CN107684657A - A kind of double-layer bend microtubular and its application method for artery chronic Occlusion interventional procedure - Google Patents

A kind of double-layer bend microtubular and its application method for artery chronic Occlusion interventional procedure Download PDF

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CN107684657A
CN107684657A CN201710708882.0A CN201710708882A CN107684657A CN 107684657 A CN107684657 A CN 107684657A CN 201710708882 A CN201710708882 A CN 201710708882A CN 107684657 A CN107684657 A CN 107684657A
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microtubular
layer
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bend
seal wire
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CN107684657B (en
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陈翔
陈临凌
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    • 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
    • A61M25/0021—Catheters; Hollow probes characterised by the form of the tubing
    • A61M25/0023—Catheters; Hollow probes characterised by the form of the tubing by the form of the lumen, e.g. cross-section, variable diameter
    • A61M25/0026—Multi-lumen catheters with stationary elements
    • 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
    • A61M25/0043—Catheters; Hollow probes characterised by structural features
    • 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
    • A61M25/0067—Catheters; Hollow probes characterised by the distal end, e.g. tips
    • A61M25/0068—Static characteristics of the catheter tip, e.g. shape, atraumatic tip, curved tip or tip structure
    • 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
    • A61M25/01—Introducing, guiding, advancing, emplacing or holding catheters
    • 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
    • A61M2025/0004—Catheters; Hollow probes having two or more concentrically arranged tubes for forming a concentric catheter system
    • A61M2025/0006—Catheters; Hollow probes having two or more concentrically arranged tubes for forming a concentric catheter system which can be secured against axial movement, e.g. by using a locking cuff
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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    • A61M25/00—Catheters; Hollow probes
    • A61M25/0021—Catheters; Hollow probes characterised by the form of the tubing
    • A61M25/0023—Catheters; Hollow probes characterised by the form of the tubing by the form of the lumen, e.g. cross-section, variable diameter
    • A61M25/0026—Multi-lumen catheters with stationary elements
    • A61M2025/0039—Multi-lumen catheters with stationary elements characterized by lumina being arranged coaxially
    • 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
    • A61M25/01—Introducing, guiding, advancing, emplacing or holding catheters
    • A61M2025/0175—Introducing, guiding, advancing, emplacing or holding catheters having telescopic features, interengaging nestable members movable in relations to one another
    • 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
    • A61M2210/00—Anatomical parts of the body
    • A61M2210/12—Blood circulatory system

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Abstract

The invention discloses a kind of double-layer bend microtubular for artery chronic Occlusion interventional procedure, including：Outer layer microtubular, the tail end of outer layer microtubular be provided with one be used for realize the rotational lock mechanism that rotates and lock；Internal layer microtubular, internal layer microtubular is located in outer microtube catheter interior, and the length of internal layer microtubular is more than the length of outer layer microtubular；The axial movement structure for realizing that outer layer microtubular and internal layer microtubular advance or retreated in the axial direction is provided between outer layer microtubular and internal layer microtubular；The head end of internal layer microtubular is provided with the elbow that can be stretched automatically inside outer layer microtubular.Also disclose the application method of the double-layer bend microtubular.The double-layer bend microtubular, seal wire can be smoothly completed and puncture the true chamber of intravasation, simultaneously, the conduit seal wire that can also follow up enters true chamber, need not change another can complete radiography through microtubular with microtubular and confirm to enter true chamber and complete seal wire to exchange, make operation more easy, save time and operation cost.

Description

A kind of double-layer bend microtubular for artery chronic Occlusion interventional procedure and its make Use method
Technical field
It is more specifically to a kind of slow for coronary artery or artery of lower extremity the present invention relates to technical field of medical instruments The double-layer bend microtubular and its application method of property Occlusion interventional procedure.
