RU2407466C1 - Surgical instrument for endarterectomy - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to instruments for vascular surgery, and can be used in eversion endarterectomy, in particular in eversion carotid endarterectomy. Instrument consists of two spring branches 1 and 2. Branches 1 and 2 are fixed with their ends to each other and have on the other doubly curved ends splints in form of working jaws. Doubly curved end of any of branches 1 and 2 includes bend in transversal direction with respect to branch axis at obtuse angle and reverse twist of bend, or turn, in the same direction at acute angle. Splint of any branch 1 or 2 is located remotedly across with respect to its branch axis in direction of reverse twist. It has variable cross-section, increasing to blunt end, variable wall thickness, which decreases towards lateral rounded edhes and smooth surfaces: internal and external, frame-forming. Surfaces splints of both branches 1 and 2 contact with artery during fixation and holding it in process of eversion and separation of plaque 13, surfaces form temporary technological frame 14 for everted wall 15 of artery. In process of eversion and de-eversion instrument ensures fixation, holding and preservation of anatomical form of artery and allows to carry out separation of atherosclerotic plaque without application of traction by it.

EFFECT: invention allows to increase treatment quality and reduce time consumption on surgery.

2 cl, 5 dwg

Description

Technical field

The invention relates to a tool for vascular surgery and can be used in eversion endarterectomy (EE), in particular in eversion carotid endarterectomy (EEC).

State of the art

EE refers to reconstructive vascular surgery performed for any local, hemodynamically significant, atherosclerotic lesion of the great arteries, for example, the internal carotid artery, superficial femoral or deep femoral arteries. It consists in the removal of atherosclerotic plaque (ASB) up to about 5 cm long from the artery by separating it from the vessel wall in the process of eversion (turning the vessel like a stocking) of the wall in the distal direction.

The crucial moments of the operation are fixing the position of the crossed artery, keeping it in a fixed position for eversion of the vessel wall with separation of the adjacent part of the ASB, moving to the next section with repeating the above sequence of procedures until the ASB is completely removed and de-eversion (returning the erected artery to its original position), while removal of ASB should be quick, complete, without wall breaks and without scraps of intima in the lumen of the artery. The required quality of these procedures depends to a large extent on the tools used.

It is known to use two thin tweezers to fix and hold the position of the crossed internal carotid artery during the eversion process (Pokrovsky A.V. Eversion carotid endarterectomy. Angiol. And vessel. Chir. 2001, 7 (2): 105-6). The result of using such tools is local fixation at four points of the far from rigid structure of the vessel wall, which can cause deformation of the vessel and an obstacle to the qualitative separation of the ASB from the wall, can lead to ruptures on the inner surface of the vessel freed from the ASB, to the formation of fragments in the lumen . To this should be added the need for a high professional level and balanced nature of the surgeon for the confident manipulation of tweezers.

Known tweezers for eversion of the vessel, consisting of a pair of external elastic flat jaws, rigidly interconnected by one end, having transverse arcuate jaws at the other ends, combined during eversion with a spherical sponge of the third intermediate jaw (EP Patent No. 0518856 B1, IPC АВВ 17/30 , publ. 07/17/1996; US patent No. 4950281, nats. C. 606-207, publ. 08.21.1990).

Known tweezers are intended for partial eversion, namely for turning away the edges of stitched or fastened vessels, and are not suitable for eversion by the type of eversion of a stocking.

Known surgical instrument for carotid endarterectomy, providing fixation and retention of the operated internal carotid artery, containing two branches connected at one end, having working jaws longitudinally located in relation to the branches on other curved ends, made with the possibility of their placement on the above artery outside in a longitudinal or axial direction (US patent No. 2842132, nat. C. 606-207, publ. 08.07.1958). The working jaws of the known tool are provided with teeth, the complete closure of which is prevented by a lock made at the ends of the jaws.

The known instrument locally fixes and holds the artery during surgery, it is not suitable for migratory fixation of the eversible and deversible arteries due to the small area of contact with the artery, due to the presence of teeth and especially the lock, contributing to the deformation and violation of the integrity of the artery.

The term “migratory fixation” is used to characterize fixation with a sequentially longitudinally changing place on the object (here on the artery) with almost no separation from it.

The tool according to US patent No. 2842132 is the closest in technical essence and is selected as the closest analogue (prototype).

Disclosure of invention

The technical problem to which the invention is directed is the development of a tool for EE that can simplify, streamline, accelerate the eversion of an artery and at the same time improve the quality of separation of the ASB from it.

The technical result that can be obtained by using the invention is to improve the quality of treatment, to reduce the time spent on the operation.

