Percutaneous device for occluding blood vessels

Abstract

To provide a percutaneous device for interrupting a function of a venous collector, which allows a venous vessel to be closed mechanically by percutaneous puncture access.SOLUTION: A percutaneous device 100 for closing a blood vessel comprises: a main body in which a distal clip 2 and a proximal clip 3 connected with each other via a tie rod 4 are housed and an abutment element 5 for the clips is housed; and a handle for maneuvering the clips, the abutment element, and the tie rod. In the device, the distal clip includes at least a proximal housing and the proximal clip includes both a distal housing and the proximal housing. The tie rod is placed inside the housings so as not to interfere with the correct sliding thereof when the clip is inserted inside the body.SELECTED DRAWING: Figure 1B

Description

[Technical field]

[0001] The subject of the present invention is a device for disrupting the function of a superficial venous collector using percutaneous access and ultrasound guidance. [Background technology]

[0002] The surgical treatment of superficial venous insufficiency of the lower extremities has undergone dramatic developments in recent years. The widespread need for minimally invasive surgery has led, with the evolution of technology, to the complete obsolescence of the most traumatic procedures (e.g., Linton procedure), the drastic reduction in standard procedures (e.g., saphenous vein stripping), and the use of minimally invasive procedures such as ablation of superficial venous collectors with thermal (laser, radiofrequency) or non-thermal techniques (curable foam, mechanochemical ablation, cyanoacrylate glue), in addition to surgical strategies such as endoscopic subfascial ligation of perforating veins or saphenous reflux segmentation.

[0003] Some of the known techniques mentioned above are directed to well-defined specific pathologies, whereas others are valid alternative therapies in terms of efficacy, reduced complications, long-term results and costs, in the absence of a clear hierarchy.

[0004] Nevertheless, it should be noted that while "surgical" techniques are associated with invasiveness and significant risks of complications, endoluminal ablation techniques carry the liability of long-term failures (recanalization) and the possibility of very small but severe complications. With regard to the above-mentioned ablation techniques, it is widely believed that the primary importance in the present methodology can be found in the sapheno-femoral vein confluence, i.e., a short venous site that, in case of over- or under-treatment, may expose the patient to the risk of thrombosis extending to the deep circulation or central embolism, and to the risk of more or less extensive recanalization of the vessel due to blood reflux with the recurrence of varicose vein syndrome.

[0005] Therefore, there is a strong need in the field of treating superficial venous insufficiency of the lower extremities to perform procedures that are "surgical" in all their effects, such as interruptions to ligate venous collectors, but do not necessarily subject the patient to invasiveness and its associated preventable complications. Summary of the Invention

[0006] It is an object of the present invention to provide a percutaneous device for interrupting the function of a venous collector, which allows mechanical occlusion of a venous vessel by percutaneous puncture access.

[0007] This object is achieved by a percutaneous device for interrupting the function of a venous collector according to claim 1. Further embodiments of the percutaneous device according to the invention are set forth in the dependent claims.

[0008] The device according to the invention allows for the execution of operations for blocking and / or closing blood vessels using percutaneous access in a simple manner, which requires a reduction in manual skills that are not necessarily surgical. As a result, the impact on the operation time and on the patient's acceptance (or compliance) is significantly reduced compared to "open" surgical techniques. [Brief description of the drawings]

