JPH06178781A - Vein valve incisor - Google Patents

Abstract

PURPOSE:To provide a durable vein valve incisor, in which even if the opening and closing operation is repeated, an arm is hard to be deformed, a gap between a cutter and the arm is prevented from being broken and a sure opening width can be maintained securely. CONSTITUTION:A vein valve incisor 1 comprises a pair of cutters 2 having a cutting edge at the forward end thereof, and a pair of arms 3 integrated with an operating wire 10 on hand, where the cutters 2 are fixed. The arms 3 are respectively provided with parts 19 parallel to the cutting edges 34 of the cutters 2 and with plural bending points 15-17 to keep fixed spaces toward the cutting edges 34. Thus, plural bending points 15-17 are provided on the respective arms 3, whereby work hardening is generated in the arms 3 so as to increase firmness as a whole. Accordingly, it is hard to cause deformation due to repeated opening and closing operation of the cutters 2. Under such a condition, a gap between the cutters 2 and the arms 3 can be maintained securely so as to improve the durability.

Description

Detailed Description of the Invention

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a venous valve dissection device for dissecting a venous valve during angioplasty.

[0002]

2. Description of the Related Art In reconstructing blood circulation in an artery that has become poorly circulated due to arterial occlusion due to an atheroma or thrombus in a lower branch blood vessel, a bypass operation of an arterial occlusion part is performed using a saphenous vein that runs in parallel with the artery. ing.

In this case, since the vein used for bypass has a valve for allowing blood flow to flow only in a certain direction, this valve must be incised to make it inoperative before bypassing.

In such an operation, in order to destroy (cut) a valve in a saphenous vein of a length required for bypass, openings are provided in upstream and downstream portions of a necessary range, respectively, and the vicinity thereof is provided. Clamp to block blood flow. Then, while inserting the incision tool from the upstream side opening, while directly observing by inserting the observation means such as a fiberscope from the downstream side opening,
Make a valve incision.

As a conventional venous valve incision instrument, Japanese Patent Laid-Open Publication No. HEI 3-
There is one disclosed in Japanese Patent No. 168132. In this incision tool, there is one in which a blade provided on the rear side surface of the rising portion of an L-shaped cutter is hooked on a valve and the incision tool is pulled forward to cut. This incision tool has excellent exchangability of the cutter.

However, there is room for improvement in the above-described incision device because there is a risk that the cutter may accidentally be hooked on the side branch blood vessel to cause a tear.

Therefore, there is a device described in USP 5,049,154. The device according to the present invention has a structure in which a pair of cutters provided at symmetrical positions advance and retreat at the tip of the sheath with a constant opening width, and a cutting blade is formed at the rear end of the cutter. FIG. 11 shows the device described in the above publication.

As shown in FIG. 11, the acting portion 62 incorporated in the tip portion 61 of the device body 60 is a cutter 63.
And an arm 64 supporting it.

The arm 64 has an arcuate portion 65 which gradually opens toward the tip so that a constant opening width h can be obtained with the cutter 63 open.

Further, in order to secure a gap: d formed between the blade 66 formed at the rear end of the cutter 63 and the arm 64,
The arm 64 has a bent portion 67.

The device has a structure in which the gap: d is secured so that the vein valve can be taken into the gap: d for incision.

[0012]

DISCLOSURE OF THE INVENTION Problems to be Solved by the Invention
SP5,049,154 has the following drawbacks, which will be described with reference to FIG.

During the cutting operation, the entire working portion 62 is pulled straight (to the right side in the drawing), and the blade 66 of the cutter 63 is pulled.
Causes the valve to disconnect. By repeating this cutting operation, the arm 64 is deformed. This occurs due to metal fatigue or excessive force applied to the arcuate portion 65 of the arm 64 or the base of the arm 64.

Then, the gap d formed between the blade 66 at the rear end of the cutter 63 and the arm 64 is crushed and narrowed. Alternatively, the arcuate portion 65 formed on the arm 64 for ensuring the opening width h of the cutter 63 is deformed, and a constant opening width h cannot be obtained.

