WO2001087168A1 - Extensible internal probe for surgical use, for dilatation, curettage and protection of physiological ducts - Google Patents

Extensible internal probe for surgical use, for dilatation, curettage and protection of physiological ducts Download PDF

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Publication number
WO2001087168A1
WO2001087168A1 PCT/FR2001/001528 FR0101528W WO0187168A1 WO 2001087168 A1 WO2001087168 A1 WO 2001087168A1 FR 0101528 W FR0101528 W FR 0101528W WO 0187168 A1 WO0187168 A1 WO 0187168A1
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WO
WIPO (PCT)
Prior art keywords
head
probe according
tube
extendable probe
physiological
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Application number
PCT/FR2001/001528
Other languages
French (fr)
Inventor
Emile Lamy-Perret
Original Assignee
Lamy Perret Emile
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Publication date
Application filed by Lamy Perret Emile filed Critical Lamy Perret Emile
Publication of WO2001087168A1 publication Critical patent/WO2001087168A1/en

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32—Surgical cutting instruments
    • A61B17/3205—Excision instruments
    • A61B17/3207—Atherectomy devices working by cutting or abrading; Similar devices specially adapted for non-vascular obstructions
    • A61B17/320725—Atherectomy devices working by cutting or abrading; Similar devices specially adapted for non-vascular obstructions with radially expandable cutting or abrading elements
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/01—Filters implantable into blood vessels
    • A61F2/0108—Both ends closed, i.e. legs gathered at both ends
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/22—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
    • A61B17/221—Gripping devices in the form of loops or baskets for gripping calculi or similar types of obstructions
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/22—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
    • A61B17/221—Gripping devices in the form of loops or baskets for gripping calculi or similar types of obstructions
    • A61B2017/2212—Gripping devices in the form of loops or baskets for gripping calculi or similar types of obstructions having a closed distal end, e.g. a loop
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/01—Filters implantable into blood vessels
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00—Catheters; Hollow probes
    • A61M25/10—Balloon catheters
    • A61M2025/1043—Balloon catheters with special features or adapted for special applications
    • A61M2025/1095—Balloon catheters with special features or adapted for special applications with perfusion means for enabling blood circulation while the balloon is in an inflated state or in a deflated state, e.g. permanent by-pass within catheter shaft
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M29/00—Dilators with or without means for introducing media, e.g. remedies
    • A61M29/02—Dilators made of swellable material

Definitions

  • the present invention relates to an internal extendable probe for surgical use for dilation, curettage and protection of physiological conduits.
  • Atheromas consisting of a lesion of the inner lining of the arteries consisting of lipid deposits (cholesterol), as well as for the extraction of clots which may cause embolism or thrombosis, so as to reduce circulatory disorders and in particular the risks of infarction caused by the obliteration of a vessel, for example the myocardium.
  • a catheter is a thin tube, of synthetic material, of variable size, which is generally introduced under radioscopic control, in particular into a blood vessel, for carrying out its examination, for injecting or withdrawing a liquid therein or for other operations such as the dilation of the walls or the installation of an anti-aneurysm sheath ("stent").
  • This probe introduced by a benign incision in the artery of the thigh of the patient is not mutilating and represents a major asset to resolve as well as possible certain risks linked to very dangerous cardiac problems due in particular to the presence of atheromas or clots in the blood vessels.
  • Atheromas Treatment of atheromas is usually done using an inflatable balloon mounted at the end of the catheter.
  • This device presents serious risks due to the fact that it causes the interruption of the blood circulation. In addition, it does not allow to extract the atheroma, which often leads to the need for further interventions.
  • the device according to the present invention aims to remedy these drawbacks. It allows indeed, without interrupting the blood circulation, not only to compress an atheroma by dilating the wall of the vessel, but also to perform a curettage and to extract it.
  • a variant of this same device makes it possible to filter the blood flow to prevent the passage of clots and to recover them to eliminate them.
  • It consists of a catheter formed of a flexible tube provided with an expandable head composed of elongated flexible elements forming in the open position a cage in the shape of a warhead whose expansion is ensured by pulling or rotating a rod. control passing inside the tube, the flexible elements being in the rest position tightened so that the diameter of the head is close to that of the tube.