[0009] Further advantages of the transcutaneous device according to the invention will become apparent from the following description, given by way of non-limiting example and given in accordance with the accompanying drawings, in which: [Figure 1A] FIG. 1 shows a device according to the present invention in a configuration for percutaneous insertion. [Figure 1B] 1 shows a device according to the present invention configured for releasing a distal clip. [Figure 1C] FIG. 1 shows a device according to the present invention configured for releasing a proximal clip. [Figure 1D] FIG. 1 shows a device according to the present invention in a configuration for occluding a venous vessel. [Diagram 2]FIG. 13 is an axonometric view of a distal clip in one embodiment comprising a slot adapted to receive a tie rod element and having a U-shaped cross-section. [Figure 3A] FIG. 13 illustrates an axonometric view of a proximal clip in one embodiment. [Figure 3B] FIG. 13 is a cross-sectional view of a proximal clip in one embodiment. [Figure 4] FIG. 13 is an axonometric view of a distal clip in a further embodiment comprising a slot adapted to receive a tie rod element and having a V-shaped cross-section. [Diagram 5] FIG. 13 is an axonometric view of a proximal clip in a further embodiment. [Figure 5A] 13A-13C show an embodiment of a hole in the proximal clip. [Figure 5B] 13A-13C show an embodiment of a hole in the proximal clip. [Figure 6A] 1 shows a device according to the invention in an embodiment with a flat tie rod. [Figure 6B] 1 shows a device according to the invention in an embodiment with a flat tie rod. [Figure 7] FIG. 13 is an axonometric view of a distal clip in a further embodiment. [Figure 8A] FIG. 13 is an axonometric view of a proximal clip in a further embodiment. [Figure 8B] FIG. 13 is a cross-sectional view of a proximal clip in a further embodiment. [Figure 9A] FIG. 13 illustrates a distal clip in one embodiment with two slots adapted to receive tie rod elements. [Figure 9B] FIG. 13 illustrates a distal clip in one embodiment with two slots adapted to receive tie rod elements. [Figure 10A] 13 shows a device according to the invention with a further configuration of the clip; [Figure 10B] 13 shows a device according to the invention with a further configuration of the clip; [Figure 11A]FIG. 1 shows a device according to the present invention, the body having a distal piercing tip. [Figure 11B] FIG. 1 shows a device according to the present invention, the body having a distal piercing tip. [Figure 12A] 13 shows a device according to the invention with a further configuration of the abutment element; [Figure 12B] 13 shows a device according to the invention with a further configuration of the abutment element; [Figure 13A] 13 shows a device according to the invention with a further configuration of a portion of the tie rod arranged between the clips. [Figure 13B] 13 shows a device according to the invention with a further configuration of a portion of the tie rod arranged between the clips. [Figure 14] FIG. 2 is a cross-sectional view of a device according to the invention with a handle in one embodiment. [Figure 15] FIG. 4 is a cross-sectional view of a device according to the invention with a handle in a further embodiment. [Figure 16A] 15A-15C are diagrams showing steps in a process for closing a venous vessel with the device of FIG. 14, in particular showing the step of puncturing the venous vessel. [Figure 16B] 15A-15C are diagrams illustrating steps in a process for occluding a venous vessel with the device of FIG. 14, in particular the step of releasing the distal clip. [Figure 16C] 15A-15C are diagrams illustrating steps in a process for occluding a venous vessel with the device of FIG. 14, particularly illustrating the step of pulling the distal clip against the vessel. [Figure 16D] 15A-15C are diagrams illustrating steps in a process for occluding a venous vessel with the device of FIG. 14, in particular the step of releasing the proximal clip. [Figure 16E] 15A-15C are diagrams illustrating steps in a process for closing a venous vessel with the device of FIG. 14, particularly showing the step of compressing a proximal clip against the vessel. [Figure 16F]15A-15C are diagrams showing steps in a process for closing a venous vessel with the device of FIG. 14, in particular the steps of clamping the clip and closing the vessel. [Figure 17A] FIG. 17 shows the final step of the process for occluding a venous vessel, in particular the step of weakening the tie rod of the clip (17A). [Figure 17B] FIG. 17B illustrates the final step in the process for occluding a venous vessel, specifically showing the step of breaking the tie rod (17B) to fully release the clip. [Figure 18A] FIG. 18 is a detailed view of the proximal cutting system for severing the tie rod of the clip, showing the cutting system (18A) deactivated. [Figure 18B] FIG. 18 is a detailed view of the proximal cutting system for severing the tie rod of the clip, showing the cutting system (18B) activated. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0010] In the foregoing figures, similar components are identified in different figures by the same reference numbers.

[0011] Reference number 100 denotes a percutaneous device for interrupting the function of a superficial venous collector according to the invention. The device is suitable for blocking and closing a blood vessel, for example the saphenous vein.

[0012] The device 100 comprises a body 1 extending along a longitudinal axis X and hollow inside to accommodate a pair of clamping clips 2,3 and an abutment element 5 for the clips 2,3.

[0013] The body 1 is preferably a metal cannula that can be percutaneously inserted and is provided with a distal tip 11. The distal tip 11 comprises a distal opening 12 through which the clips 2, 3 exit.

