un produit de traitement, l'appareil de dissection comporte en outre une réserve 40 de produit de traitement. Le produit de traitement se présente de préférence sous une forme liquide ou suffisamment fluide pour être appliqué au moyen de l'appareil chirurgical 31. Il peut s'agir d'un seul agent actif ou d'un mélange de plusieurs d'entre eux, sous une forme par exemple fluide et de préférence liquide, pur ou en solution ou suspension dans un solvant quelconque ou sous la forme d'une émulsion, d'une mousse ou d'un gel.In order to allow the application of a treatment product, the dissection apparatus further comprises a reserve 40 of treatment product. The treatment product is preferably in a liquid form or sufficiently fluid to be applied by means of the surgical device 31. It may be a single active agent or a mixture of several of them, in a form, for example fluid and preferably liquid, pure or in solution or suspension in any solvent or in the form of an emulsion, a foam or a gel.
Sur la figure 6, le liquide de travail a été symbolisé par un trait épais noir et le fluide de traitement par un trait épais gris.In FIG. 6, the working liquid has been symbolized by a thick black line and the treatment fluid by a thick gray line.
L'appareil de dissection peut comporter par exemple, en amont du cathéter 1, un organe de commutation permettant au chirurgien pratiquant l'intervention de déclencher au choix le tir d'un jet de liquide de travail ou d'un jet de produit de traitement. L'appareil peut également comporter, à la place de l'organe de commutation, un organe de mélange permettant au chirurgien de réaliser au moment approprié un mélange de liquide de travail et de produit de traitement. Lorsque l'appareil chirurgical 31 délivre un jet puisé de liquide sous pression, il peut comporter en outre un multiplexeur 41 permettant de combiner des impulsions de liquide de travail et de produit de traitement au sein du train discontinu d'impulsions constituant le jet puisé. Les paramètres des différentes impulsions, leur nature et leur succession peuvent être modifiés et programmés en fonction des besoins du chirurgien, du patient et du type d'intervention pratiquée, afin d'optimiser le résultat de l'intervention.The dissection apparatus may include, for example, upstream of the catheter 1, a switching allowing the surgeon practicing the intervention to trigger the choice of firing a jet of working liquid or a jet of treatment product. The device may also include, in place of the switching member, a mixing member allowing the surgeon to produce, at the appropriate time, a mixture of working liquid and treatment product. When the surgical device 31 delivers a pulsed jet of pressurized liquid, it may further comprise a multiplexer 41 making it possible to combine pulses of working liquid and treatment product within the discontinuous train of pulses constituting the pulsed jet. The parameters of the different pulses, their nature and their succession can be modified and programmed according to the needs of the surgeon, the patient and the type of intervention performed, in order to optimize the result of the intervention.
Le cathéter selon l'invention ne se limite évidemment pas à une application sur un appareil chirurgical tel que précédemment décrit. Il est possible d'imaginer de nombreux autres appareils chirurgicaux, thérapeutiques ou de diagnostic sur lequel il peut être adapté.The catheter according to the invention is obviously not limited to an application on a surgical device as previously described. It is possible to imagine many other surgical, therapeutic or diagnostic devices to which it can be adapted.
Le cathéter selon l'invention est particulièrement approprié pour réaliser des interventions du type de la revascularisation transmyocardiale ou myocardique, consistant à creuser une pluralité de conduits de revascularisation dans une zone ischémiée de la paroi du myocarde. Cependant, son utilisation n'est pas limitée à une intervention cardiaque. Il est possible d'imaginer de multiples applications du cathéter selon l'invention pour des interventions sur tout type d'organe ou de tissu du corps humain ou animal. The catheter according to the invention is particularly suitable for performing interventions of the type of transmyocardial or myocardial revascularization, consisting in digging a plurality of revascularization conduits in an ischemic zone of the wall of the myocardium. However, its use is not limited to cardiac intervention. It is possible to imagine multiple applications of the catheter according to the invention for procedures on any type of organ or tissue of the human or animal body.