Background technology
The maximum enemy of the cardiovascular pathological changes human health such as arterial sclerosis, narrow, inaccessible.With interventional therapeutic technique Development, including the lesion such as coronary artery stenosis, occlusion and Lower Extremity Artery Stenosis, occlusion can be obtained by the method for intervention Effective treatment.But coronary artery or artery of lower extremity Chronic total occlusion PCI are but still problem clinically One of.In human body-structural pipe wall of main artery blood vessel can be divided into endangium, middle film, outer membrane three-decker（Fig. 4）.Inner membrance is Loose connective tissue, it is relatively thin；Middle film is made up of the smooth muscle of annular array, there is some elastomers between flesh, thicker；Outer membrane ratio Middle film is thin, is made up of connective tissue.Because occlusion time is longer, the head end of its occluded blood vessel often forms harder fiber Cap, be expert at PCI when, seal wire is difficult to accurately to penetrate fibrous cap and enters the true chamber of blood vessel of occlusion, and easily passes through relatively thin blood Pipe inner membrance and under the inner membrance of intravasation or media, that is, usually said " false chamber "（Fig. 5）, and it is difficult to intravasation True chamber and cause intervene operative failure.For most of Chronic coronary artery occlusions, particularly with inaccessible segment length, or it is calcification, circuitous Bent lesion, it is ensured that seal wire is nearly impossible in the true chamber of blood vessel all the time, and is then extremely common under intravasation inner membrance 's.Now, the key of intervention operation success is that how to make how to return the true chamber of blood vessel into subintimal seal wire.This The technology of kind positive inner membrance true chamber next time is clinically referred to as ADR technologies（Antegrade Dissection Re-Entry Techniques）.
Clinically the special true cavities conduit pipe that returns to includes two big classifications at present, is answered respectively in coronary occlusion Applied with arterial occlusions in lower limbs lesion.
The true chamber system that returns to that coronary occlusion is clinically commonly used is CrossBoss ＆ Stingray systems.Under What main drive arteries and veins Occlusion was clinically commonly used, which returns to true cavities conduit pipe, includes Outback LTD conduits, Pioneer conduits, OffRoad Conduit, Enteer conduits.The shortcomings that they are common is all that above-mentioned conduit can not be by leading after seal wire smoothly returns to true chamber Silk directly follows up, and needs to exit conduit, the conventional small-bore microtubular follow-up true chamber of seal wire intravasation is exchanged, to complete to pass through Microtubular radiography exchanges the softer work seal wire of head end.So, that is, the complexity and operating time of the operation added, also make Into cost more economically.
Chinese patent literature（The day for announcing：On July 29th, 2009, notification number：CN101495171）Disclose including for arteries and veins The medical treatment device and method of the conduit system of guard system.Conduit system includes being used to enter back into formula with what many wires were used together Conduit, after wire comes into subintimal space, described conduit system instructs wire outside chamber or subintimal space enters again Enter in true chamber.The example for entering back into formula conduit is configured for being used to facilitate wire and conduit to enter and be positioned in vascular system Single lumen catheter.Wire and conduit are placed and are positioned in peripheral vascular system by one embodiment.More specifically, Formula conduit is entered back into so that in the true chamber that wire enters back into peripheral vascular system from subintimal space.
Chinese patent literature（The day for announcing：On December 10th, 2014, notification number：CN203988135U）Disclose a kind of blood vessel Interior ultrasonic two-chamber microtubular, the two-chamber microtubular by Vascular Ultrasonography conduit and with Vascular Ultrasonography conduit and the treatment that combines as a whole Microtubular is formed.The utility model apparatus external diameter is small, punctures seal wire and easily synchronously enters lesion, two-chamber with ultrasonic two-chamber microtubular Microtubular effectively increases the handling of seal wire.The utility model can show tube wall and characteristics of lesion simultaneously, due to two conduits To be conjuncted, when ultrasound instructs the seal wire to puncture in the blood vessels, the position for puncturing seal wire and ultrasonic probe is relatively fixed, it is easier to it is determined that Relation between guiding wire and target, contribute to correct hold to puncture direction, can greatly improve seal wire into true chamber into Power, improve success rate of operation.
Although above-mentioned technical proposal also relates to this microtubular, its raising operating efficiency seal wire solved enters true The problem of success rate of chamber.But the complexity and operating time of the operation added, more costs economically are also resulted in.
