CN112190297B - Adaptive modular occlusion device special for promoting thrombosis of aortic dissection false lumen - Google Patents
Adaptive modular occlusion device special for promoting thrombosis of aortic dissection false lumen Download PDFInfo
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- CN112190297B CN112190297B CN202011089637.4A CN202011089637A CN112190297B CN 112190297 B CN112190297 B CN 112190297B CN 202011089637 A CN202011089637 A CN 202011089637A CN 112190297 B CN112190297 B CN 112190297B
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
- A61B17/12022—Occluding by internal devices, e.g. balloons or releasable wires
- A61B17/12099—Occluding by internal devices, e.g. balloons or releasable wires characterised by the location of the occluder
- A61B17/12109—Occluding by internal devices, e.g. balloons or releasable wires characterised by the location of the occluder in a blood vessel
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
- A61B17/12022—Occluding by internal devices, e.g. balloons or releasable wires
- A61B17/12131—Occluding by internal devices, e.g. balloons or releasable wires characterised by the type of occluding device
- A61B17/12168—Occluding by internal devices, e.g. balloons or releasable wires characterised by the type of occluding device having a mesh structure
- A61B17/12177—Occluding by internal devices, e.g. balloons or releasable wires characterised by the type of occluding device having a mesh structure comprising additional materials, e.g. thrombogenic, having filaments, having fibers or being coated
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
- A61B17/12022—Occluding by internal devices, e.g. balloons or releasable wires
- A61B2017/1205—Introduction devices
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Abstract
The invention discloses a special adaptive modularized occluder for promoting thrombosis of an aortic dissection false cavity, which is of a three-piece structure and comprises a dissection false cavity near-end occluding piece, a false cavity middle occluding piece and a false cavity far-end occluding piece, wherein different parts are selectively combined and actually used according to different types of crevasses at the far end of an aortic dissection. The invention provides a special surface modified coagulation-promoting false lumen occluder with adaptability modularization for clinic, which can be suitable for false lumens with various shape characteristics, effectively promote the formation and reconstruction of false lumen thrombus and has wide application; the proper model can be selected according to the shape and the size of the false cavity, thereby reducing the economic burden and shortening the operation time. Meanwhile, a special release system is designed to accurately release and reduce the damage to the false cavity, so that the aims of better promoting the thrombosis of the false cavity, improving the long-term treatment effect of the false cavity and improving the overall prognosis of the interlayer are fulfilled.
Description
Technical Field
The invention relates to a shape-adaptive modular special occluder for promoting aortic dissection false lumen thrombosis.
Background
After aortic dissection endoluminal repair, repeated lumbago and backache or continuous expansion of a distal aorta of some patients occur, which are caused by continuous blood flow of a false cavity, the false cavity is completely repaired, so that blood flow perfusion does not exist in the false cavity any more, the fracture risk is reduced, a better filler for the false cavity is selected, and the purposes of better repairing a distal laceration and promoting complete thrombolysis of the false cavity are achieved.
The current treatment methods for the aortic dissection false cavity are various, but the advantages and the disadvantages are also obvious: for example, the implantation of a bare stent can promote the reconstruction of the aorta true lumen so as to ensure the distal blood supply and compress the distal false lumen, but the bare stent cannot isolate the crevasses, so the bare stent is not ideal for the conditions of large crevasses and much blood flow perfusion. The fenestration type covered stent has attracted extensive attention in recent years due to the remarkable advantages that the fenestration type covered stent can isolate the distal laceration of the visceral artery area and can also retain the blood supply of the branch blood vessel, but the fenestration type covered stent still has the problems of long customization period, high cost and the like at present, and has higher requirements on the operation skills of a main surgeon and is difficult to popularize. Chimney technology is currently commonly applied in the renal arteries to ensure renal artery blood flow, but cannot be applied if the laceration is located at the corner between the abdominal aorta and the branch artery. The multi-layer bare stent (MFM) has many advantages due to its unique design, for example, the design of multi-layer dense mesh without covering membrane can interfere the change of the blood flow of the true lumen into laminar flow, reduce the impact force on the tumor wall and the pressure of the false lumen, promote the thrombosis of the false lumen without affecting the blood flow of the branch vessel; but are not suitable for patients who incorporate a significant expansion of the distal pseudoluminal neoplasia due to their long time to promote pseudoluminal thrombosis. It has also been reported that a spring coil is implanted into the interlayer false lumen through the distal laceration by using a spring coil and bare stent technique, and the bare stent is implanted into the true lumen to isolate the laceration; however, the coil may be flushed into the true lumen and the visceral vessels branched causing a false embolism and the cost is significantly increased due to the large volume of coil used. The method of plugging the laceration by using the plugging device and then implanting the bare stent in the vacuum cavity is also provided, but the laceration is not easy to be completely sealed due to overlarge meshes of the plugging device, and the disks at the two ends are large and not easy to be pasted, so that the blood flow of the branch blood vessel is easily influenced.