In particular, when the gap d is decreased, the valve for cutting cannot be taken into this gap, which is a great obstacle to the cutting.

The present invention has been made in view of the above circumstances. Even when the opening and closing operation is repeated, the arm is not easily deformed, the gap between the cutter and the arm is not crushed, and the reliable opening width is ensured. It is intended to provide a venous valve dissector that is retained, that is, durable.

[0017]

A venous valve incision instrument of the present invention is formed by connecting a cutter having a blade at its tip with an operation wire at the hand side or integrally formed with this operation wire, and fixing the cutter. And an operating portion for opening and closing the arm. And in the venous valve incision instrument of the present invention, the arm is configured so that a parallel portion is formed between the blade portion of the cutter and a plurality of portions so as to maintain a constant distance from the blade portion of the cutter. A bending point is provided.

[0018]

According to the present invention, by providing the arm with a plurality of bending points, work hardening occurs in the arm, and the rigidity of the arm is increased as a whole. Therefore, deformation due to repeated opening and closing operations of the cutter does not occur. Further, in this state, the gap between the cutter and the arm is surely held.

[0019]

Embodiments of the present invention will be described below with reference to the drawings. 1 to 9 relate to a first embodiment of the present invention, FIG. 1 is an overall configuration diagram of a venous valve dissection device, FIG. 2 is a side sectional view of the venous valve dissection device, and FIG. 3 shows an arm configuration. FIG. 4 is a side view, FIG. 4 is a side sectional view showing the connection between the arm and the cutter,
5 is a top view of a cutter with an arm connected, FIG. 6 is a side cross-sectional view showing another structure of the arm and the cutter, FIG. 7 is an explanatory view of the structure of the arm and its storage, and FIG. 8 is a use of a venous valve incision. FIG. 9 is an explanatory view of the venous valve incision.

The venous valve dissection tool 1 shown in FIG. 1 has an action portion 4 consisting of a pair of cutters 2 and a pair of arms 3 having the cutters 2 provided at their tips. In addition, the venous valve dissection device 1 includes the action portion 4 that is movable in the axial direction.
A flexible sheath portion 6 connected to the proximal end side of the distal end portion 5, and an operating portion 7 connected to the proximal end side of the sheath portion 6. There is.

A pair of arms 3 constituting the acting portion 4
Is formed of an elastic member and is adapted to spread outward. Further, the pair of arms 3 project and open from the distal end portion 5 in accordance with the forward and backward movement in the axial direction, while the distal end portion 5 is opened.
It is designed to be stored inside. The pair of arms 3
2 is extended as a manipulation wire 10 as shown in FIGS. 2 and 3. The operation wire 10 may be a single wire, but here, as shown in FIG. 3, two wires 11 are formed close to each other. In other words, the two wires 11 are formed as a pair of operation wires 10 and a pair of arms 3 on the tip side thereof.

The arm 3 and the operation wire 10 may be formed separately, instead of being integrally formed. In the case of a separate body, so that the arm 3 and the operation wire 10 can be connected,
For example, the fitting portions may be provided to each other. In the case of this configuration, the cutter 2 may be replaced by replacing the arms 3 and up.

The operating portion 7 is composed of a main body member 8 connected to the base end portion of the sheath 6, and a slider 9 which is slidably advanced and retracted inside the main body member 8.

As shown in FIG. 2, the main body member 8 is formed in a substantially tubular shape, and a groove for preventing slipping when gripped is formed in a plurality of circumferential directions on the outer circumference thereof. The slider 9 is a sliding member 9a formed in a substantially tubular shape.
And a tubular grip end member 9b fitted on the base end side of the sliding member 9a.

Similar to the main body member 8, the sliding member 9a has a plurality of grooves formed in the circumferential direction. The grip end member 9b has a rear end portion of the operation wire 10 attached to a hole 9c formed at the center thereof. Operating wire 1
The rearmost end portion of 0 is bent and mounted in the hole 9c, and is fixed by brazing or the like.

