US 2788787 A
Abstract available in
Claims available in
Description (OCR text may contain errors)
H. D. TRACE April 16, 1957 SURGICAL INSTRUMENT FOR EXTIRPATION OF VARICOSE VEINS Filed Sept. 16, 1955 INVENTOR. Herbert D. Iiac flzzorrzcgzj United States Patent SURGICAL INSTRUMENT FOR EXTIRPATION 0F VARICOSE VEINS Hebert D. Trace, Chicago, Ill.
Application September 16, 1955, Serial No. 534,795
7 Claims. (Cl. 128-303) This invention relates to an instrument for stripping human veins. More particularly it has reference to an intraluminal stripper for saphenous varicosities.
In the Journal of the American Medical Association (Chicago), volume 10, p. 210, W. Wayne Babcock has described a so-called extractor for entry inferiorly into the lumen of the saphenous vein, which has theretofore been separated at the greater saphenous junction and, following insertion, reversing the motion, to strip the vein by means of a cup shaped element at the end of the extractor. Such instrument comprised a rigid rod capped by a conical head to facilitate passage and shipping. The procedure involved multiple incisions transversely of the vein in order to guide the instrument through the tortuous intraluminal path. Accordingly, the ugly multiple incisions characteristic of prior operative procedures was perpetuated. Without multiple incisions to provide access and assistance for traverse of the stripper the operation was, in nearly all cases, contraindicated since, in most cases, the saphenous vein was collapsed.
My invention has for its principal object the provision of an instrument for stripping the saphenous vein which requires only two buttonhole incisions, one adjacent the inferior terminal of the vein and the other in the region of the greater saphenous junction.
Another object is to provide an instrument for the purpose aforesaid which is relatively inexpensive and therefore expendable with the stripped vein.
Other objects will appear from the following description which, taken with the accompanying drawing, will disclose a preferred form which the invention may assume In practice.
In this drawing:
Fig. l is a perspective view with certain parts broken away, of an instrument in accordance with the invention;
Figs. 2, 3, and 4 are perspective views showing the principal steps in the employment of the instrument; and
Figs. 5 and 6 illustrate alternative forms of the invention instrument.
Broadly regarded the invention instrument, in one aspect, comprises a flexible tube for insertion in the lumen to serve as a smooth guide and a flexible wire for subsequent projection through the guide. The wire terminates at one end in a novel head for engaging the superior terminus of the severed vein and the stripping thereof. In another aspect the invention comprehends combining the functions of the wire and guide tube by utilizing tubing having the desired flexibility together with substantial tensile strength.
Turning now to the drawing the instrument of the invention, in one form, comprises a length of tubing 10 having an outside diameter of say, three millimeters and a bore of say one millimeter, but obviously not so limited. Desirably the tube 10 is of plastic composition having that degree of pliability consistent with its function to be described, e. g. polyethylene, and capable of withstanding the temperature of sterilization without impairment. At one end there is provided an adapter 11 of suitably compliant material for frictional fit over the nozzle of a syringe, also as will be amplified on subsequently.
An extractor member 12 comprises a resilient wire 13 having a temper similar to that of music wire, preferably of stainless steel and having a diameter permitting easy passage through the bore of the tube 10 notwithstanding the sinuous form which the same will assume during use. One end of the wire has a head 14 secured thereto as by swaging or otherwise, the same being preferably acorn shaped and concave at the base.
In the procedure with which my improved instrument is used the customary Trendelenberg operation is performed by incising at the greater saphenous junction and ligating the saphenous vein. A second buttonhole incision is made in a region providing access to the inferior terminus of the vein. A syringe S is attached to the adapter 11 and the tube 10, acting in the nature of a catheter, is inserted in the lumen (Fig. 2). By injection of saline solution slowly the tube is passed intraluminally, its transit being facilitated by the distension of the walls of the vessel by the fluid existing from the leading end of the tube 10, and the anti-friction relief afforded by the fluid. The length of the guide tube 10 is suflicient to leave convenient portions projecting from both ends of the vein. By reason of the relatively greater rigidity which is possessed by the tube as compared to the wall of the vessel the tube is enabled to bridge across the manifold tortuosities thereof and provide a path which, compared to the vein, is relatively rectilinear although slightly sinuous.