To solve this problem, a surgical instrument for endarterectomy, providing fixation and retention of the operated artery, containing two branches connected at one end, having working jaws on the other curved ends, made with the possibility of their placement on the above artery outside in its longitudinal or axial direction, according to the invention , for the implementation of EE, it is made with the possibility of forming from its working jaws a temporary, technological framework capable of eliminating traction behind the ASB in the process all eversions and ensure, in addition to fixing and holding the artery together with the ASB, the anatomical shape of the artery during the eversion and deversion, the sponges of its branch are made in the form of profile tires located in the planes of the corresponding branches remotely to them and across to their longitudinal to the axes, in the direction of the angle of inverse inflection of their ends bent in the transverse direction, the profile tires are made with a variable cross section in the form of a sector of the ring, increasing towards the blunt end of the tire, and with a variable wall thickness, decreasing towards the blunted lateral edges, the tire sizes correspond to the sizes of the stenotic section of the artery, thickened to the mouth, the inner and outer surfaces of the tires are smooth and are designed: internal for the migratory sequential fixation and retention of the artery during the eversion and deversion of its wall, and the outer , carcass-forming, for holding the eversed wall in an undeformed state, while in a particular case when using a tool in the ECE, the angle of bending of the end the battle from the branches is 140 ° ± 30 ', and the angle of its inverse inflection is 60 ° ± 30' to the longitudinal axis of the corresponding branch.

Distinctive features of the prototype of the features of the claimed tool are the following:

a) signs that provide a technical result in all cases:

- the implementation of the tool for the implementation of EE with the possibility of forming from its working jaws a temporary technological framework capable of eliminating traction behind the ASB during the eversion process and, in addition to fixing and holding the artery together with the ASB, preserve the anatomical shape of the artery in the process of its eversion and deversion,

- the implementation of the working jaws of his jaw in the form of profile tires located in the planes of the respective jaws remotely to them and across to their longitudinal axes, in the direction of the angle of the reverse bend of their ends bent in the transverse direction,

- the implementation of the profile tires with a variable cross-section in the form of a sector of the ring, increasing towards the blunt ends of the tires, and with a variable wall thickness, decreasing towards the blunt side edges,

- compliance of tire sizes with the sizes of the stenotic section of the artery thickened to the mouth,

- the implementation of the inner and outer surfaces of the tires smooth and their purpose: internal - for migratory sequential fixation and retention of the artery in the process of eversion and deversion of its wall, external, carcass-forming, - to keep the eversed wall in an undeformed state;

b) a sign that provides a technical result in a particular case:

- when using the tool in the ECE, the angle of bending of the end of any of the branches of 140 ° ± 30 ', and the angle of its inverse bending of 60 ° ± 30' to the longitudinal axis of the corresponding branch.

These distinctive features, each individually and all together, are aimed at solving the problem and are significant.

Using the combination of these features in the prior art, analogues and prototype is not found.

A single set of new essential features with common known allows you to solve the problem.

The claimed tool provides an improved quality of treatment by providing the ability to perform dynamic and at the same time sparing eversion of the stenotic artery wall without traction behind the ASB while maintaining the integrity of the wall itself, by keeping the eversible wall together with the ASB in a fixed undeformed state until the ASB disappears, due to the possibility of unimpeded deversion of the vessel, and due to the possibility of re-eversion of the endarterectomy artery in order to revise the endarterectomy zone and zones "Eroding" ASB.

The implementation of the proposed tool with working jaws in the form of tires with smooth inner and outer surfaces allows you to expand its functionality and use it not only for fixing and holding the artery, but also as a temporary technological frame for laying on it the erected wall of the vessel and to return the ejected vessel to the initial position after removal of the ASB, and this, in turn, simplifies and accelerates the eversion, ensures the purity of the walls and unhindered clearance in the operated artery.

The choice of the tire alignment angle relative to the tire is made experimentally for a particular application and is due, on the one hand, to the necessity of orientation of the branches during an operation close to vertical, and on the other, to the need to achieve a uniform fit of the tires to the artery while maintaining their exact longitudinal location on the artery.

The variability of the tire cross section is due to the shape of the artery filled with ASB with its largest dimensions at the mouth of the artery. It is at the mouth before the start of the erection that the extended ends of the tires are placed.

The variability of the wall thickness, decreasing to the side edges, is caused by the need to prevent undesirable excessive stretching of the ejected vessel due to the total thickness of the carcass, which is the sum of the thicknesses of both tires.

The tool is made with the possibility of its reciprocating movement along the vessel in the longitudinal direction with virtually no separation from its wall.