The content of the invention
The invention aims to solve at present clinically other auxiliary puncture true chamber microtubular can not puncture into Work(rear tube follows directly after seal wire and enters true chamber, and needs to change common microtubular to realize the follow-up of conduit and exchange guidewire, Complex operation and operating time length, the problems such as cost is high, and providing a kind of can complete through microtubular without needing to change microtubular Radiography confirm enter true chamber and complete seal wire exchange, using perform the operation it is easier, save the time, it is cost-effective be used for artery it is slow The double-layer bend microtubular and its application method of property Occlusion interventional procedure.
Technical scheme is used by the present invention realizes its first goal of the invention：One kind is used for artery chronic Occlusion The double-layer bend microtubular of interventional procedure, including：
Outer layer microtubular, the tail end of described outer layer microtubular be provided with one be used for realize the rotational lock machine that rotates and lock Structure；
Internal layer microtubular, described internal layer microtubular are located in outer microtube catheter interior, and the length of described internal layer microtubular Length of the degree more than outer layer microtubular；
It is provided between described outer layer microtubular and internal layer microtubular and realizes outer layer microtubular and internal layer microtubular in the axial direction The axial movement structure advanced or retreated；
The head end of described internal layer microtubular is provided with the elbow that can be stretched automatically inside outer layer microtubular.
This is used for the double-layer bend microtubular of artery chronic Occlusion interventional procedure, by setting pair of lamina elbow microtubular Structure, being internally provided with one in outer layer microtubular can be and micro- in internal layer along the internal layer microtubular that outer layer microtubular slides in and out The head end of conduit sets an elbow, when needing to being fixed between internal layer microtubular and outer layer microtubular, passes through rotation lock Tight mechanism will be locked, and when needing internal layer microtubular to stretch out outer layer microtubular, outward winding rotational lock mechanism and pass through axial direction Motion structure make it that internal layer microtubular is protruding, after the protruding outer layer microtubular of internal layer microtubular its head end natural torsion into Elbow.The double-layer bend microtubular, using a conduit, it is big into true chamber two to realize that auxiliary punctures true chamber and conduit follow-up seal wire Function, it is easy to operate without changing conduit in addition.When under seal wire and the double-layer bend microtubular intravasation inner membrance, withdraw Seal wire, and the outer layer microtubular that retracts, now the head end of internal layer microtubular can automatic bending into elbow, manipulate internal layer microtubular elbow Direction, its elbow is pointed to the true chamber of blood vessel, be now sent into the harder puncture seal wire of a head end along double-layer bend microtubular, lead to The signified true cavity direction puncture of blood vessel in the elbow end of internal layer microtubular is crossed, helps seal wire to return the true chamber of blood vessel.Now, internal layer is withdrawn Microtubular to outer microtube catheter interior, elbow stretches automatically, and whole system just reverts to the function of a common microtubular, now It can send conduit intravasation true chamber along before seal wire.The double-layer bend microtubular, by a conduit, realize that auxiliary punctures true chamber Enter true two big function of chamber with conduit follow-up seal wire, without needing to reuse an other microtubular, save operation cost.
Preferably, the tail end of described internal layer microtubular is provided with flaring structure.The tail end of internal layer microtubular is provided with Flaring structure, the flaring structure can be set in horn-like to facilitate the insertion of seal wire.
Preferably, described rotational lock mechanism is a rotation fixed handle.It is solid that rotational lock mechanism is arranged to rotation Determine handle, operable internal layer microtubular and outer layer plan conduit is sent or setback before doing respectively when unclamping rotational lock mechanism, rotation Outer layer microtubular and internal layer microtubular can be fixed during tight rotational lock mechanism, facilitate the entirety of double-layer bend microtubular to return Move back, preceding the operation such as send.
Preferably, described axial movement structure includes the raised line being arranged on outer microtube tail end of conduit internal chamber wall and set The groove on internal layer microtubular tail end outer wall is put, described raised line and groove corresponding matching are set.The setting of raised line and groove It is that can only do front and rear relative motion between ectonexine microtubular to ensure that, and mutual rotation can not be done, ensures The accuracy of operation.
Preferably, the axial length of described groove is more than the axial length of raised line.The length of groove is more than raised line Length is to facilitate raised line sliding back and forth in inside grooves, and realization moves forward and backward.
Preferably, the head end of described outer layer microtubular is provided with light tight L-type mark.Outer microtube conduit head end with it is interior Elbow side corresponding to layer microtubular is provided with a lighttight L-type mark, is easy to adjust the direction of conduit under DSA, allows curved Head points to true cavity direction.
