RU2264794C1 - Vein extractor - Google Patents

Abstract

FIELD: medical engineering.

SUBSTANCE: device has conductor having thickening end parts and working part taking the middle part of the conductor and having end taper. The working part is spindle-shaped and has uneven surface for catching vein. One working part end taper is equal to 1:220-1:270 and the other one 1:220-1:300.

EFFECT: reduced risk of traumatic complications.

6 cl, 3 dwg

Description

The invention relates to medicine, in particular to vascular surgery, and can be used in the surgical treatment of varicose veins of the lower extremities.

For the removal of saphenous varicose veins of the lower extremities according to Babcock the most commonly used are smooth special extractors - probes with fixed olives at the ends (Mamamtrishvili D.G. Venous Diseases. - M .: Medicine, 1964. - 386 p .; Sirts A.I. Modification of Bebock's operation, Surgery, 1954. - No. 6. - P.81-82; Klokov A.V. Venoextractor. Surgery, 1989. - No. 7. - P.127-129). The traditional removal of the venous trunk is done by turning the veins in the form of a stocking and gloves, which is less traumatic than the corrugation method. Moreover, almost always both methods take place. So, if during the initial traction of the probe, the vein can be assembled into an accordion, then as the thickness increases, the thickness of the corrugated section increases and the resistance increases, the corrugation is straightened and then the removal is performed by the method of eversion (Shevkunenko V.N., Geselevich A.M. lower extremities. The course of surgical surgery. 1938. - T.1. - P.155).

To extract a vein with a probe by the corrugation method, you need a large head, olive so that it does not pass into the lumen of the vein (Voznesensky VP Operational Surgery. 1940. - P.581).

Even a large probe olive, significantly exceeding the caliber of the vein, does not allow removing it into the wound in the form of a corrugated tube in one go. If this can be done, which is extremely rare, then a wider tunnel remains under the skin than during eversion, in which blood accumulates with a long period of its resorption (Sirts A.I. Modification of the Beccock operation. Surgery. 1954. - No. 6. - S.81-82). This drawback is due to the imperfect design of known venoextractors. Thus, the construction of known probes with a smooth surface of the working part leads to slipping of the removed vein with the formation of a large tissue mass in the olive region with inevitable smoothing. In this case, the vein turns into a thin tourniquet, which protrudes as it traction, loses strength and is doomed to break. Secondary insertion of the probe makes the operation more traumatic and protracted. According to the observations of the authors, such a complication is observed in 1/3 of cases. In addition, a hematoma is formed along the extracted vein in the saphenous canal, which often delays the patient's hospital stay due to the development of aseptic or septic inflammation. Other analogs have the same drawback - Grisendi, ABKlokov, N.I. Krasovsky, P.N. Ostrogorsky, V.P. Sheinis, Babcock probes (I. Chervyakov. Removal of convoluted dilated veins by a spiral vein extractor. Vestn. Surgery, 1980. - No. 11. - P.138; Pokidkin VA, Zakharov EM Venoextractor for surgical treatment of varicose veins. Surgery, 1987. - 36. - P.109-112; Komarov I.A., Sergeev N.A. A modified method for the removal of saphenous veins according to Babcock. Clin. Surgery, 1989. - No. 7. - P.76).

Techniques for removing varicose veins are known when a gauze swab is used together with a smooth extractor and olives. Pre-prepared swab is moistened with hemostatic agents (hemophobin, aminocaproic acid, hemostatic sponge, etc.). A tampon fixed to the probe loop along with olive during traction tears off all branches of the main trunk and helps stop bleeding from collaterals in the subcutaneous tunnel. The described device is taken as a prototype (I. Sukharev et al. Device for removing varicose veins of the extremities. Clin. Surgery, 1980. - No. 3. - P. 65-66; Vedensky AN, Varicose disease. L .: M. 1983; 99), which has the disadvantages:

- lack of the ability to accurately select the thickness of the gauze swab;

- the inevitable ingress of gauze fibers torn off the tampon into soft tissues, which leads to inflammation and suppuration;

- the ability to tear, tear the tampon;

- during traction, the tampon is stretched, which violates the necessary contact of its surface with the wall of the vein;

- fragility of the tampon;

- vein traction is carried out only at the place of fixation of the tampon to the extractor olive;

- mismatch of the thickness of the swab to the diameter of the vein;

- stretching the swab leads to a decrease in its thickness;

- fixing the swab to the extractor delays the operation time, leads to additional manipulations;

- lack of regenerative ability of hemostatic solutions;

- when using hemostatic solutions, the development of allergic reactions is possible.

All of these shortcomings in varying degrees and frequency were observed in the surgical treatment of varicose veins. Therefore, the further improvement of devices designed to perform stripping of the saphenous veins in the surgical treatment of varicose veins is extremely relevant.