[0014] In one example, as shown for example in Figures 1A and 11A, the distal tip 11 is a piercing tip and is shaped as a needle for piercing the wall of the blood vessel V and passing through said vessel from one side to the other. Preferably, the distal tip 11 of the body 1 has a notch 111 extending in the proximal direction. The notch 111 is dimensioned to at least partially accommodate the distal clip 2 in the release phase (Figure 11B). The notch 111 is used as an abutment element to push the distal clip 2 towards the correct lateral position during the release phase (Figure 1B).

[0015] In another example, for example shown in FIG. 10A, the distal tip 11 is not a perforating tip. In said example, a perforating tip 112 is provided on the distal clip 2, as will be better explained below. When the distal tip 11 of the body 1 is not a perforating tip, said distal tip 11 has a distal surface 113 inclined at an angle α between 90° and 45° to better push the distal clip 2 towards the correct lateral position. The distal tip 11 may also have a notch 111 for at least partially receiving the distal clip 2.

[0016] The abutment element 5 is preferably a cylindrical, elliptical or semicircular rod.

[0017] The abutment element 5 extends along a longitudinal axis X and is provided with a passage for the tie rod 4, for example a hole 511 through which the tie rod 4 slides inside the abutment element 5 or a transverse groove through which the tie rod 4 slides outside the abutment element 5. The abutment element 5 is provided with a distal end 51 adapted to press against the proximal clip 3.

[0018] In the example of Figures 12A and 12B, the distal end 51 of the abutment element 5 is dimensioned to be accommodated in the proximal housing 33 of the proximal clip 3 (Figure 12B). This solution allows the distal end 51 of the abutment element 5 to be located very close to the pivot point (i.e. the seat 31) of the proximal clip 3, thus improving the pushing of the proximal clip 3 towards the correct lateral position during the release phase (Figure 1C).

[0019] The device 100 preferably comprises a handle 7 connected to a proximal portion of the body 1 and adapted to manipulate the clips 2 , 3 and the tie rod 4 .

[0020] The overall configuration of the device 100 is such that the pair of clamping clips 2, 3 and the abutment element 5 can be slidably inserted inside the body 1, can exit through a distal opening 12, and can be operated externally by means of a handle 7. It should be noted that the abutment element 5 is integral with the handle 7.

[0021] The pair of clips includes a distal clip 2 for blocking the blood vessel and a proximal clip 3 for clamping the blood vessel.

[0022] The clips 2, 3 are preferably substantially in the form of a bar or rod, ie having a cylindrical and elongated shape.

[0023] In the example of Figures 10A and 10B, the mutually opposing ends 211, 311 of the clips 2, 3 are shaped to allow partial overlap of said clips when inserted into the body 1 (Figure 10a). In this example, the clips 2, 3 have a solid, cylindrical body and the ends 211, 311 have parallel inclined surfaces. This solution allows the clips 2, 3 to be accurately aligned with respect to the plane of rotation and thus facilitates lateral positioning during the release phase.

[0024] If the distal tip 11 of the body 1 is not a piercing tip, a piercing tip is provided on the distal clip 2, as in Fig. 10A. In said example, the distal clip 2 has a distal piercing end 26 shaped as a needle for piercing the wall of the blood vessel V and passing through said vessel from one side to the other. In said example, at least the distal piercing end 26 of the distal clip 2 exits from the distal opening 12 of the body 1, as shown in Fig. 10A.

[0025] Each clip 2, 3 preferably has a length determined by the particular surgical requirements and the dimensions of the vessel to be treated, for example in the range of about 6-12 mm.

[0026] The clips 2, 3 may be of the same length or of different lengths.

[0027] The clips 2, 3 are preferably made of a biocompatible metallic material or are made of a bioabsorbable material.

[0028] The clips 2, 3 are connected to each other by a tie rod 4 or equivalent means.

[0029] In one embodiment, shown in FIG. 1B, the tie rod 4 has a substantially circular or semicircular cross-section.

[0030] In a further embodiment shown in FIG. 6A, the tie rod 4 has a flat cross section or is substantially a tape.

[0031] In yet another embodiment, the tie rod 4 has a flat cross section distally, preferably between the two clips 2, 3, and then continues proximally with a circular cross section. In this embodiment, the tie rod 4 has a flat cross section for its distal length between half the clip length and the length of the two clips.