Disclosure of Invention
The technical problem to be solved by the invention is as follows: the existing aortic dissection false lumen occluder cannot be simultaneously applied to false lumens with various characteristics, and the application is limited.
In order to solve the problems, the technical scheme of the invention is to provide a shape-adaptive modular special occluder for promoting aortic dissection false cavity thrombosis, which is characterized in that: the interlayer false cavity near-end plugging piece is arranged at the near end of the interlayer false cavity and is of a capsule-shaped structure with one end open and the other end blind, and the blind is used for limiting blood flow and promoting thrombopoiesis;
the middle blocking piece of the dummy cavity is arranged in the middle of the interlayer dummy cavity and is of a hollow cylindrical structure with openings at two ends, and the middle of the side wall of the hollow cylindrical structure is inwards sunken from the periphery to form a narrow section for slowing down the blood flow and promoting the thrombopoiesis;
the distal end plugging piece of the false cavity is symmetrical to the structure of the proximal end plugging piece of the interlayer false cavity and is used for limiting reverse blood flow and promoting thrombopoiesis;
the interlayer false cavity near-end plugging piece, the false cavity middle-part plugging piece and the false cavity far-end plugging piece are all main body covered film bracket structures, and one or two or three combinations are adopted to be placed in the interlayer false cavity when the interlayer false cavity plugging device is used.
Preferably, the main body covered stent structure takes nickel-titanium alloy wires as a stent and polyester multifilament as a covered membrane, and is integrally woven and formed by adopting a non-reinforcing rib design.
Preferably, the surface of the coating is provided with coating villi for reducing the flow velocity of blood flowing through the occluder, increasing the contact area of the occluder and the blood and promoting the formation of thrombus.
Preferably, the recess of the narrow section is arc-shaped, and the narrow section is smoothly transited and connected with the two ends of the hollow cylindrical structure.
Preferably, the diameter ratio of the two ends of the middle blocking piece of the false cavity to the narrow section is 3: 1.
Preferably, the diameter of the two ends of the dummy cavity middle plugging piece is 1-2mm larger than that of the interlayer dummy cavity near-end plugging piece, and the diameter of the dummy cavity far-end plugging piece is 1-2mm larger than that of the two ends of the dummy cavity middle plugging piece.
Preferably, the interlayer false cavity proximal plugging piece, the false cavity middle plugging piece and the false cavity distal plugging piece are self-expanding released in the interlayer false cavity.
Compared with the prior art, the invention has the beneficial effects that:
the invention provides a special surface modified coagulation-promoting false lumen occluder with adaptability modularization for clinic, which can be suitable for false lumens with various shape characteristics, effectively promote the formation and reconstruction of false lumen thrombus and has wide application; the proper model can be selected according to the shape and the size of the false cavity, thereby reducing the economic burden and shortening the operation time. Meanwhile, a special release system is designed to accurately release and reduce the damage to the false cavity, so that the aims of better promoting the thrombosis of the false cavity, improving the long-term treatment effect of the false cavity and improving the overall prognosis of the interlayer are fulfilled.
Drawings
FIG. 1 is a structural schematic diagram of a shape-adaptive modular occlusion device special for promoting thrombosis of an aortic dissection false lumen of the invention;
FIG. 2 is a schematic diagram of a conveyor system;
fig. 3 is a schematic diagram of the process of pushing the stopper by the delivery system.
Detailed Description
In order to make the invention more comprehensible, preferred embodiments are described in detail below with reference to the accompanying drawings.
The invention relates to a shape-adaptive modular special occluder for promoting thrombosis of an aortic dissection false cavity, which is of a three-piece structure and comprises a dissection false cavity near-end occluding part 1, a false cavity middle occluding part 2 and a false cavity far-end occluding part 3.
The interlayer false cavity proximal end plugging piece 1 is a capsule-shaped structure with an opening at one end and a blind end at the other end, is placed at the interlayer false cavity proximal end, and the blind end is in a mushroom head shape and is used for limiting blood flow and promoting thrombopoiesis.
