JP2016150222A - Blood vessel protection device - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a blood vessel protection device capable of exerting excellent workability of blood vessel sampling by protecting a blood vessel.SOLUTION: A blood vessel protection device 100 includes a guide device 200 which is inserted into an organism along a large saphenous vein 1000, and a protection device 300 which is configured by spirally winding a filament 301 and which moves by being guided by the guide device 200, while positioning the large saphenous vein 1000 therein by rotating. Additionally, the guide device 200 has a guide hole 234 for inserting the protection device 300.SELECTED DRAWING: Figure 1

Description

  The present invention relates to a vascular protection device.

  Arterial grafts typified by the internal thoracic artery, gastroepiploic artery, radial artery, and venous grafts typified by the great saphenous vein are used as bypass blood vessels when performing vascular bypass surgery (coronary artery bypass surgery: CABG) in the heart. It is widely known to use. At present, it has been reported that arterial grafts (particularly internal thoracic arteries) have a higher long-term patency rate than venous grafts. Thus, although it is a vein graft that is said to be inferior in the long-term patency rate, in recent years the vein graft has been replaced with surrounding tissues (for example, fat, connective tissue, tissue between the skin layer and muscle layer, skin If it is collected in a state covered with tissue, bifurcated blood vessels, etc. between the layer and the periosteum, and used as a bypass blood vessel in a state covered with the tissue, the long-term patency rate is improved. Has also been reported. And as a device which can extract | collect a vein graft in the state covered with the surrounding tissue, there exists a device described in patent document 1, for example.

  In the device described in Patent Document 1, a guide wire (support member 50) is inserted into a blood vessel to be collected as a bypass blood vessel, and the tubular member (portion 40) is pushed forward while being guided by the guide wire. It can be collected while covered with tissue. However, the device described in Patent Document 1 has a problem that the inner wall of the blood vessel may be damaged by the guide wire, and the workability of blood vessel collection is poor.

US2006 / 0276815

  An object of the present invention is to provide a blood vessel protection device capable of protecting blood vessels and exhibiting excellent workability in collecting blood vessels.

Such an object is achieved by the present inventions (1) to (9) below.
(1) a protection device formed by spirally winding a linear body;
A guidance device for guiding the protection device,
A blood vessel protection device comprising: arranging the guide device in a living body along a blood vessel, and surrounding the blood vessel with the protection device by arranging the protection device in the living body while guiding the protection device with the guide device.

  (2) The blood vessel protection device according to (1), wherein the guide device has a guide hole through which the protection device is inserted.

(3) The guide device has a main body portion and a lid portion detachably provided from the main body portion,
The blood vessel protection device according to (2), wherein the protection device can be detached from the guide device by detaching the lid from the main body.

(4) The main body has a groove that opens in a surface facing the lid,
The blood vessel protection device according to (3), wherein the guide hole is formed by the lid portion closing an opening of the groove.

(5) The guide device has a flat cross section,
The blood vessel protection device according to (3) or (4), wherein the main body portion and the lid portion are provided along a major axis direction of the transverse section.

(6) The protection device has a tip provided at a tip of the linear body,
The tip has a spindle-shaped portion, and can advance in a tissue around the blood vessel without cutting a branch blood vessel branched from the blood vessel. The vascular protection device described.

  (7) The blood vessel protection device according to any one of (1) to (6), wherein the protection device has a gap between the linear bodies.

  (8) The blood vessel protection device according to any one of (1) to (7), wherein the gap is 1 mm to 10 mm.

  (9) The blood vessel protection device according to any one of (1) to (8), wherein the guide device is disposed apart from the blood vessel.

  According to the present invention, a blood vessel can be protected by the protective device by arranging the protective device around the blood vessel. For this reason, for example, when collecting blood vessels, contact between various devices used for hemostasis and cutting of branched blood vessels and excision of surrounding tissues is suppressed, and excellent workability of blood vessel collection is exhibited. It is possible to collect blood vessels with little damage. Moreover, since it has the guide guide which guides a protection device, a protection device can be easily arrange | positioned around the blood vessel and it is excellent in the workability | operativity.