Claims

REVENDICATIONS
1. Cathéter composé d'un conduit (2) souple orientable et comportant un outil d'extrémité rétractable du type perforant ou piquant, mobile entre une position sortie de travail et une position rentrée de sécurité à l'intérieur du cathéter, permettant l'injection d'un liquide sous pression caractérisé en ce qu'il comporte un moyen (10) se déplaçant sous l'effet de la pression du liquide (3) s 'échappant du cathéter ( 1 ) ce qui provoque la sortie automatique de l'outil d'extrémité (9).1. Catheter composed of a flexible swiveling conduit (2) and comprising a retractable end tool of the puncturing or puncturing type, movable between an extended working position and a retracted safety position inside the catheter, allowing the injection of a liquid under pressure characterized in that it comprises a means (10) moving under the effect of the pressure of the liquid (3) escaping from the catheter (1) which causes the automatic exit of the end tool (9).
2. Cathéter selon la revendication 1 caractérisé en ce qu'il comporte un moyen de retrait (21) provoquant le retrait automatique de l'outil d'extrémité (9) à l'intérieur du cathéter en l'absence de liquide (3) ou si la pression de celui-ci est inférieure à une valeur de seuil.2. Catheter according to claim 1 characterized in that it comprises a withdrawal means (21) causing the automatic withdrawal of the end tool (9) inside the catheter in the absence of liquid (3) or if the pressure thereof is below a threshold value.
3. Cathéter selon la revendication précédente caractérisé en ce que la valeur de seuil pour la pression du liquide (3) est voisine de 5 bars.3. Catheter according to the preceding claim, characterized in that the threshold value for the pressure of the liquid (3) is close to 5 bars.
4. Cathéter selon l'une quelconque des revendications précédentes caractérisé en ce que l'outil d'extrémité (9) comprend une aiguille (12) rétractable.4. Catheter according to any one of the preceding claims, characterized in that the end tool (9) comprises a retractable needle (12).
5. Cathéter selon la revendication précédente caractérisé en ce que l'aiguille (12) joue le rôle d'une buse de sortie pour le liquide (3) sous pression. 5. Catheter according to the preceding claim characterized in that the needle (12) acts as an outlet nozzle for the liquid (3) under pressure.
6. Cathéter selon la revendication 4 ou 5 caractérisé en ce que l'aiguille (12) est sensiblement conique, pointue, arrondie ou biseautée. 6. Catheter according to claim 4 or 5 characterized in that the needle (12) is substantially conical, pointed, rounded or bevelled.
7. Cathéter selon l'une quelconque des revendications 4 à 6 caractérisé en ce que la surface externe de l'aiguille (12) présente des reliefs.7. Catheter according to any one of claims 4 to 6 characterized in that the external surface of the needle (12) has reliefs.
8. Cathéter selon l'une quelconque des revendications 4 à 7 caractérisé en ce que l'outil d'extrémité (9) comprend un coulisseau (10) et une embase (11) portant une aiguille (12).8. Catheter according to any one of claims 4 to 7 characterized in that the end tool (9) comprises a slide (10) and a base (11) carrying a needle (12).
9. Cathéter selon la revendication précédente caractérisé en ce que le coulisseau (10) est une pièce sensiblement cylindrique, de diamètre extérieur légèrement inférieur au diamètre interne du conduit (2) et percée d'un canal traversant (13).9. Catheter according to the preceding claim characterized in that the slide (10) is a substantially cylindrical part, with an outside diameter slightly less than the internal diameter of the conduit (2) and pierced with a through channel (13).
10. Cathéter selon la revendication 8 ou 9 caractérisé en ce que le coulisseau (10) peut coulisser dans le conduit (2) du cathéter et est solidaire ou susceptible de pousser l'embase porte-aiguille (11) afin de l'entraîner dans son mouvement de coulissement.10. Catheter according to claim 8 or 9 characterized in that the slide (10) can slide in the conduit (2) of the catheter and is integral or capable of pushing the needle holder base (11) in order to drive it into its sliding movement.
11. Cathéter selon l'une quelconque des revendications 8 à 10 caractérisé en ce que l'embase porte-aiguille (11) comporte une platine (15), sensiblement circulaire et de diamètre inférieur au diamètre interne du conduit (2), d'où s'élève l'aiguille (12).11. Catheter according to any one of claims 8 to 10 characterized in that the needle holder base (11) comprises a plate (15), substantially circular and of diameter less than the internal diameter of the conduit (2), where the needle (12) rises.
12. Cathéter selon la revendication précédente caractérisé en ce que la platine (15) est percée d'un canal traversant (20) dont les extrémités sont en communication fluidique pour l'une avec l'extrémité du canal (13) du coulisseau (10) et pour l'autre avec le canal interne (18) de l'aiguille (12). 12. Catheter according to the preceding claim characterized in that the plate (15) is pierced with a through channel (20) whose ends are in fluid communication for one with the end of the channel (13) of the slide (10 ) and for the other with the internal channel (18) of the needle (12).
