CN1204242A - Method and apparatus for bypassing arterial obstructions and/or performing other transvascular procedures - Google Patents

Method and apparatus for bypassing arterial obstructions and/or performing other transvascular procedures Download PDF

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Publication number
CN1204242A
CN1204242A CN 96199063 CN96199063A CN1204242A CN 1204242 A CN1204242 A CN 1204242A CN 96199063 CN96199063 CN 96199063 CN 96199063 A CN96199063 A CN 96199063A CN 1204242 A CN1204242 A CN 1204242A
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blood vessel
path
break
conduit
parts
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CN 96199063
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P·C·埃瓦特
J·C·弗拉赫蒂
J·T·加里博托
P·E·麦考利
T·R·麦克霍尔德
J·马科韦
J·B·惠特
C·A·维达尔
R·J·雷德蒙
T·班克斯
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Transvascular Inc
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Transvascular Inc
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Priority to CN 96199063 priority Critical patent/CN1204242A/en
Publication of CN1204242A publication Critical patent/CN1204242A/en
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Abstract

This invention is methods, devices, and systems for re-vascularization, and/or performing other medical procedures at a vascular or non-vascular intra-corporeal locations within a mammalian body. The methods generally comprise the formation of at least one extravascular passageway from a blood vessel to a vascular or non-vascular target location. In the re-vascularization methods the extravascular passageway is utilized as a conduit for accessing or performing procedures at the vascular or non-vascular target location. Also disclosed are catheter devices (100, 103) and systems (138) which are usable to form the extravascular passageways of the invention, as well as apparatus for modifying, maintaining and/or closing such extravascular passageways.

Description

Be arterial obstructions bypass and/or other intravascular method of operating and device
Related application
The application requires the preference of No. 60/005,164, U.S. Provisional Application of submitting to October 13 nineteen ninety-five and 60/010, No. 614 application submitting on February 2nd, 1996.Whole disclosures of No. the 60/005th, 164, provisional application and 60/010, No. 614 are incorporated this paper into as a reference at this.
Invention field
The present invention relates generally to therapy, and parts, system relates in particular at a) revascularization and/or b) implement the method for the medical care precess of blood vessel or non-blood vessel, equipment, system in the mammalian body.
Background of invention
A. relate to the background of revascularization operation
In the modern medicine practice, usually need to add bypass for the ill part that reaches the tremulous pulse that damages that gets clogged.Be used to these obstructions, ill, the typical operation technique that the blood vessel of damage adds bypass needs the open surgery of tremulous pulse to expose, and to impaired tremulous pulse (for example: from the body value of moving, heteroplastic transplantation gillies' graft is connected (for example: sew up), heteroplastic transplantation of the same clan, repair or the biological restoration transplanting) so that an end of graft is connected in obstruction, ill, the upstream of damage location, the other end of graft is connected in this tremulous pulse in its downstream.Pass through the bypass graft open walk in this method arterial blood, thereby recover to get clogged, blood flow ill or that damage the arterial distal position with the prevention tissue ischemia, blocks with other because the consequence that the impaired blood flow of process diseased arteries causes.
Though the surgery artery bypass grafting is each position execution in vivo, it is to be used to carry out following treatment: ⅰ that its most typical tremulous pulse adds bypass operation. coronary artery disease or ⅱ. influence the peripheral vascular disease of lower limb.
ⅰ. coronary artery disease
Coronary artery disease is the one of the main reasons of whole world M ﹠ M always.The typical cause of disease of coronary artery disease is to form atherosclerotic plaque in coronary artery, and the accumulation of this atherosclerosis plaque is easy to cause all or part of obstruction of coronary flow, can not cause myocardial ischaemia, infraction and death if do not treat.
For many years, the surgical intervention of traditional coronary artery disease is to adopt coronary artery to add by-pass operation always.Wherein patient is anaesthetized usually, place cardiopulmonary bypass (extracorporeal circulation), and patient's heart quits work temporarily.Open breast (for example: positive gladiolus cut) and expose the coronary artery of obstruction, do bypass graft with one or more patients' people's saphena or IMA with the mode of surgery dissecting.Tremulous pulse or the vein segment collected are coincide to the coronary artery that blocks, form bypass manifold with obstruction around tremulous pulse.The surgical intervention method that this traditional coronary artery adds bypass is expensive, and extreme has traumatic, and the complication before the art in this operation and the art has tangible relation.