1 is a perspective view showing a blood vessel protection device according to a first embodiment of the present invention. It is a section perspective view of a guidance device. It is a top view of a guidance device. It is a top view which shows the state which guided the protection device with the guidance device. It is a top view which shows the state which has arrange | positioned the protection device so that the blood vessel may be covered. It is a top view which shows a peeling device. It is a top view which shows a cutting device. It is a figure explaining the method to extract | collect a blood vessel. It is a figure explaining the method to extract | collect a blood vessel. It is a figure explaining the method to extract | collect a blood vessel. It is a figure explaining the method to extract | collect a blood vessel. It is a figure explaining the method to extract | collect a blood vessel. It is a figure explaining the method to extract | collect a blood vessel. It is a figure explaining the method to extract | collect a blood vessel. It is a figure explaining the method to extract | collect a blood vessel. It is a perspective view of the blood vessel protection device concerning a 2nd embodiment of the present invention.

  Hereinafter, the blood vessel protection device of the present invention will be described in detail based on preferred embodiments shown in the accompanying drawings.

<First Embodiment>
FIG. 1 is a perspective view showing a blood vessel protection device according to a first embodiment of the present invention. FIG. 2 is a cross-sectional perspective view of the guide device. FIG. 3 is a plan view of the guidance device. FIG. 4 is a plan view showing a state in which the protection device is guided by the guidance device. FIG. 5 is a plan view showing a state in which the protection device is arranged so as to cover the blood vessel. FIG. 6 is a plan view showing the peeling device. FIG. 7 is a plan view showing the cutting device. 8 to 15 are diagrams for explaining a method of collecting blood vessels. In the following, for convenience of explanation, the left side in FIG. 1 is also referred to as “tip”, and the right side is also referred to as “base end”.

≪vascular protection device≫
A blood vessel protection device 100 shown in FIG. 1 is a device used to protect a blood vessel when collecting a blood vessel used as a bypass blood vessel when performing a blood vessel bypass operation (coronary artery bypass operation: CABG). By using such a blood vessel protection device 100, contact between the device used during the procedure and the blood vessel can be reduced, and damage to the blood vessel can be reduced. In addition, blood vessels can be collected more easily while being covered with surrounding tissues (fat, connective tissue, etc.). The blood vessel collected using the blood vessel protection device 100 is not particularly limited as long as it is a blood vessel that can be used as a bypass blood vessel. For example, the internal thoracic artery, gastric omental artery, radial artery, great saphenous vein, etc. Is mentioned.

  However, among these blood vessels, the greater saphenous vein is preferable. By using the blood vessel protection device 100, as described above, it becomes easy to collect a blood vessel in a state covered with surrounding tissues. Therefore, the great saphenous vein is collected using the blood vessel protection device 100, It is considered that the long-term patency after surgery is increased by using as a bypass blood vessel. Therefore, in the following, an example in which the large saphenous vein is collected using the blood vessel protection device 100 will be described as a representative.

  A blood vessel protection device 100 illustrated in FIG. 1 includes a long guide device 200 and a protection device 300 that is guided by the guide device 200 and is formed by winding a linear body 301 in a spiral shape. According to such a blood vessel protection device 100, first, the guide device 200 is inserted into the living body along the great saphenous vein 1000, and then the protection device 300 is inserted while being guided by the guide device 200. The protective device 300 can surround the large saphenous vein 1000. Therefore, a device for detaching the great saphenous vein 1000 from the surrounding tissue, a branch blood vessel (branch blood vessel) 1100 branching from the large saphenous vein 1000, and a device for performing hemostasis to the great saphenous vein 1000 are provided. Contact is prevented and damage to the great saphenous vein 1000 can be prevented.

Hereinafter, the guidance device 200 and the protection device 300 will be sequentially described in detail.
[Guidance device]
The guidance device 200 is a flexible long body. As shown in FIG. 2, the guide device 200 has a flat cross-sectional shape having a major axis L and a minor axis W. The guide device 200 of the present embodiment has a substantially elliptical cross-sectional shape. In addition, the length of the long axis L is not specifically limited, For example, it can be set as about 2 mm-10 mm. The cross-sectional shape of the guide device 200 is not limited to an ellipse, and may be an ellipse, an oval, a rectangle (particularly, a rectangle with rounded corners), or the like.

