RU2151558C1 - Device for clipping perforated veins - Google Patents

Abstract

FIELD: medical engineering. SUBSTANCE: device has parallel legs joined with arch-like region shaped as equilateral rhomb. Free ends of the legs are bent outward. When compressing the arc-shaped region, the legs become crossed at the place they turn into arch-like region retaining their parallel relation. The curved legs of knives touch each other with their ends for preventing clamp from slipping off from vein and for creating lumen for the vessel to be occluded. EFFECT: enhanced reliability in occluding perforated veins; lower risk of traumatic complications. 2 cl, 3 dwg

Description

 The invention relates to medicine, namely to vascular surgery.

 Varicose veins are a common pathology of the superficial veins of the lower extremities. It occurs in 9 - 22% of all people, and the disease has the most pronounced clinical manifestation mainly in people 25 - 55 years old, that is, of the most working age. It is believed that over 45 years old, every fifth woman and every 15th man suffers from varicose veins of the lower extremities.

 Regardless of the method of removal or obliteration of the saphenous dilated veins, a prerequisite for the quality treatment of varicose veins is the separation of the superficial and deep venous systems by ligation and dissection of perforating veins under aponeurosis (Linton's operation). The aponeurosis is widely opened on the medial or posterior surface of the lower leg, perforating veins are ligated and intersected. In some cases, the integrity of the aponeurosis is restored in the form of duplication (A.V. Pokrovsky, "Clinical Angiology", M., "Medicine", 1979, p. 287). Linton's method is reliable, but extremely traumatic and cannot be used with a conservative and combined method of treatment of varicose veins.

 Known bracket clip for pinched blood vessels during surgery, consisting of a pair of working jaws, turning into branches and connected in the form of a node. The clip is superimposed with a tool that spreads working jaws before applying to the vessel (Japan, application N 3-34730, M. class A 61 B 17/12, publ. 91.05.23, N 1-869 "Clip for clamping blood vessels. ..).

 The disadvantage of the clip is that it is not suitable for use in an endoscopic device: the sponges cannot intersect, therefore, without additional action, they are not able to open themselves before being applied to the vessel and lock themselves on it.

 Known medical clamp used in the treatment of vein expansion and containing two elongated flat clampable legs connected by an intermediate segment with a separate ring segment, in which there is a silicone rubber liner to create an effort that reduces the elongated legs (USA, US Pat. N 4416266, publ. 83.11 .22, t. 1036, No. 4, M. class A 61 B 17/12, "Medical clip").

 The disadvantage of the clamp is that it is not suitable for use in an endoscopic device: its legs are not suitable for independent opening and closing on a vein, an external tool is required for this. In addition, the clamp is made of a material that is transparent to x-rays, which does not allow it to be used for puncture overlay on a vein under radiopaque control.

 The closest device to the claimed is a clamp for applying anastomoses to vessels, containing parallel legs connected by an arcuate section (A. S. USSR N 787014, A 61 B 17/12, 1980, BI N 46.80). The disadvantage of the bracket is that the legs can not be independently bred, and then locked in a vein, which does not allow its use in an endoscopic device.

 The objective of the invention is to increase the reliability and efficiency of clamping perforating veins, the possibility of percutaneous aiming endoscopic installation of brackets, reducing the invasiveness of the operation. The problem is achieved in that the arcuate section has the shape of an equilateral rhombus, and the free ends of the legs are opposite bent outward, while the legs themselves when squeezing the arcuate section are made with the possibility of crossing at the point of transition into the arcuate section while maintaining parallelism and with the possibility of closing the curved ends with their ends to prevent the bracket from slipping from the vein and the formation of a lumen under the constricted vessel; The bracket is made of spring metal elastic wire.

The novelty of the design:
1. The implementation of the legs with the possibility of crossing in the transition zone of the arcuate section with the formation and preservation of the gap between them due to their parallelism and elastic properties of the metal - ensures that the perforating vein is uniform and full, and the staple design allows for percutaneous puncture installation on the vein, and the presence of bent ends of the legs ensures reliable fixation of the bracket on the vein, prevents its slipping from the vein.