A kind of alternative that traditional coronary artery is added the surgical intervention of bypass is the sacculus angioplasty.In the sacculus angioplasty, a flexible guide catheter, percutaneous injects peripheral arterial (as: femoral artery), and passes blood vessel by the tube chamber propelling, till the far-end of conduit arrives at the opening part coronarius that gets clogged.After this, foley's tube passes guide catheter and enters the damage location of obstruction.With the sacculus of foley's tube once or more times fill, block the coronary artery of damage field with expansion.These sacculus angioplasty add the surgical intervention method of bypass than traditional coronary artery, cost less and damage few.Yet the method for this sacculus angioplasty has the vascularization position of suitable ratio that the case of restenosis takes place.The reason of this restenosis and mechanism are the exercise questions of constantly studying always.But, this restenosis usually by owing to: a) agglomerate on the arterial wall increases (for example: neointima forms), b) thickening of arterial wall, and do not change substantially in the agglomerate.(as: blood vessel is reinvented) and/or arterial wall slight crack and the crack arterial wall through balloon expandable when recovering that c) produces through the balloon expandable operation are the auxilliary shape contraction of penetrating.
Another kind of traditional coronary artery adds (for example: arteriotomy) or skiving art (for example: ultrasonic, laser) removes art in the lumen of vessels that the by-pass operation Therapeutic Method is a coronary artery internal congestion material.The operation of removal or skiving is to pass vascular system by conduit placement removal or skiving device to arrive obstructive position coronarius in these lumen of vessels.Removal that this conduit is placed or skiving device are to utilize to cut, scrape, and sound wave, pulverizing or gasification or other mode are worn down clogged material from the coronary artery intracavity.This operating process must be careful avoiding that arterial wall is caused perforation or infringement, because this perforation or infringement can cause bleeding or the lumen of artery of too much cicatrix and secondary inaccessible again.In addition, the operation of these skivings at least in some cases, is removed from obturator or isolated fragment owing to need control carefully and remove, and avoids entering patient's blood circulation with the fragment that prevents this obturator, makes this process seem chaotic.
The example of the device for excising that the conduit of arteriotomy and other conduits are placed has been described in United States Patent (USP) the 3rd, 433, No. 226 (Boyel), 3,823, No. 717 (Pohlman, etc.), 4,808, No. 153 (Parisi), 4,936, No. 281 (Stasz), 3,565, No. 062 (Kuris), 4,924, No. 863 (Stener), 4,370, No. 953 (Don Michael, etc.), 5,069, No. 664 (Suess, etc.), 4,920, No. 954 (Alliger, Deng) and 5,100,423k number (Fearnot), and foreign patent/patent publication us EP0347098A2 (Shiber), WO87-05739 (Cooper), WO89-06515 (Bernstein, Deng), WO90-0130 (Sonic Needle Corp.), EP316789 (DonMicheal, Deng), DE3,821,836 (Schubert), DE2438648 (Pohlman), and EP0443256A1 (Barush).
Other surgical intervention methods that substitute traditional coronary artery bypass also comprise: the endoscopic procedure of minimally invasive, at least be directly, the little otch (as: 1-3cm) of cutting on patient's thoracic wall passes this otch with thoracoscope and relevant operating theater instruments and undergos surgery.This minimally invasive coronary artery adds bypass operation at United States Patent (USP) the 5th, 452, describes in No. 733 (Sterman etc.).If the operation of the coronary artery bypass of these minimally invasives is perfectly, the patient who carries out this minimally invasive operation can reduce sticky feeling and shorten recovery time with respect to carrying out traditional tremulous pulse by-pass operation therapist.Yet, a large amount of operator's technology and the training of this typical endo-surgical action need.And, the same with the operation method that adds bypass with traditional coronary artery, the operating process of these thoracoscopies is generally carried out under general anesthesia, generally need one or more breast pipes to be left on any blood that fixed position spills from the transplanting anastomotic stoma with drain, and reduce the generation of pneumothorax in postoperative following period of time.This pneumothorax is that the formation owing to holostrome otch on thoracic wall causes.The certain operations of the coronary artery bypass of this thoracoscope needs patient to be placed heart bypass and patient's only work of heart time-out in addition.This thoracoscope operation of other can be used when being intended to not place patient's cardiopulmonary bypass and not stopping heart working.Yet this operation that is intended to not have cardiopulmonary bypass and heart to stop the dancing thoracoscope that can be used is the operation of relative complex, and generally need hold under the arm temporarily and close or ligation will be added the coronary artery of bypass.Therefore, in addition this do not have thoracoscope operation that cardiopulmonary bypass/heart quits work down and can be used also because the complexity of operation and need to suspend only hold under the arm or ligation be added the coronary artery of bypass and easily have unique and significant dangerous and difficult.Like this, the many drawbacks relevant with traditional coronary artery surgery, and additional potential drawback can be associated with the thoracoscope operation of these minimally invasives.
