Sub-intimal dissector and methods for performing endarterectomies therewith

• US 3,929,138 A
• Filed: 07/18/1973
• Issued: 12/30/1975
• Est. Priority Date: 07/18/1973
• Status: Expired due to Term

• Current Assignee: Eli Curi
• Original Assignee: Eli Curi
• Inventors: Curi, Eli
• Primary Examiner(s): Pace, Channing L.
• Application Number:
  US05/380,508
• Time in Patent Office: 895 Days
• Field of Search: 128/33R,304,305,311
• US Class Current: 606/167
• CPC Class Codes: A61B 17/320708 Curettes, e.g. hollow scraping instruments
• CPC Class Codes: A61B 2017/320741 for stripping the intima or the internal plaque from a blood vessel, e.g. for endarterectomy
• CPC Class Codes: A61B 2090/0817 Spatulas or spatula like extensions

Abstract

A sub-intimal dissector and methods for performing endarterectomies therewith in which the said dissector comprises an elongated shape-retaining, bendable shaft, a dissecting tip on one end of the shaft, the tip being arcuate transverse to its longitudinal axis, a slightly forwardly convex leading edge of the tip smoothly merging with opposed side edges which taper rearwardly and inwardly to the shaft, the leading edge and the side edges being smoothly rounded between the top and bottom surfaces of the tip, the arcuately longest portion of the convex bottom of the tip being equal to approximately between one fifth and one third of the circumference of the artery upon which the instrument is employed; the method including the steps of longitudinally incising the artery to expose the diseased intima; transversely incising the artery to gain access to the interface of the intima and media; intruding the leading edge of the dissector tip intermediate the intima and media, passing the tip longitudinally along the artery intermediate to the intima and media with a steady forward pressure to detach the intima from the media by a wedging action for the length of the shaft inserted; withdrawing the dissecting tip to the position of entry and repeating the procedure with the remaining portions of the circumference of the artery; sequentially each newly dissected portion preferably being immediately adjacent to and contiguous with the previously dissected portion; incising the artery distially at a distance from the proximal incision no greater than approximately twice the length of the shaft and repeating the aforesaid dissecting procedure to disengage the intima from the media; and removing the dissected intima through one of the incisions.

Claims

1. A sub-intimal dissector comprising:

a. an elongated shaft, the shaft being bendable and having shape memory, b. a dissecting tip on one end of the shaft, c. the tip being arcuate transverse to its longitudinAl axis to define a concave top surface and a convex bottom surface extending between side edges, d. a slightly forwardly convex leading edge on the tip smoothly merging with the said opposed side edges, e. the opposed side edges tapering rearwardly and inwardly toward the shaft from a position slightly rearwardly of the leading edge, f. the arcuately longest portion of the said convex bottom surface extending along an arc transverse to the longitudinal axis of the tip a distance equal to approximately one third to one fifth of the circumference of an artery upon which it is to be employed, and g. the said leading edge in both said opposed side edges being smoothly rounded between the concave top and convex bottom surface of the tip.

2. A sub-intimal dissector comprising, a. the structure in accordance with claim 1, and b. the said tip being provided with an extremely low friction surface.

3. A sub-intimal dissector comprising, a. the structure in accordance with claim 1, in which, b. the said opposed side edges are parallel for a relatively short distance immediately rearwardly of the said leading edge.

4. A sub-intimal dissector comprising, a. the structure in accordance with claim 1, in which, b. a portion of the shaft immediately rearwardly of the top is sufficiently rigid to prevent significant flexure at the junction of the tip and shaft.

5. A sub-intimal dissector comprising, a. the structure in accordance with claim 1, in which, b. the said opposed side edges are parallel for a relatively short distance immediately rearwardly of the said leading edge, c. a portion of the shaft immediately rearwardly of the tip is sufficiently rigid to prevent significant flexure at the junction of the tip and shaft, and d. the tip is provided with an extremely low friction surface.

6. A method for performing endarterectomies comprising:

a. incising an artery to expose the interface between the intima and the media, intruding a dissecting tip intermediate the intima and the media at said exposed interface, c. wedging the intima and media apart by passing the dissecting tip longitudinally along said interface for a distance from said incision while avoiding damaging the integrity of both the intima and media, d. withdrawing the dissecting tip longitudinally to the incision, e. reintruding the dissecting tip intermediate the intima and media and wedging the intima and media apart as aforesaid successively along paths contiguous to previous paths of movement of said tip for said distance until substantially the entire intima is wedged from the media along said distance, and f. withdrawing the disengaged intima from the artery.

7. A method for performing endarterectomies comprising:

a. the procedure in accordance with claim 6 including b. the steps of wedging the intima from the media by passing along said interface a dissecting tip having a concave top surface and a conforming convex bottom surface;

the arc of the said tip being generally transverse to the longitudinal axis of movement of the said tip and extending an arcuate distance equal to approximately one third to one fifth of the circumference of the artery;

the said tip having a slightly forwardly convex leading edge smoothly merging with opposed side edges;

the leading edges and both side edges being smoothly rounded between the top and bottom surfaces.

8. A method for performing endarterectomies comprising:

a. the procedure in accordance with claim 6, and the steps of b. incising the artery to expose interfaces between the intima and media both distal and proximal to an occlusion, and c. wedging the intima and media apart by passing the dissecting tip longitudinally along said interface as aforesaid from both the distal and proximal incisions in the direction of the opposite incision until the paths of disengagement from the respective incisions engage.