JP2005152145A - Catheter for angiography - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide a catheter for angiography for moving the catheter by preventing the precedence of a guide wire by reinserting the guide wire when right and left common iliac arteries are photographed. <P>SOLUTION: The catheter 1 for angiography includes: a J shape curve part 22 arranged at the distal end; an angle 24 arranged at the proximal end-side than the J shape curve part 22; and a linear part 23 arranged between the J shape curve part 22 and the angle 24. The linear part 23 includes a flexibility-changing point 26. A distal end-side than the flexibility-changing point 26 including the J shape curve part 22 is more flexible than a proximal end-side. <P>COPYRIGHT: (C)2005,JPO&NCIPI

Description

  The present invention relates to a catheter that is inserted from an artery of an arm and introduced into a section to the left and right common iliac arteries.

  Before endovascular treatment, a blood vessel is diagnosed using a catheter. Diagnosis using a catheter is performed by introducing a catheter through a puncture hole formed in a patient's blood vessel. Recently, in order to reduce the burden on the patient, catheters are often introduced from the arm.

  In particular, when the site to be diagnosed is the left and right common iliac arteries, in order to inject an X-ray contrast medium into the site, when a catheter is introduced from the arm through the sheath, conventionally, the vessel wall is not damaged. The guide wire was inserted into the catheter, and the guide wire was taken out from the distal end of the catheter to advance the blood vessel. For example, in order to image the right common iliac artery first, the catheter is introduced to the relevant site, the guide wire is pulled out, a stopcock or device is connected to inject the contrast agent into the hub, and the contrast agent is injected.

  Next, when imaging the left common iliac artery, remove the stopcock and device for injecting the contrast medium from the hub, insert the guide wire from the hub again, pull the catheter back, and then remove the left total iliac artery. It was introduced into the iliac artery, the guide wire was removed, the device and stopcock were connected again, and a contrast medium was injected.

  In contrast, when contrasting thick blood vessels, a large amount of contrast medium is injected in consideration of visibility. Therefore, when an angle is provided in a catheter of the type in which the contrast medium is ejected from the tip of the catheter, it is ejected at a high pressure. Since the contrast agent directly hits the blood vessel wall, there is a possibility of adversely affecting the site.

  In the conventional catheter described above, the guide wire is preceded, but it is necessary to remove the guide wire when imaging. For this reason, when the catheter is moved and another region is imaged, the imaging instrument is temporarily removed and the guide wire is inserted again.

  This operation includes not only the insertion / removal of the guide wire but also the removal operation of a device or a stopcock connected to the hub, so that it takes a long operation time and may be stressful for the operator.

  Furthermore, it is necessary to inject a large amount of contrast agent in order to ensure sufficient visibility in contrast with a thick blood vessel.

  The present invention changes the position of the distal end portion in a short time without inserting a guide wire when the contrast and the movement of the catheter are alternately performed in order to image a plurality of blood vessels such as left and right common iliac arteriography. To provide an angiographic catheter that can safely contrast without influencing the blood vessel wall and using an excessive amount of contrast agent when injecting a contrast agent into a portion to be diagnosed. With the goal.

  Such an object of the present invention is achieved by the following (1) to (5).

  (1) A catheter that is introduced from the artery of the arm and inserted into the common iliac artery via the aortic arch and abdominal aorta, and the catheter includes a distal end portion and a proximal end portion, and the distal end portion and the proximal end portion. A catheter body having a lumen in between and a hub provided at the proximal end of the catheter body, the catheter having a J-shaped curve provided at the distal end of the body, and the J-shaped curve A curved portion provided on the proximal side with respect to the portion, and a straight portion provided between the J-shaped curved portion and the curved portion, and a guide wire is inserted into the lumen of the catheter body portion The J-shaped curve portion and the bending portion have flexibility to open substantially linearly, and further, the flexibility change point is provided in the linear portion, and the flexibility change including the J-shaped curve portion. The vascular structure is characterized in that the distal end side is more flexible than the proximal end side. Use catheter.

  (2) The angiography according to (1), wherein the radius of curvature of the J-shaped curve is at least smaller than the radius of the common iliac artery, and has a dimension that allows the J-shape to be maintained inside the common iliac artery. Catheter.

  (3) The angiographic catheter according to (1) or (2) above, wherein at least one or more side holes are provided on the distal end side with respect to the curved portion.