Preferably, the bar portion of outer layer microtubular is integral pipe fitting, the material internal of described outer layer microtubular is poly- Tetrafluoroethene, outside are compiled into for stainless (steel) wire, and the overall outer surface of bar portion is hydrophilic coating.
Preferably, the bar portion of internal layer microtubular is integral pipe fitting, the material internal of described internal layer microtubular is poly- Tetrafluoroethene, internal layer microtubular head end outside are compiled into for stainless (steel) wire, and the outer surface of bar portion head end is hydrophilic coating.
Technical scheme is used by the present invention realizes its second goal of the invention：One kind is used for artery chronic Occlusion The application method of the double-layer bend microtubular of interventional procedure, it is characterised in that comprise the following steps：
Step 1：Prepare the harder superslide of double-layer bend microtubular, head end and puncture seal wire, common soft seal wire；
Step 2：The harder superslide of head end is punctured into seal wire to be located in inside double-layer bend microtubular, and superslide is punctured seal wire and enters After entering under endangium, the double-layer bend microtubular is punctured under seal wire intravasation inner membrance along superslide；
Step 3：The double-layer bend microtubular and superslide is set to puncture the position of seal wire entirety intravasation distal end needs, when superslide is worn Pierce seal wire and behind double-layer bend microtubular entirety intravasation distal end, now rollback superslide puncture seal wire, rollback outer layer microtubular, Expose the head end of internal layer microtubular, now the head end of internal layer microtubular can be automatically restored to 120 degree of elbow, and double by reversing Layer elbow microtubular adjusts the direction of elbow；
Step 4：The lighttight L-type set by outer microtube conduit head end elbow side corresponding with internal layer microtubular identifies, The direction of double-layer bend microtubular is adjusted under DSA, allows elbow to point to the true cavity direction of blood vessel；
Step 5：Superslide is sent into along the double-layer bend microtubular and punctures seal wire, and superslide punctures elbow of the seal wire by internal layer microtubular The signified direction in end punctures, and helps superslide to puncture the true chamber of seal wire intravasation；
Step 6：After superslide, which punctures seal wire, returns to blood vessel true chamber in distal vessels, retaining superslide, to puncture seal wire true in distal vessels In chamber, double-layer bend microtubular is overall to enter the true chamber of distal vessels along superslide puncture seal wire.
Step 7：Withdraw superslide and puncture seal wire, retain double-layer bend microtubular in the true chamber of distal vessels, change common soft leads Silk enters the true chamber of distal vessels, can smoothly complete intervention operation.
The beneficial effects of the invention are as follows：This is used for the double-layer bend microtubular of artery chronic Occlusion interventional procedure and its made With method, seal wire can be smoothly completed and punctured enter true chamber, meanwhile, the conduit seal wire that can also follow up enters true chamber, without replacing It is another to complete the radiography confirmation through microtubular into true chamber with microtubular and complete seal wire exchange, make operation more easy, The time is saved, also saves operation cost.
Brief description of the drawings
Fig. 1 is a kind of structural representation for the double-layer bend microtubular that the present invention is used for artery chronic Occlusion interventional procedure Figure；
Fig. 2 is a kind of partial sectional view of the invention for the double-layer bend microtubular of artery chronic Occlusion interventional procedure；
Fig. 3 is the A-A sectional views in Fig. 2；
Fig. 4 is in human body-the structural pipe wall figure of main artery blood vessel；
Fig. 5 in the prior art under the inner membrance of seal wire intravasation or media " false chamber " a kind of structural representation；
Fig. 6 is that the present invention is used for the one kind of the double-layer bend microtubular of artery chronic Occlusion interventional procedure as common microtubular Structural representation；
Fig. 7 is subintimal one kind of double-layer bend microtubular intravasation that the present invention is used for artery chronic Occlusion interventional procedure Structural representation；
Fig. 8 be the present invention be used for artery chronic Occlusion interventional procedure double-layer bend microtubular in internal layer microtubular head end from A kind of dynamic structural representation for bending to elbow；
Fig. 9 is to utilize the present invention to be used for the double-layer bend microtubular of artery chronic Occlusion interventional procedure to help superslide to puncture seal wire A kind of structural representation of the true chamber of intravasation；
Figure 10 is that the present invention is used for the double-layer bend microtubular of artery chronic Occlusion interventional procedure with superslide puncture seal wire entrance A kind of structural representation of the true chamber of blood vessel；
Figure 11 is that the present invention withdraws a kind of structural representation after superslide puncture seal wire and internal layer microtubular；
In figure：1st, outer layer microtubular, 2, rotational lock mechanism, 3, internal layer microtubular, 4, be axially moved structure, 5, elbow, 6, expand Mouth structure, 7, raised line, 8, groove, 9, light tight L-type mark, 10, puncture seal wire.