The sliding member 9a of the slider 9 is slidably held in the through hole of the main body member 8. Further, between the main body member 8 and the sliding member 9a of the slider 9, an O-ring 1 coated with silicone oil is provided.
2 is interposed so as to have sliding resistance.

As shown in FIG. 2, the operating wire 10 is
The operating portion 7, the sheath portion 6, and the distal end portion 5 that form the slider 9 and the main body member 8 are inserted through the middle of the operation portion 7. The arm 3 connected to the operation wire 10 is inserted from the middle of the tip portion 5 to the tip.

The slider 9 is provided with the operating wire 10
And the arm 3 that constitutes the acting portion 4, and is connected to the cutter 2. As the slider 9 moves back and forth in the axial direction, the cutter 2 attached to the tip of the arm 3 moves back and forth in the axial direction.

Next, the joint between the arm 3 and the cutter 2 will be described with reference to FIGS. 2, 4 to 6.
The shape of the arm 3 will be described with reference to FIG.

As shown in FIG. 4, the tip of the arm 3 has a spherical portion 13 larger than the wire diameter of the arm 3 by plasma processing or the like.
Are formed. The spherical portion 13 of the arm 3 engages with and locks a hole 31 provided near the tip of the cutter 2.

The cutter 2 has a step portion when viewed from the tip side, and as shown in FIG. 2, this step portion forms an abdominal portion 35, and a blade portion 34 is formed toward the rear end side of the abdominal portion 35. Has been done. The abdomen 35 of the cutter 2 has a hole 3
1 is formed.

The hole portion 31 of the cutter 2 is composed of a stupid hole portion 31a that can easily pass through the spherical portion 13 of the arm 3 and an engaging hole portion 31b that can lock the spherical portion 13. As shown in FIG. 5 when FIG. 4 is viewed from above, the stupid hole portion 31a forming the hole portion 31 is formed to be a long hole in the axial direction. The stupid hole portion 31a may be formed as a long hole in the direction perpendicular to the axial direction.

The tip of the stupid hole 31a is provided with the arm 3
The diameter is larger than that of the spherical portion 13. Further, the engagement hole portion 31b is slightly larger than the wire diameter of the arm 3,
Moreover, the size is such that it cannot pass through the spherical portion 13.
The arm 3 and the cutter 2 pass through the spherical portion 13 of the arm 3 through the stupid hole portion 31a, and then move to the engagement hole portion 31b to be locked. Further, the arm 3 and the cutter 2 are joined firmly by the brazing or the like so as to fill the hole 31 in addition to the engagement and locking.

With the above-described structure, that is, the arm 3 and the cutter 2 are locked to each other, and in addition to this primary fixing means, secondary fixing means such as brazing is used for further fixing. The cutter 2 does not fall off the arm 3.

Further, as shown in FIG. 6, a hole 32 and a groove 33 are formed in the cutter 2, the arm 3 is bent into a crank shape, and the tip of the arm 3 is hooked in the groove 23, and then the lower end is cut. It is also possible to use a structure in which the hole 22 is filled with an attachment or the like to connect and fix.

In any of the above structures, after brazing, the outer surface 2a of the cutter 2 is smoothed by sanding or buffing in order to remove the protrusion of the brazing.

The arm 3 is formed as follows, as shown in FIG. 7 (a). That is, the arm 3 has the first to third bending points 15 to 17, and the bending portion 18 formed between the first bending point 15 and the second bending point 16 and the second bending point 16 Third bending point 1
7 and the parallel part 19 formed up to 7. Further, the arm 3 has an arcuate arc portion 20 provided from the third bending point 17 to the rear end side, and a branch portion 21.

