RU34075U1 - Partial occlusion of the inferior vena cava - Google Patents

Description

CLIPS FOR PARTIAL OCCLUSION OF THE LOWER HOLLOW VEIN

The proposed utility model relates to medicine, namely to devices for the prevention of pulmonary embolism during wide-band surgery on the abdominal cavity.

Known devices for the prevention of pulmonary embolism, which have received the most widespread use, such as B.C. Saveliev, E.G. Yablokov, A.I. Kiriyenko "Thromboembolism of the pulmonary arteries, M., publishing house" Medicine, 1979, p. 264.

Cava filters are implanted into the inferior vena cava and are an obstacle to the migration of thromboembol into the pulmonary artery, while maintaining blood flow in the vein.

The disadvantage of such devices is that special angiographic equipment is necessary for implanting the cavafilter, and surgeons who have undergone special training can perform the implantation, while the threat of pulmonary embolism very often arises when performing wide-band abdominal operations in conventional operating rooms.

In addition, when performing a wide-cavity operation on the abdominal cavity, the second cava-filter implantation operation is an additional burden for the patient.

Known clip (terminal) for partial occlusion of the inferior vena cava, used to prevent pulmonary embolism, consisting of two jagged branches, the ends of which are made with the possibility of pulling them with B.C. ligature thread. Saveliev, E.G. Yablokov, A.I. Kiriyenko "Thromboembolism of the pulmonary arteries, M.," Medicine, 1979, p. 112 ... 113. When applying the clip, it is superimposed on the inferior vena cava, and its ends are pulled together by ligature thread, which allows the vein to be divided into several small ducts, impassable for an embolos thrombus. The overlay of the clip is performed by operative access and can be easily performed during wide-band abdominal surgery.

A disadvantage of the known clip is that when it is applied, partial occlusion persists for life and is a risk factor for thrombosis of the inferior vena cava. As practice shows, in the distant period, more than half of the patients experience occlusion of the inferior vena cava at the level of the clip installation, even if the vein remained passable after the end of the embolism-hazardous period.

The basis of the proposed solution is the creation of a device for the prevention of pulmonary embolism in the form of a clip for partial occlusion of the inferior vena cava, which makes it possible to remove the occlusion after an embolus period.

The problem is achieved in that the clip for partial occlusion of the inferior vena cava, consisting of two elastically connected

gear branches, the ends of which are made with the possibility of pulling them with ligature thread, according to the proposal, at the end of one of the branches

a slot is made and a hole perpendicular to it, through which a monofilament with a thickness of 0.4 ... 0.6 mm is drawn, while the ligature thread is brought into the slot and circled around the monofilament.

Thanks to such distinguishing features of the proposed clip, it is possible to remove partial occlusion after an embolus period without significant surgical intervention.

The following is a detailed description of the design and use of the clip for partial occlusion of the inferior vena cava, which is illustrated by the following figures:

;

FIG. 2 illustrates a section AA in FIG. 1;

FIG. 3 illustrates a clip mounted on the inferior vena cava;

FIG. 4 illustrates a clip mounted on the inferior vena cava after removal of occlusion.

Shown in FIG. 1 and 2, the clip for partial occlusion of the inferior vena cava, according to the proposed utility model, consists of jagged jaws 1 and 2 connected by an elastic part 3. A ligature thread 4 is fixed at the end of the jaw I. To cut the thread 4 in the jaw 1, a slot 5 is made and perpendicular she has an opening 6 through which monofilament 7 is made of a thickness of 0.4 ... 0.6 mm. Thread 4 is wound into slot 5 and bends around monofilament 7. At the end of branch 2, neck 8 is made.

The clip for partial occlusion of the inferior vena cava is used as follows.

With surgical intervention on the abdominal cavity and the occurrence of a threat of pulmonary embolism, the jaw 1 of the clip together with the ligature thread 4 and monofilament 7 is carried out under the inferior vena cava, and then the neck 8 of the jaw 2 is covered with the ends of the ligature thread 4 and the jaws 1 are tied together, 1 and 2 until their ends touch. Thread 4 is tied with a triple knot and its ends cut off. Monofilament 7 is withdrawn subcutaneously, as shown in FIG. 3.

At the same time, monofilament 7 with a thickness of 0.4 ... 0.6 mm is sufficiently rigid to ensure reliable fastening of the ligature thread 4 at the end of jaw 2 without deflection in slot 5, and at the same time flexible enough to remove it subcutaneously.

The tightened branches 1 and 2 flatten the vein 9, and its channel under the influence of the teeth on the branches 1 and 2 is divided into a number of channels with a diameter of 6 mm (Fig. 3). Channels with a diameter of 6 mm are impassable for an embolosome blood clot and therefore the clip prevents the pulmonary embolism, but this partial occlusion of the vein disrupts normal blood flow and is a risk factor for blood clots in the area where the clip is placed in the long-term postoperative period.

After the end of the embolus period, if complete occlusion of the vein has not occurred with a migrating thrombus, partial occlusion is removed.

To do this, isolate the monofilament 7 and pull it out of the hole 6 in the jaw 1. When removing the monofilament 7, the ligature thread 4 is disconnected from the jaw 1, and due to the elastic part 3 and the internal pressure in the vein 9, the jaws 1 and 2 diverge from each other by an angle of 30 °, which gives an increase in the lumen in vein 9 to a state close to normal (Fig. 4).

Monofilament 7 is removed from the patient’s body.

This procedure for removing partial occlusion is simple and less traumatic.

In the event that the clip has fulfilled its direct purpose, i.e. due to partial occlusion, a blood clot was delayed, which prevented pulmonary embolism, and partial occlusion was not removed. In this case, the jaws 1 and 2 of the clip remain tightened with ligature thread 4 forever.

Thus, the proposed clip for partial occlusion of the inferior vena cava allows not only to effectively prevent pulmonary embolism, but also to remove partial occlusion after the end of the embolism period.

Industrial applicability

The proposed clip for partial occlusion of the inferior vena cava was tested in the clinical practice of the Chelyabinsk Regional Clinical Hospital and showed its high efficiency for the prevention of pulmonary embolism.

Claims (1)

A clip for partial occlusion of the inferior vena cava, consisting of two elastically connected dentate branches, the ends of which are made with the possibility of pulling them with a ligature thread, characterized in that a slot is made at the end of one of the branches and an opening perpendicular to it through which a monofilament with a thickness of 0.4 is made. ..0.6 mm, while the ligature thread is wound into a slot and circled around the monofilament.