But another kind of in fact not adding bypass for coronary occlusion still can being used to improve the operating process of the blood flow in myocardial ischemia zone of above mentioning is the operation that is called as through myocardium vascular reconstructive surgery (TMR).In TMR operation, utilize the probe of an energy penetrate tissue, form the penetration channel that many holostromes pass the Ischemic Heart wall as laser microprobe and enter left ventricular cavity.From behind the oxygenated blood crack of left ventricle to outflow, by this penetration channel, so as the perfusion ischemia cardiac muscle.This example through myocardium vascular reconstructive surgery operation is described in United States Patent (USP) the 5th, 554, No. 152 (Aita etc.), 5,380, No. 316 (Aita etc.) and 5,125, No. 926 (Linbares etc.).
A kind of improved TMR action need from left ventricle to the coronary artery that blocks, the downstream part of obstruction form a kind of that add valve and/or inner Jia Sitante fixedly film through myocardium road (for example :) in a kind of interstice tunnel of myocardial wall formation.The operation of this improved TMR is described in United States Patent (USP) the 5th, 287, No. 861 (Wilk), 5,409, No. 019 (Wilk) and 5,429, No. 114 (Wilk).
ⅱ. peripheral angiopathy
Peripheral angiopathy normally by atherosclerotic plaque form and/or the thrombosis material around intra-arterial cause.In many cases, the main drive arteries and veins promptly produces the phenomenon that is called a kind of intermittent limping because peripheral angiopathy forms when blocking instantly.Intermittent limping is when firmly (promptly walking or running), and suffering from lower limb, pain and carrying out property to occur weak for characteristics.
General outer operation method to the peripheral angiopathy treatment, particularly among the patient who shows the intermittent limping symptom, be with underwent operative expose ill tremulous pulse and the bypass graft of a kind of pipeline that coincide (for example, the pipe that a kind of polyester of braiding or expanded polytetrafluoroethyl, ne (ePTFE) form) to ill tremulous pulse, so that an end of this graft is linked to the upstream of obturator, the other end of graft is linked to the downstream of obturator.In this way, arterial blood will flow gives tubulose bypass graft and bypassing artery block, thereby recovers the downstream of blood flow to obstruction of artery.
A kind of alternative method of traditional artery bypass graft surgery of treatment lower limb peripheral angiopathy is to be called the method that the bypass of original position vein adds.The execution that this original position vein adds bypass operation is by forming two (2) open otch at least at shank to expose diseased arteries in the upstream and downstream position of blocking.Stretch a PeV that is in substantially parallel relationship to ill tremulous pulse through shank, go to dissolve or destroy the venous valve that is positioned at this radicular vein and prepare by a kind of apparatus is inserted vein subsequently.After this any side shoot that extends from this vein be cut off, ligation or block by thromboembolism.The vein of this root through preparing grafted on the obstruction of artery and under the position, the vein end of this velamen grafting is placed and makes contact and directly be sutured in tremulous pulse in the upstream and downstream position of blocking.In this way, artery blood flow flows through the vein sections through preparing, and what this vein through preparing saved will be as bypass duct bypassing artery block thing.The example of up-to-date original position vein bypass operation is described in White, R.A and Fogarty, intervention method Pgs in the T.J., peripheral vessels, 166-169, Mosby﹠amp; CO. (1996).
ⅲ. wound and other disease of infringement artery blood flow
The various tremulous pulsies of health can be damaged (for example: spread laceration, crush injury, passivity glue portion wound) by wound or be invaded by the outer disease of blood vessel (for example: the hypertrophy of adjacent tumor and inwardly growth) and split or push.Treatment is a surgical exposure and separate ill tremulous pulse sections by the typical operation method of the tremulous pulse of this wound or sickness influence, and subsequently a) excision and link again or b) add bypass for ill tremulous pulse sections, flow through or walk around ill tremulous pulse sections with the recovery artery blood flow.In many cases, it can be very big being damaged tremulous pulse sections with sickness influence so that operation can not be excised merely, ill section remove and the end-end of the contiguous tremulous pulse broken ends of fractured bone identical.Therefore this excision and end-end identical be under the situation of inappropriate selection, on ill tremulous pulse, connect a kind of tubulose by-pass graft thing, (as by braiding polyethylene, the gillies' graft that orePTET forms) adds bypass to ill tremulous pulse sections may be desirable.