[0032] The tie rods 4 are preferably made from nylon or polyester, or from an absorbent material.

[0033] The clips 2, 3 are provided with seats 21, 31 into which the tie rod 4 is inserted.

[0034] The distal clip 2 is provided with a distal seat 21 to which the tie rod 4 is fastened.

[0035] Distal seat 21 is preferably a through hole having a circular (FIGS. 2 and 4) or rectangular cross section.

[0036] The distal seat 21 preferably traverses the distal clip 2 vertically laterally. This solution allows for a precise orientation and eversion of the distal clip 2 when it is released.

[0037] The proximal clip 3 is provided with a proximal seat 31 in which the tie rod 4 is slidably inserted.

[0038] The proximal seat 31 is preferably a through hole having a circular (FIG. 5A) or elliptical (FIG. 5B) or rectangular (FIG. 8A) cross section.

[0039] The proximal seat 31 preferably traverses the proximal clip 3 obliquely. This solution allows both a correct orientation of the proximal clip 3 and a correct sliding of the tie rod 4 when the proximal clip 3 is released.

[0040] In particular, the distal end 41 of the tie rod 4 is fixed to the seat 21 of the distal clip 2, the tie rod 4 is also slidably inserted into the seat 31 of the proximal clip 3 such that an intermediate portion 42 of the tie rod 4 is positioned between the clips 2, 3, and the proximal end 43 of the tie rod 4 can be manipulated by the surgeon directly or by handle 7.

[0041] Depending on the particular application, the tie rod 4 and clips 2, 3 may be made of non-absorbable or absorbable materials.

[0042] The clips 2, 3 preferably have a lateral dimension (ie diameter) that allows them to slide freely inside the body 1, possibly with minimal friction to prevent slippage.

[0043] When the clips 2 , 3 are inserted inside the body 1 , the longitudinal axis of the clips 2 , 3 coincides with the longitudinal axis of the body 1 .

[0044] One essential aspect for the correct functioning of the device 100 is the positioning of the tie rod 4 inside the body 1, which must not impede the correct sliding of the clips 2,3.

[0045] The clip 2,3 therefore comprises at least one housing 22,32,33 in which the tie rod 4 is arranged when the clip 2,3 is inside the body 1.

[0046] The housings 22, 32, 33 are longitudinal grooves formed in the outer surfaces of the clips 2, 3 so that the tie rod 4 is inserted into this groove and thus fits within the volume of space occupied by the clips 2, 3, as can be seen in Figures 1A and 6A.

[0047] The distal clip 2 is provided with a proximal housing 22 and, optionally, also a distal housing for fastening a tie rod.

[0048] The proximal clip 3 includes both a distal housing 32 and a proximal housing 33 .

[0049] Preferably, the housings are longitudinal grooves on the outer surfaces of the clips 2, 3, with the proximal housing 22 of the distal clip 2 occupying at least a proximal portion of the distal clip 2, the distal housing 32 of the proximal clip 3 occupying at least a distal portion of the proximal clip 3, and the proximal housing 33 of the proximal clip 3 occupying at least a proximal portion of the proximal clip 3.

[0050] Note that the distal and proximal housings are disposed on opposite sides of the clip.

[0051] In one embodiment shown in Figures 2, 3A and 9A, the housings 22, 32, 33 have a rectangular or square or U-shaped or semicircular cross-section.

[0052] In one embodiment, shown in Figures 4 and 5, the housings 22, 32, 33 have a triangular or V-shaped cross-section.

[0053] In one embodiment shown in Fig. 9A, the distal clip 2 comprises a pair of proximal housings 22 arranged parallel to each other on either side of the distal clip. In this configuration, the tie rod 4 extends into the first proximal housing 22, crosses through the seat 21 and is fixed in the second proximal housing 22, as shown in Fig. 9B. In yet another example, the distal clip 2 comprises a proximal housing 22 and a distal housing. In this configuration, the tie rod 4 extends into the proximal housing 22, crosses through the seat 21 and is fixed in the distal housing. The solution of fixing the tie rod 4 in the housing allows a secure and reliable fixation and improves the control of the direction of the distal clip 2 during the release phase (Fig. 1B).