  • FIGS. 1 and 2 show the device as a whole respectively in the rest position and with the expanded head
  • FIG. 3 is an enlarged axial section of the end of the catheter opposite the expanding head
  • FIG. 4 shows under the same conditions a variant of this end
  • FIG. 5 is an enlarged axial section of the expansion head
  • FIGS. 6 and 7 represent the expandable head covered with a blood filtration net in two different positions
  • FIG. 8 shows an expandable head coated with a perforated rubberized envelope
  • Figure 9 is an axial section of a variant of the expansion head provided with a closing spring
  • Figure 10 shows a flexible element consisting of a blade with sawtooth edge
  • Figures 11 and 12 show an alternative embodiment of the expandable head respectively in the rest and open position.
  • the device consists of a flexible tube 1 in which slides an operating rod 2 and having at one of its ends an expandable head 3 and, at the other end, a control wheel 4 integral with the internal rod.
  • the expandable head 3 is formed of elongate bendable elements 5 fixed, on the one hand, on a hollow end piece 6 disposed at the end of the tube 1 and, on the other hand, to a moving part 7 mounted at the end of the rod operation 2.
  • the bendable elements 5 are arranged to be substantially parallel at rest to the axis of the tube 1 (FIG. 1) and to open by constituting a cage in the shape of an ogive when the moving part 7 approaches the end of the tube 1 under the effect of a traction exerted on the operating rod ( Figure 2).
  • This traction is carried out using the wheel 4 which advantageously will include a threaded or threaded portion 8 screwed onto a sleeve 9 placed at the end of the tube 1 opposite the head 3.
  • a stop screw 10 will be integrated in the sleeve 8 in order to block the opening of the bendable elements 5, the adjustment of which will be ensured as a function of the diameter of the pipes to be treated, this to facilitate movement of the assembly and avoid a malfunction which could be dangerous if this opening was not controlled.
  • the expandable head 3 can be rotatable by means of a hollow end-piece 6 provided with a rotating part 1 1 (FIG. 5), the operating rod 2 in this case passing through the wheel 4 and being rotated by means of a button 12 fixed at its end (figure 4).
  • This arrangement avoids having to rotate the tube 1 to drive the expandable head 3, for example to perform the curettage of an atheroma.
  • the hollow tip 6 will advantageously include a seal of known type (not shown).
  • the entire catheter will preferably be made of synthetic material but may include metal parts and even be entirely made of metal.
  • Atheromas may be adapted to the latter a rubberized envelope 15 covering the expanding head 3, and provided with perforations 16 forming a screen, this in order not to block circulation during this compression operation.
  • the use of rubber for this operation is very useful because of the flexibility and the damping properties of this material.
  • the perforations 16 may be provided only on a lateral half of the envelope 15, the opposite side comprising one or more ribs 17 lengthwise in order to create, during the expansion of the head 3 on a atheroma one or more channels facilitating blood circulation after withdrawal of the catheter ( Figure 8).
  • a spring 18 could advantageously be placed on the operating rod, to inside the expandable head (Figure 9).
  • blades With 5 'bendable elements in the form of blades, one can cut atheromas or cholesterol and capture them inside the cage so that they can be extracted from the vessel. These blades may have a sawtooth edge 19 ( Figure 10) if the atheromas are too rigid to be cut with a normal blade.
  • the number of cutting blades attached to the device will vary, depending on the volume of the atheromas to be cut.
  • the system with saw-shaped blades could also be used for fixing, and especially removing, internal vascular prostheses, or "stents".
  • the sawtooth makes it possible to facilitate the recovery of "stents" out of use embedded in the atheromas.
  • the duration of a "stent" in the body is considered to be around five years. After this time, they are fouled enough to no longer ensure the normal blood flow to which they are adapted. Consequently, their removal is essential if we want to introduce new "stents” in new condition to ensure their replacement. Usually, this operation is very difficult to carry out, the securing of this part and its pinching to ensure its satisfactory removal is fairly random, hence the need to be able to grasp the "stent” in good conditions. This is what the medical probe which is the subject of this patent achieves.
  • the expandable head 3 may be removable and interchangeable so as to be able to adapt several different models on the catheter.
  • the expandable head 3 can be produced by making longitudinal slots 20 at the periphery of the end of a flexible tube 1 "so as to delimit bendable elements 5" between them ( Figures 11 and 12 ).
  • the catheter according to the invention may advantageously be for single use, which ensures greater hygienic security with the minimum of risks in the operation of this device.
  • a mesh sleeve of suitable shape acting as a barrier can little block the expansion of the atheroma.