The arm 3 is vertically connected to the cutter 2 from a connecting portion with the cutter 2, and has a first bending point 15 which is bent to the rear of the cutter 2 with a constant length. The arm 3 secures a space between the cutter 2 and the arm 3 necessary for taking in the object to be incised, between the first bending point 15 and the second bending point 16.
A bent portion 18 is formed toward the central axis in the longitudinal direction of the vein valve dissector 1.

Further, in the arm 3, the blade portion 34 provided at the rear end of the cutter 2 and the parallel portion 19 in which the arm 3 is completely parallel to each other are formed from the second bending point 16 to the third bending point 1.
And 7 are formed.

Third bending point 1 at the end of the parallel portion 19
The area rearward of 7 transitions to a gentle arcuate arc portion 20. The arcuate arc portion 20 is connected to the operation wire 10 via the branch portion 21 on the base end side thereof.
The other arm 3 provided at a symmetrical position with respect to the axial centerline of the venous valve dissector 1 extends from the distal end of the branch portion 21. The cutter 2 is also connected to the other arm 3 as described above.

The branching portion 21 is also a point at which the offset portion of the two wires 11 ends, and it is desirable to provide a stopper portion 22 with brazing or the like inside the tip portion 5 in order to prevent fraying.

Next, when the cutter 2 is closed, that is, when the arm 3 is pulled toward the hand side, the tip portion 5
Is formed as follows. That is, FIG. 7B
As shown in FIG. 3, the diameter of the opening 23 is sufficiently secured so that the pair of cutters 2 are entangled with each other and the blade portion 34 at the rear end of the cutter 2 is housed in the opening 23 of the tip member 5. . The tip portion 5 is tapered so that the diameter of the tip portion 5 increases toward the tip of the opening 23 so that the pair of arms 3 can slide freely.

In the venous valve dissector 1, the cutter 2 and the arm 3 project from the tip portion 5 according to the advance / retreat of the slider 9, while the cutter 2 is housed in the opening 23.

Since the blade portions 34 of the pair of cutters 2 are formed on the arm 3 side, the blade portions 34 are not limited to being housed, and are not cut unnecessarily (on the outer side opposite to the arm 3). There is.

The operation of this embodiment will be described with reference to FIGS. 8 and 9.

As shown in FIG. 8, the catheter 4 is inserted into the upstream side opening 41 and the downstream side opening 42 of the venous blood vessel 40, respectively.
3,44 are inserted. The venous valve dissector 1 is inserted into the venous blood vessel 40 through the upstream opening 41 and the catheter 43.

At this time, the cutter 2 of the venous valve dissector 1 is inserted in the closed state, and the blade portion 19 is completely contained in the tip member 5.

From the downstream opening 42, a catheter 44
The observation means such as the fiberscope 45 is inserted through the.

In actual valve incision, as shown in FIG.
In the vicinity of the target venous valve 46, the slider 9 of the operation unit 7
Push to open the cutter 2. By controlling the pushing length of the slider 9, the opening width of the cutter 2 can be adjusted.

With the cutter 2 open, the venous valve dissector 1 is pulled toward the upstream side opening 41, and at the same time, the blade portion 34 formed at the rear end of the cutter 2 is hooked on the venous valve 46 to make an incision. . This incision is performed under the direct view of the observation means described above.

In the present embodiment, the shape of the first bending point 15 and the bending portion 18 from the above-mentioned joining portion allows the venous valve to be reliably cut open between the cutter 2 and the arm 3. That is, in the present embodiment, the cutter can be reliably hooked on the vein valve, and the vein valve can be reliably opened.

Further, in this embodiment, by providing a plurality of bending points so that the arcuate arc portion of the arm becomes short, work hardening occurs in the arm and the overall rigidity becomes strong. Therefore, the incision tool of this embodiment is unlikely to be deformed even if the opening / closing operation of the cutter is repeated. Therefore, in this embodiment, the gap between the cutter and the arm can be reliably held in the above state.