[0054] In one embodiment shown in Figures 7 and 8A, the housings 22, 32, 33 are longitudinally flattened sections or C- or crescent-shaped recesses.

[0055] The housings 22,32,33 have entrance ends to the clips 2,3 and ends which traverse the clips 2,3 and flow into the seats 21,31.

[0056] The distal clip 2 thus comprises a path for the tie rod 4 which starts at the seat 21 and continues along the housing 22. The path for the tie rod 4 occupies approximately half the length of the distal clip 2.

[0057] In one embodiment, the distal clip 2 also comprises a distal housing that is used as a further section (in addition to the seat 21) for fastening the tie rod 4. Thus, in this example, the distal clip 2 includes a path for the tie rod 4 that starts at the distal housing and continues through the clip into the seat 21 to exit on the opposite side and continue along the housing 22. Thus, in this case, the path for the tie rod 4 occupies more than half the length of the distal clip 2.

[0058] The proximal clip 3 includes a passage for the tie rod 4 that begins at the housing 33 and continues through the clip to the seat 31 to exit on the opposite side and continue along the housing 32. The passage for the tie rod 4 occupies the entire length of the proximal clip 3.

[0059] 6A and 6B, in which the tie rod 4 has a flat cross section, the seat 21, 31 in which the tie rod 4 is inserted may be rectangular and arranged longitudinally or transversely with respect to the clips 2, 3. Furthermore, in this embodiment, the housing 22, 32, 33 in which the tie rod 4 is located when the clips 2, 3 are inside the body 1 may be C-shaped or crescent-shaped.

[0060] The device 100 comprises a handle 7 connected to a proximal part of the body 1, formed by two half-shells extending mainly in the longitudinal direction and mechanically connected to each other.

[0061] The handle 7 comprises a handle body 71 having a track 73 in which an operating lever 72 for operating the clips 2, 3 and the tie rod 4 is slidably housed.

[0062] The operating lever 72 can be seen in detail in Fig. 18A and extends mainly in the longitudinal direction and is preferably provided with a slider 721 shaped to facilitate gripping said slider and sliding it inside the track 73. In the embodiment of Fig. 16a, the handle 7 is provided with a slider 721 on the upper side. In a further embodiment, the handle 7 is provided with a slider 721 on the upper side and an opposing slider on the lower side, in said example both sliders being connected to the lever 72.

[0063] The body 1 is integral with the operating lever 72, which means that when the operating lever 72 is retracted, the body 1 is also retracted, for example as in FIG. 16B.

[0064] The operating lever 72 comprises at least one seat 722 for the passage of the tie rod 4 so that the lever can slide on the tie rod 4 .

[0065] The operating lever 72 has a lever stop 725 at its rear adapted to abut against an associated tie rod stop 45, as can be seen in FIG. 16D, so that the operating lever 72 becomes integral with the tie rod 4, and when the operating lever 72 is retracted, the tie rod 4 is also retracted.

[0066] The handle 7 comprises a handle stop 75 adapted to abut against a lever stop 725 or a slider 721 to prevent further retraction of the operating lever 72, as can be seen in FIG. 16E.

[0067] The tie rod 4 is also provided with a traction element adapted to pull the tie rod 4 against the handle 7 .

[0068] In the variation of Fig. 14, a traction element 45 is connected to the proximal end 43 of the tie rod 4. The traction element 45 at least partially exits the handle 7 to be grasped and optionally pulled by a medical professional, as in Fig. 16F.

[0069] In the variant of FIG. 15, the traction element is a wheel 47 connected to the proximal end 43 of the tie rod 4. The wheel 47 extends at least partially from the handle 7 to be optionally rotated by the medical professional.

[0070] The operating lever 72 comprises, adjacent to the slider 721, a cut button 723 with a blade 724 adapted to cut the tie rod 4. The cut button 723 is vertically slidable between a rest position (FIG. 18A) in which the blade 724 is spaced away from the tie rod 4 and a cut position (FIG. 18B) in which the blade 724 is pressed against the tie rod 4 to cut it.