Though the up-to-date relatively progress of above-mentioned many operation technique representatives, relevant with traditional surgical approaches invade fragility and danger is relaxed, this area is demand still, be tremulous pulse sections damage and ill that gets clogged add path and develop new, safety, reliably, minimally invasive and/or see through the operation of periosteum.
B. relate to the background of other blood vessel outer operation/interventional procedures
Many types of operation and interventional procedure at the organ of health, are pre-formed in tissue or the body cavity scope.Traditionally, enter into this organ, tissue or body cavity are to finish by the open surgery otch of one or more healths, thereby make ill organ, and tissue or body cavity are exposed by surgery ground.
In recent years, carry out substantial effort and removed the surgical technic of development " minimally invasive ", thereby one or more endoscopies is used in the ill organ of observation, tissue or body cavity, operating theater instruments or other device are inserted in the body to finish the operation or the interventional procedure of requirement by relatively little " minimum path " (for example: less than 3cm) otch.
Though the appearance of these endoscopies " minimum path " operation method, its superiority surpasses traditional open surgical technic, be that they can make operative incision be reduced in the minimum scope, therefore can cause after the minimum operation uncomfortable, but this endoscopic procedures often is restricted to by the tube chamber of health and the come-at-able operation of body cavity, and this tube chamber or body cavity can be full of by limpid body fluid or be blown into the zone that an opening is provided with gas places operation endoscope and apparatus in wherein.
Even in view of with the most modern " smallest passage " the operation restriction relevant with interventional procedure, still need development to be used in the art near tumor, organ, the new method and the device of blood vessel external position are performed a surgical operation and/or the operation of intervention property needn't form any open surgery otch in vivo in tissue and other healths.
Brief summary of the invention
In general, the invention provides use the intravital vascular system of mammal as a kind of pipeline to implement the method for various types of medical procedure.Because the extensive distribution that spreads all over the duct conduits of whole body, vascular system provides a kind of path, and by this passage, parts can be moved and arrive the therapentic part of selecting, otherwise these positions are only to arrive by a direct otch.Specific process of the present invention comprises a) revascularization method, and b) in vivo the blood vessel external position carry out the method for various types of medical care precesses.
Revascularization method of the present invention generally comprises between blood vessel, between the diverse location of same vessel, or blood vessel and the another kind of morphological structure of holding blood (for example: the chamber of heart), the formation of the outer path of one or more blood vessels is so that blood flow is through these paths.In many application of the present invention, oxygenated blood (that is: pO 2Blood greater than 50) being carried through the outer path of blood vessel, is desired so that the purpose that provides or increase perfused tissue to be provided.Can use percutaneous according to the outer path of blood vessel that revascularization method of the present invention forms, form through the tube chamber method, this method has avoided forming the open surgery otch in mammalian body.This revascularization method of the present invention goes for peripheral vessels and/or coronary vasodilator.
According to revascularization method of the present invention, damage or disease and lost the method for the tissue of blood flow are provided to providing artery blood flow to arrive owing in the tremulous pulse sections, exist and block.This method comprises usually: will and enter this blood vessel by this blood vessel auterblood road holding the such arterial blood of step that forms the outer path of first blood vessel between the blood vessel that the morphology passage of arterial blood (for example: tremulous pulse or left ventricular cavity) and will pour into blood flow forfeiture tissue, to remove to pour into the tissue that blood flow is lost by this blood vessel.In some application of this method, first blood stream access will be formed between the vein of a kind of tremulous pulse and a kind of vicinity, and blood will flow to contiguous vein from tremulous pulse like this, and drive in the wrong direction subsequently by this vein to pass through vein blood vessel system reverse perfusion tissue.In addition, second blood stream access can be at vein and obstruction, be formed between damage or the existing tremulous pulse of disease, so enter the venous arterial blood and will enter this tremulous pulse again, in its obstruction, wound or by the downstream of the sections of sickness influence, thereby by blocking the tissue of the endogenous arterial perfusion blood flow forfeiture at the sections place of damage or sickness influence.Medical procedure method of the present invention mainly comprises, the position (for example: vascular tissue in from a blood vessel to another kind of body, organ, body cavity, the formation step of the outer path of at least a blood vessel tumor etc.), the outer path of intravascular transmits a kind of material or device subsequently, to carry out desired medical care precess on the position in selected body.
