U.S. patent number 3,837,345 [Application Number 05/393,653] was granted by the patent office on 1974-09-24 for venous valve snipper.
Invention is credited to Adel F. Matar.
United States Patent |
3,837,345 |
Matar |
September 24, 1974 |
VENOUS VALVE SNIPPER
Abstract
A cylindrical catheter-type instrument has a tubular member
slidable lengthwise relative to a distal head member. The
instrument may be inserted in the distal end of a vein in closed
position causing it to pass through the venous valves in the
direction of normal blood flow. When the instrument is partially
withdrawn in open position the venous valve leaflets protrude into
a gap between the tubular and head members and become impaled on
spikes in the head member. Then the tubular member is closed on the
head member causing an annular cutting blade on the tubular member
to snip off the valve leaflets. Opening and closing of the head and
tubular members is accomplished by a scissors-type handle connected
to the two parts.
Inventors: |
Matar; Adel F. (Portland,
OR) |
Family
ID: |
23555673 |
Appl.
No.: |
05/393,653 |
Filed: |
August 31, 1973 |
Current U.S.
Class: |
606/159; 606/167;
606/171 |
Current CPC
Class: |
A61B
17/32053 (20130101); A61B 17/320016 (20130101); A61B
2017/320064 (20130101); A61B 2017/22097 (20130101) |
Current International
Class: |
A61B
17/32 (20060101); A61B 17/22 (20060101); A61b
017/32 () |
Field of
Search: |
;128/2B,305,311,328 |
References Cited
[Referenced By]
U.S. Patent Documents
Foreign Patent Documents
|
|
|
|
|
|
|
1,069,398 |
|
May 1967 |
|
GB |
|
1,160,573 |
|
Jan 1964 |
|
DT |
|
67,204 |
|
Jun 1969 |
|
DL |
|
Primary Examiner: Pace; Channing L.
Attorney, Agent or Firm: Schermerhorn; Lee R.
Claims
Having now described my invention and in what manner the same may
be used, what I claim as new and desire to protect by Letters
Patent is:
1. A venous valve snipper catheter instrument comprising a tubular
member having a distal end and a proximal end, an annular cutting
blade on said distal end, a rounded head mounted on a core rod
extending through said tubular member, means for sliding said
tubular member on said core rod to reciprocate said cutting blade
toward and away from said head, said blade having an open position
leaving a gap between the blade and head to receive the valve
leaflets in a vein when the instrument is inserted and manipulated
in the vein, and spikes in said head extending in a proximal
direction beyond the head and partially across said gap when the
blade is in said open position to impale said valve leaflets by
manipulation of the instrument in the vein, said valve leaflets
being excised by closing said cutting blade against said head.
2. An instrument as defined in claim 1, said head being hollow to
contain said excised valve leaflets on said spikes.
3. An instrument as defined in claim 1, said tubular member and
core rod being flexible.
4. An instrument as defined in claim 1, said spikes being mounted
on said core rod.
5. An instrument as defined in claim 1 including a rigid collar on
said proximal end of said tubular member.
6. An instrument as defined in claim 5, said means for sliding said
tubular member on said core rod comprising a handle having a pair
of pivotal levers, means for detachably connecting one of said
levers with said rigid collar, and means for detachably connecting
the other lever with said core rod.
7. An instrument as defined in claim 1, said tubular member and
core rod being flexible, a rigid collar on said proximal end of
said tubular member, said means for sliding said tubular member on
said core rod comprising a handle having a pair of pivotal levers,
a clamp on one of said levers for clamping said rigid collar, and a
nut on the other lever having threaded engagement with said core
rod.
Description
BACKGROUND OF THE INVENTION
This invention relates to an instrument for removing the venous
valves from veins.
In utilizing vein grafts to bypass blocked arteries, the standard
procedure is to reverse the vein in order to avoid obstruction to
the blood flow by the valves in the vein. However, in reversing the
vein the arterial flow through the graft then proceeds from the
narrow end to the wider end. This produces undesirable flow
characteristics including turbulence which is believed to be one of
the causes of development of intimal hyperplastia reported after
such operations.
By excising the valves it is possible to place the vein with the
wider end toward the inflow anastomosis and the narrower end toward
the outflow anastomosis. This achieves better flow characteristics
and reduces the possibility of stasis in the vein graft which
sometimes predisposes to thrombosis. It is also often desirable to
remove the venous valves while the vein remains in situ, obviating
the necessity to dissect the vein out. This reduces the operative
time significantly in appropriate situations.
Objects of the invention are, therefore, to provide an instrument
for excising venous valves safely and without damage to the vein
wall, to provide an instrument for this purpose which can be used
after the vein is dissected out or while the vein still remains in
situ, and to provide an instrument of the type described having a
disposable part which does not have to be cleaned and sterilized
after use.
SUMMARY OF THE INVENTION
The present instrument consists of a disposable part and a
permanent or re-usable part. The utilization of a disposable part
insures good functioning of the instrument every time it is used.
The disposable part comprises a flexible tubular portion having an
annular cutting blade which may be closed and opened toward and
away from a rounded metal head. The permanent part comprises a
scissors-type handle which may be detachably connected with the
disposable part to accomplish the cutting action.
