RU1773417C - Method for restoration of blood flow in atheroselerotic blood vessels - Google Patents

Abstract

The invention relates to medicine, namely to vascular surgery, and can be used to treat patients with obliterating atherosclerosis of lower limb arteries. The goal is to increase the penetration of the laser beam when exposed to helium-neon laser radiation on atheros clerotic formations. The goal is achieved. that a 0.15% hydrogen peroxide solution is introduced at a rate of 6-9 ml / min into the artery, to the end of the fiber, simultaneously with the action of radiation from a helium-neon laser. As a result, tiny oxygen bubbles are formed which provide significant scattering of the laser radiation. This creates the best conditions for the transmission of laser radiation to an atherosclerotic substrate, regardless of the location of the working end of the fiber in the lumen of the artery. Fig. 1.

Description

The method relates to medicine, namely to vascular surgery and can be used to treat patients with arteriosclerosis obliterans of the lower limb arteries.

A known method of restoring blood flow in vessels affected by atherosclerosis by exposure to helium-neon laser radiation.

A disadvantage of the known method is the screening effect, which prevents the transmission of laser radiation energy to the material of the atherosclerotic plaque.

However, a disadvantage of the known method for restoring blood flow in vessels affected by atherosclerosis is the low degree of penetration of the laser beam.

The aim of the proposed method is to increase the penetration of the laser beam.

The goal is achieved in that a 0.15% hydrogen peroxide solution is injected at a speed of 6-9 ml / min into the artery, to the end of the fiber, simultaneously with exposure to radiation from a helium-neon laser. When a hydrogen peroxide solution was brought to the working end of the fiber, a new property of peroxide was revealed, namely, the formation of tiny oxygen bubbles upon contact of the peroxide with blood, which provided significant scattering of laser radiation. This effect provides the best conditions for the transmission of laser radiation to an atherosclerotic substrate, regardless of the location of the working end of the fiber in the lumen of the artery.

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The illumination of the artery wall was evaluated experimentally on a device for selecting the optimal solution capable of increasing the transmission of helium-neon laser radiation to the artery wall.

Schematic diagram of the device shown in the drawing. The main element of the device is a glass tube-artery 1. The tubes and adapters of the device are made of thromboresistant materials. The peristaltic pump 2 is able to pump blood through the tube at the required speed. A catheter 3 with an optical fiber 4 is inserted into the artery tube. The peristaltic pump 5 is capable of delivering various solutions to the catheter to the end of the optical fiber. The value of the laser radiation penetrating outside the artery was determined using an integrating sphere 6. As a source of laser radiation 7, the LFL-1 physiotherapeutic unit based on a 0.632 µm helium-neon laser A was used. Laser energy was transmitted through a flexible quartz-polymer fiber with a quartz core diameter of 200 microns. The radiation power at the end of the fiber is 15 mW. The divergence of the radiation at the output of the fiber is 0.25-0.3 rad.

Heparinized blood of a patient with atherosclerosis was pumped from tank 8 through a glass tube-artery ($ - 5 mm) at a rate of 300 ml / min.

The table shows the relative units of illumination of the artery wall under various conditions. Over 100% of accepted maximum illumination of the arterial wall. As follows from the table, a significant increase in the illumination of the artery wall was noted when a 0.15% hydrogen peroxide solution was brought from the container 9 to the end of the fiber. This effect is due to the fact that upon the contact of hydrogen peroxide with blood, a large number of tiny oxygen bubbles formed at the end of the fiber 10. The presence of gas provided, first of all, for mechanical dilution of blood at the end of the fiber. Gas bubbles, which were nonabsorbing elements scattering laser radiation, provided pronounced scattering of radiation from a helium-neon laser, which contributed to the illumination of the artery wall. Changing the blood flow velocity from 300 to 700 ml / min, using tube-arteries with a diameter of 5 to 9 mm, it was found that the maximum

the illumination of the artery wall at a blood flow rate of 300 ml / min is ensured by bringing a 0.15% hydrogen peroxide solution at a speed of 6 to the end of the fiber

ml / min At a blood flow of 700 ml / min, the rate of addition of the hydrogen peroxide solution increases to 9 ml / min. Changing the diameter of the artery in this case does not matter. Thus, summing up to

0 the end of the fiber 0.15% hydrogen peroxide solution to b ml / min does not provide maximum illumination of the artery wall, summing up the hydrogen peroxide solution, more intense than 9 ml / min, does not

5 more to increase the illumination of the artery wall, regardless of its diameter. Therefore, the addition of a 0.15% hydrogen peroxide solution at a speed of 6–9 ml / min to the fiber end is optimal for creating the best conditions for illuminating the arterial wall

iliac-femoral-popliteal arterial segment.