  (4) The angiographic catheter according to (3) above, wherein the side hole is on a radially outer curved surface on the J-shaped curved portion.

  (5) The angiographic catheter according to (3), wherein the side hole is in the vicinity of the flexibility change point.

  According to the present invention, since the J-shaped curve portion is provided in the vicinity of the distal end of the angiographic catheter, the distal end can be moved without contacting the blood vessel wall without inserting a guide wire inside the catheter. Can do. Further, since the portion is made of a flexible resin, it is difficult to damage the blood vessel wall.

  Further, by providing an angle to the base side of the J-shaped curve, it is possible to select a blood vessel by applying torque to the catheter without leading a guide wire inside the catheter.

  In addition, since a side hole is provided between the tip and the angle, the contrast medium can be concentrated and injected at the target site, and sufficient X-ray contrast can be performed with a small amount of contrast medium.

  Hereinafter, embodiments of the present invention will be described with reference to the drawings.

  FIG. 1 is an external view of an angiographic catheter (hereinafter simply referred to as a catheter) of the present invention, and FIG. 2 is a cross-sectional view showing the internal structure of the catheter of FIG. In FIG. 2, in order to facilitate understanding of the internal structure, the curve of the catheter is omitted and shown in a straight line, and the ratio of dimensions is different from the actual one.

  A catheter 1 shown in FIG. 1 includes a resin main body 2 formed into a tubular shape having an outer diameter of 1.0 to 2.0 mm, an inner diameter of 0.7 to 1.7 mm, and an effective length of 1000 to 1500 mm, and a main body 2 and a hub 3 for connecting a contrast medium injector and the like, and a J-shaped curved portion 22 is provided at the distal end of the main body 2, followed by a straight portion 23 and a curved portion. An angle 24 is formed. A main body linear portion 25 is formed on the base end side from the angle 24.

  The catheter 1 has a flexibility change point 26 at an intermediate portion of the straight portion 23. As shown in FIG. 2, the proximal-side main body 10 on the proximal side from the flexibility change point 26 has a three-layer structure including an inner layer 11, an intermediate layer 12, and an outer layer 13. The distal end side main body portion 14 on the distal end side from the change point 26 is made of a single material that is more flexible than the proximal end side main body portion 10, and this portion constitutes the J-shaped curve portion 22. A tip flexible tip 15 that is more flexible than the tip side main body 14 is provided at the tip of the tip side main body 14. In addition, a lumen 16 that communicates from the distal end 21 to the proximal hub 3 is provided inside the catheter 1.

  Specifically, it is desirable that the inner layer 11 of the base-end-side main body 10 is made of a material having relatively high rigidity and high slidability, such as nylon 12 or PTFE. The intermediate layer 12 is formed by embedding a braided body in which about 10 to 40 metal wires are knitted into a cylindrical shape in the same resin as the inner layer 11. The metal wire is preferably a stainless alloy wire. The outer layer 13 is made of the same resin as the inner layer 11 or a resin that is compatible with the inner layer 11 and relatively soft. Specifically, it is desirable that the resin used for the inner layer 11 and the intermediate layer 12 is nylon 12, and the outer layer 13 is a polyamide elastomer alone or a blend of nylon 12 and polyamide elastomer.

  As the distal end side main body portion 14, a polyamide elastomer is desirable as a resin having higher flexibility than the proximal end side main body portion 10. As the tip flexible tip, a polyurethane elastomer or the like that is more flexible than the tip side main body portion 14 is preferably used.

  It is desirable that about 30 to 60% by mass of X-ray opaque particles are mixed with each of the above-described resin materials. Specific examples of the radiopaque particles include barium sulfate, tungsten, and bismuth oxide. By including such X-ray opaque particles, the state of the catheter 1 in the blood vessel can be confirmed in the X-ray transmission image.

  FIG. 3 is a diagram for explaining in detail the shape of the distal end portion of the catheter 1. As shown in FIG. 3, the radius of curvature of the J-shaped curve portion 22 is 1.5 to 3 mm, which is smaller than the inner radius of the right common iliac artery, with reference to the largest position outside the catheter. It has a 200 ° arc portion. Further, the straight portion 23 is provided 50 to 100 mm on the base side from the J-shaped curved portion 22, and an angle 24 bent at 10 to 30 ° is formed at the base end of the straight portion 23.