Abstract

The invention concerns an extensible internal probe for surgical use for dilatation, curettage and protection of physiological ducts. It consists of a catheter formed with a flexible tube (1) provided with an expansible head (3) consisting of elongated bending elements (5) forming in open position a cone-shaped cage expandable by pulling or rotating a control rod (2) passing inside the tube, the flexible elements being in neutral position compact such that the diameter of the head is close to that of the tube. It is generally used for the treatment by catheterization of physiological ducts or for atherectomy, and for extracting blood clots liable to cause embolism or thrombosis.

Description

SONDE EXTENSIBLE INTERNE A USAGE CHIRURGICAL INTERNAL EXTENSIBLE PROBE FOR SURGICAL USE
La présente invention a pour objet une sonde extensible interne à usage chirurgical pour la dilatation, le curetage et la protection de conduits physiologiques.The present invention relates to an internal extendable probe for surgical use for dilation, curettage and protection of physiological conduits.
Elle se rapporte d'une manière générale au traitement par cathétérisme de conduits physiologiques et en particulier des vaisseaux sanguins. Elle est notamment indiquée pour la compression ou l'enlèvement d'athéromes consistant en une lésion de la tunique interne des artères constituée de dépôts lipidiques (cholestérol), ainsi que pour l'extraction de caillots risquant d'entraîner une embolie ou une thrombose, de façon à diminuer les troubles circulatoires et en particulier les risques d'infarctus provoqués par l'oblitération d'un vaisseau, par exemple du myocarde.It relates generally to the treatment by catheterization of physiological conduits and in particular of the blood vessels. It is particularly indicated for the compression or removal of atheromas consisting of a lesion of the inner lining of the arteries consisting of lipid deposits (cholesterol), as well as for the extraction of clots which may cause embolism or thrombosis, so as to reduce circulatory disorders and in particular the risks of infarction caused by the obliteration of a vessel, for example the myocardium.
Un cathéter est un tube fin, en matière synthétique, de taille variable, que l'on introduit en général sous contrôle radioscopique, notamment dans un vaisseau sanguin, pour procéder à son examen, pour y injecter ou en retirer un liquide ou pour d'autres opérations telles que la dilatation des parois ou la mise en place d'une gaine anti-anévrisme ("stent").A catheter is a thin tube, of synthetic material, of variable size, which is generally introduced under radioscopic control, in particular into a blood vessel, for carrying out its examination, for injecting or withdrawing a liquid therein or for other operations such as the dilation of the walls or the installation of an anti-aneurysm sheath ("stent").
Cette sonde introduite par une incision bénigne dans l'artère de la cuisse du patient n'est pas mutilante et représente un atout majeur pour résoudre au mieux certains risques liés à des problèmes cardiaques très dangereux dus en particuliers à la présence d'athéromes ou de caillots dans les vaisseaux sanguins.This probe introduced by a benign incision in the artery of the thigh of the patient is not mutilating and represents a major asset to resolve as well as possible certain risks linked to very dangerous cardiac problems due in particular to the presence of atheromas or clots in the blood vessels.
Le traitement des athéromes est généralement effectué au moyen d'un ballonnet gonflable monté à l'extrémité du cathéter. L'utilisation de ce dispositif présente des risques sérieux dus au fait qu'il provoque l'interruption de la circulation sanguine. En outre, il ne permet pas d'extraire l'athérome, ce qui entraîne souvent la nécessité d'interventions ultérieures. Le dispositif selon la présente invention a pour objectif de remédier à ces inconvénients. Il permet en effet, sans interrompre la circulation sanguine, non seulement de comprimer un athérome en dilatant la paroi du vaisseau, mais également d'effectuer un curetage et de l'extraire. Une variante de ce même dispositif permet de filtrer le flux sanguin pour empêcher le passage de caillots et les récupérer pour les éliminer.Treatment of atheromas is usually done using an inflatable balloon mounted at the end of the catheter. The use of this device presents serious risks due to the fact that it causes the interruption of the blood circulation. In addition, it does not allow to extract the atheroma, which often leads to the need for further interventions. The device according to the present invention aims to remedy these drawbacks. It allows indeed, without interrupting the blood circulation, not only to compress an atheroma by dilating the wall of the vessel, but also to perform a curettage and to extract it. A variant of this same device makes it possible to filter the blood flow to prevent the passage of clots and to recover them to eliminate them.