In order to prevent intra- and postoperative complications, reduce trauma, and ensure reliable hemostasis while maintaining cosmetic properties, a vein extractor of various geometries with an uneven working surface along its entire length, with a high ability to capture the vein to be removed, is proposed.

The uneven surface of the venoextractor allows it to be continuously turned inside out during removal of the vein. At the same time, the device provides continuous continuous capture of the vein as it moves along its uneven surface. An increase in the length of the segment of the removed vein, an increase in the length of the inverted invaginated vessel, does not lead to a violation of its close working contact with the surface of the device, and prevents separation and breakage of the extracted vein.

The invention is illustrated by drawings, where

Figure 1 is a General diagram of the design of the venoextractor of various options: a) spindle-shaped; b) conical bilateral; c) conical unilateral hollow - longitudinal section; g) cylindrical with a central location of the working part - thickening; e) conical with a central location of the working part - thickening;

Figure 2 - needle options for the surface of the working part

Figure 3 - options for individual ledges of various geometric shapes.

A vein extractor for removing varicose saphenous veins of the extremities with varicose veins represents a special spindle-shaped elastic elastic cord with an extension in the center - the working part 1 and gradual thinning from both ends 2 and 3. One end 2 of the vein extractor has a taper from 1: 220 to 1: 270, the other end has a taper from 1: 220 to 1:30. The flattened segments of the venoextractor are made in the form of multifilament flexible cables, strings-conductors 4 and 5, ending with flattening in the form of a “falling drop” 6 with holes 7 for threads. The difference in the taper of the thinned segments of the vein extractor is due to the fact that the vessels of various diameters and lengths are stripped (on one or both limbs on separate or both saphenous vein systems). For forced extraction of veins of small diameter and large lengths, use working segment 2 with a smooth change in diameter.

In the second embodiment (figb), the working part 1 of the device has the same taper 2 and 3 from 1: 220 to 1: 270 from both ends 4 and 5.

In the third embodiment (figv), the venoextractor has a one-sided hollow conical thickening of the working part 1 with a smoother transition to the thinned end with a taper from 1: 200 to 1: 270.

In the fourth embodiment (Fig. 1d), the working part 1 is made in the form of a cylinder, and in the fifth (Fig. 1d) - in the form of a cone rounded at the ends 8 and 9 with the working part 1 being placed in the center of the extractor, the surface 10 of the working part 1 of the vein extractor contains hidden (figa) needles 11 placed recessed into the elastic porous plastic 12, and the height of the needles 11 is less than the thickness of the plate 12, fixedly fixed on the working part 1 of the device. The head 13 of the needle 11 may have various options, for example in the form of a conical spiral.

Of the other options for artificially increasing the roughness of the surface 10 of the working part 1 of the vein extractor, there can be: 1) reinforced open (fig.2b) needle tape (card, card tape) on a soft base, seated with elastic needles 11 in the form of a "hedgehog", "ruff", "brushes" evenly spaced and bent at an angle to the side of the refined segments; 2) inconsistent with the difference of individual elementary protrusions of the same height 1 (Fig. 3), but of different shapes (a, b) of the same protrusions (c, d), but with different gaps between them b ₁ and b ₂ of macro- and microgeometrically similar surfaces (e, e), but differing in absolute sizes b ₁ and b ₂ .

When the plate 12 sags during the passage of the working part 1 of the venextractor along the venous trunk of the needle 11, they pierce the plate 12 and capture the vessel wall around the circumference. The height of the protruding free ends of the needles 11, capable of capturing the vein wall at the time of extraction, does not exceed the average thickness of the venous wall. The height of the needles 11 in the 2nd embodiment (FIG. 2b) is the same as in the 1st embodiment (FIG. 2a).

As a medicine for impregnating the working part of the venoextractor, a composition was taken containing absorbent components - 1-β-hydroxyethyl-4,6-dimethyl-1,2-dihydro-2-hydroxypyridine (xymedon) and medical gelatin in the following ratios, respectively, wt. %:

Ximedon 0.5-0.8 Medical gelatin 8.0-10.0 Sodium chloride 0.4-0.5 Distilled water Rest

The solution is prepared, if necessary, ex tempore in compliance with all conditions necessary for the preparation of injection solutions.

The proposed multicomponent therapeutic composition - XIMEZHEL (this abbreviated name means a combination of the initial letters of the main active ingredients of the therapeutic composition) includes effective chemical and biological pharmacological agents that have a direct regenerative and hemostatic effect. Xymedon is a modern optimizer of the reparative tissue process. By order of the Ministry of Health of the Russian Federation No. 287 of December 7, 1993, he was included in the Register of Medicinal Products of the Russian Federation (registration certificate No. 93/287/7) as a medicine. With topical use of xymedon solution, it is proved that the processes of tissue regeneration and reparative ability are enhanced (Izmailov S.G. et al. Xymedon in clinical practice. Nizhny Novgorod: Publishing House NGMA. - 2001. - 188 pp.).

