JPH0741449Y2 - Venous valve opener - Google Patents

Description

DETAILED DESCRIPTION OF THE INVENTION [Industrial application] The present invention relates to a venous valve dissector for dissecting a venous valve during angioplasty.

[Prior Art] When treating an artery of the lower limb, which has poor blood circulation due to a thrombus or atheroma, a technique of bypassing the occluded part of the artery using a saphenous vein is used. When performing a bypass operation using this saphenous vein, it is necessary to open the venous valve for sending blood in one direction and remove the blood flow barrier by the venous valve. As an example of an incision instrument for incising this venous valve, one having a structure in which a guide tube or a blade is connected to the distal end of a flexible sheath is known as shown in Japanese Utility Model Laid-Open No. 63-38505. There is.

FIG. 7 shows a method of incising a venous valve using such an incision tool.

When incising a venous valve, first, the upstream side and the downstream side of the vein 1 to be incised are clamped to block the blood flow, and the required incision portions 2, 2 are provided at the upstream portion and the downstream portion. 3
To provide. Then, the incision tool 5 is inserted from one incision part 2, the scope 6 is inserted from the other incision part 3, and the venous valve 4 is incised while observing the inside of the vein 1.

In this method, in order to secure the visual field of the scope 6 in the vein 1, it is necessary to inject physiological saline into the vein 1. When the scope 6 is not provided with a channel for water supply, as shown in FIG. 7, a catheter 7 with a water supply function is provided.
Is inserted through the incision 3, and the scope 6 is inserted through the catheter 7. Then, the syringe 8 is connected to the catheter 7
Then, physiological saline is injected into the vein 1 through a gap between the scope 6 and the outer peripheral portion.

[Problems to be Solved by the Invention] As described above, when the physiological saline is injected to secure the field of view of the scope 6, the catheter 7 with a water supply function is required, and thus the procedure is extremely complicated. Further, since physiological saline flows into the vein 1 from the catheter 7 through the outer peripheral portion of the scope 6, it is not possible to completely remove blood in the vicinity of the objective lens of the scope 6 and ensure a complete visual field. I can't.

Further, in performing the bypass operation, it is necessary to occlude the side branch blood vessel of the vein. In order to occlude the side branch blood vessel, a venous valve incision device must be taken out and an instrument or device for occluding the side branch blood vessel must be inserted into the vein 1 in place of this, which requires time and the procedure is extremely complicated. Becomes

The present invention has been made in view of the above, and an object of the present invention is to provide a venous valve incision instrument that can surely secure the visual field of the scope and can simplify the procedure.

[Means for Solving the Problem] The venous valve incision device according to the present invention is provided with a rigid portion at the distal end of a flexible sheath, bends the tip of the rigid portion, and cuts the blade on the proximal side of the bent portion. The first feature of the venous valve incision device having the formed portion is that the conduit opening to the proximal side operation portion and the hard portion is provided in the flexible sheath.

Further, the venous valve incision device according to the present invention is provided with a rigid portion at the distal end of the flexible sheath, the tip of the rigid portion is bent, and a blade portion is formed on the proximal side of the curved portion. A second feature of the venous valve dissector in which a conduit opening to the operation part and the hard part is extended in a flexible sheath, and a side branch blood vessel occlusion catheter can be inserted through the conduit. And

[Operation] Any of the venous valve dissectors having the first and second characteristics described above is inserted into a vein so as to face the scope when performing bypass surgery. Then, physiological saline is injected into the vein through the opening of the rigid portion at the distal end of the vein valve incision device through the conduit. The saline infused intravenously flows toward the opposite scope, and blood that obstructs the scope's visual field is completely removed. Further, in the venous valve dissection device having the second feature, a catheter for occluding the side branch blood vessel can be inserted through this conduit, and the side branch vessel can be inserted while the venous valve dissection device is inserted into the vein. Blood vessels can be occluded.

[Embodiment] A first embodiment of the present invention will be described below with reference to FIGS. 1 to 3.

As shown in the cross-sectional view of FIG. 1, the venous fecal incision instrument of this embodiment
10 has a flexible sheath 12. A grip portion 14 is fixed to the hand side operation portion 11 of the flexible sheath 12 with a screw or the like, and a mouthpiece 16 to which a syringe can be attached is connected to the grip portion 14. Further, a hard portion 18 is fixed to the distal end 13 of the flexible sheath 12 by screwing, for example.

As shown in FIGS. 2 and 3, the hard portion 18 is a main body portion.
19 and a bent portion 20 that is bent from the tip of the main body portion 19. The bent portion 20 is formed by a blade portion 22 and a smooth spherical head portion 24, and a curved blade 26 is provided on the hand side of the blade portion 22. This bent portion 20 has a body portion 19 of its axis 20a.
Is bent so that the angle α with respect to the tip side axis 19a is 90 ° or less. Further, the tip end side of the main body portion 19 is formed by bending in the direction of the bent portion 20 at substantially the center of the main body portion 19 so that the angle β of the tip end side axial line 19a with respect to the proximal side axis line 19b is 3 ° or more. There is.

The flexible sheath 12, the plug 16 and the main body 19 of the hard portion 18 of the venous valve dissector 10 are all formed in a hollow structure, and in the integrally connected state, the venous valve dissector A conduit 30 is formed that runs along the entire length of 10. This conduit 30 is the first
As shown in the figure, the tip side communicates with the opening 32 of the tip end surface of the main body 19 of the hard portion, and the hand side is the opening 34 of the hand side end surface of the spigot 16.
Communicate with. By attaching a syringe to the mouth plug 16, water can be supplied through this conduit 30.