Ce système permet avec une efficacité remarquable d'obtenir des résultats très importants dans le domaine de la chirurgie liée aux affections cardiaques et vasculaires auxquels sont soumis très fréquemment les patients de notre époque qui souvent développent ce type d'affection en raison d'un mode de vie pas toujours en conformité avec les critères et les règles à respecter dans ce domaine vital.This system allows with remarkable efficiency to obtain very important results in the field of surgery related to cardiac and vascular affections to which are subjected very frequently the patients of our time who often develop this type of affection due to a mode not always in conformity with the criteria and the rules to be respected in this vital area.
Il est constitué d'un cathéter formé d'un tube souple pourvu d'une tête expansible composée d'éléments flexibles allongés formant en position ouverte une cage en forme d'ogive dont l'expansion est assurée par tirage ou rotation d'une tige de commande passant à l'intérieur du tube, les éléments flexibles étant en position de repos resserrés de manière à ce que le diamètre de la tête soit voisin de celui du tube.It consists of a catheter formed of a flexible tube provided with an expandable head composed of elongated flexible elements forming in the open position a cage in the shape of a warhead whose expansion is ensured by pulling or rotating a rod. control passing inside the tube, the flexible elements being in the rest position tightened so that the diameter of the head is close to that of the tube.
Sur les dessins annexés, donnés à titre d'exemples non limitatifs de formes de réalisation de l'objet de l'invention: les figures 1 et 2 représentent le dispositif dans son ensemble respectivement en position de repos et avec la tête expansée, la figure 3 est une coupe axiale agrandie de l'extrémité du cathéter opposé à la tête expansible, la figure 4 montre dans les mêmes conditions une variante de cette extrémité, la figure 5 est une coupe axiale agrandie de la tête d'expansion, les figures 6 et 7 représentent la tête expansible recouverte d'un filet de filtration du sang dans deux positions différentes, la figure 8 montre une tête expansible revêtue d'une enveloppe caoutchoutée perforée, la figure 9 est une coupe axiale d'une variante de la tête d'expansion pourvue d'un ressort de fermeture, la figure 10 représente un élément flexible constitué d'une lame avec bord en dents de scie et les figures 11 et 12 représentent une variante d'exécution de la tête expansible respectivement en position de repos et ouverte.In the accompanying drawings, given by way of nonlimiting examples of embodiments of the subject of the invention: FIGS. 1 and 2 show the device as a whole respectively in the rest position and with the expanded head, FIG. 3 is an enlarged axial section of the end of the catheter opposite the expanding head, FIG. 4 shows under the same conditions a variant of this end, FIG. 5 is an enlarged axial section of the expansion head, FIGS. 6 and 7 represent the expandable head covered with a blood filtration net in two different positions, FIG. 8 shows an expandable head coated with a perforated rubberized envelope, Figure 9 is an axial section of a variant of the expansion head provided with a closing spring, Figure 10 shows a flexible element consisting of a blade with sawtooth edge and Figures 11 and 12 show an alternative embodiment of the expandable head respectively in the rest and open position.
Le dispositif, figures 1 à 12, est constitué d'un tube flexible 1 dans lequel coulisse une tige de manoeuvre 2 et comportant à l'une de ses extrémités une tête expansible 3 et, à l'autre extrémité, une molette de commande 4 solidaire de la tige interne.The device, Figures 1 to 12, consists of a flexible tube 1 in which slides an operating rod 2 and having at one of its ends an expandable head 3 and, at the other end, a control wheel 4 integral with the internal rod.
La tête expansible 3 est formée d'éléments cintrables 5 allongés fixés, d'une part, sur un embout creux 6 disposé à l'extrémité du tube 1 et, d'autre part, à une pièce mobile 7 montée en bout de la tige de manoeuvre 2.The expandable head 3 is formed of elongate bendable elements 5 fixed, on the one hand, on a hollow end piece 6 disposed at the end of the tube 1 and, on the other hand, to a moving part 7 mounted at the end of the rod operation 2.
