Rosenthal D, Herring M B, McCready R A, Levy A M
Department of Vascular Surgery, Georgia Baptist Medical Center, Atlanta.
Cardiovasc Surg. 1993 Jun;1(3):225-7.
The feasibility of angioscope-assisted occlusion of venous tributaries from within a vein using a steerable 'shaped-memory' nickel-titanium (nitinol) alloy catheter and occlusion coils was evaluated. An initial series of tests was designed to establish the necessary pressure (275 p.s.i., 1897.5 kPa), time (1.5 s) and volume (2.5 ml normal saline) requirements for hydraulic delivery of platinum occlusion coils from the nitinol catheter through a 3-Fr tracking catheter. In a second series, 25 side branches of the saphenous vein in 11 amputated limbs were visualized angioscopically and cannulated with the nitinol catheter under angioscopic and fluoroscopic surveillance to determine whether the catheter tip could be positioned and coils deployed. In a third series of studies, ten canine femoral vein tributaries were successfully cannulated with an 8-Fr nitinol catheter and 19 occlusion coils delivered under angioscopic surveillance. Fluoroscopy verified coil placement and all embolized venous tributaries were thrombosed. An ideal approach for femoropopliteal in situ saphenous vein bypass would allow the surgeon to divide saphenous vein valves while occluding venous side branches from within the saphenous vein. These initial studies demonstrate that the nitinol catheter can occlude venous tributaries from within a vein by coil embolization. Further development of this technique for clinical investigation is warranted.
评估了使用可操控的“形状记忆”镍钛合金导管和闭塞线圈经静脉腔内进行血管镜辅助静脉属支闭塞的可行性。最初的一系列测试旨在确定通过镍钛合金导管经3F追踪导管液压输送铂闭塞线圈所需的压力（275磅力/平方英寸，1897.5千帕）、时间（1.5秒）和体积（2.5毫升生理盐水）。在第二个系列中，在血管镜和荧光透视监测下，对11条截肢肢体的大隐静脉的25个侧支进行血管镜检查并使用镍钛合金导管插管，以确定导管尖端是否能够定位并展开线圈。在第三个系列研究中，使用8F镍钛合金导管成功地对10条犬股静脉属支进行插管，并在血管镜监测下输送19个闭塞线圈。荧光透视证实了线圈的放置，并且所有栓塞的静脉属支均形成血栓。对于股腘原位大隐静脉旁路移植术而言，理想的方法是外科医生在闭塞大隐静脉内的静脉侧支时能够分开大隐静脉瓣膜。这些初步研究表明，镍钛合金导管可通过线圈栓塞经静脉腔内闭塞静脉属支。该技术值得进一步开展临床研究。