The middle blocking piece 2 of the dummy cavity is located in the middle of the interlayer dummy cavity and is of a hollow cylindrical structure with openings at two ends, the middle of the side wall of the hollow cylindrical structure is inwards recessed from the periphery to form a narrow section 201, the narrow section 201 is designed into a candy shape by adopting an arc shape, two ends of the hollow cylindrical structure are smoothly connected with the narrow section 201 in a transition mode, the diameter ratio of the two sections is about 3:1, and the middle blocking piece is used for slowing down blood flow and promoting thrombopoiesis.
The far end plugging piece 3 of the false cavity and the near end plugging piece 1 of the interlayer false cavity are symmetrical in structure and are placed at the far end of the interlayer false cavity, one end of the far end plugging piece is open, and the blind end of the other end of the far end plugging piece is used for limiting reverse blood flow and promoting thrombopoiesis.
The interlayer false cavity near-end plugging piece 1, the false cavity middle-part plugging piece 2 and the false cavity far-end plugging piece 3 are all main body film-covered support structures. The main body covered stent structure takes nickel-titanium alloy wires and polyester multifilaments as basic raw materials, wherein the nickel-titanium alloy wires are used as a stent, the polyester multifilaments are used as covering films, the design without reinforcing ribs is adopted, the covering films are integrally woven on a weaving machine, the top end of a plugging device is integrally manufactured to be similar to a mushroom head-shaped blind end, and the process of thrombopoiesis is accelerated.
Film coating structure: the tectorial membrane can be designed into an outer surface villus structure, when blood contacts the tectorial membrane villus, on one hand, the flow velocity of the blood on the surface of the tectorial membrane can be reduced, and the thrombus is quickly formed, and on the other hand, because the specific surface area of the tectorial membrane villus is relatively large, more tectorial membrane materials can be contacted with the blood, and the formation of the thrombus is also promoted to a certain extent.
As shown in fig. 2, the delivery system pusher of the occluding device is made of a modified nylon (PEBAX) material. 11 is a delivery sheath, 12 is an occluder storage short sheath, and 13 is a catheter pusher. After aortic dissection repair, a marked pigtail catheter is sent into a dissection false cavity, the size of the dissection false cavity is measured by high-pressure radiography, a guide wire is exchanged, a delivery sheath 11 is sent to the near end of the dissection false cavity along the guide wire, the guide wire and a sheath core are withdrawn, as shown in figure 3, after the delivery sheath 11 is smoothly placed, a plugging device with a corresponding size is selected according to the measurement result, a short plugging device storage sheath 12 is connected with the short plugging device storage sheath 12, and then the plugging device is pushed to a pre-release position by a catheter pusher 13; after the occluder is delivered to the near end of the interlayer false cavity for accurate positioning, the delivery sheath is withdrawn, the occluder is released in a segmented self-expanding manner, and finally the delivery sheath 11 is withdrawn.
The three pieces of the occluder are all nickel-titanium alloy wires serving as a support structure, and the occluder can be automatically opened after being released due to the memory metal characteristics of the occluder. The three-piece set can be put into one set, two sets or three sets according to the size of the false cavity, when one set is used, the interlayer false cavity near-end plugging piece 1 or the false cavity far-end plugging piece 3 can be selected, and the blind end is arranged at the near-end or far-end of the false cavity crevasse. The two pieces of the sleeve are the combination of the interlayer false cavity near-end plugging piece 1 and the false cavity far-end plugging piece 3, the false cavity far-end plugging piece 3 is firstly placed at the far end of a false cavity crevasse, and the interlayer false cavity near-end plugging piece 1 is sleeved at the near end to form a capsule shape. The three-piece sleeve is a combination of an interlayer false cavity near-end plugging piece 1, a false cavity middle plugging piece 2 and a false cavity far-end plugging piece 3, the interlayer false cavity near-end plugging piece 1, the false cavity middle plugging piece 2 and the false cavity far-end plugging piece 3 are released in a segmented mode, the diameter of the two ends of the false cavity middle plugging piece 2 is 1-2mm larger than that of the interlayer false cavity near-end plugging piece 1, and the diameter of the false cavity far-end plugging piece 3 is 1-2mm larger than that of the two ends of the false cavity middle plugging piece 2. After such release, the joint is tightly closed.