Les éléments cintrables 5 sont agencés pour être sensiblement parallèles au repos à l'axe du tube 1 (figure 1) et s'ouvrir en constituant une cage en forme d'ogive lorsque la pièce mobile 7 se rapproche de l'extrémité du tube 1 sous l'effet d'une traction exercée sur la tige de manoeuvre (figure 2). Cette traction est effectuée à l'aide de la molette 4 qui comportera avantageusement une partie filetée 8 ou taraudée se vissant sur un manchon 9 placé à l'extrémité du tube 1 opposé à la tête 3.The bendable elements 5 are arranged to be substantially parallel at rest to the axis of the tube 1 (FIG. 1) and to open by constituting a cage in the shape of an ogive when the moving part 7 approaches the end of the tube 1 under the effect of a traction exerted on the operating rod (Figure 2). This traction is carried out using the wheel 4 which advantageously will include a threaded or threaded portion 8 screwed onto a sleeve 9 placed at the end of the tube 1 opposite the head 3.
Une vis de butée 10 sera intégrée dans le manchon 8 afin d'assurer un blocage de l'ouverture des éléments cintrables 5 dont le réglage sera assuré en fonction du diamètre des canalisations à traiter, ceci pour faciliter le déplacement de l'ensemble et éviter un dysfonctionnement qui pourrait être dangereux si cette ouverture n'était pas contrôlée.A stop screw 10 will be integrated in the sleeve 8 in order to block the opening of the bendable elements 5, the adjustment of which will be ensured as a function of the diameter of the pipes to be treated, this to facilitate movement of the assembly and avoid a malfunction which could be dangerous if this opening was not controlled.
La tête expansible 3 peut être rotative grâce à un embout creux 6 pourvu d'une partie tournante 1 1 (figure 5), la tige de manoeuvre 2 traversant dans ce cas la molette 4 et étant mise en rotation au moyen d'un bouton 12 fixé à son extrémité (figure 4). Cette disposition permet d'éviter d'avoir à faire tourner le tube 1 pour entraîner la tête expansible 3, par exemple pour effectuer le curetage d'un athérome. Pour éviter une pénétration du liquide sanguin dans le tube 1 , l'embout creux 6 comportera avantageusement un joint d'étanchéité de type connu (non représenté).The expandable head 3 can be rotatable by means of a hollow end-piece 6 provided with a rotating part 1 1 (FIG. 5), the operating rod 2 in this case passing through the wheel 4 and being rotated by means of a button 12 fixed at its end (figure 4). This arrangement avoids having to rotate the tube 1 to drive the expandable head 3, for example to perform the curettage of an atheroma. To avoid penetration of blood liquid into the tube 1, the hollow tip 6 will advantageously include a seal of known type (not shown).
L'ensemble du cathéter sera de préférence réalisé en matière synthétique mais pourra comporter des parties métalliques et même être entièrement fabriqué en métal.The entire catheter will preferably be made of synthetic material but may include metal parts and even be entirely made of metal.
Plusieurs options sont possibles pour adapter le dispositif à différentes utilisations :Several options are possible to adapt the device to different uses:
- On peut obtenir une récupération des caillots de sang en transformant le dispositif en une sorte d'épuisette, les éléments cintrables 5 étant constitués de tiges flexibles qui déploieront un filet 13, 14 en tissu ajouré de nylon ou matériau similaire éventuellement caoutchouté. Ce filet sera fixé à la base (figure 6) ou au sommet (figure 7) de la tête expansible 3 suivant l'utilisation nécessaire pour cette opération. Cette variante sera très utile pour filtrer le sang d'un patient soumis à un choc par accident ou autre motif qui pourrait provoquer une embolie, en filtrant rapidement le liquide sanguin sans être dans l'obligation de transfuser le patient. Celui-ci, en conservant son sang originel, réduit les risques d'embolie créés souvent par cet apport étranger dans son organisme.- One can obtain a recovery of the blood clots by transforming the device into a sort of landing net, the bendable elements 5 being constituted by flexible rods which will deploy a net 13, 14 in openwork fabric of nylon or similar material possibly rubberized. This net will be attached to the base (Figure 6) or the top (Figure 7) of the expandable head 3 depending on the use required for this operation. This variant will be very useful for filtering the blood of a patient subjected to an accidental shock or other reason which could cause an embolism, by rapidly filtering the blood liquid without being obliged to transfuse the patient. This one, by preserving its original blood, reduces the risks of embolism often created by this foreign contribution in its organization.
Il est possible au cours de la filtration de procéder à l'essorage du sang par compression des éléments cintrables 5 et du filtre permettant ainsi d'augmenter l'efficacité de l'opération.It is possible during filtration to spin the blood by compression of the bendable elements 5 and the filter thereby increasing the efficiency of the operation.
