RU163156U1 - TOOL FOR DESTRUCTION OF FREE VALVES OF AUTO-AUTONOMOUS TRANSPLANT - Google Patents

Abstract

A tool for destroying the valves of a free autogenous transplant, containing a nozzle for a syringe, a hollow conductor with a working part, a channel for supplying washing liquid and a perforation hole, characterized in that the working part of the tool corresponds to the shape of the venous sinus, and the perforation hole is located at the base of the working part with flushing fluid supply along the tool path.

Description

Valve destruction instrument for a free autogenous graft

The utility model relates to medical equipment, more specifically to instruments used in vascular surgery and can be used to destroy valves of a free autovenous transplant.

Closest to the proposed tool is a device for the destruction of the valves of the phlebotransplant, developed by Yanov V.V. et al. Patent No. 2251392. In this case, the working cylinders of the device are introduced into the distal section of the autovenous graft and they are advanced in the proximal direction. Then, simultaneously with the liquid supply from above, from the proximal end of the graft, the tool begins to move in the distal direction. When there is a feeling of resistance, indicating that the cutting part of the proximal working cylinder contacts the base of the valve leaflet, they begin to carefully pump liquid under pressure into the channel, the valve leaflet opens and the graft valves are excised with the cutting edge.

The disadvantages of the known device are:

1). When the device is held in the proximal direction, valve flaps stick to the vein wall due to overstretching of the venous sinuses due to the mismatch between the diameter of the venous sinus and the diameter of the working cylinders of the device. As a result, when the liquid is supplied from above, the damaged, stuck valves do not fully open and only their partial destruction occurs during reverse traction of the cutting working part of the device.

2). The known device has a cutting edge in the working part, as a result of which intimate trauma can occur, which provokes platelet adhesion and further contributes to thrombosis of the autovenous graft.

3). It is necessary to control the complete destruction of valves using angioscopy, which requires special equipment and lengthens the duration of the operation.

4). The design of the device is very complex, which leads to difficulties in its manufacture and increases the cost.

Effect: to create an optimal tool for the destruction of the valves of a free autogenous graft under visual control in order to increase its throughput without damaging the inner wall of the autogenous shunt.

The technical result is achieved by the fact that the tool consists of a nozzle for a syringe, a hollow conductor with a channel for supplying washing fluid and a working part, in the form corresponding to the venous sinus. An instrument is inserted into the proximal section of the graft with a diameter corresponding to the size of the vein. It is promoted in the distal direction, pre-pumping saline into the lumen of the graft. Under visual control, valve flaps are determined. The working part of the instrument, corresponding to the shape of the venous sinus, under the control of vision, first destroys the valve of the autovenous valve on one side, and then on the opposite side. The complete destruction of the valves is convinced by the good pressure of the flushing fluid emerging from the distal end of the graft.

The utility model is illustrated by the following figure:

In FIG. 1 shows the proposed tool:

A - free autovenous graft

1 - tip for connecting a syringe

2 - channel for starting washing fluid

3 - perforation hole

4 - sash autogenous valve

5 - the working part of the tool

The tool is used in the following way:

A large saphenous vein is excised over the thigh from separate sections. The flowing collaterals are bandaged. An instrument with a diameter corresponding to a vein gauge is inserted into the proximal section of a free autovenous transplant (A). It is promoted in the distal direction, pre-pumping saline with a syringe connected to the tip (1). The fluid enters the graft through the channel (2) and exits the perforation (3). Under visual control, valve flaps are determined. The working part of the instrument (5), having the shape of a venous sinus, under the control of vision, is first destroyed by the autogenous valve flap on one side (4), and then on the opposite side. The complete destruction of the valves is convinced by the good pressure of the flushing fluid emerging from the distal end of the graft.

The utility model is illustrated by the following example:

Execution example. Patient C., age 58 years.

Hospitalized in the department of the city of Kursk 04/15/14 with complaints of constant pain in the right lower limb. After examination, critical ischemia of the right lower limb was revealed due to occlusion of the superficial femoral artery. The popliteal artery is passable. 04/18/2014 surgery: femoral-popliteal autovenous bypass graft. A cut in the inguinal region reveals a bifurcation of the common femoral artery. An audit found that the superficial femoral artery is completely occluded. A cut in n / 3 of the thigh along the inner surface reveals the initial section of the popliteal artery, which is passable. 2 cuts of the skin and subcutaneous tissue were made along the inner surface of the thigh, a large saphenous vein was exposed and isolated, the flowing tributaries were bandaged and crossed. The vein is cut off at the place where it flows into the femoral vein, the defect in the last is sutured. The large saphenous vein is crossed at the level of the knee joint, the distal end is doped. An instrument with a diameter of 3 mm was inserted into the proximal end of the graft. The latter is advanced in the distal direction, pre-pumping saline into the lumen of the graft. Under visual control, valve flaps are identified. The working part of the instrument, corresponding to the shape of the venous sinus, under the control of vision, is first destroyed by the autogenous valve flap on one side, and then on the opposite side. Moving the instrument distally, another 3 venous valves were destroyed in the same way. The complete destruction of the valves was confirmed by the good pressure of the flushing fluid emerging from the distal end of the graft. A proximal anastomosis was placed between the common femoral artery and the proximal end of the graft end to end. The transplant conducted a campaign of the neurovascular bundle and anastomosed with the initial section of the popliteal artery end to side. Restored blood flow by shunt, sutures for wounds. The postoperative period was uneventful. During the control ultrasound, the volumetric blood flow through the shunt was 500 ml / min. Examined after 3 months: the shunt is functioning. Critical ischemia is stopped. The patient complains of pain in the limb does not show.

Advantages of the proposed tool: allows you to destroy the valves of a free autogenous graft under the control of vision, the working part, having the form of a venous sinus, which contributes to the minimum trauma of intima and low risk of thrombosis

Claims (1)

A tool for destroying the valves of a free autogenous transplant, containing a nozzle for a syringe, a hollow conductor with a working part, a channel for supplying washing liquid and a perforation hole, characterized in that the working part of the tool corresponds to the shape of the venous sinus, and the perforation hole is located at the base of the working part with flushing fluid supply along the tool path.

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