13. Cathéter selon l'une quelconque des revendications 8 à 12 caractérisé en ce que le coulisseau (10) et l'embase (11) sont réalisés d'une seule pièce.13. Catheter according to any one of claims 8 to 12 characterized in that the slide (10) and the base (11) are made of single piece.
14. Cathéter selon l'une quelconque des revendications précédentes caractérisé en ce que la paroi interne (14) du conduit (2) du cathéter et les parties coulissantes de l'outil d'extrémité (9) en contact avec celle-ci sont garnies d'un revêtement à base de téflon.14. Catheter according to any one of the preceding claims, characterized in that the internal wall (14) of the conduit (2) of the catheter and the sliding parts of the end tool (9) in contact with the latter are lined. a teflon-based coating.
15. Cathéter selon l'une quelconque des revendications précédentes caractérisé en ce qu'une force de rappel élastique rappelle l'outil d'extrémité (9) en position rétractée.15. Catheter according to any one of the preceding claims, characterized in that an elastic restoring force recalls the end tool (9) in the retracted position.
16. Cathéter selon la revendication précédente caractérisé en ce que la force de rappel est exercée par un ressort (21). 16. Catheter according to the preceding claim characterized in that the restoring force is exerted by a spring (21).
17. Cathéter selon la revendication précédente caractérisé en ce que le ressort (21) est disposé entre la platine (15) de l'embase porte- aiguille (11) et la paroi frontale d'extrémité (6) du cathéter. 17. Catheter according to the preceding claim characterized in that the spring (21) is disposed between the plate (15) of the needle holder base (11) and the end end wall (6) of the catheter.
18. Cathéter selon l'une quelconque des revendications précédentes caractérisé en ce qu'il comporte en outre un moyen d'aspiration débouchant à proximité de la zone d'intervention.18. Catheter according to any one of the preceding claims, characterized in that it also comprises a suction means opening out near the intervention zone.
19. Cathéter selon la revendication précédente caractérisé en ce que le moyen d'aspiration comporte un conduit d'aspiration (25) de forme générale cylindrique, entourant le conduit (2) de manière concentrique et s 'évasant au niveau de l'extrémité distale (5) du cathéter jusqu'à former une jupe (26). 19. Catheter according to the preceding claim characterized in that the suction means comprises a suction duct (25) of generally cylindrical shape, surrounding the duct (2) concentrically and flaring at the distal end (5) from the catheter to form a skirt (26).
20. Cathéter selon l'une quelconque des revendications précédentes caractérisé en ce qu'il comporte en outre un moyen d'ancrage permettant d'assurer l'immobilisation de son extrémité active (5) lors des tirs de liquide sous pression.20. Catheter according to any one of the preceding claims, characterized in that it further comprises an anchoring means allowing ensuring the immobilization of its active end (5) when firing pressurized liquid.
21. Cathéter selon les revendications 18 et 20 caractérisé en ce que le moyen d'ancrage utilise l'aspiration du cathéter.21. Catheter according to claims 18 and 20 characterized in that the anchoring means uses the suction of the catheter.
22. Cathéter selon l'une quelconque des revendications précédentes caractérisé en ce que la profondeur maximale de pénétration de l'outil d'extrémité (12) dans un tissu (27) est d'environ 2 mm. 22. Catheter according to any one of the preceding claims, characterized in that the maximum penetration depth of the end tool (12) in a tissue (27) is approximately 2 mm.
23. Cathéter selon l'une quelconque des revendications précédentes caractérisé en ce que son extrémité distale (5) peut être protégée par une pièce d'obturation amovible. 23. Catheter according to any one of the preceding claims, characterized in that its distal end (5) can be protected by a removable closure piece.
EP02800639A 2001-10-09 2002-10-08 Catheter with retractable perforating or piercing end tool Withdrawn EP1434617A2 (en)

Applications Claiming Priority (3)

Application Number Priority Date Filing Date Title
FR0112992 2001-10-09
FR0112992A FR2830455B1 (en) 2001-10-09 2001-10-09 CATHETER WITH RETRACTABLE PERFORATING OR STITCHING TOOL
PCT/FR2002/003418 WO2003030980A2 (en) 2001-10-09 2002-10-08 Catheter with retractable perforating or piercing end tool

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EP (1) EP1434617A2 (en)
FR (1) FR2830455B1 (en)
WO (1) WO2003030980A2 (en)

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FR2830455A1 (en) 2003-04-11
US20050148952A1 (en) 2005-07-07
US20030069547A1 (en) 2003-04-10
WO2003030980A3 (en) 2003-10-23
FR2830455B1 (en) 2004-06-25
US20050148951A1 (en) 2005-07-07
WO2003030980A2 (en) 2003-04-17

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