- Pour augmenter la surface de compression des athéromes avec l'utilisation du cathéter, il pourra être adapté à celui-ci une enveloppe caoutchoutée 15 recouvrant la tête expansible 3, et pourvue de perforations 16 formant tamis, ceci afin de ne pas bloquer la circulation sanguine pendant cette opération de compres- sion. L'emploi du caoutchouc pour cette opération est très utile en raison de la souplesse et des propriétés amortissantes de ce matériau.- To increase the compression surface of atheromas with the use of the catheter, it may be adapted to the latter a rubberized envelope 15 covering the expanding head 3, and provided with perforations 16 forming a screen, this in order not to block circulation during this compression operation. The use of rubber for this operation is very useful because of the flexibility and the damping properties of this material.
Les perforations 16 pourront être prévues seulement sur une moitié latérale de l'enveloppe 15, le côté opposé comportant une ou plusieurs nervures 17 dans le sens de la longueur afin de créer, lors de l'expansion de la tête 3 sur un athérome un ou plusieurs canaux facilitant la circulation sanguine après retrait du cathéter (figure 8).The perforations 16 may be provided only on a lateral half of the envelope 15, the opposite side comprising one or more ribs 17 lengthwise in order to create, during the expansion of the head 3 on a atheroma one or more channels facilitating blood circulation after withdrawal of the catheter (Figure 8).
- Pour garantir une bonne fermeture de la tête 3 lors du retrait du cathéter, en particulier lorsque le système est utilisé pour extraire des éléments tels que morceaux d'athéromes ou autres, un ressort 18 pourra avantageusement être disposé sur la tige de manoeuvre, à l'intérieur de la tête expansible (figure 9).- To guarantee a good closing of the head 3 during the withdrawal of the catheter, in particular when the system is used to extract elements such as pieces of atheromas or others, a spring 18 could advantageously be placed on the operating rod, to inside the expandable head (Figure 9).
- Avec des éléments cintrables 5' en forme de lames, on peut découper des athéromes ou cholestérol et les capter à l'intérieur de la cage de façon à pouvoir les extraire du vaisseau. Ces lames peuvent comporter un bord en dents de scie 19 (figure 10) si les athéromes sont trop rigides pour être découpés avec une lame normale.- With 5 'bendable elements in the form of blades, one can cut atheromas or cholesterol and capture them inside the cage so that they can be extracted from the vessel. These blades may have a sawtooth edge 19 (Figure 10) if the atheromas are too rigid to be cut with a normal blade.
Le nombre de lames coupantes fixées sur le dispositif sera variable, ceci en fonction du volume des athéromes à découper.The number of cutting blades attached to the device will vary, depending on the volume of the atheromas to be cut.
Le système avec lames en forme de scie pourrait être également utilisé pour la fixation, et surtout le retrait, des prothèses vasculaires internes, ou "stents".The system with saw-shaped blades could also be used for fixing, and especially removing, internal vascular prostheses, or "stents".
Les dents de scie permettent en effet de faciliter la récupération "stents" hors d'usage incrustés dans les athéromes. On considère la durée d'un "stent" dans l'organisme à environ cinq années. Passé ce délai, ceux-ci sont encrassés suffisamment pour ne plus assurer le débit sanguin normal auquel ils sont adaptés. En conséquence, leur retrait est indispensable si l'on veut introduire à nouveau des "stents" à l'état neuf pour assurer leur remplacement. Habituellement, cette opération est très difficile à réaliser, l'arrimage de cette pièce et son pincement pour assurer son retrait de façon satisfaisante est assez aléatoire, d'où la nécessité de pouvoir saisir le "stent" dans de bonnes conditions. C'est ce que réalise la sonde médicale objet de ce brevet.The sawtooth makes it possible to facilitate the recovery of "stents" out of use embedded in the atheromas. The duration of a "stent" in the body is considered to be around five years. After this time, they are fouled enough to no longer ensure the normal blood flow to which they are adapted. Consequently, their removal is essential if we want to introduce new "stents" in new condition to ensure their replacement. Usually, this operation is very difficult to carry out, the securing of this part and its pinching to ensure its satisfactory removal is fairly random, hence the need to be able to grasp the "stent" in good conditions. This is what the medical probe which is the subject of this patent achieves.