  The guide device 200 is composed of two members divided in the direction of the long axis L. That is, the guide device 200 includes a main body part 230 and a lid part 240 that is detachable from the main body part 230, and the main body part 230 and the lid part 240 are arranged along the direction of the long axis L. Is provided. The thickness T1 of the main body portion 230 is thicker than the thickness T2 of the lid portion 240, and the short axis W is located on the main body portion 230. Further, the thickness T of the main body 230 is longer than the short axis W. Thereby, as will be described in the blood vessel collection method described later, the main body 230 can be easily detached from the protection device 300 by rotating the main body 230 with respect to the protection device 300.

  In addition, the surface 231 of the main body 230 facing the lid 240 and the surface 241 of the lid 240 facing the main body 230 are each formed of a flat surface. Further, a convex rail 232 extending in the axial direction is provided on the surface 231 of the main body 230, and a groove 242 extending in the axial direction and engageable with the rail 232 is formed on the surface 241 of the lid 240. Is provided. Therefore, the lid 240 can be attached to and detached from the main body 230 by sliding the lid 240 with respect to the main body 230. Thus, by adopting a slide-type attachment / detachment, the lid 240 can be easily detached from the main body 230 even when the guide device 200 is inserted into the living body (removing the lid 240 from the living body). Can do). The rail 232 is disposed so as not to overlap an opening 233a of a groove 233 described later (so as not to cross the opening 233a).

  Further, as shown in FIG. 3, the main body 230 has a plurality of grooves 233 that open to the surface 231. Each groove 233 extends in a direction inclined with respect to the axial direction of the main body 230 in accordance with the spiral shape of the protection device 300 and is provided side by side in the axial direction. In a state where the lid portion 240 is attached to the main body portion 230, the opening 233 a of the groove 233 is closed by the lid portion 240, and becomes a guide hole 234 for guiding the protection device 300. Such a guide hole 234 can guide the protection device 300 smoothly.

  Then, when the protection device 300 is rotated in a state where the distal end portion 310 of the protection device 300 is inserted into the guide hole 234, the protection device 300 is gradually moved toward the distal end side of the guide device 200 while being guided by the guide hole 234. Although not shown, the opening portion of the guide hole 234 on the side where the protection device 300 is inserted is tapered, so that the tip 310 of the protection device 300 can be easily guided to the guide hole 234. On the other hand, when the cover 240 is removed from the main body 230 from the state in which the protection device 300 is guided by the guide device 200, an opening 233a of the groove 233 appears as shown in FIG. 4, and the main body is formed through the opening 233a. 230 can be removed from the protection device 300.

[Protective device]
As shown in FIG. 1, the protection device 300 is a coil-like device formed by winding a linear body 301 in a spiral shape. The linear body 301 has such a rigidity that it can move smoothly in the living body without excessive deformation, and, for example, a degree that can prevent damage to the branch blood vessel 1100 by deforming itself when it contacts the branch blood vessel 1100. It has a good balance of elasticity. Such a linear body 301 is not particularly limited, and for example, various kinds of metals such as stainless steel and titanium, and various kinds of plastics can be used. In addition, the surface of the linear body 301 may be provided with a hydrophilic coat or a water-repellent coat for the purpose of improving the slidability in the living body, or the linear body 301 itself has a hydrophilic material. Or a material having water repellency (for example, Teflon (registered trademark)).

  A tip portion 310 for facilitating insertion of the protection device 300 into the living body is provided at the tip portion of such a linear body 301. The tip portion 310 is located on the tip side of the spindle portion 311 having a substantially conical tapered portion whose cross-sectional area gradually decreases toward the tip side, and the protruding portion 312 having a round tip. And have. By providing such a tip portion 310, resistance when the protection device 300 is inserted into the living body can be reduced, and the protection device 300 can be inserted into the living body more smoothly. Such a distal end 310 can penetrate the fat 1200 around the saphenous vein 1000 (advance it through), but has such a sharpness that the branch blood vessel 1100 cannot be cut. Therefore, cutting of the branch blood vessel 1100 when the protective device 300 is inserted into the living body can be suppressed, and the procedure can be performed more safely.