This can also be said from the following points. Although a force is applied to the arm 3 axially rearward during incision, the force applied to the arcuate arc portion 21 of the arm 3 is divided into an axial component and a component perpendicular thereto. At this time, the force of the vertical component applied to the arcuate arc portion 21 by the distance from the branch point 23 as a fulcrum is
It will be big. In the configuration as in the conventional example, since all the protruding arms are formed by the arcuate arc portions, the arms are also long and are easily deformed.

On the other hand, in the incision tool 1 of this embodiment,
In the parallel portion 20, a vertical component force is not generated, and the arcuate arc portion is short, so that the shape is difficult to deform.
Therefore, in the present embodiment, even if the opening and closing operation is repeated, the arm is not easily deformed, the gap formed between the cutter and the arm is not crushed, and the reliable opening width is reliably maintained, that is, the durability is improved. Can be improved.

FIG. 10 is a front view of the vein valve incising device according to the second embodiment of the present invention.

The second embodiment is different from the first embodiment in that the bending shape of the arm 3 is changed and the number of bending points is increased. Since the other configurations and operations are the same as those of the first embodiment, the same reference numerals are given and the description and the drawing of the rear end side of the incision tool are omitted.

From the joint between the cutter 2 and the arm 3,
The arm 3 is bent rearward at the first bending point 24 so as to be substantially in contact with the abdomen 35 of the cutter 2. From the first bending point 24 to the second bending point 25 of the arm 3, the abdomen 35 is formed.
Is a first parallel portion 26 that is parallel to. At the second bending point 25 from the vicinity of the blade portion 34 of the cutter 2, the arm 3 is bent so that the arm 3 forms a constant space with the cutter 2.
Are formed. At the third bending point 28 behind the arm 3, the arm 3 forms a second parallel portion 29 that is bent so that the blade portion 34 and the arm 3 are parallel to each other.

At the end of the second parallel portion 29, a fourth bending point 30 is formed, and the arcuate arc portion 21 is formed therefrom.

The second embodiment is different from the first embodiment in that two parallel portions are formed, and the other structures are all the same. It can be said that the present embodiment has higher durability than the incision tool of the first embodiment. Other functions and effects are the same as those in the first embodiment, and the description thereof will be omitted.

[0060]

As described above, according to the present invention, even if the opening / closing operation is repeated, the arm is not easily deformed, the gap between the cutter and the arm is not crushed, and the opening width is surely maintained. That is, there is an effect that durability can be improved.

[Brief description of drawings]

1 to 9 relate to a first embodiment of the present invention,
FIG. 1 is an overall configuration diagram of a vein valve incision device.

FIG. 2 is a side sectional view of the venous valve dissection device.

FIG. 3 is a side view showing a configuration of an arm.

FIG. 4 is a side sectional view showing the connection between the arm and the cutter.

FIG. 5 is a top view of a cutter having arms connected thereto.

FIG. 6 is a side sectional view showing another configuration of the arm and the cutter.

FIG. 7 is an explanatory view of a structure of an arm and its storage.

[Fig. 8] Fig. 8 is a view showing a usage state of the venous valve incision.

FIG. 9 is an explanatory diagram of venous valve incision.

FIG. 10 is a distal end configuration diagram of the vein valve incision tool according to the second embodiment.

FIG. 11 is a configuration diagram of a vein valve incision device according to a conventional example.

[Explanation of symbols]

 DESCRIPTION OF SYMBOLS 1 ... Vein valve incision tool 2 ... Cutter 3 ... Arm 4 ... Action part 5 ... Tip part 6 ... Sheath part 7 ... Operation part 15-17 ... Bending point 18 ... Bending part 19 ... Parallel part 20 ... Bow arc part 21 ... Bifurcation

Claims (1)

[Claims] 1. A cutter having a blade at its tip and an arm for connecting an operation wire at the hand side or integrally formed with the operation wire and fixing the cutter, and for performing an opening / closing operation. In the venous valve dissection device having an action portion, the arm is configured such that a parallel portion is formed between the blade portion of the cutter and a constant distance from the blade portion of the cutter, A venous valve incision instrument having a plurality of bending points.