Further according to the present invention, a kind of parts are provided, this parts can inject blood vessel and can be used to form the outer path of blood vessel, the outer path of this blood vessel extends to a target site from the blood vessel that parts of vessels inserted, (for example: a) other blood vessel, b) EV position of the morphological structure of other containment blood (for example: the chamber of heart), c) another position or the d of same blood vessel) is (for example: organ, tumor, body cavity etc.).The outer path of blood vessel that forms by this parts of vessels can be used for implementing method of the present invention, summarizes as mentioned.This path forms parts of vessels can comprise a kind ofly having one and (for example organize the break-through element, a kind of element, parts or energy stream) extension, easily curved catheter body, this element can pass from catheter body, with the vascular wall by the conduit place, and by (for example: other blood vessels being positioned at blood vessel and the target location that extends to of this path of expectation, anatomical structure, EV position, or other positions on the same blood vessel) between any other tissue form path.This break-through element of organizing can comprise: a kind of suitable type organize the break-through element, parts or energy stream, pin including but not necessarily limited to hollow and/or entity, the trocar (with or without a kind of flexible sheath that holds), laser beam, Laser emission element, the probe of electrotome, the thermal spike probe, feedthrough is organized in rotation, or the ultrasonic probe that wears down.Randomly, parts of vessels can be equipped and attract chamber, expandable sacculus or other architectural features maybe can be used for facilitation or the device that pass through of aid in tissue break-through element (for example element installs, energy stream) from blood vessel to selected target location.Also can choose wantonly, the break-through element of organizing of parts of vessels can be in conjunction with a kind of guidewire lumen, or for by other instrument by the outer path transmission of the blood vessel of organizing the break-through element to form seal wire.
Further according to the present invention, this path with above-mentioned characteristic forms parts of vessels can organize break-through element orientation for making in conjunction with one or more, with the element that guarantees that the outer path of blood vessel is formed in the position of its expection.This orienting device can be installed in path and form on the conduit or be combined in wherein, or can form conduit with path and form discretely, and with use from the conduits join of any suitable intravital and/or external position.This orienting device can comprise various types of actives and/passive device, include, but are not limited to, external or intravital Vltrasonic device, external or intravital doppler equipment, the interior or external beam radiotherapy display of body, MR imaging apparatus, x-ray tomography photographic attachment, induction coil, electromagnetic component and various labelling with conduit, this labelling can be by the radiation video picture, sound, ultrasonic, photography, MRI or additive method are recognized.
Still further according to the present invention, be to remove tissue, lining, stante fixed mouldization, vertically other correction of compressing and/or the outer path of blood vessel that forms by the present invention provides the path correcting part.
Further purpose of the present invention and advantage are conspicuous to those skilled in the art after reading the preferred embodiment of hereinafter describing in detail, and wherein some the preferred embodiments of the invention and example are proposed in detail.
The accompanying drawing summary
Fig. 1 a is a kind of front perspective view of human heart, shows coronary artery and the venous exemplary position on it.
Fig. 1 b is a kind of rear perspective view of human heart, shows tremulous pulse and the typical position of venous on it.
Fig. 1 c is the adjacent coronary artery of the 1c sections by being arranged in Fig. 1 a and the sectional side elevation of Coronary vein, wherein forms according to blood stream access of the present invention, thinks that IC obstruction adds bypass.
Fig. 1 d is the cross-sectional figure of the 1d-1d line of a kind of Fig. 1 c of passing through.
Fig. 1 e is a kind of sketch of Brouck-Moscheau triangle, and this triangle is a kind of anatomic landmark that limits by some coronary artery and the Coronary vein of human heart.Can on right anterior oblique position X-ray sheet, see.
Fig. 1 f is an another kind of revascularization method perspective view of the present invention, and wherein extravascular tissue gap path forms from the second position (downstream of obstruction) of primary importance (upstream of obstruction) on same blood vessel on the blood vessel.