All of the above allows us to conclude that the main advantages of the proposed tool over the prototype tool is the additional functional ability to use it as a frame and the ability to carry out the eversion of the stenosed artery wall without traction for ASB. Other advantages are associated with the ability to use the instrument for migratory, multiple fixation of the vessel with long-term retention for a high-quality eversion.

The invention is illustrated by drawings, where figure 1 shows the claimed tool, General view, figure 2 shows the branch of the tool, general view, figure 3 shows a view I of figure 2, figure 4a is an enlarged section along aa Fig.3, Fig.4b is an enlarged section along BB of Fig.3, Fig.5 shows a diagram of the placement of the erected artery wall on the frame formed by the tires of the proposed tool.

The EE tool, which ensures the fixation, retention and preservation of the anatomical shape of the artery during the eversion and deversion, consists of two identical spring-loaded branches 1 and 2, fastened together by one of their ends 3, having on the other bent ends 4 of the bus 5 as working jaws ( figure 1, 2; figure 2 for example presents branch 1).

The jaws 1 and 2 are fastened by any connection suitable for this purpose, for example a screw connection.

The bent end 4 of any of the branches 1 or 2 includes a bend 6 in the transverse direction relative to the axis O of the branch at an angle α and a reverse bend 7 of bend 6, or a turn in the same direction at an angle β. In the case of using the tool for EEC, the angle α will be 140 ° ± 30 ', and the angle β 60 ° ± 30'.

Tire 5 of any of branches 1 or 2 is located remotely across the axis O of its branches in the direction of backward inflection 7. It has a variable cross section increasing towards the blunt end 8. It also has a variable wall thickness decreasing towards lateral rounded edges 9, and smooth surfaces: inner 10 and outer, carcass-forming, 11 (Fig.3, 4). The surface 10 of the tires 5 of both branches 1 and 2 are in contact with the artery 12 while fixing and holding it during the eversion and separation of the ASB 13, and the surface 11 form a temporary technological frame 14 for the eversed wall 15 of the artery 12 (Fig. 5).

Work tool.

To remove the ASB 13, the artery 12 is crossed at the mouth, holding the clipped stenotic part with the tires 5 of the claimed instrument. Tires 5 are placed along the artery 12 with the alignment of their ends 8 with its mouth and ensuring contact with it of their inner surfaces 10. Bend the edge of the artery 12, separating the body of the ASB 13, and eject the freed wall 15 while pulling it on the outer surfaces 11 of the tires 5. From this moment, the tires 5 become the carcass 14 for the eversed wall 15 of the artery 12, and their outer surfaces 11 become carcass-forming, providing contact with the artery 12. Removal of the ASB 13 and the ejection of the freed artery 12 are performed until the ASB 13 “disappears”, 5 tires in the longitudinal direction, practically without tearing them away from the artery 12. Upon completion of the removal of the ASB 13, the artery 12 is de-eversed, moving the bus 5 in the opposite direction.

The experience of using the claimed instrument in ECE confirmed the persistent clinical effect of its use and adequate patency in the reconstructed arteries. He also confirmed a decrease in the time of clamping the carotid artery, and hence the duration of the operation, by 5.5 minutes.

Industrial applicability

The claimed surgical instrument is manufactured under industrial conditions from a material suitable for this purpose, for example, from metal.

Claims (2)

1. A surgical instrument for endarterectomy, providing fixation and retention of the operated artery, containing two branches connected at one end, having working jaws on the other curved ends, made with the possibility of their placement on the above artery outside in its longitudinal or axial direction, characterized in that for the implementation of eversion endarterectomy, it is made with the possibility of forming from its working jaws a temporary technological framework capable of eliminating traction beyond the atherosclerotic a plaque during the eversion process and, in addition to fixing and holding the artery, along with the plaque, ensure the preservation of the anatomical shape of the artery in the process of eversion and deversion, while the working jaws of its jaw are made in the form of profile tires located in the planes of the corresponding branches remotely to them and across to them longitudinal axes in the direction of the angle of inverse inflection of their ends bent in the transverse direction, the profile tires are made with a variable cross section in the form of a ring sector, increasing towards the blunt to the flare end of the tire, and with a variable wall thickness decreasing towards the blunted lateral edges, the tire sizes correspond to the sizes of the stenotic section of the artery thickened to the mouth, the inner and outer surfaces of the tires are made smooth and are intended: internal for the migratory sequential fixation and holding of the artery during eversion and deversion of its wall, and external, frame-forming, to hold the eversed wall in an undeformed state. 2. The tool according to claim 1, characterized in that when used in an eversion carotid endarterectomy, the angle of bending of the end of any of the branches is 140 ° ± 30 ', and the angle of its inverse bending is 60 ° ± 30' to the longitudinal axis of the corresponding branch.

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