The instrument is introduced in closed position into the distal end
of a vein in the direction of blood flow and is therefore easily
maneuvered past all of the venous valves. The instrument is then
placed in the open position, leaving a gap between the head and the
cutting blade on the tubular portion. By partially withdrawing the
instrument in open position, sharp spikes in the head portion spear
and impale the venous valve leaflets which protrude into the gap.
Closing of the tubular portion and blade against the head cleanly
excises the valve leaflets without damaging the vein wall.
Then the insrument is withdrawn to the next valve and the above
manipulations repeated. When the instrument is finally withdrawn
from the vein, it contains all the excised valve leaflets impaled
on the spikes in the head portion. The vein is then capable of
conveying a flow of blood in the reverse direction, i.e., from the
wider end to the narrower end.
The invention will be better understood and additional objects and
advantages will become apparent from the following description of
the preferred embodiment illustrated on the accompanying drawing.
Various changes may be made, however, in the details of
construction and arrangement of parts and certain features may be
used without others. All such modifications within the scope of the
appended claims are included in the invention.
BRIEF DESCRIPTION OF THE DRAWING
FIG. 1 is an elevation view with parts broken away and parts in
section, showing an instrument embodying the invention in open
position;
FIG. 2 is an enlarged longitudinal sectional view of a portion of
FIG. 1;
FIG. 3 is a view on the line 3--3 in FIG. 2;
FIG. 4 is a longitudinal sectional view of a vein, showing how the
instrument is introduced into the vein; and
FIG. 5 is a view similar to FIG. 3, showing the operation of the
instrument .
DESCRIPTION OF THE PREFERRED EMBODIMENT
The instrument comprises a flexible catheter tube A of suitable
plastic material such as Teflon, a highly polished and rounded
metal head B and a manipulating handle C. A metal collar or cap 10
is fixedly mounted on the proximal end of tube A and a sharpened
annular metal cutting blade 11 is fixedly mounted on the distal end
of the tube. The tube contains a lumen or bore 12.
The proximal end of head B is cylindrical and its wall section is
notched or recessed at 13 forming an anvil to guide and receive the
sharpened cutting edge of blade 11. A transverse wall 14 in the
head B has a central threaded opening to receive the threaded
distal end 15 of a flexible metal core rod or wire 20 which is
slidable longitudinally in the lumen 12. The proximal end 21 of the
core rod is also threaded.
Four spikes or prongs 22 having sharpened ends are mounted on a nut
or collar 23 which is fixedly secured to the rod 20. Spikes 22
extend divergently in a proximal direction slightly beyond the end
13 of head B, the sharpened ends of the spikes being within the
diameter of blade 11 so that the blade will reciprocate freely past
the ends of the spikes without interference.
Handle C has a forceps or scissors action comprising a pair of
levers 30 and 31 pivotally connected together at 32. Lever 31 has a
link 33 pivotally connected therewith at 34. A circular clamp 35 is
pivotally connected at 36 with link 33. Clamp 35 may be tightened
on collar 10 by means of clamp screw 37.
Lever 30 contains a smooth bore at 38 to slidably receive the rod
20. Proximal end 21 of rod 20 is threaded through a cylindrical nut
40. Nut 40 has a peripheral groove 41 which receives projections 42
on a retainer 43 mounted on handle lever 30.
Thus, the handle C is adapted to reciprocate tube A and blade 11
relative to head B. Nut 40 provides means for adjustment of head B
relative to tube A and handle C. Tube A and core rod 20 may be made
to different lengths as desired and tube A and head B may be made
in different diameters, the outside diameter of collar 10 being
uniform in all cases to fit the clamp 35 which is a part of the
handle C. Tube A and head B with its core rod 20 and spikes 22 are
preferably made as disposable parts while handle C is a re-usable
or permanent part.
FIGS. 4 and 5 illustrate the operation of the instrument. With tube
A and head B closed together, these parts are introduced from the
distal end of the vein V in the direction of venous blood flow and
passed through the valve leaflets L as shown in FIG. 4. Depending
on the length of the vein, the instrument may have to pass through
a number of such valves. When head B has passed through all the
valves in the vein segment which is being treated, the instrument
is then placed in opened position as shown in FIG. 2, leaving a gap
between cutter blade 11 and head B.
When the instrument is slightly withdrawn in the open position, the
valve leaflets L enter the gap between cutter blade 11 and head B
and become impaled on spikes 22 as shown in FIG. 5. This will
impose a resistance to further withdrawal of the instrument which
will be felt by the operator. The instrument is then closed,
causing cutter blade 11 to move against the anvil 13 and excise the
valve leaflets. The cutting action leaves the valve leaflets
impaled on the spikes in the head with the spikes protruding
through the upstream sides of the leaflets.
When the first pair of valve leaflets has been excised as
described, it will then be possible to withdraw the instrument
further. Then the instrument is re-opened and the procedure is
repeated at the next valve. After all the valves have been excised,
the instrument is withdrawn from the distal end of the vein with
all the excised valve leaflets speared on the spikes 22 and
contained in the hollow head B. Free flow of blood is then possible
in the vein in the reverse direction, i.e., from the wider to the
narrower end. The vein may then be used as an artery in situ or as
a transplant.
Flexible tube A follows the path of a vein in situ in the manner of
a catheter. When the vein is dissected out of the body for use as a
transplant graft, the tube A may be a rigid tube.
The present type of instrument may also be used to excise any
valves, webs or strictures in any tubular structure in the body,
such as the urethra, esophagus or the bile ducts.
* * * * *