JPH0584307U - Side branch vascular obturator - Google Patents

Abstract

(57) [Summary] [Object] An object of the present invention is to provide a side-branch blood vessel occluding device which is easy to insert into a blood vessel without the outer tube being caught in the blood vessel, and which is safe. A flexible outer tube (11) having a side hole (13) at a tip end and an opening at a base end, and a flexible outer tube (11) that can move back and forth in the outer tube (11) and project from the side hole (13) at the tip end. The inner tube 12 is inserted freely and can be loaded with the occluding member 30 for the side branch blood vessel. A push-out member 18 for pushing out the closing member 30 loaded inside the inner tube 12 is provided so as to be movable back and forth, and the inner tube 12 inserted from the base end opening of the outer tube 11 is guided to the side hole 13. Therefore, a guide member 14 is provided at the tip of the outer tube 11.

Description

[Detailed description of the device]

[0001]

[Industrial applications]

 The present invention relates to a side branch vessel occluding device for occluding a side branch vessel of a vein during angioplasty.

[0002]

[Prior Art]

 In recent years, surgery has been performed in which a saphenous vein is used to bypass a blood vessel that has become impaired in blood flow due to a blood clot in a lower limb blood vessel or an arterial occlusion due to atheroma. In bypass surgery of such an artery, a part of the vein adjacent to the artery is used as a bypass artery. Therefore, it is necessary to open the venous valve in the part of the vein to be used.

In this venous valve incision, openings are provided in the blood vessel wall at the upstream side portion and the downstream side portion, respectively, with the vein valve in the venous blood vessel to be used as a bypass as a boundary. Next, the outer portion near each opening is clamped to block the blood vessel portion with the venous valve, the incision tool is inserted from the upstream opening, and the small-diameter endoscope for blood vessel is inserted from the downstream opening. Under the endoscope, and deeply insert the incision tool up to the site where the blade crosses the venous valve. Then, the venous valve is opened by pulling the inserted incision device to a predetermined position toward you.

It is common for the vein to be used as this bypass to have a large number of side branch vessels. If this side branch blood vessel is left as it is, the bypass blood flow will flow into that side branch blood vessel. Therefore, it is necessary to occlude the side branch blood vessel of the vein part to be used as this bypass.

Therefore, it is conceivable to use the clip device shown in Japanese Patent Laid-Open No. 64-2639 as an obturator for obstructing a side branch blood vessel. This clip device uses a scissor-like clip, and pushes this clip out to the outer peripheral portion of a side branch blood vessel, and pinches and crushes the blood vessel portion to close it.

However, since this clip device surgically performs an incision operation to attach a clip to the outer peripheral portion of the side branch blood vessel, it is necessary to incise a wide area along a vein used for bypass. According to this, there is a problem that the degree of invasiveness of the living body is large and the hospital stay of the patient becomes long after the operation.

Therefore, a side branch blood vessel occluding device schematically shown in FIG. 11 has been proposed. This side-branch blood vessel occluding device has an outer tube 1, a tip portion 2 of which is bent and protruded laterally, and a tip opening 3 thereof is opened laterally. A closure member (not shown) is loaded inside the outer tube 1, and an inner cylinder 4 is inserted into the outer tube 1 so as to be capable of projecting and retracting from the distal end opening 3 of the outer tube 1 and moving back and forth in the outer tube 1. Further, a wire 5 for pushing out the loaded closing member is inserted into the inner cylinder 4.

When this side-branch blood vessel occluding device is used, the outer tube 1 is inserted through the opening formed in the venous blood vessel, and the distal end opening 3 of the outer tube 1 is opened while observing with the endoscope. Aim at the entrance of the blood vessel. In this state, the inner tube 4 is projected from the tip opening 3 of the outer tube 1, and the tip of the inner tube 4 is inserted into the side branch blood vessel. Further, by pushing the wire 5, the occluding member is pushed into the side branch blood vessel and left indwelling to close the side branch blood vessel.

[0009]

[Problems to be solved by the device]

 By the way, in the side branch blood vessel occluding device described above, the distal end portion 2 of the outer tube 1 is curved and protrudes laterally, and the distal end thereof protrudes laterally beyond the outer diameter of the outer tube 1 and has a protruding shape. Therefore, when inserting the distal end portion 2 of the outer sheath tube 1 into a blood vessel having a small diameter, the distal end portion 2 of the outer sheath tube 1 is caught on the inner wall of the blood vessel, which is difficult to insert into the blood vessel. It was In addition, since the blood vessel itself may be damaged, it is necessary to perform it carefully with a high degree of caution, and the workability of the surgery is poor.