Avec des contre-lames fixes disposées face aux lames mobiles, on obtiendra aussi une sorte de cisaillement qui pourra faciliter la découpe des athéromes. La tête expansible 3 pourra être amovible et interchangeable de manière à pouvoir adapter plusieurs modèles différents sur le cathéter.With fixed counterblades arranged opposite the movable blades, we will also obtain a kind of shearing which can facilitate the cutting of atheromas. The expandable head 3 may be removable and interchangeable so as to be able to adapt several different models on the catheter.
Selon une variante d'exécution, la tête expansible 3 peut être réalisée en pratiquant à la périphérie de l'extrémité d'un tube flexible 1" des fentes longitudinales 20 de manière à délimiter entre elles des éléments cintrables 5" (figures 11 et 12).According to an alternative embodiment, the expandable head 3 can be produced by making longitudinal slots 20 at the periphery of the end of a flexible tube 1 "so as to delimit bendable elements 5" between them (Figures 11 and 12 ).
Le cathéter selon l'invention pourra avantageusement être à usage unique, ce qui assure une plus grande sécurité hygiénique avec le minimum de risques dans le fonctionnement de cet appareil.The catheter according to the invention may advantageously be for single use, which ensures greater hygienic security with the minimum of risks in the operation of this device.
Plusieurs méthodes sont envisageables pour obtenir une réduction des athéromes au moyen du dispositif décrit : - En injectant préalablement un liquide approprié se coagulant rapidement, on obtiendrait, par compactage avec la tête expansible 3, une diminution du volume de ces amas graisseux permettant une meilleure circulation sanguine.Several methods can be envisaged to obtain a reduction of atheromas by means of the device described: - By previously injecting an appropriate liquid which coagulates rapidly, we would obtain, by compacting with the expanding head 3, a reduction in the volume of these fatty deposits allowing better circulation blood.
- En fixant sur ces excroissances, à l'aide du cathéter objet de l'invention, un manchon grillagé de forme adaptée tenant lieu de barrage on peu obtenir un blocage de l'expansion de l'athérome.- By fixing on these outgrowths, using the catheter object of the invention, a mesh sleeve of suitable shape acting as a barrier can little block the expansion of the atheroma.
Dans l'industrie, un système similaire construit avec les matériaux appropriés et une dimension adaptée pourrait rendre de grands services dans certains travaux où l'on utilise des tubulures, en mer ou sur terre, dans les métiers de off-shore et produits pétroliers divers, par exemple.In industry, a similar system built with the appropriate materials and an adapted dimension could be of great service in certain works where pipes are used, at sea or on land, in the trades of off-shore and various petroleum products. , for example.
Le positionnement des divers éléments constitutifs donne à l'objet de l'invention un maximum d'effets utiles qui n'avaient pas été, à ce jour, obtenus par des dispositifs similaires. The positioning of the various constituent elements gives the object of the invention a maximum of useful effects which had not, to date, been obtained by similar devices.

Claims

REVEND1CAT1ONS REVEND1CAT1ONS
1 °. Sonde extensible interne à usage chirurgical pour la dilatation, le curetage et la protection de conduits physiologiques, destiné d'une manière générale au traitement par cathétérisme de conduits physiologiques et en particulier des vaisseaux sanguins et notamment indiqué pour l'enlèvement d'athéromes ou l'extraction de caillots risquant d'entraîner une embolie ou une thrombose, constitué d'un cathéter formé d'un tube flexible (1 ) pourvu d'une tête expansible (3) composée d'éléments cintrables (5) allongés agencés pour être sensiblement parallèles au repos à l'axe du tube (1), et former en position ouverte une cage en forme d'ogive dont l'expansion est assurée par la traction d'une tige de manoeuvre (2) passant à l'intérieur dudit tube flexible, au moyen d'une molette de commande (4) située à l'extrémité du tube flexible opposée à la tête expansible (3), caractérisé en ce que les lames constituant les éléments cintrables (5") comportent un bord en dents de scie (18).1 °. Internal extensible probe for surgical use for dilation, curettage and protection of physiological conduits, generally intended for the treatment by catheterization of physiological conduits and in particular of blood vessels and in particular indicated for the removal of atheromas or l extraction of clots which may lead to embolism or thrombosis, consisting of a catheter formed by a flexible tube (1) provided with an expandable head (3) composed of elongated bendable elements (5) arranged to be substantially parallel at rest to the axis of the tube (1), and in the open position form a cage in the shape of a warhead whose expansion is ensured by the traction of an operating rod (2) passing inside said tube flexible, by means of a control wheel (4) located at the end of the flexible tube opposite the expanding head (3), characterized in that the blades constituting the bendable elements (5 ") have an edge in sawtooth (18).
