RU2436523C2 - Method of endovascular vessel occlusion - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, namely to surgery. End of guide catheter with internal diameter not less than 1.5 mm with Y-shaped connector in positioned in proximal part of vessel or near its orifice. In distal parts of vessel coronary guide with diameter 0.014 inch is passed. Guide end is positioned on the part of vessel requiring embolisation. Gianturco spiral with section thickness from 0.018 inch to 0.038 inch and diameter of coil not less than 1.5 mm is put on guide. Spiral is pushed by delivering device made from coronary balloon catheter by cutting off balloon itself from carrying part. Spiral pushed by delivering device is moved through lumen of guide catheter into vessel lumen. When spiral reaches guide end and slides off it, it coils in vessel, causing its occlusion.

EFFECT: method extends arsenal of means for carrying out endovascular vessel occlusion.

1 ex

Description

The invention relates to medicine, namely to surgery, and can be used with endovascular interventions to stop bleeding, treat a pathological arteriovenous shunt or aneurysm, or ischemic organ or tissue.

A known method of endovascular occlusion of blood vessels, which consists in introducing into the vessel through a catheter embolizing steel spirals Gianturko [1, 2], including determining the location of occlusion during angiography, transcatheter delivery of the spiral to the embolized portion of the vessel, pushing the spiral out of the catheter using a guide wire followed by a collar ejection followed by separation from the delivery device. The disadvantages of this method are the need to conduct a catheter directly to the embolization site, the difficulty of applying the method if it is necessary to embolize the distal convoluted arteries of small diameter, the inability to simultaneously contrast the occluded vessel to control the intervention (the lumen of the catheter is made by a spiral and a conductor).

The prototype of the claimed invention is a method of embolization of arteries, proposed by N. A. Lopatkin and A. V. Morozov, in which it is recommended to introduce a spiral mounted on a stylet directly into the artery, pushing the spiral using a pushing device [1]. Positive in this method are: the possibility of precision insertion of the helix, the exclusion of spring recoil arising from a mismatch between the diameters of the helix and the occluded vessel, as well as with an unstable position of the catheter. The disadvantage of this method is the limited therapeutic possibilities, manifested in the fact that the pushing device proposed by the authors does not have sufficient strength to overcome the resistance expressed when the vessels are crimped; in addition, embolization can be carried out only in the area directly accessible for delivering the catheter; twisting of the helix occurs immediately after the first turn out of the catheter, which makes embolization of crimped vessels of small diameter impossible.

The objective of the invention is the expansion of therapeutic options for endovascular vascular occlusion.

This task in the proposed method for endovascular occlusion of blood vessels is achieved by performing diagnostic angiography using a guide catheter with an inner diameter of at least 1.5 mm, with a Y-shaped connector, position the end of the catheter in the proximal part of the vessel requiring embolization, or near its mouth , a coronary conductor with a diameter of 0.014 inches is drawn into the distal portions of the vessel, the end of the conductor is positioned in the portion of the vessel requiring embolization, a Gianturco spiral with a thickness is put on the conductor sections from 0.018 inches to 0.038 inches and a coil diameter of at least 1.5 mm, the spiral is pushed with a delivery device made of a coronary balloon catheter by cutting the balloon itself from the supporting part, the spiral pushed by the delivery device is advanced through the lumen of the guide catheter into the lumen of the vessel, upon reaching the end of the conductor and slipping off it, the spiral twists in the vessel, which causes its occlusion.

The specified method is as follows. After performing diagnostic angiography, the end of a guide catheter with an inner diameter of 1.5 mm can be larger, but not less than 1.5 mm, with an attached Y-shaped connector with a side port for introducing contrast, they are positioned in the proximal part of the vessel requiring embolization, or near its mouth . Then a coronary conductor with a diameter of 0.014 inches is drawn into the distal portions of the vessel. The end of the coronary conductor is installed in the area of the vessel requiring embolization. The small cross-sectional diameter of the coronary conductor, as well as its flexibility, allows the conductor to be inserted into any segment of the vessel. A Gianturco spiral is worn on the conductor with a section thickness from 0.018 inches to 0.038 inches and a coil diameter of 1.5 mm, more, but not less than 1.5 mm. The spiral is pushed with a delivery device made of a coronary balloon catheter by cutting off the balloon itself from the supporting part. The spiral, pushed by the delivery system, is advanced through the lumen of the guide catheter into the lumen of the vessel. Upon reaching the end of the conductor, and therefore the zone of interest, the spiral slides off the conductor and twists, which causes vessel occlusion. The use of a Y-shaped connector with a side port for introducing contrast allows radiopaque control of the intervention at all stages by introducing a contrast medium through the side port of the connector.

The method allows to carry out embolization of arteries without introducing a catheter into the distal sections of the convoluted vessels, to carry out stable positioning of the embolizing spiral in the zone of interest, to control the course of the intervention using contrasting.

Concrete example

Patient Sh., 51 years old. She was hospitalized on October 12, 2006 with the diagnosis: “Exacerbation of chronic pancreatitis. Pancreatic tail pseudocyst. ” Under ultrasound control, on October 13, 2006, a fine-needle diagnostic puncture of a liquid formation was performed; upon removal of the mandrin from the needle, blood was obtained with a pulsating stream. An angiographic study was performed - a false aneurysm of the splenic artery was diagnosed. The splenic artery was embolized by the proposed method, the Gianturco spirals were positioned immediately distal and proximal to the defect in the splenic artery. Subsequent contrasting confirmed the gradual cessation of blood flow in the cavity of the aneurysm. Complications associated with the application of the proposed method were not noted.

INFORMATION SOURCES

1. X-ray endovascular surgery / Rabkin I.Kh., Matevosov A.L., Getman L.N. - M.: Medicine, 1987, 416 p.

2. Guidelines for endovascular surgery of the heart and blood vessels. - M .: NTSSSH them. A.N. Bakuleva RAMS, 2008, Vol. 1, 598 p.

Claims (1)

A method of endovascular vascular occlusion, including performing diagnostic angiography, embolization with Gianturco spirals, characterized in that after performing diagnostic angiography with a guide catheter with an inner diameter of at least 1.5 mm, with a Y-shaped connector, the end of the catheter is positioned in the proximal part of the vessel, requiring embolization, or near its mouth, into the distal portions of the vessel conduct a coronary conductor with a diameter of 0.014 inches, the end of the conductor is positioned in the portion of the vessel requiring bolts, a Gianturco spiral is put on the conductor with a cross section thickness from 0.018 to 0.038 inches and a coil diameter of at least 1.5 mm, the spiral is pushed with a delivery device made of a coronary balloon catheter by cutting the balloon itself from the supporting part, the spiral pushed by the delivery device is advanced, through the lumen of the guiding catheter into the lumen of the vessel, upon reaching the end of the conductor and slipping off it, the spiral twists in the vessel, which causes its occlusion.