The present invention has been made in view of the above problems, and an object thereof is to prevent an outer tube from being caught in a blood vessel, to easily and safely insert the outer tube into the blood vessel. To provide a side-branch blood vessel occluding device.

[0011]

[Means for Solving the Problems]

 The side-branch vascular obturator of the present invention is provided with a flexible outer tube having a side hole at the distal end and an opening at the proximal end, and is capable of advancing and retracting in the outer tube and at the side of the distal end. An outer tube is provided which is inserted into the hole so that it can be inserted and retracted, and which is provided with an inner cylinder into which a blocking member for a side branch blood vessel can be loaded, and further includes an extruding member for pushing out the blocking member loaded in the inner tube. The guide member for guiding the inner cylinder inserted from the base end opening to the side hole is provided at the tip of the outer tube.

[0012]

[Action]

 According to this side-branch blood vessel occluding device, when the outer tube having flexibility is inserted into the blood vessel and the tip of the inner cylinder inserted in the outer tube is moved along the guide member, the tip of the inner tube is covered. It projects laterally from the side hole at the tip of the tube and is inserted into the side branch vessel. Then, the occluding member loaded from the tip of the inner cylinder is pushed into the side branch blood vessel by the pushing member to occlude the side branch blood vessel. Since the tip of the mantle tube is not bent to the side, it does not get caught in the blood vessel, and the mantle tube can be easily inserted into the blood vessel without damaging the blood vessel.

[0013]

【Example】

 1 and 2 show an embodiment of the present invention. As shown in FIG. 1, the side-branch blood vessel occluding device has an outer tube 11 made of resin as a flexible outer tube, and inside the outer tube 11, a flexible tube as an inner cylinder is provided. An inner tube 12 made of a resin having elasticity is inserted so as to be able to move back and forth. A side hole 13 into which the inner tube 12 can be inserted is opened in a side wall portion near the tip of the outer tube 11. The base end of the outer tube 11 is open, and the inner tube 12 is inserted through this opening.

A guide member 14 for guiding the inner tube 12 inserted into the outer tube 11 to the side hole 13 is located in the tip portion of the outer tube 11 and is located on the tip side of the side hole 13. Is fixedly provided. The guide member 14 is formed of a short columnar member, and is provided so as to be caulked inside the distal end portion of the outer tube 11 and to be buried in the inner cavity thereof. The end face of the guide member 14 on the base end side is curved with a certain curvature, and the end face forms a guide surface 15 that is inclined toward the side hole 13.

More specifically, one end (upper end) of the circular arc of the guide surface 15 coincides with the tip end of the side hole 13. Further, the angle of the guide surface 15 with respect to the longitudinal axis direction of the outer tube 11 becomes the largest at the upper end portion 16, and in this embodiment, the portion of the largest angle with respect to the longitudinal axis direction of the outer tube 11. It is a right angle. The guide member 14 is fixed such that the upper end portion 16 of the guide surface 15 is aligned with the tip edge portion 17 of the side hole 13, but the upper end portion 16 of the guide surface 15 is fixed to the tip edge portion 17 of the side hole 13. It may be located slightly closer to the base end side.

The outermost edge of the outer tube 11 has a narrowed outer diameter so that the guide member 14 does not fall out of the outer tube 11 even if the outer tube 11 and the guide member 14 are loosely fixed. .. A tightly wound pusher coil 18 as an extruding member is inserted into the inner cavity of the inner tube 12 so as to be movable back and forth with respect to the inner tube 12.

On the other hand, operating portions 19, 20, and 21 are attached to the proximal ends of the outer tube 11, the inner tube 12, and the pusher coil 18 described above, respectively. The operation portion 19 of the outer tube 11 is made of a member having a tapered hole 22. The operating portion 20 of the inner tube 12 is composed of a member having a tapered outer peripheral portion 23 fitted into the tapered hole 22. Then, the tapered outer peripheral portion 23 of the operating portion 20 of the inner tube 12 is fitted into the tapered hole 22 of the operating portion 19 of the outer tube 11 and engaged and fixed by the frictional force therebetween. Further, when the operating portion 20 of the inner tube 12 is fitted and fixed to the operating portion 19 of the outer tube 11 as described above, the positional relationship between the outer tube 11 and the inner tube 12 is determined, and the inner tube 12 thereof is fixed. As shown in FIG. 1, the relative lengths of the two tubes 11 and 12 are set so that the tip of each of the tubes projects from the side hole 13 to the outside of the outer tube 11 by about 15 mm.

Further, the operation portion 20 of the inner tube 12 is formed with a guide hole 25 through which a cylindrical operation rod 24 connected to the proximal end of the pusher coil 18 is inserted. A grip operation member 26 having a relatively large diameter is attached to the end of the operation rod 24. The operating portion 21 of the pusher coil 18 is composed of an operating rod 24 and a grip operating member 26 having a diameter larger than that of the operating portion 20.

