RU2283624C2 - Method and device for through-skin phleboectomy - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method and device can be used for surgical treatment of varicose extension of under-skin veins of lower extremities. Device for through-skin phleboectomy has conductor, string, olive made for placement onto string and flexible spiral-shaped jig. Conductor is made in form of puncture tubular needle. Jig is made for insert into co conductor. String is made in form of stiletto for pass through space in jig. Stiletto has smooth surface.

EFFECT: reduced traumatism; high cosmetic effect; reduced risk of post-operational complications; reduced operation time.

1 ex, 11 dwg

Description

The invention relates to medicine and can be used for surgical treatment of varicose veins of the saphenous veins of the lower extremities (VRPVNA).

The combined treatment of HRVPV is based on a surgical aid, which is most often carried out according to the Babcock method by subcutaneous extraction of pathologically altered veins using special devices - phleboextractors (Mamamtavrishvili D.G. Venous Diseases. M .: Medicine. 1964). The known method and device, taken by us as a prototype, are as follows. Usually, a region of the oval fossa is exposed by a longitudinal or oblique incision, all veins flowing into the large saphenous vein of the femur are ligated and cross. A capitate extractor is retrogradely introduced into the lumen of the vein, guided by it, an additional skin incision is made with mobilization of the vessel, its intersection distal to the olive after preliminary ligation and phlebextraction is performed. Similarly, from two, and sometimes more, sections, other pathologically altered saphenous veins are removed, which is rather traumatic. Multiple incisions made, especially with the loose type of varicose veins of the lower extremities, are traumatic, accompanied by quite strong blood loss, require subsequent suturing, and often lead to the formation of long-term non-healing wounds and trophic ulcers, ligature fistulas, rough scars and cosmetic defects.

The well-known phlebextractor (RU 94017276 A1, A 61 B 17/32, 07/10/1996), taken by us as a prototype, is a probe with fixed olives or replaceable olives. Such a design of the instrument does not allow puncture of the vessel through the skin and removal of the vein through punctures. Pulling out a vein is possible only when at least two cuts are performed (Pokrovsky A.V., Klioner L.I. Surgery of chronic obstruction of the main veins. M .: Medicine, 1977. - 144 p .; Vedensky A.N. Varicose disease. L., Medicine, 1983.- 207 p.). In the event of a vein or olive breakage, the extractor cannot be retrograde carried out through a subcutaneous wound tunnel without additional trauma to the tissues.

The aim of the invention is to achieve non-invasiveness, high cosmetic effect, reduce the incidence of postoperative complications, reduce the time of surgery.

The goal is achieved by using a minimally invasive puncture device for percutaneous phlebectomy.

Figure 1 shows a device for removing veins, General view; figure 2 - puncture needle-conductor, a longitudinal section; figure 3 - conductor; figure 4 - stylet; figure 5 - collet olive; 6 is a complete device, a diagram of the interaction of the constituent elements of the device; 7 is a diagram of the operation of the device.

The proposed device for removing veins consists (option 1) of a puncture tubular needle - conductor 1 with a sharpened end 2 cut off at a right angle of 90 ° (Fig. 2). A tightly fitted flexible spiral conductor 3 (Figs. 1, 3) with beveled blunt ends 4 is inserted into the conductor tube 1 with the presence of a rigid stylet 5 string (Fig. 4) made in, for example, stainless steel in its channel - lumen. The device is equipped with removable olives of 6 different sizes with fixing them on a stylet with 5 collet grips.

The essence of the proposed percutaneous phlebectomy is as follows. First, prepare the device for operation. To do this, remove olives 6 from stylet 5 and displace all elements of the device so that one of its ends 2 is a piercing part 7 with protruding in the middle part of a sharp cone 8 (Fig. 8). The assembly in the position set for operation is fixed with a collet olive 6 located on the opposite end of the stylet 5 and made close to the elements of the device. In this case, stylet 5 at the piercing end 7 serves simultaneously as a mandrin and facilitates puncture of tissues.