2 ° . Sonde extensible selon la revendication 1 , se caractérisant par le fait que la tête expansible (3) est rendue rotative au moyen d'un embout creux (6) pourvu d'une partie tournante (11), la tige de manoeuvre (2) traversant la molette de commande (4) et étant mise en rotation au moyen d'un bouton (12) fixé à son extrémité.2 °. Extendable probe according to claim 1, characterized in that the expandable head (3) is made rotatable by means of a hollow tip (6) provided with a rotating part (11), the operating rod (2) passing through the control wheel (4) and being rotated by means of a button (12) fixed at its end.
3°. Sonde extensible selon l'une quelconque des revendications précédentes, se caractérisant par le fait qu'elle comporte des contre-lames fixes face à des lames mobiles de façon à provoquer un cisaillement apte à faciliter la découpe des athéromes.3 °. Extendable probe according to any one of the preceding claims, characterized in that it comprises fixed counterblades facing movable blades so as to cause a shear capable of facilitating the cutting of atheromas.
4°. Sonde extensible selon la revendication 1 , se caractérisant par le fait qu'elle comporte un filet (13, 14) en tissu ajouré de nylon ou matériau similaire éventuellement caoutchouté fixé à la base ou au sommet de la tête expansible (3), les éléments cintrables (5) étant constitués de tiges flexibles permettant de déployer ledit filet.4 °. Extendable probe according to claim 1, characterized in that it comprises a net (13, 14) of perforated fabric of nylon or similar possibly rubberized material fixed at the base or at the top of the expandable head (3), the bendable elements (5) being constituted by flexible rods making it possible to deploy said net.
5°. Sonde extensible selon l'une quelconque des revendications 1 à 3, se caractérisant par le fait que la tête expansible (3) est recouverte d'une enveloppe caoutchoutée (15) pourvue de perforations (16) formant tamis, de manière à augmenter la surface de compression du dispositif.5 °. Extendable probe according to any one of claims 1 to 3, characterized in that the expandable head (3) is covered with a rubberized envelope (15) provided with perforations (16) forming a screen, so as to increase the surface compression device.
6°. Sonde extensible selon la revendication 5, se caractérisant par le fait que les perforations (16) sont prévues seulement sur une moitié latérale de l'enveloppe (15), le côté opposé comportant une ou plusieurs nervures (17) longitudinales aptes à créer, lors de l'expansion de la tête (3) sur un athérome un ou plusieurs canaux facilitant la circulation sanguine après retrait du cathéter.6 °. Extendable probe according to claim 5, characterized in that the perforations (16) are provided only on a lateral half of the envelope (15), the opposite side comprising one or more longitudinal ribs (17) capable of creating, during expansion of the head (3) on an atheroma one or more channels facilitating blood circulation after withdrawal of the catheter.
7°. Sonde extensible selon l'une quelconque des revendications précédente, se caractérisant par le fait qu'elle est agencée pour pouvoir injecter préalablement un liquide coagulant rapidement, de manière à obtenir, par compactage avec la tête expansible 3, une diminution du volume de l'athérome permettant une meilleure circulation sanguine.7 °. Extendable probe according to any one of the preceding claims, characterized in that it is arranged to be able to inject a coagulating liquid quickly beforehand, so as to obtain, by compacting with the expanding head 3, a reduction in the volume of the atheroma allowing better blood circulation.
8°. Sonde extensible selon l'une quelconque des revendications précédente, se caractérisant par le fait qu'elle est agencée pour pouvoir fixer sur l'athérome un manchon grillagé formant un barrage bloquant l'expansion de l'athérome. 8 °. Extendable probe according to any one of the preceding claims, characterized in that it is arranged to be able to fix on the atheroma a screened sleeve forming a barrier blocking the expansion of the atheroma.
PCT/FR2001/001528 2000-05-18 2001-05-18 Extensible internal probe for surgical use, for dilatation, curettage and protection of physiological ducts WO2001087168A1 (en)

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FR00/06338 2000-05-18
FR0006338A FR2808991A1 (en) 2000-05-18 2000-05-18 Extending internal surgical probe esp for removing blood clots has expanding head made from bending strips with saw-toothed edges

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