  Further, the outer diameter of the base end portion 311 a of the spindle-shaped portion 311 is larger than the outer diameter of the linear body 301. By making the base end portion 311a thicker than the linear body 301 in this way, it is possible to form an insertion hole having a sufficient width for inserting the linear body 301 into the living body by the distal end portion 310. Therefore, the linear body 301 can be inserted into the living body more smoothly. Note that the outer diameter of the base end portion 311 a is not limited to the case where it is larger than the outer diameter of the linear body 301, and may be substantially equal to the linear body 301.

  Although it does not specifically limit as length of such a front-end | tip part 310, For example, it is preferable that it is about 5 mm-10 mm. By setting it as such length, the front-end | tip part 310 can be made small enough and the front-end | tip part 310 can be moved smoothly in the living body. Further, the maximum diameter of the tip portion 310 (the maximum diameter of the spindle-shaped portion 311) is not particularly limited, but is preferably larger by about 1 mm to 2 mm than the diameter of the linear body 301, for example. As a result, the insertion hole that is sufficiently wide to allow the linear body 301 to pass through can be formed in the living body while reducing the size of the distal end portion 310.

  Moreover, the protection device 300 has a gap between lines (a gap between the linear bodies 301) D as shown in FIG. That is, adjacent portions of the linear body 301 are separated from each other. Therefore, when the protection device 300 is inserted into the living body, the branch blood vessel 1100 passes through the inter-line gap D, and cutting and damage of the branch blood vessel 1100 by the protection device 300 can be suppressed. Therefore, the procedure can be performed more safely. The inter-line gap D is not particularly limited, but is preferably about 1 mm to 10 mm. By setting the line gap D to such a size, the line gap D can be made large enough for the branch blood vessel 1100 to pass through, and the line gap D between the peeling device 400 and the cutting device 500 described later. Can be suppressed, and thus damage to the saphenous vein 1000 can be more effectively prevented.

  Further, the inclination angle θ of the linear body 301 with respect to the plane f orthogonal to the axial direction of the protective device 300 is not particularly limited, but is preferably about 10 ° to 30 °, for example. By setting it as such a range, inclination | tilt angle (theta) is fully suppressed and the unintended deformation | transformation of the protection device 300 by the resistance received from a structure | tissue when inserting in a biological body can be suppressed. Therefore, the protection device 300 can be inserted into the living body more smoothly.

In addition, the outer diameter R of the protection device 300 is not particularly limited, but is preferably about 5 mm to 12 mm larger than the outer diameter of the blood vessel (in this embodiment, the large saphenous vein 1000) disposed inside. In the case of this embodiment, since the outer diameter of the large saphenous vein 1000 is generally about 2 to 3 mm, the outer diameter R of the protection device 300 is preferably about 7 mm to 15 mm. By setting it as such a range, contact with the protection device 300 and the great saphenous vein 1000 can be suppressed, and damage to the great saphenous vein 1000 can be effectively prevented. In addition, it becomes easier to peel off the large saphenous vein 1000 while it is covered with the fat 1200.
Heretofore, the blood vessel protection device 100 of the present embodiment has been described.

  In addition, although the guide device 200 of this embodiment has flexibility over the entire length, for example, a portion to be inserted into a living body is hard enough not to be substantially deformed depending on the stress received during insertion. It may be. Thereby, the guidance device 200 can be smoothly inserted into the living body. Moreover, the full length may be hard.

  In this embodiment, a rail is provided in the main body 230 and a groove is provided in the lid 240. Conversely, a groove may be provided in the main body and the rail may be provided in the lid.

≪Peeling device≫
Next, the peeling device 400 used together with the above-described blood vessel protection device 100 when collecting the great saphenous vein 1000 will be described.

  The peeling device 400 is a device for forming an insertion hole for inserting the guide device 200 in the living body. As shown in FIG. 6, the peeling device 400 has a flat plate shape (a spatula shape). Further, a peeling portion 410 for peeling the fat 1200 is provided at the distal end portion of the peeling device 400. The peeling portion 410 tapers toward the tip of the peeling device 400 and has a sharpness that can peel the fat 1200 without cutting the branch blood vessel 1100. Thereby, damage / cutting of the branch blood vessel 1100 by the peeling part 410 is suppressed.

  In addition, as a peeling device, if the insertion hole for inserting the guide device 200 can be formed, it will not be limited to said structure.