  Further, a single side hole 27 is provided at the apex portion of the J-shaped curve portion 22, and a side hole group 28 is provided near the flexibility changing point 26 on the straight portion 23. The size of the side holes is about 0.4 to 0.8 mm in diameter. Four side hole groups 28 are provided at intervals of about 1.5 mm in a section of about 25 mm to 35 mm from the tip 21, and the arrangement thereof is arranged in a spiral shape.

  Next, the manner in which the catheter 1 of the present invention is inserted from the radial artery of the wrist into the common iliac artery located in the lumbar region will be described with reference to FIGS. FIG. 4 is a diagram for explaining the arrangement of main arteries in the human body. In FIG. 4, 40 indicates the heart, 41 indicates the radial artery, 42 indicates the aortic arch, 43 indicates the abdominal aorta, 44 indicates the right common iliac artery, and 45 indicates the left common iliac artery.

  First, as shown in FIG. 5, an access port to a blood vessel is established in the radial artery 41. Specifically, after inserting an injection needle (not shown) into the radial artery 41 and replacing the injection needle with a dedicated guide wire (not shown), an introducer sheath 51 having a relatively short length along the guide wire is provided. Introduce. The introducer sheath 51 is provided with a valve (not shown) in the lumen passage and allows passage of the guide wire and the catheter 1, but prevents blood from leaking out of the body. Since the guide wire (not shown) is a short one for introducing the introducer 51, it is removed, and then a guide wire 50 for angiographic catheter, which is separately prepared, is introduced into the lumen of the catheter 1 is prepared. Then, it is inserted into the introducer sheath 51 and introduced into the blood vessel deeper than the radial artery 41 as it is.

  When the guide wire 50 is inserted, the J-shaped curve portion 22 has flexibility such that the J-shape is stretched and becomes a straight line. You can proceed.

  FIG. 6 shows a state where the catheter 1 and the guide wire 50 inserted from the radial artery 41 enter the aortic arch 42 via the brachiocephalic artery and further toward the abdominal aorta. In this description, since the example introduced from the radial artery 41 of the right arm is described, the catheter 1 extends from the brachiocephalic artery to the abdominal aorta. However, when introduced from the left arm, the catheter 1 extends from the left subclavian artery. The catheter 1 extends over the abdominal aorta.

  When the distal end portion of the catheter 1 passes through the abdominal aorta 43 and reaches the right common iliac artery 44 shown in FIG. 7, the guide wire 50 is pulled out. Since the outer diameter of the J-shaped curve portion 22 is set to be smaller than the inner diameter of the common iliac artery, the distal end of the catheter 1 becomes J-shaped as shown in FIG. Return. The internal diameter of the common iliac artery is generally about 8 mm to 12 mm.

  If it can arrange | position in the position of FIG. 7, in order to inject | emit X-ray contrast agent to the hub 3, the port of the syringe which is not illustrated is connected and X-ray contrast agent is inject | poured. A plurality of arrows shown in FIG. 7 indicate the directions of the injected X-ray contrast medium.

  Since the common iliac artery is thick, the contrast agent is ejected at a relatively high pressure in consideration of the visibility under the X-ray image. In the present catheter 1, the distal end 21 faces the proximal end in the axial direction of the catheter 1. Therefore, it does not face the direction of the blood vessel wall, and care is taken not to damage the blood vessel wall when the contrast medium is ejected. Further, since the contrast agent is ejected from the side holes 27 and 28, the contrast agent is dispersed and ejected throughout the vicinity.

  After making a diagnosis for confirming the blood vessel running in this way, the catheter 1 is then moved to the left common iliac artery 45. At this time, even if the guide wire 50 is not inserted into the catheter 1 again, the radius of curvature of the J-shaped curve portion 22 is smaller than the radius of the common iliac artery, so that a circular arc hits the blood vessel wall and the guide wire is inserted. As is done, the distal end 21 is prevented from contacting the vessel wall directly.

  Further, when the catheter 1 once pulled back into the abdominal aorta 43 is advanced to the left common iliac artery 45, it is necessary to select the branch of the blood vessel. However, since the angle 24 is provided, as shown in FIG. When the catheter 1 is rotated by applying torque, the traveling direction of the catheter 1 can be selected by the same operation as selecting a blood vessel with a guide wire. Here, since the angle 24 is configured by the base end side main body portion 10 having high rigidity, the torque can be transmitted firmly.