Fig. 1 f ' is a kind of perspective view of blood vessel shown in Fig. 1 f, revascularization method of the present invention use the bypass channel of walking around obstruction with formation fully.
Fig. 2 is that a kind of perspective view of human body is in conjunction with a kind of graphic extension that is used in vivo implementing on the blood vessel external position the transvascular method of medical procedure according to the present invention.
Fig. 2 a is the perspective view of amplification of the destination organization of a kind of Fig. 2, and display organization break-through element forms the mode that conduit penetrates destination organization from path.
Fig. 2 a ' is the enlarged drawing of the destination organization of a kind of Fig. 2, show a kind of near pipeline, this pipeline be pushed into by and/or by the outer path target approach tissue of exchange intravasation.
Fig. 2 b is a kind of sketch map with the inherent transmission/drive pipe of subcutaneous injection opening, and this sleeve pipe is used for repetition infusion/extraction material, or the condition in the monitoring objective zone.
Fig. 2 c is the sketch map of the conduit that inserts of the outer path of intravascular, and this conduit is used to launch a kind of parts target approach zone temporarily, the condition in the monitoring objective zone, or to target area infusion/or therefrom extract material out.
Fig. 2 d utilizes the permanent parts of placing of the outer path of the blood vessel of the present invention sketch map of (as, fluid conduction diverter).
Fig. 2 e is a kind of sketch map of conduit, and this conduit inserts and enter the tube chamber of another tubulose morphology path through the outer path of blood vessel of the present invention, is used for sampling, near or in tubulose morphology path, perform a surgical operation or interventional procedure.
Fig. 2 f is a sketch map of implementing the intravascular operation of the outer little operation of blood vessel according to the present invention.
Fig. 3 a shows the sectional side elevation of not revising blood stream access that forms according to the present invention.
Fig. 3 b is the sectional side elevation that shows the inside lining blood stream access that forms according to the present invention.
Fig. 3 c is the sectional side elevation that shows the stringer compressing blood stream access that forms according to the present invention.
Fig. 3 d has the fixedly fixing blood stream access sectional side elevation of the present invention that is placed in one of film graft of film or Si Tante of non-outstanding Si Tante.
Fig. 3 d ' is a kind of perspective view, shows optional flange and/or optional ridge, and they can be incorporated into and can place the fixing fixing film graft of film or Si Tante according to the non-outstanding Si Tante of the blood stream access of the present invention of Fig. 2 d.
Fig. 3 e is the profile by blood stream access of the present invention, has fixedly fixing first embodiment of film graft of film or Si Tante of half outstanding or outstanding Si Tante in this blood stream access.
Fig. 3 f is the profile by first and second blood stream accesses of the present invention, has fixedly fixing second embodiment of film graft of film or Si Tante of outstanding Si Tante in this blood stream access.
Fig. 4 a is the diagram that forms first method of arteriovenous blood stream access according to the present invention.
Fig. 4 b is the diagram that forms second method of arteriovenous blood stream access according to the present invention.
Fig. 4 c is the diagram that forms third party's method of arteriovenous blood stream access according to the present invention.
Fig. 4 d is the diagram that forms the cubic method of arteriovenous blood stream access according to the present invention.
Fig. 4 e is the diagram that forms the 5th method of arteriovenous blood stream access according to the present invention.
Fig. 5 a is a kind of sectional side elevation of two (2) blood vessels adjacent, has illustrated to directed, aims at and guides a kind of break-through element of organizing to form first method according to arteriovenous blood path of the present invention.
Fig. 5 b is a kind of contiguous tremulous pulse and venous sectional side elevation, illustrated to directed, and aiming, and guide a kind of break-through element of organizing to form second method according to arteriovenous blood stream access of the present invention.
Fig. 5 c is a kind of contiguous tremulous pulse and venous sectional side elevation, illustrated to directed, and aiming, and guide a kind of break-through element of organizing to form third party's method according to arteriovenous blood stream access of the present invention.
Fig. 5 d is a kind of contiguous tremulous pulse and venous sectional side elevation, illustrated to directed, and aiming, and guide a kind of break-through element of organizing to form cubic method according to arteriovenous blood path of the present invention.
Fig. 5 e is a kind of diagram, illustrates a kind ofly for to utilize the passive visible label of radiation video picture to go orientation, aims at and/or guides a kind of break-through element of organizing to go to form method according to the outer path of blood vessel blood vessel of the present invention.