≪Cut device≫
Next, the cutting device 500 used together with the above-described vascular protection device 100 when collecting the great saphenous vein 1000 will be described.

  The cutting device 500 is a device for cutting the fat 1200 around the saphenous vein 1000 and processing (thermal coagulation and cutting) the branch blood vessel 1100. As illustrated in FIG. 7, the cutting device 500 includes a main body 510 and an operation unit 520 that extends to the proximal end side of the main body 510. Further, the main body 510 is provided with a groove 530 that is open at the tip thereof. The groove 530 has a tapered blood vessel guide groove 531 whose width gradually decreases toward the base end side, and a blood vessel processing groove 532 which is located on the base end side of the blood vessel guide groove 531 and has a substantially constant width. doing. The blood vessel guide groove 531 is a groove that guides the branch blood vessel 1100 to the blood vessel processing groove 532 when the cutting device 500 is pushed in vivo. On the other hand, the blood vessel processing groove 532 is a groove for thermally coagulating (hemostasis) / cutting the branched blood vessel 1100 guided by the blood vessel guide groove 531. The blood vessel processing groove 532 is provided with a processing unit 540 for cutting and stopping the branch blood vessel.

  The processing unit 540 has a bipolar structure including a pair of electrodes 541 and 542 that generate an electric field in the blood vessel processing groove 532. The electrode 542 is provided at the proximal end portion of the blood vessel processing groove 532, and the electrode 541 is provided on both sides of the blood vessel processing groove 532. By applying a high-frequency alternating voltage between the electrodes 541 and 542, the branch blood vessel 1100 guided by the blood vessel processing groove 532 can be cauterized, thermally coagulated, hemostatic, and cut. Note that the distal end portion 542a of the electrode 542 is preferably sharp enough to cut the branch blood vessel 1100. Accordingly, if at least the branch blood vessel 1100 can be thermally coagulated by the electric field, the branch blood vessel 1100 can be physically cut by the tip 542a of the electrode 542. Therefore, the certainty of processing by the processing unit 540 is improved.

  The main body 510 is provided with a blade 560 for cutting the fat 1200. The blade portion 560 is provided on the distal end side of the main body portion 510, and is provided along the blood vessel guide groove 531 in this embodiment. The blade portion 560 has such a sharpness that the fat 1200 can be cut without cutting the branch blood vessel 1100. Thereby, since the cutting of the branch blood vessel 1100 by the blade portion 560 is suppressed, the procedure can be performed safely.

  The cutting device 500 is not limited to the above configuration as long as the fat 1200 can be cut and the branch blood vessel 1100 can be processed. For example, fat 1200 may be cut and branch blood vessel 1100 may be processed using an electric knife. Further, scissors may be used for cutting the fat 1200, and various processing devices such as a bipolar structure and a monopolar structure may be used for processing the branch blood vessel 1100.

≪How to collect blood vessels≫
The blood vessel collection method using the blood vessel protection device 100 includes a first step of placing the protection device 300 around the great saphenous vein 1000 using the blood vessel protection device 100, and covering the large saphenous vein 1000 with the surrounding fat 1200. A second step of peeling in a broken state, a third step of cutting after ligating the great saphenous vein 1000, and a fourth step of removing the great saphenous vein 1000 from the living body while being covered with surrounding fat 1200 And have.

Hereinafter, the first step to the fourth step will be described in detail.
[First step]
First, the position of the great saphenous vein 1000 to be collected is confirmed, and the skin is incised based on the position. As shown in FIG. 8, in this work, the skin is incised at two places, and the great saphenous vein 1000 between the incisions 1310 and 1320 is collected.

  Next, the peeling device 400 is inserted into the living body through the incision 1310 to peel off the fat 1200, and the tip is protruded from the incision 1320 outside the living body. Then, by removing the peeling device 400 from the living body, an insertion hole 1210 for inserting the guide device 200 is formed as shown in FIG.