Subsequently, after a pre-applied venous tourniquet on the limb in the projection of the venous pathologically altered subcutaneous segment 9 (Fig. 7) intended for removal, percutaneous puncture 10 is made with the sharp end of the assembly 8 facing the proximal side. The olive 6 is removed, the conductor 1 is removed, and the flexible conductor 3 in the form of a spiral is advanced into the lumen of the vein until it stops. Then, a flexible elastic stylet 5 is passed through the lumen of the conductor 3, with a sharp end 8 of which pierce the skin in the opposite section of the removed vein 9, and the stylet 5 is brought out. After this, the jig 3 is retrogradely removed with the stylet 5 left in the lumen of the removed venous segment 9. Proximal and distal to the puncture sites - the outlet of the stylet 5 ends, while pulling and lifting it continuously, subcutaneous ligation of the 11 vein 9 and its subcutaneous intersection are performed. Next, to one of the protruding segments of the stylet 5, at a distance from the end equal to the length, the collet olive 6 of the extractor is fixed, the bandage 11 is tied over the stylet 5 and the vein 9 is removed by reverse traction of the stylet 5 through the puncture 10.

In the case of a small extent of the removed veins, a phleboextractor of the second option is used. In the second variant of the phlebextroactor, the extraction of the venous trunk 9 is done using the stylet 5 "ruff" (Fig. 8), without preliminary subcutaneous ligation of the vessel. If in the first version the stylet 5 is made with a smooth surface, then in the second on the surface of the working part of the stylet there are rigid or spring teeth 12, with sharp protrusions, the vertices of which are turned at an angle to one side. This design of the stylet 5 allows the extraction of the vein 9 at the same time as its puncture along the entire length of the vessel 9. In the variant with spring teeth 12, the stylet 5 is placed in a tubular conductor 13 with a channel through or muffled from one end 14 (Fig. 9). One of the ends of the stylet 5 may be blunt 14 or pointed 15 (figure 10, 11). The stylet 5 located in the conductor 13 does not lead to possible additional trauma to the surrounding paravasal tissues and greatly facilitates the passage of the stylet 5 into the lumen of the vein 9. After the assembly is introduced, the stylet is a conductor 5, 13, the last 13 is removed through punctures at the injection site 10 or puncture and stripping is performed veins 9.

We give one example of practical use in the treatment of 15 patients with varicose veins of the proposed phlebectomy method and device for its implementation with good long-term consequences.

Patient J., 47 years old, was admitted with varicose veins of the lower extremities in the compensation phase. On both lower extremities, multiple varicose saphenous veins of the loose type are determined according to the system of both saphenous veins. Diagnostic methods used showed deep vein patency. According to the proposed method in two stages with a break of 2 months, a phlebectomy was performed on both lower limbs. There were no complications in the postoperative period. One year after the operation, no relapse was detected. All patients, observing such rules as wearing elastic bandages or stockings, limiting static loads on their legs, performing a set of physical therapeutic and preventive exercises, felt quite satisfactory. The results of the operation are regarded as good. Relapses of varicose veins were not detected.

The advantages of the proposed device for percutaneous phlebectomy are minimal trauma, ease of use, the absence of traumatic incisions in the field of trophic changes in the soft tissues of the limbs, obtaining good cosmetic results, the maximum reduction in the frequency of various postoperative complications, especially purulent-inflammatory. The device makes it possible to successfully perform radical safenectomy in a polyclinic, which is especially important in the absence of specialized vascular departments in rural hospitals.

Claims (1)

Device for percutaneous phlebectomy containing a conductor, string and olive, made with the possibility of placement on the string, characterized in that it is equipped with a flexible spiral conductor, while the conductor is made in the form of a puncture tubular needle, the conductor is made to be inserted into the conductor, and the string is made in in the form of a stylet with the possibility of conducting a conductor through the lumen, and the stylet has a smooth surface.

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