  In this way, the catheter 1 can be moved to the left common iliac artery 45 without re-inserting the guide wire, so that it is possible to omit the attachment and detachment of the contrast agent port to the hub 3. Shortening and reducing stress on the surgeon can be achieved.

  The present invention is not limited to the above embodiment. For example, the side hole for ejecting the contrast agent may not be provided in the J-shaped curve portion 22 (side hole 27), and may be provided only in the section on the straight portion 23 (only the side hole 28 may be provided). Further, the number of the side holes 28 is not limited to four, but can be increased to several tens, and the arrangement can be changed as appropriate.

  In addition, various values such as the radius of curvature, inner and outer diameters, and effective length of the J-shaped curve portion in the catheter 1 are preferably the values given in the embodiment, but are not limited thereto, and the patient's physique and target It can be set as appropriate according to the branched blood vessel.

  The structure and material of the catheter 1 main body are not limited to the combination of the resin and the metal blade described above, and can be selected such that the catheter 1 is made of only resin.

  An angiographic catheter (shown in FIGS. 1 to 3) under the following conditions was prepared.

Total length: 1200mm
Outer diameter: 1.4mm
Inner diameter: 1.1mm
Wall thickness: 0.15mm
Curvature radius of J-shaped curve portion 22: 2 mm
Arc angle of J-shaped curve portion 22: 180 °
Length of straight part 23: 80 mm
Length of distal end side main body part 14: 25 mm
Length of base end side main body 10: 1175 mm
Angle of angle 24: 20 °
Diameter of side holes 27 and 28: 0.65 mm
Material of tip flexible tip 15: polyurethane elastomer blended with barium sulfate Material of tip body 14: polyamide elastomer blended with bismuth oxide Outer layer 13: polyamide elastomer blended with bismuth oxide Intermediate layer 12 material: nylon 12 blended with bismuth oxide Embedded with stainless wire braided body Material of inner layer 11: nylon 12 containing bismuth oxide

1 is an overall view of an angiographic catheter 1 of the present invention. 1 is a cross-sectional view of a catheter 1. FIG. 1 is an enlarged view of a distal end portion of a catheter 1. FIG. It is a figure explaining arrangement | positioning of the main artery in a human body. It is a figure explaining a mode that 1 introduced to the radial artery of an arm is introduced. It is a figure explaining a mode that catheter 1 passes through an aortic arch. It is a figure explaining the state which has arrange | positioned the catheter 1 in the right common iliac artery and inject | poured the X-ray contrast agent. It is a figure explaining a mode that catheter 1 is rotated in order to insert in a left common iliac artery.

Explanation of symbols

1 ・ ・ Catheter 21 ・ ・ Terminal 22 ・ ・ J shape curve part 23 ・ ・ Linear part 24 ・ ・ Angle 25 ・ ・ Linear part 26 ・ ・ Flexibility change point 27, 28 ・ ・ Side hole 3 ・ ・ Hub

Claims (5)

A catheter introduced from the artery of the arm and inserted into the common iliac artery via the aortic arch and abdominal aorta, and the catheter is located between the distal end and the proximal end and between the distal end and the proximal end. A catheter body having a lumen; and a hub provided at a proximal end portion of the catheter body portion. The catheter includes a J-shaped curve portion provided at a distal end of the body portion, and a base formed from the J-shaped curve portion. A curved portion provided on the end side, and a straight portion provided between the J-shaped curved portion and the curved portion, and when a guide wire is inserted into the lumen of the catheter body, The J-shaped curve portion and the curved portion have flexibility to open substantially linearly, and further, a flexibility change point is provided in the straight portion, and the tip of the flexibility change point including the J-shape curve portion is provided. The angiography card is characterized in that the side is more flexible than the proximal side. Ether. The angiographic catheter according to claim 1, wherein the radius of curvature of the J-shaped curve is at least smaller than the radius of the common iliac artery, and has a dimension capable of maintaining the J shape inside the common iliac artery. The angiographic catheter according to claim 1, wherein the angiographic catheter has at least one or more side holes on a distal end side with respect to the curved portion. The angiographic catheter according to claim 3, wherein the side hole is in a radially outer curved surface on the J-shaped curve portion. The angiographic catheter according to claim 3, wherein the side hole is in the vicinity of the flexibility change point.

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