 2. The implementation of the arcuate portion of the bracket in the form of a rhombus ensures its uniform compression in the device for clipping and aimed crossing of the legs only in the zone of transition of the legs into the rhomboid part.

 The invention is illustrated by drawings, where in Fig.1 shows a General view of the brackets, Fig.2 - the position of the brackets in the auxiliary device for its installation; figure 3 is a bracket mounted on the vessel. Bracket 1 for the surgical treatment of insolvent perforating veins is made of spring metal wire with spring properties and is made in one piece, which contains straight parallel legs 2 connected at one end by an arcuate (diamond-shaped) section 3 having the shape of an equilateral rhombus. Other free (distal) ends of 4 legs are bent opposite outwards. The legs of the bracket when squeezing the arcuate rhomboid section at the place of its transition 5 into the mentioned legs intersect, maintaining parallelism, and form a lumen 6 under the pinch vessel (vein) 7, while the bent ends of the legs with their ends 8 are closed. And due to the elastic properties of the metal held in this form. The bracket is brought to the vein using a special device 9.

 Bracket for clipping perforating veins works as follows.

 In a patient with varicose veins in an x-ray, an ascending contrast phleboscopy of 20–40 ml of a 76% solution of urografin is performed, and inconsistent perforating veins to be clipped are detected. In the projection of veins, the skin on the lower leg, thigh is marked with a solution of brilliant green or potassium permanganate, treated with an antiseptic and transdermally punctured under X-ray control close to the perforating vein under local anesthesia with a 0.25-0.5% novocaine solution and a clipping device is inserted into which a sterile is inserted bracket 1. When installed in the device, the diamond-shaped part 3 of the bracket is compressed, the legs 2 intersect at the place of their transition 5 into the diamond-shaped section and move apart to the stop in the inner wall of the device. After making sure that the device is correctly standing, the bracket is brought to the perforating vein under x-ray control, then the bracket is completely ejected from the device. At this moment, the diamond-shaped part of it is compressed as much as possible and the opposite curved distal ends of the 4 legs 2 diverge. In this case, the bent ends with their ends 8 are oriented towards each other. The bracket approaches the vein, completely leaves the device and, due to the springing property, squeezes the perforating vein with its legs. The free ends of the 4 legs 2 are again parallel, but crossed at the junction 5, due to this, the opposite curved ends of the 4 legs 2 are installed in the opposite direction, forming a lumen 6 and preventing the bracket from sliding off the vein 7. At the same time, the size of the formed lumen is minimal for adequate compression veins. The device is removed from the soft tissues of the limbs. Using X-ray control, they are convinced of the correct position of the brackets and interruption of blood flow through the vein. If necessary, other inconsistent perforating veins are similarly clipped. Then, varicose dilated subcutaneous veins of the limbs are treated. The bracket remains in the tissues for life, without causing negative consequences.

 Thus, the design of the bracket allows for endoscopic percutaneous puncture clipping of perforating veins without significant trauma to the tissues and on an outpatient basis. Clipping performance is comparable to the effect of surgical ligation of perforating veins. In addition, the possibilities of a comprehensive outpatient treatment of varicose veins of the lower extremities are significantly expanding.

Claims (2)

 1. Bracket for clipping perforating veins, containing parallel legs connected at one end by an arcuate section, characterized in that the arcuate section has the shape of an equilateral rhombus, and the free ends of the legs are oppositely bent outward, while the legs themselves when squeezing the arcuate section are configured to cross at the point of transition to the arcuate section while maintaining parallelism and with the ability to close the curved ends with their ends to prevent the brackets from sliding off the vein and Anija lumen of the vessel under the pinch.  2. The bracket according to claim 1, characterized in that the bracket itself is made of elastic metal wire with spring properties.

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