[0071] In one embodiment shown in Fig. 17A, the tie rod 4 is provided with a predetermined breaking point 44, e.g. a pre-made notch or weakened portion, proximal to the proximal clip 3, adapted to give way in response to a certain traction force applied to the tie rod 4. Said predetermined breaking point 44 is a calibrated weak point that allows the pair of clips to be released only after an optimal traction force has been applied to clamp and thus occlude the vessel. This solution allows as little tie rod 4 as possible to remain in the patient's body after the vessel has been closed, as shown in Fig. 17B.

[0072] The series of figures, Figures 16A through 16F, illustrates the use of device 100 to close a blood vessel.

[0073] As shown in Fig. 16A, first the body 1 is percutaneously introduced by the needle tip 11. Then the tip 11 punctures the wall of the blood vessel V and passes through said vessel from one side to the other. During the insertion of the device 100, the longitudinal axes of the clips 2, 3 are aligned with the longitudinal axis of the body 1.

[0074] At this point, as shown in Figure 16B, the distal clip 2, along with a portion of the tie rod 4, is caused to exit the distal opening 12 of the body 1. The distal clip 2 is caused to exit by retracting the body 1 with the operating lever 72 while holding the proximal clip 3 and the abutment element 5 in place.

[0075] The tie rod 4 is then pulled by pulling the handle 7, as seen in FIG. 16C, to precisely position the distal clip 2 against the outer wall of the vessel V. At this point, the distal clip 2 is positioned outward and substantially laterally relative to the body 1. Ultrasound examination is used to verify that the distal clip 2 is abutting laterally against the distal wall of the vessel V.

[0076] At this point, as shown in Figure 16D, the proximal clip 3, and with it a portion of the tie rod 4, is caused to exit the distal opening 12 of the body 1, as is the distal clip 2. The proximal clip 3 is caused to exit by retracting the body 1 together with the operating lever 72, while holding the abutment element 5 in place.

[0077] The tie rod 4 is then pulled by pulling the handle 7, as seen in FIG. 16E, to precisely position the proximal clip 3 against the outer wall of the vessel V. At this point, the proximal clip 3 is also positioned outward and substantially laterally relative to the body 1.

[0078] At this point, the tie rod 4 is also pulled, as seen in Fig. 16F, to precisely clamp the vessel between the distal clip 2 and the proximal clip 3. The tie rod 4 is optionally pulled by a traction element 45 or by rotating a wheel 47.

[0079] It should be noted that the tie rod slides into the seat 21 of the proximal clip 3 with a calibrated friction that allows the clips 2, 3 to clamp.

[0080] The tie rod 4 is preferably provided with a radial dimension in the proximal position, for example a flat or thickened portion, which prevents the tie rod from being able to re-enter the seat 31 of the proximal clip 3 after this radial dimension has left it. This solution makes it possible to maintain a precise clamping of the vessel between the distal clip 2 and the proximal clip 3, thus avoiding the need to create a node on the tie rod that must be pressed into place. Figures 13A and 13B show the tie rod 4, in particular at least the intermediate portion 42 arranged between the clips, with a fixing fin 421 suitable for preventing retraction of the proximal clip 3 during the clamping phase of the vessel (Figure 16F).

[0081] At this point, if a predetermined breaking point 44 on the tie rod 4 is used, it is possible to sever the tie rod 4 by activating the sever button 723 on the handle or by pulling further.

[0082] The percutaneous device according to the invention makes it possible to carry out operations for percutaneously blocking and / or closing blood vessels in a simple manner, which requires a reduction in manual skills that are not necessarily surgical.

[0083] Advantageously, in the percutaneous device according to the invention, as a result of the respective paths provided in the housings 22 , 32 , 33 and the clips 2 , 3 , the tie rod 4 does not impede the correct sliding of the clips 2 , 3 inside the body 1 .

[0084] The percutaneous device according to the invention advantageously makes it possible to carry out mechanical methods for closing veins, or generally blood vessels, and even larger caliber blood vessels, by closing or "clamping" the outer wall of the vessel, which methods are carried out percutaneously. It is thus possible to carry out ultrasound-guided closure of veins by percutaneous clamping.

[0085] Advantageously, as a result of using a percutaneous device according to the present invention, the impact on surgical time and patient acceptance (or compliance) is significantly reduced as compared to "open" surgical techniques.

[0086] The clips 2, 3 may advantageously be made of absorbable material and can remain in place to ensure interruption of venous blood flow without disrupting the anatomical continuity of the vasculature.