Embodiment
Technical scheme is described in further detail below by specific embodiment and with reference to accompanying drawing.
Embodiment 1：
In the embodiment shown in Fig. 1, Fig. 2, Fig. 3, a kind of double-layer bend for artery chronic Occlusion interventional procedure is micro- to lead Pipe, the total length of the double-layer bend microtubular is two kinds of models, respectively 130cm and 150c, and the double-layer bend microtubular includes：
Outer layer microtubular 1, the tail end of outer layer microtubular 1 be provided with one be used for realize the rotational lock mechanism 2 that rotates and lock；
Internal layer microtubular 3, internal layer microtubular 3 are located in inside outer layer microtubular 1, and the length of internal layer microtubular 3 is more than outer The length of layer microtubular 1；
It is provided between outer layer microtubular 1 and internal layer microtubular 3 before realizing outer layer microtubular 1 and internal layer microtubular 3 in the axial direction The axial movement structure 4 entered or retreated；
The head end of internal layer microtubular 3 is provided with the elbow 5 that can be stretched automatically inside outer layer microtubular 1.The angle of bend of elbow 5 For obtuse angle.
The tail end of internal layer microtubular 3 is provided with flaring structure 6.
Rotational lock mechanism 2 is a rotation fixed handle.
Being axially moved structure 4 includes the raised line 7 that is arranged on the tail end internal chamber wall of outer layer microtubular 1 and is arranged on that internal layer is micro- to lead Groove 8 on the tail end outer wall of pipe 3, raised line 7 and the corresponding matching of groove 8 are set.The axial length of groove 8 is more than the axial direction of raised line 7 Length.The length of groove 8 is at least twice of the length of convex length 7.
The head end of outer layer microtubular 1 is provided with light tight L-type mark 9.Outer microtube conduit head end is corresponding with internal layer microtubular Elbow side be provided with a lighttight L-type mark, be easy to adjust the direction of conduit under DSA, allow elbow to point to true chamber side To.
The bar portion of outer layer microtubular 1 is integral pipe fitting, and the material internal of outer layer microtubular 1 is polytetrafluoroethylene (PTFE), outside It is compiled into for stainless (steel) wire, the overall outer surface of bar portion is hydrophilic coating.
The bar portion of internal layer microtubular 3 is integral pipe fitting, and the material internal of internal layer microtubular 3 is polytetrafluoroethylene (PTFE), internal layer It is compiled into outside the head end of microtubular 3 for stainless (steel) wire, the outer surface of bar portion head end is hydrophilic coating.
The head end of the double-layer bend microtubular can integrally realize flexural deformation, to realize double-layer bend microtubular with seal wire Into the true chamber of distal vessels and the true intracavitary portion of distal vessels can be rested on, it is true into distal vessels to be convenient for changing common soft seal wire Chamber, smoothly complete intervention operation.
In the present embodiment, the total length of double-layer bend microtubular is 130cm in the present embodiment, and the head end of internal layer microtubular 3 is grown Degree 2mm long compared with outer layer microtubular；The angle of bend of elbow is 120 degree, and the length of elbow is 1mm；Flaring structure 6 is arranged to small loudspeaker Shape；The raised line 7 being axially moved in structure 4 is symmetrically arranged with two, and corresponding groove 8 is also equipped with two, the length of raised line 7 10mm is arranged to, the length of groove is arranged to 20mm.