Closing the tube - black paper artery with a window & 2 mm at the level of the end of the fiber, it was found that when the hydrogen peroxide solution is supplied, the illumination of the diaphragmed section of the artery does not change with the location of the end of the fiber in the artery lumen. When a saline solution is supplied, the displacement of the fiber end along the vessel diameter leads to a significant decrease in the illumination of the diaphragm

5 sections of the artery. The diaphragm end face of the artery established that the recorded increase in illumination of the artery during the supply of saline is due to a change in illumination

0 of this particular area, therefore, physiological saline allows to increase the depth of radiation penetration along the laser beam, while the illumination of the artery wall does not change.

5 to the end of the fiber, a weak solution of hydrogen peroxide provides an increase in the illumination of the artery wall, and the penetration depth of the laser beam along the axis of the vessel also increases.

0 Thus, the effect of laser radiation scattering creates the best conditions for the effective action of laser radiation on the atherosclerotic substrate, and the location of the working end of the fiber relative to the atherosclerotic plaque is not important. The addition of a 0.15% hydrogen peroxide solution at a rate of 6-9 ml / min provides the conditions for the effective action of laser radiation on atherosclerotic occlusions,

and stenotic segments of the artery. In addition, the introduction of a solution of hydrogen peroxide in the radiation zone of a helium-neon laser provides the donation of free oxygen, which has an effect on the efficiency of the laser action. In turn, radiation from a helium-neon laser reduces the possibility of the toxic effect of hydrogen peroxide, increasing the activity of catalase,

A method of restoring blood flow in vessels affected by atherosclerosis is as follows; Under local anesthesia, an angiographic catheter with a diameter of 1.1 mm is transfemorally inserted into the lumen of the artery under the control of fluoroscopy to the site of narrowing or atherosclerotic occlusion. A flexible quartz-polymer laser waveguide with a quartz core diameter of 200 µm is inserted into the lumen of the catheter. A 0.15% hydrogen peroxide solution is supplied to the catheter lumen through the Infusomat under pressure at a rate of 6-9 ml / min. At the same time, laser A 0.632 μm is turned on. The divergence of the radiation at the output of the fiber is 0.25-0.3 rad. The radiation power at the end of the fiber is 15 mW. Exposure time 10 min. After the session, the catheter is removed and hemostasis is performed.

Example Patient P. 53 years old, East. Bol, No. 23922, was admitted to the vascular department on 11/27/89, with complaints of pain in the left foot at rest, difficulty in moving fingers, numbness of the foot. Sick for about 5 years, during which he noted the effects of intermittent claudication. The condition has worsened over the past 6 months. Gradually, pains appeared at rest. A clinical examination found that the state of moderate severity. Bullet 92 in 1 min. AD-130/80 mm Hg The left foot is pale, cold to the touch. Finger movements are limited, pain sensitivity on the foot is reduced. Pulsation of the left femoral artery is detected, but weakened, there is no pulse distal. Diagnosis: Obliterating atherosclerosis of the vessels of the lower extremities, Occlusion of the left femoral artery. Decompensation of impaired circulation in the left lower limb.

In ultrasound dopplerography (Doppler ultrasound), the ankle index (ID) on the left is 0.21. The infographic index (RI) of the left lower leg is 0.15. 12/12/89, under local anesthesia, the femoral artery was catheterized. Arteriography of the left lower limb was performed. There is atherosclerotic occlusion of the femoral artery in the middle third. The catheter is brought to the site of occlusion. A flexible light guide was inserted into the catheter, and the laser radiation I was 0.632 µm. The radiation power at the end of the fiber is 15 mW. Exposure time 10 min. At the same time, a 0.15% hydrogen peroxide solution was supplied to the end of the fiber at a rate of 9 ml / min. After the session, the catheter was removed, hemostasis was performed. The day after the session, the patient noted the disappearance of spontaneous pain in the left foot, warming of the limb, and sensitivity was restored. After 3 days, intermittent claudication occurred only after 100 m distance. After 5 days the patient passed 400 m. A peripheral pulse was transmitted along the wils. Overall well-being improved significantly, sleep was normalized. RI of the left tibia increased to 0.48. During the control ultrasound examination, it was found that the ID on the left is 0.85. In satisfactory condition, the patient was discharged for outpatient treatment.

Thus, a single intra-arterial exposure to helium-neon laser radiation with the simultaneous addition of a hydrogen peroxide solution to the end of the optical fiber ensured the restoration of the arterial blood flow to the extremities, which is confirmed clinically as well as by functional research methods.

Claims (1)

The claims A method of restoring blood flow in vessels affected by atherosclerosis by exposing atherosclerotic lesions in the artery to radiation of a helium-neon laser while simultaneously supplying an anti-shielding solution to the artery to the end of the fiber, characterized in that, in order to increase the penetration of the laser beam, as an anti-shielding solution hydrogen peroxide of 0.15% is supplied at a rate of 6-9 ml / min.