JPH0611265B2 - Venous valve opener - Google Patents

Description

Description: TECHNICAL FIELD The present invention relates to a venous valve dissector for use in inserting a vein into a vein for cutting a vein valve in the blood vessel.

[Prior Art] As a method of treating femoral artery occlusion, a part of the great saphenous vein may be used as a bypass. As described above, in order to use a vein as an artery, it is necessary to incise the venous valve that prevents the backflow of blood and destroy the valve function. DE 3
In the 320984A1, a blade portion is provided at the tip of the operation wire, and the blade portion has a tip-side portion formed in a bullet-head shape and a linear cutting blade at the proximal end of the operation wire. The venous valve dissection device blindly moves the blood flow in the lumen of the vein from the downstream side to the upstream side so that the venous valve is dissected with a linear dissection blade having a blade portion. .

[Problems to be Solved by the Invention] However, when this venous valve dissection instrument is used, the venous valve can be reliably dissected because the venous lumen is blindly moved from the downstream side to the upstream side of the blood flow. Not necessarily.
In other words, the venous valve consists of two thin membranes that are tightly attached within the venous lumen, with the valve association line being a straight diametric line across the center of the venous lumen. Therefore, the venous valve cannot be incised in a direction in which the linear incision blade of the bladed portion coincides with the valve association line of the venous valve.

As described above, the conventional device described above has a problem in that the incision operation must be repeated many times, and the venous valve cannot be reliably incised because it is performed blindly.

When using this venous valve dissector, it is possible to introduce a small-diameter endoscope into the vein lumen and observe the blade portion of the venous valve dissector that cuts the venous valve from its tip side. Conceivable.

However, since the tip side portion of the bladed portion is formed into a warhead type, even when observing the tip side portion of the bladed portion with an endoscope,
The blade portion only looks round, and the direction of the linear cutting blade for cutting the venous valve cannot be observed. That is, the incision blade cannot be defined in the direction intersecting the valve association line of the venous valve.

The present invention has been made in view of the above-mentioned problems, and the purpose thereof is to confirm the direction of the incision blade with a blade portion under observation with an endoscope in advance, and the direction of this incision blade is the venous valve. The object of the present invention is to provide a venous valve incision instrument that can be surely incised in a direction intersecting the valve association line.

[Means and Actions for Solving the Problems] In order to solve the above problems, the present invention provides a distal end portion of an operating wire with a blade portion and a guide portion in order from the distal end side, and inserts it into a vein to upstream side of blood flow. In the venous valve incision device for incising the venous valve with the blade of the blade portion by moving to, to confirm the orientation of the blade by observing with an endoscope from the downstream side of the blood flow to the tip of the blade portion. The index means is provided.

Then, when the venous valve is incised with the blade having the blade inserted into the vein, the direction of the blade can be easily confirmed by observing with an endoscope by the index means. Therefore, the incision of the vein valve can be reliably performed in a short time.

[Embodiment] FIGS. 1 to 5 show a first embodiment of the present invention. The venous valve dissection device 1 shown in FIG.
The blade portion 3 and the guide portion 4 are arranged in series at the tip of the blade from the tip side. The guide portion 4 is composed of a cylindrical body whose both ends are formed in a spindle-shaped smooth shape. Further, the bladed portion 3 has a spherical shell-shaped tip portion, and a linear blade 5 is formed at the end portion on the guide portion 4 side in a direction orthogonal to the axial direction. Further, as shown in FIG. 2, a linear index 6 parallel to the direction of the blade 5 is provided on the tip surface of the spherical tip portion of the blade portion 3. This index 6 is the bladed part 3
Although it may be printed on the front end surface thereof, it may be formed of a concave groove or a convex structure. Alternatively, the concave groove may be coated with paint.

When this venous valve dissection device 1 is used, it is inserted into the vein 7 and moved from the downstream side (central side) to the upstream side (peripheral side) so that the venous valve 8 is moved by the blade 5 of the bladed portion 3. Make an incision.
At this time, the index 6 on the tip surface of the bladed portion 3 is observed by the endoscope 9 to know the direction of the blade 5, and the index 6 is formed by the leaflets 8a and 8b of the venous valve 8 as shown in FIG. The operation wire 2 is twisted so as not to be parallel to the valve assembly line 10 to be rotated, and the blade portion 3 and the guide portion 4 are rotated. By this operation, the blade 5 is oriented so as to intersect the valve association line 10 of the venous valve 8. Then, as shown in FIG. 3, the venous valve 8 is positioned between the blade-bearing portion 3 and the guide portion 4, and the guide-bearing portion 4 causes the blade-bearing portion 3 to move.
The blade 5 is placed in the center of the lumen of the vein 7. Then, the operating wire 2 is pulled to move the blade portion 3 in the vein 7, and the blade 5 cuts the leaflets 8a and 8b of the vein valve 8.