Embodiment 2：
A kind of double-layer bend microtubular for artery chronic Occlusion interventional procedure described in embodiment and the skill in embodiment 1 Art scheme is essentially identical, and difference is：The total length of double-layer bend microtubular is 150cm, the head end length of internal layer microtubular 3 3mm long compared with outer layer microtubular；The angle of bend of elbow is 135 degree, and the length of elbow is 1.5mm；Flaring structure 6 is arranged to cylinder Shape；The raised line 7 being axially moved in structure 4 is symmetrically arranged with three, and corresponding groove 8 is also equipped with three, and the length of raised line 7 is set 10mm is set to, the length of groove is arranged to 20mm.
The double-layer bend for coronary artery or artery of lower extremity Chronic coronary artery occlusion interventional procedure described in above-described embodiment is micro- Conduit（See Fig. 1）.The flaring structure of the end of internal layer microtubular 3 is horn-like, is inserted with facilitating seal wire.Outer layer microtubular end is set There is rotatable rotation fixed handle, operable ectonexine microtubular send or retreated before doing respectively when unclamping rotation fixed handle, Outer layer microtubular and internal layer microtubular can be fixed when screwing rotation fixed handle, facilitate the entirety of double-layer bend microtubular to return Move back, preceding the operation such as send.Two layers of close connection, is divided into two kinds of types according to the big I of lumen diameter inside and outside the double-layer bend microtubular Number, respectively for double-deck microtubular coronarius, its tube chamber is only capable of the seal wire by 0.014 inch.And it is used for lower main drive Arteries and veins occlusion can then pass through 0.018 inch of seal wire.Elbow angulation of the internal layer microtubular head end provided with 1mm is 120 degree, the bilayer The total length of elbow microtubular is 130cm and two kinds of 150cm.
When outer layer microtubular is concordant with internal layer microtubular head end, it functions as clinically conventional common micro- lead Pipe.When rollback outer layer microtubular, can now expose the head end of internal layer microtubular, its head end can automatic bending into elbow 5.Now, The direction of duct bend is manipulated, its elbow is pointed to the true chamber of blood vessel, it is harder to be then sent into a head end along double-layer bend microtubular Puncture seal wire 10, punctured by the elbow end of the internal layer microtubular true cavity direction of signified blood vessel, dress thorn seal wire 10 enters blood True chamber is managed, then double-deck microtubular is overall along seal wire follow-up is punctured, and the true chamber of intravasation, is confirmed through microtubular radiography true in blood vessel After chamber, the softer seal wire of head end is exchanged, completes operation.
The double-layer bend microtubular is double-decker, and the material of internal layer microtubular 3 and outer layer microtubular 1 is polytetrafluoroethyl-ne Alkene, and Stainless Steel organization level is set outside internal layer microtubular 3 and outer layer microtubular 1 respectively, can effectively antitorque folding；Internal layer is micro- The overall outer surface of the pipe portion of conduit 3 and outer layer microtubular 1 is hydrophilic coating, is easy to microtubular to pass through in the blood vessels.Internal layer is micro- Conduit 3 grows at least 2mm compared with outer layer microtubular 1.The header terminal design of internal layer microtubular 3 has the elbow 5 that at least 1mm grows, the bending of elbow 5 Angle is obtuse angle, preferably 120 degree, and when 3 retraction outer layer microtubular 1 of internal layer microtubular, its elbow 5 can straighten, at this time Function as the common microtubular clinically used（See Fig. 4）.
The specifically used method of double-layer bend microtubular is：
Step 1：Prepare double-layer bend microtubular and superslide punctures seal wire 10, common soft seal wire；
Step 2：The harder superslide of a head end is sent into along double-layer bend microtubular and punctures seal wire 10, is entered when superslide punctures seal wire 10 After entering under endangium, the double-layer bend microtubular is then punctured under the intravasation inner membrance of seal wire 10 along superslide（See Fig. 7）；
Step 3：After superslide punctures seal wire 10 with double-layer bend microtubular entirety intravasation distal end, now rollback superslide punctures Seal wire 10, rollback outer layer microtubular 1, can expose the head end of internal layer microtubular 3, and now the head end of internal layer microtubular 3 can be automatic extensive It is 120 degree of elbow again（See Fig. 8）, the direction of its elbow 5 can be adjusted by reversing double-layer bend microtubular；
Step 4：The lighttight L-type set by the head end of outer layer microtubular 1 side of elbow 5 corresponding with internal layer microtubular 3 identifies 9, the direction of double-layer bend microtubular is adjusted under DSA, allows elbow 5 to point to true cavity direction；
The raised line 7 prominent into tube chamber of two 10mm that the tail end lumen wall of outer layer microtubular 1 is provided with length and internal layer is micro- leads The groove 8 for two 20mm length that the tail end exocoel of pipe 3 is provided with is superimposed with each other（See Fig. 2, Fig. 3）, ensure that ectonexine microtubular it Between can only do fore-aft relative motion, and mutual rotation can not be done.When the true cavity direction of the alignment blood vessel of L-type mark 9, return Outer layer microtubular 1 is moved back, the direction of the meaning of elbow 5 of internal layer microtubular 3 is the accurate direction of true chamber.