  The insertion hole 1210 is formed along the great saphenous vein 1000 while being spaced apart from the great saphenous vein 1000. By separating from the great saphenous vein 1000, the peeling device 400 (and the guide device 200 to be inserted later) does not contact the great saphenous vein 1000, and damage to the great saphenous vein 1000 is prevented. Further, the insertion hole 1210 is preferably formed on the skin 1400 side with respect to the great saphenous vein 1000. The skin 1400 side of the great saphenous vein 1000 tends to have fewer branch blood vessels 1100 than the opposite fascia side (bone side). Therefore, by inserting the peeling device 400 closer to the skin 1400 than the great saphenous vein 1000, damage and cutting of the branch blood vessel 1100 due to contact with the peeling device 400 can be suppressed. Therefore, the procedure can be performed more safely.

  Next, the guide device 200 is inserted into the insertion hole 1210 from the incision portion 1310 and the tip is protruded from the incision portion 1320 to the outside of the living body, so that the guide device 200 is connected to the great saphenous vein 1000 as shown in FIG. Placed along the great saphenous vein 1000 while being spaced apart. Thus, by forming the insertion hole 1210 in advance, the flexible guide device 200 can be smoothly inserted into the living body.

  Next, the tip 310 of the protection device 300 is inserted into the guide hole 234 of the guide device 200, and the protection device 300 is rotated. Then, the protection device 300 is inserted into the living body while circling around the great saphenous vein 1000 while being guided by the guide device 200. Thereby, as shown in FIG. 11, the large saphenous vein 1000 is surrounded by the protection device 300. At this time, since the protective device 300 advances while passing the large saphenous vein 1000 and the branch blood vessel 1100 through the gap D between the lines, damage and cutting of the large saphenous vein 1000 and the branch blood vessel 1100 by inserting the protective device 300 are performed. Can be suppressed. In this operation, the protection device 300 can be inserted more smoothly by bending the proximal end side of the guide device 200 (that is, the portion exposed from the incision 1310 to the outside of the living body) away from the living body. Can do.

[Second step]
Next, the cutting device 500 is prepared, and the cutting device 500 is inserted from the incision portion 1310 along the outer periphery of the protection device 300. Then, as shown in FIG. 12, the fat 1200 is cut by the cutting device 500 and the branch blood vessel 1100 is thermally coagulated (hemostatic) and cut. By performing this operation over the entire circumference of the protection device 300, the large saphenous vein 1000 was peeled off from the fat 1200 located outside the protection device 300 in a state covered with the surrounding fat 1200 and the protection device 300. It becomes a state. By moving the cutting device 500 along the outer periphery of the protection device 300 in this manner, the work by the cutting device 500 can be performed more smoothly, and the contact of the cutting device 500 with the great saphenous vein 1000 is suppressed. And damage to the saphenous vein 1000 can be suppressed. From this, it can be said that the protection device 300 has a function of protecting the great saphenous vein 1000 and a function of guiding the cutting device 500.

  The thickness of the fat 1200 that is peeled off together with the large saphenous vein 1000 and is located around the large saphenous vein 1000 is not particularly limited, but is preferably about 0.1 mm to 10 mm, for example, and 1 mm to 8 mm. More preferably, it is about 3 mm to 5 mm.

  Next, the lid part 240 of the guide device 200 is slid with respect to the main body part 230, and the lid part 240 is removed from the main body part 230 (removed from the living body). By removing the lid portion 240 in this manner, the opening 233a of the groove 233 provided in the main body portion 230 is opened as shown in FIG. Next, as shown in FIG. 14, the main body 230 is rotated about 90 ° around the axis of the main body 230 with respect to the protective device 300 in the living body, and the protective device 300 is inserted into the groove 233 (main body through the opening 233a Part 230). As described above, the main body 230 is detached from the protection device 300 by the rotation of the main body 230, so that the operation can be performed more smoothly. And the main-body part 230 is extracted from a biological body. As a result, as shown in FIG. 15, only the protection device 300 is placed in the living body.

  In the present embodiment, the main body 230 is rotated with respect to the protection device 300 so that the protection device 300 is separated from the groove 233 through the opening 233a. The protective device 300 may be detached from the groove 233 through the opening 233a by displacing toward the greater saphenous vein 1000 side.

[Third step]
Next, both ends of the collected portion of the great saphenous vein 1000 are ligated and cut through the incisions 1310 and 1320. In addition, before performing this operation | work, if this cuts the unnecessary part (part which protrudes from the incision part 1310, 1320) of the protection device 300, this operation | work can be performed more smoothly.