Following placement of the tube the syringe is removed and the wire 13 is inserted in the guide tube 10 at the upper end and thrust toward the lower end until it emerges. However, the reverse action may be employed. The lower end of the wire is gripped in pliers, wound around the nose thereof for security and traction applied. Thus the cap 14 will engage the end of the vein and the same, together with the guide tube, stripped downwardly. Obviously the tube may be cleared at the lower end as stripping proceeds. During this step the vein becomes firmly pleated in a small fusiform mass against the concave undersurface of the cap. Thus inversion of the vessel is avoided and a clean stripping of the vein from its surrounding tissues and tributaries accomplished. The acorn shape of the cap 14 has been found to provide the least friction as stripping proceeds.
Inasmuch as the traction for stripping is substantial the wire 13 is, by reason thereof and its winding upon the pliers, rendered unfit for repeated use. Moreover the tube may undergo deformation. By utilizing a simple plastic tube and a wire having a relatively inexpensive cap, cost is low and the entire instrument may, after a single use, be discarded.
Alternatively the functions of the guide tube and traction wire may be combined. Referring to Fig. 5, I have illustrated a tube 21 of material characterized by reasonable rigidity in order that the same may take moderate thrust and yet such flexibility as will allow the same to conform to the meanderings of the vein. Nylon has been found suitable. At one end a fitting 22 is threadedly engaged with tube or cemented thereto, as at 23, and includes a female bayonet connector 24 for locking the instrument to the syringe. The element 25 conforms in configuration and function with the element 14 heretofore described and, accordingly, elaboration is deemed superfluous. In operation the end A of the tube 21 is introduced into the vein, it being understood that the preferred solution is continuously being supplied to the tube from a syringe attached to the socket 24. Upon the end A reaching an accessible position at the opposite end of the vein the same is grasped by'apliers or'equivalent and stripping effected as previously described.
in Fig. 6 a further alternative form 24a of the fitting 24 is shown and differs therefrom in the provision of a somewhat .deeper cup 25a having an interior 26. Where,.herein'I refer to a concave vein abutting surface for the cap, such as 14 or 25, I intend to include'deeper concavities onthe order of that shown in Fig. 6. It has been found that deepening of the concavity is, in some cases, better assurance of the end of the vein being dis lodged from the stripper cap.
While 'I have shown a particular embodiment of my invention, it will be understood, of course, that I do not Wish to be limited thereto since many modifications may be made and I therefore contemplate by the appended claims to cover any such modifications as fall within the true spirit andscope of my invention.
I 1. A surgical instrument for stripping a human vein comprising a tube for insertion through the tortuosities of the vein to provide a relatively straight, artificial lumen therefor and having the degree of flexibility which will permit its projection intraluminally without columnar collapse and a flexible Wire having a cross section for passage through said tube and a cap at one end of the wire for engaging the cut end of the vein as the wire is retracted through the tube by gripping its other end.
2. An instrument in accordance with claim 1 wherein said cap is acorn shaped and the base whereof is adjacent the wire.
' 3. An instrument in accordance with claim 1 wherein said cap is provided with a base which is concave with respect to the wire and the base is adjacent the wire.
4. An instrument in accordance with claim 1 further characterized by a sleeve at one end of-the tube for-adapt ing the tube to the nozzle of a syringe to inject a veindistending fluid through the tube and into the lumen as the tube is admitted intralumin ally.
5. A surgical instrument for stripping a human vein comprising a tube for insertion through the tortuosities of the vein for admission of a vein-distending and lubricating fluid through the tube. to facilitate. passagev of the tube and characterized by a degree of flexibility which will allow the tube to conform to the direction of the vein without columnar collapse, said' tube having a cap secured to one end thereof includingafacefor abutment with the end of the vein for stripping the same upon gripping of the fluid-exit end' of the tube, and a fitting secured to said cap to receive a complementary fitting of a syringe carrying a supply of fluid. V
6. An instrument in accordance with claim 5 in which the face of said cap is concave.
7. An instrument in accordance with claim 5 wherein said tube comprises nylon.
References Citedin the file of this patent Polyethylene Rod. Vein Stripper, Surgery, vol. 27, February 1950, p. 281. (Copy in Div. 55.)
New Vein Stripper and Technique of Stripping, Kutz and Hendricks, Surgery, February 1951, pp. 271-275. (Copy in Div. 55.). V
Treatment. of Varicose Veins With a Flexible Stripper, Emerson and Muller, Surgery, January 1951, pp. 71-76. (Copy in Div..55.)