Step 5：Now superslide being sent into along the double-layer bend microtubular and puncturing seal wire 10, superslide punctures seal wire 10 and passes through internal layer The signified direction in the end of elbow 5 of microtubular 3 punctures, and helps the superslide in false chamber to puncture the true chamber of the intravasation of seal wire 10（See Fig. 9）；
Step 6：After superslide seal wire 10 returns to blood vessel true chamber in distal vessels, overall punctured along superslide of double-layer bend microtubular is led Silk 10 enters the true chamber of distal vessels（Figure 10）.
Step 7：Withdraw superslide and puncture seal wire 10, retain double-layer bend microtubular in the true chamber of distal vessels（Figure 11）, change Common soft seal wire 11 enters the true chamber of distal vessels, smoothly completes intervention operation.
Pass through the rotational lock mechanism of outer microtube tail end of conduit between ectonexine microtubular：Fixed handle is rotated to fix, Operable internal layer microtubular and outer layer microtubular are sent or setback before doing respectively when unclamping rotation fixed handle, and it is solid to screw rotation Outer layer microtubular and internal layer microtubular can be fixed when determining handle, facilitate the double-layer bend cylinder conduit overall retract, preceding send Operation.
（1）Simplify operation.Utilize piece conduit of the double-layer bend microtubular, it is possible to achieve auxiliary puncture true chamber and conduit with Enter seal wire and enter true two big function of chamber, it is easy to operate without other exchanging pipe.When seal wire and double-layer bend microtubular enter blood When under pipe inner membrance, withdraw seal wire, and the outer layer microtubular that retracts, now the end of internal layer microtubular can automatic bending into elbow, manipulation The direction of duct bend, its elbow is pointed to the true chamber of blood vessel, be now sent into that a head end is harder wears along double-layer bend microtubular Seal wire is pierced, is punctured by the elbow end of the internal layer microtubular true cavity direction of signified blood vessel, helps seal wire to return the true chamber of blood vessel.Now Double-deck microtubular can along seal wire it is direct before be fed into the true chamber of distal vessels.And clinically other auxiliary puncture the micro- of true chamber at present Conduit can not then realize puncture successfully rear tube with entering true chamber, and need to change common microtubular realize the follow-up of conduit and Exchange guidewire.
（2）Save cost.The double-layer bend microtubular utilizes a conduit, at the same realize auxiliary puncture true chamber and conduit with Enter seal wire and enter true two big function of chamber, without needing to reuse an other microtubular, save operation cost.

Claims (9)

  1. A kind of 1. double-layer bend microtubular for artery chronic Occlusion interventional procedure, it is characterised in that including：
    Outer layer microtubular（1）, described outer layer microtubular（1）Tail end be provided with one be used for realize rotate and lock rotation lock Tight mechanism（2）；
    Internal layer microtubular（3）, described internal layer microtubular（3）It is located in outer layer microtubular（1）Inside, and described internal layer is micro- Conduit（3）Length be more than outer layer microtubular（1）Length；
    Described outer layer microtubular（1）With internal layer microtubular（3）Between be provided with and realize outer layer microtubular（1）With internal layer microtubular （3）The axial movement structure advanced in the axial direction or retreated（4）；
    Described internal layer microtubular（3）Head end be provided with can be in outer layer microtubular（1）The elbow that inside is stretched automatically（5）.