Fig. 5 e ' illustrates a kind of first kind of the radiation video picture labelling that can be utilized according to Fig. 5 e.
Fig. 5 e " illustrates a kind of second type of the radiation video picture labelling that can be utilized according to Fig. 5 e.
The 3rd type of a kind of radiation video picture labelling that can be utilized according to Fig. 5 e of Fig. 5 e explanation.
Fig. 5 f is a kind of diagram, illustrates a kind ofly to utilize ultrasonic witness marking to go aiming alignment and/or guide a kind of break-through element of organizing to form the method according to the outer path of blood vessel of the present invention.
Fig. 5 f ' is the perspective view of ultrasonic witness marking shown in Fig. 5 f.
Fig. 5 g a kind ofly goes orientation with MRI, aims at or guide a kind of break-through element of organizing, to form the sketch map according to the method for the outer path of blood vessel of the present invention.
Fig. 5 g ' is a kind of with nuclear magnetic resonance (MRI) witness marking facilitation orientation, and aiming and/or transmitting tissue's break-through element form the perspective view according to first embodiment of the outer path of a kind of blood vessel of the present invention.
" be a kind of with nuclear magnetic resonance (MRI) witness marking facilitation orientation, aiming and/or transmitting tissue's break-through element form the perspective view according to second embodiment of the outer path of a kind of blood vessel of the present invention to Fig. 5 g.
Fig. 5 h is a kind of diagram, illustrates to utilize doppler equipment facilitation orientation, and aiming and/or transmitting tissue's break-through element are to form the method according to the outer path of a kind of blood vessel of the present invention.
Fig. 5 i is a kind of diagram, illustrates that the facilitation of pressure experience device organizes the orientation of break-through element, and aiming and/or guiding are to form the method for the outer path of blood vessel according to the present invention.
Fig. 5 j is a kind of diagram, illustrates to utilize the emitter and receiver device to come orientation, and aiming and/or transmitting tissue's break-through element are to form a kind of method of arteriovenous blood stream access according to the present invention.
Fig. 5 k is a kind of diagram, illustrates to utilize emission and induction coil device to come orientation, aims at and/or guides a kind of break-through element of organizing to form the method for arteriovenous blood stream access according to the present invention.
Fig. 5 l is a kind of diagram, illustrates to utilize the magnetic devices orientation, aims at and/or guides a kind of break-through element of organizing to form a kind of method of arteriovenous blood stream access according to the present invention.
Fig. 6 a is a sectional side elevation of wearing the part of organizing the break-through conduit of blood vessel of the present invention, and first method of organizing the break-through element to withdraw from from conduit is described.
Fig. 6 b is a sectional side elevation of wearing the part of organizing the break-through conduit of blood vessel of the present invention, and second method of organizing the break-through element to withdraw from from conduit is described.
Fig. 6 c is a sectional side elevation of wearing the part of organizing the break-through conduit of blood vessel of the present invention, and third party's method of organizing the break-through element to withdraw from from conduit is described.
Fig. 6 d is a sectional side elevation of wearing the part of organizing the break-through conduit of blood vessel of the present invention, and the cubic method of organizing the break-through element to withdraw from from conduit is described.
Fig. 6 d ' is the perspective view by the distal tip of parts of vessels shown in Fig. 6 d.
Fig. 6 e is a sectional side elevation of wearing the part of organizing the break-through conduit of blood vessel of the present invention.The 5th method of organizing the break-through element to withdraw from from conduit is described.
Fig. 6 f is a sectional side elevation of wearing the part of organizing the break-through conduit of blood vessel of the present invention, and the 6th method of organizing the break-through element to withdraw from from conduit is described.
Fig. 6 g is a sectional side elevation of wearing the part of organizing the break-through conduit of blood vessel of the present invention, and the 7th method of organizing the break-through element to withdraw from from conduit is described.
Fig. 6 h is a sectional side elevation of wearing the part of organizing the break-through conduit of blood vessel of the present invention, and all directions method of organizing the break-through element to withdraw from from conduit is described.
Fig. 6 i is a part of sectional side elevation of organizing the break-through conduit of wearing blood vessel of the present invention, and the 9th method of organizing the break-through element to withdraw from from conduit is described.
Fig. 7 a is a distal portions sectional side elevation of organizing first embodiment of break-through element according to of the present invention.
Fig. 7 a ' is the cross-sectional figure of a kind of 7a ' along Fig. 7 a-7a ' line.