Then, when the vein valve 8 is incised by the blade 5 of the bladed portion 3 inserted into the vein 7, the direction of the blade 5 can be easily confirmed by observing it with the endoscope 9 using the index 6. Therefore, the venous valve 8 can be reliably incised in a short time by directing the blade 5 in a direction intersecting the valve association line 10 of the venous valve 8.

6 and 7 show a second embodiment of the present invention. In this embodiment, an index 6 provided on the tip surface of the bladed portion 3
Is different from the first embodiment in that it has a linear shape substantially perpendicular to the direction of the blade 5 of the blade portion 3.

Therefore, in this embodiment, as shown in FIG.
The index 6 of the bladed portion 3 inserted into the valve fitting line 1 of the venous valve 8
Operate so that the direction crosses 0.

8 and 9 show a third embodiment of the present invention. In this embodiment, the blade portion 3 is made of a transparent material, for example, acrylic resin, and the index means is configured so that the direction of the blade 5 can be seen through the endoscope 9.

10 and 12 show a fourth embodiment of the present invention. In this embodiment, the bladed portion 3 is formed in a directional shape to constitute index means for instructing the direction of the blade 5. In this embodiment, as shown in FIG. The shape was an ellipse when viewed from the front. Therefore, even if the long axis direction and the direction of the blade 5 in the elliptical shape of the blade portion 3 are made parallel to each other, the direction of the blade 5 can be known by looking at this with the endoscope 9.

12 to 14 show a fifth embodiment of the present invention. In this embodiment, the blade portion 3 is formed in a directional shape similarly to the fourth embodiment, but the shape is made flatter.

In the fourth embodiment and the fifth embodiment, when observing with the endoscope 9 as shown in FIG. 14, the venous valve 8 can be seen well in the short axis direction of the bladed portion 3, so that the incision work is performed. Easy and reliable.

The present invention is not limited to the above-mentioned embodiments, and various modifications can be considered.

[Effects of the Invention] As described above, according to the present invention, the distal end portion of the operating wire is provided with the bladed portion and the guide portion in order from the distal end side, and is inserted into the vein to move to the upstream side of the blood flow. In a venous valve incision tool for incising a venous valve with a blade of a blade portion, an index means for confirming the orientation of the blade by observing with an endoscope from the downstream side of blood flow is provided at the tip of the blade portion. It is a thing.

Therefore, when the venous valve is incised with the blade having the blade inserted into the vein, the direction of the blade can be easily confirmed by observing it with the endoscope by the index means. Therefore, the incision of the vein valve can be reliably performed in a short time.

[Brief description of drawings]

FIG. 1 is a perspective view of a venous valve dissector of the first embodiment of the present invention, FIG. 2 is a front view of the venous valve dissector of the first embodiment, and FIG. 3 is a view of the first embodiment. FIG. 4 is a side sectional view showing a use state of the venous valve dissection device, FIG. 4 is a sectional view of a vein, and FIG. 5 is a state diagram of an endoscope observation visual field in a use state of the venous valve dissection device according to the first embodiment. 6 is a perspective view of the venous valve dissector of the second embodiment of the present invention, FIG. 7 is a front view of the same venous valve dissector of the second embodiment, and FIG. 8 is a third embodiment of the present invention. FIG. 9 is a perspective view of an example venous valve dissection tool, FIG. 9 is a front view of the same venous valve dissection apparatus of the third embodiment, and FIG. 10 is a perspective view of the venous valve dissection apparatus of the fourth embodiment of the present invention. FIG. 11 is a front view of the vein valve dissector of the fourth embodiment, FIG. 12 is a perspective view of the vein valve dissector of the fifth embodiment of the present invention, and FIG. 13 is the same as the fifth embodiment. Front of the venous valve incision device , FIG. 14 is a state diagram of an endoscope observation field of use state of the venous valve cutting instrument of the fifth embodiment. 1 ... Venous valve dissection tool, 2 ... operation wire, 3 ... blade part, 4 ... guide part, 5 ... blade, 6 ... index, 7 ... vene, 8 ... venous valve, 10 …… Benkai Line.

Claims (1)

[Claims] 1. A venous valve is incised by a blade of a blade portion by providing a blade portion and a guide portion at the distal end portion of an operation wire in order from the distal end side, and inserting the blade into a vein and moving to the upstream side of blood flow. In the venous valve dissection device, an index means for confirming the orientation of the blade by observing with an endoscope from the downstream side of the blood flow is provided at the tip of the bladed portion.