The feasibility of including medical gelatin in the composition is justified by its pronounced hemostatic activity, as well as the ability to stimulate regenerative processes (Mashkovsky M.D. Medicines. - M .: Medicine, 1988. - T2. - P.85).

The combined effect of the use of XIMEZHEL composition is more pronounced than the simple total effect of the ingredients included in it, due to their mutual potentiated effect. Both drugs do not have a toxic effect.

The technique of operation using the proposed device is a venoextractor is as follows. In the inguinal region, the mouth of a large saphenous vein is isolated from a small incision and the Troyanov-Trendelenburg operation is performed. At the distal end, on which a circular hemostatic provisional ligature is applied, the crossed veins are injected with the thinned end (previously aged in XIMEZHELA solution with an exposure of 10-15 minutes), which is carried out to the foot. Due to its elasticity, flexibility and design features of the end part in the form of a “falling drop”, the venoextractor freely repeats all the bends of the vein, which greatly facilitates and accelerates its conduct to the thinnest sources of the main trunks. Having reached the final goal or introducing the device to the entire length of its thinned part, a skin incision is made over the end thickening and the end part of the device is removed into the wound. A vein is crossed with ligation of its distal end. Then the previously imposed provisional ligature below the working part of the device is finally sutured. Through the holes of the end thickenings, conduct and tie the threads with a length equal to the length of the removed vein, which serves as a safety net in case of separation of the device. Next, a venoextractor is traced along the vein downward, removing the vein along Bebkok. The taper of the device, which repeats that of a large saphenous vein, allows it to be extracted without additional trauma, bursting around the circumference of the wound channel, the tissue tunnel that is formed. At the same time, the diameter of the latter gradually increasing at the same time is completely closed by the growing thickness of the extractor, pressing the channel walls, which causes a mechanical stop of bleeding from damaged vessels. Gradually moving the device along the vein lumen, the walls of which constantly compress the surface of its working part with the needles exposed, the venous wall is captured from the inside and the vessel is turned inside out with layering on the extractor in the form of a stocking. The presence of a gap between the tip of the needles and the surface of the plate allows not only permanent adhesion to the extracted vein, but also simultaneous smoothing of the walls on the working part of the device without breaking them. The simultaneous reliable fixation of the walls of the vein along its entire circumference with needles, combined with smoothing, provides better conditions for uncomplicated vessel stripping. After complete removal of the veins, the device is removed through the wound on the foot. Stitches to the skin. Elastic bandage.

If necessary, in a similar manner from the popliteal fossa, the small saphenous vein is extracted onto the lower leg.

Removal of a vein by other venoextractor options, in particular with its different geometry and working surface, does not differ from the described technique.

The only difference is that after the stripping is completed, the extractor can be temporarily installed retrograde and left with the working part in the subcutaneous tunnel for 5-10 minutes for the purpose of hemostasis.

Using the proposed venoextractor allows achieving such a combination of fixation reliability, uniform distribution of the capture forces of the removed vein by eversion, chemical-biological and mechanical hemostatic and regenerative effects, which is crucial in improving the technology of safenectomy and in preventing intra- and postoperative complications. The advantages of a venoextractor are especially significant in elderly and senile patients with sclerotic and fragile vessels.

Claims (6)

1. Venoextractor containing a conductor with thickenings at the ends and a working part located in the central part of the conductor, the ends of which have a taper, characterized in that the working part is spindle-shaped and has an uneven surface for gripping a vein, while one end of the working part has a taper of 1: 220-1: 270, and the other 1: 220-1: 300. 2. Venoextractor according to claim 1, characterized in that the thickenings have a two- and one-sided conical shape, a cylindrical and conical shape with a central location. 3. Venoextractor according to claim 1, characterized in that the surface of the working part contains needles recessed in an elastic porous plate, and the height of the needles is less than the thickness of the plate. 4. Venoextractor according to claim 1, characterized in that the uneven surface is made in the form of protrusions. 5. Venoextractor according to claim 1, characterized in that the thickenings are made movable and have the shape of a “falling drop”, and holes for the threads are made in the thickenings. 6. Venoextractor according to claim 1, characterized in that the working part is impregnated with a therapeutic composition, including, wt.%: Xymedon 0.5-0.8; medical gelatin 8.0-10.0; sodium chloride 0.4-0.5; distilled water - the rest.

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