[Fourth step]
Next, the large saphenous vein 1000 is taken out of the living body through the incision 1310 or the incision 1320 while being covered with the surrounding fat 1200 and the protection device 300.

  Through the first to fourth steps as described above, the great saphenous vein 1000 can be collected in a state covered with the surrounding fat 1200. In such a method, the large saphenous vein 1000 is damaged during the procedure (particularly during the second step) in order to cut the surrounding tissue (fat 1200) with the protective device 300 protecting the large saphenous vein 1000. Can be suppressed. Therefore, the large saphenous vein 1000 with little damage can be collected. In addition, since it is possible to perform the second step without cutting the great saphenous vein 1000, blood can be passed through the great saphenous vein 1000 as long as possible. Therefore, the great saphenous vein 1000 having a shorter ischemic state and less damage can be collected. When the collected great saphenous vein 1000 is actually used as a bypass blood vessel, the protection device 300 may be removed or the protection device 300 may be left attached.

  Here, the great saphenous vein 1000 covered with fat 1200 becomes a bypass blood vessel having a long-term patency rate superior to that of the great saphenous vein 1000 not covered with fat 1200. This is believed to be due to the following reasons. That is, the great saphenous vein 1000 is used as an arterial bypass blood vessel, but the artery has higher blood pressure (internal pressure received by blood) than the vein. Therefore, when a large saphenous vein that is not covered with tissue is used as a bypass blood vessel, the large saphenous vein expands without enduring blood pressure, and blood flow decreases. In addition, the vessel wall thickens during remodeling (structural alteration) and repairing tissue damage. Such thickening of the blood vessel wall is considered to affect long-term progression of arteriosclerosis. For these reasons, if a large saphenous vein that is not covered with tissue is used as a bypass blood vessel, it will lead to stenosis or occlusion of the blood vessel in the long term.

  On the other hand, by covering the large saphenous vein 1000 with the fat 1200, the fat 1200 suppresses the expansion of the large saphenous vein 1000, and the bending of the large saphenous vein 1000 is suppressed. Therefore, a decrease in blood flow as described above can be suppressed. In particular, the above-described effect is further improved by using the large saphenous vein 1000 as a bypass blood vessel with the protective device 300 attached. In addition, by being covered with fat 1200, damage to the greater saphenous vein 1000, specifically, damage to endothelial cells, smooth muscle, nutrient blood vessels (small blood vessel network), and the like is reduced. Therefore, the thickening of the blood vessel wall as described above can be suppressed. From the above, excellent long-term patency can be exhibited by using the large saphenous vein 1000 covered with fat 1200 as a bypass blood vessel. In particular, in this embodiment, since the nutritional blood vessels remain in the blood vessel wall and fat 1200 of the great saphenous vein 1000, the nutrition is supplied to the great saphenous vein 1000 as a bypass blood vessel even after bypassing, and the above effect is achieved. There is a possibility of improvement.

  In this embodiment, the fat 1200 is peeled by the peeling device 400 and the insertion hole 1210 is formed in the fat 1200. For example, the peeling device 400 is inserted between the fat 1200 and the skin 1400 (boundary). Then, the fat 1200 and the skin 1400 may be peeled, and the insertion hole 1210 may be formed between them. Since such parts having different properties are easily peeled off, the insertion hole 1210 can be formed more easily. In the present embodiment, the guide device 200 is disposed so as not to contact the great saphenous vein 1000. However, the guide device 200 may be disposed so as to contact the large saphenous vein 1000.

  In this embodiment, the insertion hole 1210 for inserting the guide device 200 is formed in advance using the peeling device 400. However, for example, the guide device 200 is suddenly inserted into the living body without forming the insertion hole 1210. It may be inserted into. In the present embodiment, the guide device 200 is removed from the living body after the processing by the cutting device 500 in the second step is finished. However, the guide device 200 is removed from the living body before the processing by the cutting device 500 is performed. Also good.

Second Embodiment
FIG. 16 is a perspective view of a blood vessel protection device according to the second embodiment of the present invention.

  Hereinafter, the second embodiment will be described with reference to this drawing. However, the difference from the above-described embodiment will be mainly described, and the description of the same matters will be omitted.