An elastic O-ring 27 is attached to the inner surface of the guide hole 25. On the other hand, a round groove 28 is formed near the tip of the operation rod 24 inserted into the guide hole 25, and the elastic O-ring 27 is fitted into and engaged with the round groove 28, The inner tube 12 and the pusher coil 18 are temporarily fixed. In this temporarily fixed state, the tip of the pusher coil 18 is at a position retracted from the tip of the inner tube 12 as shown in FIG. That is, the tip of the pusher coil 18 is located closer to the hand side than the position where the blocking member 30 is loaded in the tip portion of the inner tube 12. Further, the tip end of the pusher coil 18 is located closer to the hand side than the tip end portion of the inner tube 12 which is curved when the tip end portion of the inner tube 12 is projected from the side hole 13.

In addition, the grip operation member 26 of the operation portion 21 is pushed forward against the operation portion 20 side against the temporary fixing force of the O-ring 27, and the grip operation member is provided at the rear end of the operation portion 20 of the inner tube 12. The relative lengths of the pusher coils 18 are set so that the tip end of the pusher coil 18 protrudes from the tip end of the inner tube 12 by, for example, about 3 mm when the tip end face of 26 is abutted.

The blocking member 30 is a coil-shaped member when loaded in the inner tube 12, and has a habit of curling when separated from the inner tube 12 and released. A large number of hairs (not shown) are attached to the strand. The hair is preferably made of a material that absorbs blood well. The large number of hairs makes it easier for blood clots to attach. Examples of blood-absorbing materials include Dacron (trade name, manufactured by DuPont) and Operon (trade name, manufactured by DuPont).

Next, an example of use of this side branch blood vessel occluding device will be described. After blocking the blood flow by tying the downstream and upstream portions of the vein 31 with a thread or the like, incisions are made in the wall portions of the downstream portion and the upstream portion of the vein 31 within the blocked area. The openings 32 and 33 are opened, the small-diameter endoscope 34 for a blood vessel is inserted through one of the openings 32, and the outer tube 11 of the side branch blood vessel obturator is inserted through the other opening 33. Then, under the observation of the endoscope 34, the outer tube 11 is guided so that the side hole 13 of the outer tube 11 of the side branch blood vessel obturator comes directly under the opening of the side branch blood vessel 35 to be closed. When the position is reached, the inner tube 12 is inserted from the proximal side of the outer tube 11 while maintaining its posture. When the operating portion 19 of the outer tube 11 is inserted into a position where the operating portion 19 of the inner tube 12 is fitted and fixed, the distal end portion of the inner tube 12 is curved along the guide surface 15 of the guide member 14. As shown in FIG. 2, the tip of the inner tube 12 projects from the side hole 13 of the outer tube 11, and the tip of the inner tube 12 is inserted into the side branch blood vessel 35.

Finally, by pushing in the pusher coil 18, the blocking member 30 previously loaded in the front end portion of the inner tube 12 is pushed out from the tip of the inner tube 12 into the side branch blood vessel 35. When the blocking member 30 is separated from the inner tube 12 and released, the blocking member 30 rolls and is left in the side branch blood vessel 35. Since many strands of hair (not shown) as described above are attached to the strands of the occluding member 30, a thrombus is easily attached and the side branch blood vessel 35 can be easily occluded. This operation is sequentially performed for each side branch blood vessel 35.

However, since the side branch blood vessel 35 is occluded from the inside of the blood vessel by the occluding member 30, the amount of incision of the patient can be reduced, the operation can be simplified and the healing can be quickened, and the patient can be hospitalized after the operation. Can be shortened.

Further, since the operating section 20 and the operating section 21 can be temporarily fixed by the O-ring 27, the operating section 23 is inadvertently pushed when the inner tube 12 is inserted, so that the blocking member 32 does not contact the side branch blood vessel 35. It can be prevented from falling off.

FIG. 3 shows a modification of the outer tube 11. The outer tube 11 has a structure in which a reinforcing blade 38 is arranged between the inner and outer two layers of tubes 36 and 37. With such an outer tube 11, the rotation following performance of the outer tube 11 can be improved, and the side hole 13 of the outer tube 11 can be easily and reliably guided to directly below the side branch blood vessel 35.

A modified example of the closing member 30 is shown below. The closing member 30 shown in FIG. 4 is formed by sandwiching a plurality of hairs 42 between the pitches of the coil wires 41 that are tightly wound. The hair body 42 is made of the above-described material having good blood absorbability. According to this closing member 30, since the hair body 42 sandwiched between the pitches of the coil wires 41 is made of a material having a good blood absorbability, the side branch blood vessel 35 in which the hair body 42 is placed is closed quickly and surely. can do.