  2. 2. a kind of double-layer bend microtubular for artery chronic Occlusion interventional procedure according to claim 1, it is special Sign is：Described internal layer microtubular（3）Tail end be provided with flaring structure（6）.
  3. 3. a kind of double-layer bend microtubular for artery chronic Occlusion interventional procedure according to claim 1, it is special Sign is：Described rotational lock mechanism（2）For a rotation fixed handle.
  4. 4. a kind of double-layer bend microtubular for artery chronic Occlusion interventional procedure according to claim 1, it is special Sign is：Described axial movement structure（4）Including the raised line being arranged on outer microtube tail end of conduit internal chamber wall（7）Be arranged on Groove on internal layer microtubular tail end outer wall（8）, described raised line（7）And groove（8）Corresponding matching is set.
  5. 5. a kind of double-layer bend microtubular for artery chronic Occlusion interventional procedure according to claim 4, it is special Sign is：Described groove（8）Axial length be more than raised line（7）Axial length.
  6. 6. a kind of double-layer bend microtubular for artery chronic Occlusion interventional procedure according to claim 1, it is special Sign is：Described outer layer microtubular（1）Head end be provided with light tight L-type mark（9）.
  7. A kind of 7. double-layer bend for artery chronic Occlusion interventional procedure according to claim 1 to 6 any one Microtubular, it is characterised in that：Outer layer microtubular（9）Bar portion be integral pipe fitting, described outer layer microtubular（1）Material in Portion is polytetrafluoroethylene (PTFE), and outside is compiled into for stainless (steel) wire, and the overall outer surface of bar portion is hydrophilic coating.
  8. A kind of 8. double-layer bend for artery chronic Occlusion interventional procedure according to claim 1 to 6 any one Microtubular, it is characterised in that：Internal layer microtubular（3）Bar portion be integral pipe fitting, described internal layer microtubular（3）Material in Portion is polytetrafluoroethylene (PTFE), internal layer microtubular（3）It is compiled into outside head end for stainless (steel) wire, the outer surface of bar portion head end is hydrophilic painting Layer.
  9. A kind of 9. application method of double-layer bend microtubular for artery chronic Occlusion interventional procedure, it is characterised in that including Following steps：
    Step 1：Prepare the harder superslide of double-layer bend microtubular, head end and puncture seal wire, common soft seal wire；
    Step 2：The harder superslide of head end is punctured into seal wire（10）It is located in inside double-layer bend microtubular, and punctures superslide and lead Silk（10）After under intravasation inner membrance, the double-layer bend microtubular is punctured into seal wire along superslide（10）Under intravasation inner membrance；
    Step 3：The double-layer bend microtubular and superslide is set to puncture the position of seal wire entirety intravasation distal end needs, when superslide is worn Pierce seal wire（10）Behind double-layer bend microtubular entirety intravasation distal end, now rollback superslide punctures seal wire（10）, retract it is outer Layer microtubular（1）, expose internal layer microtubular（3）Head end, now internal layer microtubular（3）Head end can be automatically restored to 120 degree Elbow（5）, and adjust elbow by reversing double-layer bend microtubular（5）Direction；
    Step 4：Pass through outer layer microtubular（1）Head end and internal layer microtubular（3）Corresponding elbow（5）The lighttight L that side is set Type identifies（9）, the direction of double-layer bend microtubular is adjusted under DSA, allows elbow（5）Point to true cavity direction；
    Step 5：Superslide, which is sent into, along the double-layer bend microtubular punctures seal wire（10）, superslide puncture seal wire（10）Led by the way that internal layer is micro- Pipe（3）Elbow（5）The signified direction in end punctures, and helps superslide to puncture seal wire（10）The true chamber of intravasation；
    Step 6：When superslide punctures seal wire（10）After distal vessels return to the true chamber of blood vessel, retain superslide and puncture seal wire（10）In blood Guan Zhong, then double-layer bend microtubular is overall punctures seal wire along superslide（10）Into the true chamber of distal vessels；
    Step 7：Withdraw superslide and puncture seal wire（10）, retain double-layer bend microtubular in the true chamber of distal vessels, change common soft leads Silk enters the true chamber of distal vessels, can smoothly complete intervention operation.
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