  This embodiment is mainly the same as the first embodiment described above except that the configuration of the guide holes is different.

  As shown in FIG. 16, in the blood vessel protection device 100 of the present embodiment, the guide hole 234 (groove 233) is composed of one long hole. For example, when the guide hole 234 (groove 233) is divided into a plurality of portions as in the first embodiment described above, the protection device 300 can be smoothly inserted into the predetermined guide hole 234 when the protection device 300 is bent. There is a risk that it cannot be guided. On the other hand, according to this embodiment, the above problems can be reduced, and even when the protective device 300 is bent, it can be smoothly guided to the guide hole 234.

  Also according to the second embodiment, the same effects as those of the first embodiment described above can be exhibited.

  The vascular protection device of the present invention has been described based on the illustrated embodiment. However, the present invention is not limited to this, and the configuration of each part is replaced with an arbitrary configuration having the same function. can do. In addition, any other component may be added to the present invention. Moreover, you may combine each embodiment suitably.

  In the above-described embodiment, the large saphenous vein is peeled off in a state where the entire circumference is covered with fat, but is not limited to the case where the entire circumference is covered with fat. That is, the large saphenous vein may be peeled off in a state where a part of its periphery is covered with the set fat, or may be peeled off without being covered with fat. For example, the upper and lower fats may be thin (or no fat in the upper and lower sides), and the left and right fats may be thick and covered with flat fat. In such a state, the state of the great saphenous vein (for example, presence or absence of damage, shape, twist) can be easily confirmed from above and below. Therefore, after grasping the state of the great saphenous vein, it can be appropriately used for a bypass blood vessel or the like.

  Moreover, although embodiment mentioned above demonstrated the case where the bypass blood vessel at the time of performing blood vessel bypass surgery was extract | collected, the use of the extract | collected blood vessel is not limited to a bypass blood vessel.

DESCRIPTION OF SYMBOLS 100 Blood vessel protection device 200 Guide device 230 Main body part 231 Surface 232 Rail 233 Groove 233a Opening 234 Guide hole 240 Cover part 241 Surface 242 Groove 300 Protection device 301 Linear body 310 Front end part 311 Part 311a Base end part 312 Protrusion part 400 Separation device 410 Exfoliation part 500 Cutting device 510 Main part 520 Operation part 530 Groove 531 Blood vessel guide groove 532 Blood vessel treatment groove 540 Treatment part 541 Electrode 542 Electrode 542a Tip part 560 Blade part 1000 Great saphenous vein 1100 Branching blood vessel 1200 Fat 1210 Incision hole 1310 Incision Part 1320 Incision part 1400 Skin D Line gap L Long axis R Outer diameter W Short axis T Thickness T1 Thickness T2 Thickness f Plane θ Inclination angle

Claims (9)

A protection device formed by spirally winding a linear body;
A guidance device for guiding the protection device,
A blood vessel protection device comprising: arranging the guide device in a living body along a blood vessel, and surrounding the blood vessel with the protection device by arranging the protection device in the living body while guiding the protection device with the guide device.   The blood vessel protection device according to claim 1, wherein the guide device has a guide hole through which the protection device is inserted. The guide device has a main body portion and a lid portion detachably provided from the main body portion,
The blood vessel protection device according to claim 2, wherein the protection device can be detached from the guide device by detaching the lid from the main body. The main body has a groove that opens on a surface facing the lid,
The blood vessel protection device according to claim 3, wherein the guide hole is formed by the lid portion closing an opening of the groove. The guide device has a flat cross section,
The blood vessel protection device according to claim 3 or 4, wherein the main body portion and the lid portion are provided along a major axis direction of the transverse section. The protection device has a tip provided at the tip of the linear body,
The said front-end | tip part has a spindle-shaped part, and can advance in the structure | tissue around the said blood vessel, without cut | disconnecting the branch blood vessel branched from the said blood vessel. Blood vessel protection device.   The blood vessel protection device according to claim 1, wherein the protection device has a gap between the linear bodies.   The blood vessel protection device according to any one of claims 1 to 7, wherein the gap is 1 mm to 10 mm.   The blood vessel protection device according to any one of claims 1 to 8, wherein the guide device is disposed apart from the blood vessel.

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