The closing member 30 shown in FIG. 5 is configured by sandwiching a plurality of hair bodies 44 between the strands of a stranded wire wire 43 made of metal or resin. The hair body 44 is made of the above-mentioned material having a good blood absorption property. Also by the closing member 30, the hair 44 is made of a material having a good blood absorbability, so that the side branch blood vessel 35 in which the hair is placed can be closed quickly and reliably.

The closing member 30 shown in FIG. 6 is formed of a stranded wire 45 made of metal or resin. Further, the twisted wire is unwound at the one end portion 46 of the twisted wire 45, and the strand is spread so as to have a conical shape. In this case, the closing member 30 is loaded on the distal end portion of the inner tube 12 so that the one end portion 46 becomes the proximal end. When this is used, since the conically widened one end portion 46 is located downstream of the side branch blood vessel 35, its strand is caught by the inner wall of the side branch blood vessel 35, and the occluding member 30 becomes the side branch blood vessel. It can be prevented from dropping from 35.

The blocking member 30 shown in FIGS. 7 and 8 is made of a highly water-absorbent resin and is formed in a short column shape. Immediately after being placed in the side branch blood vessel 35, it is relatively small as shown in FIG. 7, but after placement, it absorbs surrounding water and expands, then expands as shown in FIG. 8, and finally closes the side branch blood vessel 35. .. Examples of the super absorbent polymer include crosslinked polyacrylic acid type polymers, isobutylene / maleic acid copolymer crosslinked products, PVA / maleic anhydride reaction products, vinyl acetate / acrylic acid ester copolymer saponified products, etc. There are currently commercially available superabsorbent polymers, including pilot production. Further, the closing member 30 may be formed by blending the highly water-absorbent resin with another resin.

The closing member 30 shown in FIG. 9 is formed by compression-molding a plurality of hairs made of a material having good blood absorbability into a spherical shape. When this is placed in the side branch blood vessel 35, it absorbs the surrounding blood and expands, blocking the side branch blood vessel 35. Note that FIG. 10 differs from that of FIG. 9 in that the shape is compression-molded into a bullet shape, and the other points are the same.

[0032]

[Effect of the device]

 As described above, according to the side-branch blood vessel occluding device of the present invention, as described above, a side hole is provided at the distal end portion of the outer tube, and a guide member is provided at the distal end of the outer tube, and the device is inserted into the outer tube. Since the inner tube is guided to the side hole, the outer tube has no part protruding laterally, the tip of the outer tube is straight, and is not caught in the blood vessel. Therefore, if this side branch blood vessel occluding device is used, it is easy to insert the outer tube into the blood vessel, and the work of occluding the side branch blood vessel can be performed safely.

[Brief description of drawings]

FIG. 1 is a cross-sectional view showing a side branch blood vessel occluding device according to an embodiment of the present invention.

FIG. 2 is an explanatory view of a usage state of the side branch blood vessel occluding device of the embodiment.

FIG. 3 is a side view showing a modified example of an outer tube of the side branch blood vessel occluding device with a part thereof cut away.

FIG. 4 is a side view showing a modified example of the occluding member of the side branch blood vessel occluding device.

FIG. 5 is a side view showing another modification of the occluding member of the side branch blood vessel occluding device.

FIG. 6 is a side view showing still another modified example of the occluding member of the side branch blood vessel occluding device.

FIG. 7 is an explanatory view of a state in which another different modification of the occluding member of the side branch blood vessel occluding device is used.

FIG. 8 is an explanatory view of a usage state of the closing member.

FIG. 9 is an explanatory view of still another modification of the occluding member of the side branch blood vessel occluding device.

FIG. 10 is an explanatory view of still another modification of the occluding member of the side branch blood vessel occluding device.

FIG. 11 is a perspective view of the vicinity of the tip of a conventional side branch blood vessel occluding device.

[Explanation of symbols]

11 ... Outer tube (outer tube), 12 ... Inner tube (inner tube), 13 ... Side hole, 14 ... Guide member, 18 ... Pusher coil (extruding member), 30 ... Occlusion member, 31 ... Vein, 35 ... Side branch blood vessel ..

Claims (1)

[Scope of utility model registration request] 1. A flexible outer tube having a side hole at a tip end and an opening at a base end, and a flexible outer tube inserted into the outer tube so as to be able to move forward and backward and project from the side hole. An inner cylinder into which the side branch blood vessel occluding member can be loaded, an pushing member to push out the occluding member loaded into the inner cylinder, and an inner tube inserted into the outer tube to guide the inner tube to the side hole A side-branch blood vessel occluding device comprising: a guide member provided at the tip of the outer tube.