[0087] The device according to the invention advantageously has various fields of application such as: superficial venous insufficiency, when the venous line needs to be "ligated" or interrupted, sapheno-femoral vein cross-section, sapheno-popliteal vein cross-section, interruption of varicose side branches, interruption of incontinent perforating veins, segmentation of saphenous reflux.

[0088] The process may advantageously be intended as a simple isolated surgical procedure performed at one or more sites, or may be a process performed in conjunction with other surgeries, an example of which is the interruption of the saphenofemoral junction performed in conjunction with a procedure for ablation of the great saphenous vein, performed using physical or chemical techniques.

[0089] It is understood that a person skilled in the art can make modifications to the above products, all of which fall within the scope of protection defined by the following claims. [Explanation of symbols]

[0090] 1 Main unit 2,3 Clamp clip 4 Tie rod 5 Contact elements 11 Clamp Clip 12 Distal opening 21,31 Seat 22,32,33 Housing 111 Notch 100 Percutaneous Devices 211,311 End 421 Fixed Fin

Claims

1. A percutaneous device (100) for closing a blood vessel, comprising: a hollow body (1) having a distal tip (11) with a distal opening (12); a distal clip (2) and a proximal clip (3) slidably housed inside the body (1), the clips (2, 3) being connected to each other by a tie rod (4), the distal clip (2) being fastened to the tie rod (4) and the proximal clip (3) sliding relative to the tie rod (4); an abutment element (5) for the clip (2, 3) slidably accommodated inside the body (1), the abutment element (5) being provided with a longitudinal passage for the tie rod (4); a handle (7) connected to said body (1) for manipulating the clips (2, 3), the abutment elements (5) and the tie rods (4); Equipped with A percutaneous device, characterized in that the distal clip (2) comprises at least one proximal housing (22), the proximal clip (3) comprises both a distal housing (32) and a proximal housing (33), and the tie rod (4) is disposed inside the housings (22, 32, 33) when the clips (2, 3) are inserted into the body (1).

2. The percutaneous device (100) of claim 1, wherein the housings (22, 32, 33) are longitudinal grooves on the outer surfaces of the clips (2, 3), the proximal housing (22) of the distal clip (2) occupies at least a proximal portion of the distal clip (2), the distal housing (32) of the proximal clip (3) occupies at least a distal portion of the proximal clip (3), and the proximal housing (33) of the proximal clip (3) occupies at least a proximal portion of the proximal clip (3).

3. 3. The percutaneous device (100) according to claim 1 or 2, wherein the distal clip (2) is provided with a distal seat (21) to which the tie rod (4) is fastened, the distal seat (21) being perpendicularly transverse to the distal clip (2).

4. The percutaneous device (100) according to claim 1 or 2, wherein the distal clip (2) has a further housing to which the tie rod (4) is fastened.

5. The percutaneous device (100) according to any one of claims 1 to 4, wherein the proximal clip (3) is provided with a proximal seat (31) into which the tie rod (4) is slidably inserted, the proximal seat (31) being a through hole that traverses the proximal clip (3) obliquely.

6. The percutaneous device (100) according to any one of claims 1 to 5, wherein the clips (2, 3) and the tie rods (4) are made of absorbent material.

7. The percutaneous device (100) according to any one of claims 1 to 6, wherein the abutment element (5) has a distal end (51) dimensioned to be received within the proximal housing (33) of the proximal clip (3).

8. A percutaneous device (100) according to any one of claims 1 to 7, wherein the clips (2, 3) have opposing ends (211, 311) with parallel inclined surfaces to allow partial overlap of the clips (2, 3) when inserted into the body 1.

9. The percutaneous device (100) according to any one of claims 1 to 8, wherein the tie rod (4) has a fixing fin (421) at least in an intermediate portion (42) arranged between the clips (2, 3) when inserted into the body (1).

10. 10. The percutaneous device (100) of any one of claims 1 to 9, wherein the body (1) has a distal piercing tip (11) extending in a proximal direction and having a notch (111) dimensioned to at least partially accommodate the distal clip (2).

11. The percutaneous device (100) of any one of claims 1 to 9, wherein the distal clip (2) has a distal piercing end (26).

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