Claims (7)
1. The utility model provides a special plugging device of false chamber thrombosis of aortic dissection of adaptability modularization which characterized in that: the interlayer false cavity near-end plugging piece is characterized by comprising an interlayer false cavity near-end plugging piece (1), wherein the interlayer false cavity near-end plugging piece (1) is arranged at the interlayer false cavity near end and is of a capsule-shaped structure with one end open and the other end blind end, and the blind end is used for limiting blood flow and promoting thrombopoiesis;
the middle blocking piece (2) of the dummy cavity is arranged in the middle of the interlayer dummy cavity and is of a hollow cylindrical structure with openings at two ends, and the middle of the side wall of the hollow cylindrical structure is inwards sunken from the periphery to form a narrow section (201) for slowing down the blood flow and promoting the thrombopoiesis;
a false cavity far end plugging piece (3) which is symmetrical with the structure of the interlayer false cavity near end plugging piece (1) and is used for limiting reverse blood flow and promoting thrombopoiesis;
the interlayer false cavity near-end plugging piece (1), the false cavity middle-part plugging piece (2) and the false cavity far-end plugging piece (3) are all main body film-covered support structures, and one or two or three combinations are adopted to be placed in the interlayer false cavity during use.
2. The adaptive modular occlusion device special for promoting aortic dissection false lumen thrombosis of claim 1, wherein: the main body covered stent structure takes nickel-titanium alloy wires as a stent and polyester multifilament as a covered membrane, and is integrally woven and formed by adopting a non-reinforcing rib design.
3. The adaptive modular occlusion device special for promoting aortic dissection false lumen thrombosis of claim 1, wherein: the surface of the coating is provided with coated villi which are used for reducing the flow rate of blood flowing through the occluder, increasing the contact area of the occluder and the blood and promoting the formation of thrombus.
4. The adaptive modular occlusion device special for promoting aortic dissection false lumen thrombosis of claim 1, wherein: the depression of the narrow section (201) is arc-shaped, and the narrow section (201) is connected with two ends of the hollow cylindrical structure in a smooth transition mode.
5. The adaptive modular occlusion device special for promoting aortic dissection false lumen thrombosis of claim 1, wherein: the diameter ratio of the two ends of the dummy cavity middle blocking piece (2) to the narrow section (201) is 3: 1.
6. The adaptive modular occlusion device special for promoting aortic dissection false lumen thrombosis of claim 1, wherein: the diameter of two ends of the dummy cavity middle plugging piece (2) is 1-2mm larger than that of the interlayer dummy cavity near-end plugging piece (1), and the diameter of the dummy cavity far-end plugging piece (3) is 1-2mm larger than that of two ends of the dummy cavity middle plugging piece (2).
7. The adaptive modular occlusion device special for promoting aortic dissection false lumen thrombosis of claim 1, wherein: the interlayer false cavity near-end plugging piece (1), the false cavity middle-part plugging piece (2) and the false cavity far-end plugging piece (3) are released in a self-expanding manner in the interlayer false cavity.
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| Application Number | Priority Date | Filing Date | Title |
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| CN202011089637.4A CN112190297B (en) | 2020-10-13 | 2020-10-13 | Adaptive modular occlusion device special for promoting thrombosis of aortic dissection false lumen |
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| CN202011089637.4A CN112190297B (en) | 2020-10-13 | 2020-10-13 | Adaptive modular occlusion device special for promoting thrombosis of aortic dissection false lumen |
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| CN112190297A CN112190297A (en) | 2021-01-08 |
| CN112190297B true CN112190297B (en) | 2021-12-24 |
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| RU206863U1 (en) * | 2021-06-07 | 2021-09-30 | Сергей Петрович Семитко | OKKLUDER |
| RU2766867C1 (en) * | 2021-06-07 | 2022-03-16 | Сергей Петрович Семитко | Device for closing a vessel lumen, a method for its manufacture and a method for its delivery to a target area |
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| CN101579265B (en) * | 2008-05-12 | 2011-03-30 | 先健科技(深圳)有限公司 | Aortic arch stent-graft |
| CN107569300A (en) * | 2017-09-25 | 2018-01-12 | 上海长海医院 | A kind of intracavitary repair implant for treating dissection of aorta vacation chamber |
| CN108113785B (en) * | 2017-12-25 | 2020-04-21 | 有研医疗器械（北京）有限公司 | Intravascular false cavity plugging support |
| CN110037828B (en) * | 2019-04-15 | 2023-12-22 | 中南大学湘雅二医院 | Adjustable renal artery fenestration abdominal aorta tectorial membrane support system |
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