FIG. 4 shows a state in which the venous valve 4 is incised by the venous valve dissection tool 10.

As usual, first, the vein 1 to be incised is clamped at a required position on the upstream side or the downstream side of the venous valve 4 to block the blood flow, and then the vicinity is incised to make an incision of a required size.
Form a few. Then, the venous valve incision tool 10 is inserted from the incision section 2 on the upstream side, and is opposed to this, and the incision section 3 on the downstream side is inserted.
Then, the blood vessel scope 6 is inserted.

Then attach the syringe 8 to the base 16 of the venous valve dissection tool 10,
The physiological saline is fed into the conduit 30. This saline is the hard part
The blood is discharged from the opening 32 that opens in the distal end surface of 18 to the vicinity of the objective lens at the distal end of the blood vessel scope 6, and blood in this vicinity is removed. Thereby, the visual field of the blood vessel scope 6 is secured. After that, while observing with the blood vessel scope 6, the venous valve incision tool
When the venous valve dissecting tool 10 is pulled toward the hand while holding the grip 14 of the venous valve 10, the venous valve 4 is dissected by the blade 26 of the bent portion 20. Since the tip end side of the main body portion 19 of the hard portion 18 is bent in the direction of the bent portion 20, the blade 26 is easily caught on the venous valve 4.

FIG. 5 shows a state in which the side branch blood vessel 1a is occluded.

In order to occlude the side branch blood vessel 1a, the balloon catheter 40, which is a side branch blood vessel occluding catheter, can be inserted through the conduit 30 of the venous valve dissection device 10. In this case, the balloon 42 is deflated and the balloon catheter 40 is inserted through the duct 30 to place the balloon 42 in the side branch blood vessel 1a. Thereafter, air is supplied from the air supply syringe 44 in the same manner as usual to inflate the balloon 42 and close the side branch blood vessel 1a.
Further, the coagulant 48 is injected into the side branch blood vessel 1a from the syringe 46 to close the side branch blood vessel 1a.

Therefore, according to the venous valve dissection device 10 described above, the visual field of the vascular scope 6 can be secured by directly supplying the physiological saline to the vicinity of the objective lens of the vascular scope 6 by the conduit 30 formed therethrough. Therefore, it is not necessary to use a catheter having a water supply function as in the conventional case, and thus the procedure for the operation can be simplified. In addition, a balloon catheter 40 for closing the side branch blood vessel 1a from the conduit 30 of the venous valve dissection device 10.
Since it is possible to insert the treatment instrument, it is not necessary to replace the treatment instrument as in the conventional case, and it is possible to reduce the time and simplify the procedure.

FIG. 6 shows a second embodiment of the present invention.

In the venous valve dissection device 10 of this embodiment, the conduit 30 communicates with the opening 33 formed at the distal end side of the bent portion 20 of the hard portion 18, and the opening 33 is formed parallel to the axis 19a of the main body. There is. Further, a branch pipe 31 penetrating the bent portion 20 branches from a pipe line 30 in the bent portion 20, and the branch pipe 31 communicates with an opening 35 opened in the head 24. The other points are similar to those of the first embodiment.

According to the venous valve dissector 10 of the second embodiment, water can be supplied into the vein from the conduit 30, and the balloon catheter 40 for occluding the side branch blood vessel 1a can be inserted through the branch pipe 31 through the opening 35. You can

Therefore, in the venous valve dissector 10 of the second embodiment, the bent portion 20 of the hard portion 18 is brought close to the required side branch blood vessel 1a, and the balloon catheter 40 can be inserted from the branch tube 31 penetrating the inside of the side branch blood vessel 1a. The blood vessel 1a can be blocked very easily in a short time.

[Advantages of the Invention] As is clear from the above, according to the present invention, water can be supplied from the conduit extending inside the venous valve incision instrument, and the visual field of the scope can be reliably ensured. Furthermore, in the case where a catheter for occluding the side branch blood vessel can be inserted through the conduit of the venous valve dissection device,
The procedure can be simplified.

[Brief description of drawings]

1 is a sectional view of a venous valve dissection device according to a first embodiment of the present invention, 2 is a sectional view of a distal end thereof, FIG. 3 is a side view of a portion similar to FIG. 2, and FIG. 5 and 5 are explanatory views of a treatment state using the venous valve dissection instrument according to the first embodiment,
FIG. 6 is a sectional view of a hard portion of the venous valve dissector according to the second embodiment, and FIG. 7 is an explanatory view showing a treatment state by the conventional venous valve dissector. 10 …… Venous valve dissector, 12 …… Flexible sheath, 14 …… Grip part, 16 …… Base, 18 …… Hard part, 22 …… Blade part, 30 …… Pipeline.

Claims (2)

[Scope of utility model registration request] 1. A venous valve incision instrument comprising a flexible sheath provided with a hard portion at a distal end thereof, a tip of the rigid portion being bent, and a blade portion being formed on a proximal side of the curved portion, at a proximal side operation. A venous valve incision instrument, characterized in that a conduit opening to the rigid portion and the rigid portion is provided in the flexible sheath. 2. A flexible sheath is provided with a hard portion at its distal end, the tip of this rigid portion is bent, and a blade portion is formed on the proximal side of this curved portion to provide a proximal operating portion and a hard portion. A venous valve incision instrument having a conduit opening to the inside of a flexible sheath, wherein the side branch vascular occlusion catheter can be inserted through the conduit.