Fig. 7 b is a distal portions sectional side elevation of organizing second embodiment of break-through element according to of the present invention.
Fig. 7 c is a distal portions sectional side elevation of organizing the 3rd embodiment of break-through element according to of the present invention.
Fig. 7 d is a distal portions sectional side elevation of organizing the 4th embodiment of break-through element according to of the present invention.
Fig. 7 d ' is the cross-sectional figure of Fig. 7 d along 7d '-7d ' line.
Fig. 7 e is the sectional side elevation according to the distal portions of the 5th embodiment of organizing the break-through element of the present invention.
Fig. 7 e ' is the cross-sectional figure of Fig. 7 e along 7e '-7e ' line.
" be the cross-sectional figure by the replacement embodiment of parts shown in Fig. 7 e, the stylet that it includes a kind of real property is positioned at a kind of hollow pipe wherein to Fig. 7 e.
Fig. 7 f is the sectional side elevation according to the distal portions of the 6th embodiment of organizing the break-through element of the present invention.
Fig. 7 f ' forms the perspective view of organizing the most advanced and sophisticated extending element with well of a break-through element part shown in Fig. 7 f.
Fig. 7 g is the sectional side elevation according to the distal portions of the 7th embodiment of organizing the break-through element of the present invention.
Fig. 7 h is the sectional side elevation according to the distal portions of the 8th embodiment of organizing the break-through element of the present invention.
Fig. 7 i is the sectional side elevation according to the distal portions of the 9th embodiment of organizing the break-through element of the present invention.
Fig. 7 j is the sectional side elevation according to the distal portions of the tenth embodiment of organizing the break-through element of the present invention.
Fig. 7 k is the sectional side elevation according to the distal portions of the 11 embodiment of organizing the break-through element of the present invention.
Fig. 7 l is a distal portions sectional side elevation of organizing the 12 embodiment of break-through element according to of the present invention.
Fig. 7 m is a distal portions sectional side elevation of organizing the 13 embodiment of break-through element according to of the present invention.
Fig. 8 a is a kind of sectional side elevation, and this figure shows first embodiment of the device that is used to revise the interstice's path that forms according to the present invention.
Fig. 8 b is a kind of sectional side elevation, and this figure shows second embodiment of the device that is used to revise the interstice's path that forms according to the present invention.
Fig. 8 c is a kind of sectional side elevation, and this figure shows the 3rd embodiment of the device that is used to revise the interstice's path that forms according to the present invention.
Fig. 8 d is a kind of sectional side elevation, and this figure shows the 4th embodiment of the device that is used to revise the interstice's path that forms according to the present invention.
Fig. 8 e is a kind of sectional side elevation, and this figure shows the 5th embodiment of the device that is used to revise the interstice's path that forms according to the present invention.
Fig. 8 f is a kind of sectional side elevation, and this figure shows the 6th embodiment of the device that is used to revise the interstice's path that forms according to the present invention.
Fig. 8 g is a kind of sectional side elevation, and this figure shows the 7th embodiment of the device that is used to revise the interstice's path that forms according to the present invention.
Fig. 8 h is a kind of sectional side elevation, and this figure shows the 8th embodiment of the device that is used to revise the interstice's path that forms according to the present invention.
Fig. 8 h ' is the front view of Fig. 8 h parts, and these parts are used to revise the arteriovenous blood stream access that forms according to the present invention.
Fig. 8 i is a kind of sectional side elevation, and this figure shows the 9th embodiment of the device that is used to revise the interstice's path that forms according to the present invention.
Fig. 8 j is a kind of sectional side elevation, and this figure shows the tenth embodiment of the device that is used to revise the interstice's path that forms according to the present invention.
Fig. 9 a is a kind of front view of first embodiment of parts, and these parts can be used in the arteriovenous path that the stringer compression forms according to the present invention.
The exploded perspective illustration of the parts shown in Fig. 9 a ' Fig. 9 a.
Fig. 9 b is a kind of front view of second embodiment of parts, and these parts can be used in the arteriovenous blood stream access that the stringer compression forms according to the present invention.
Fig. 9 b ' is installed on a kind of part sectional side elevation that transmits Fig. 9 b parts in the conduit.
Fig. 9 b " is a kind of perspective view that partly ejects Fig. 9 b parts of its delivery catheter.
Fig. 9 b is a kind of perspective view that fully ejects Fig. 9 b parts of its delivery catheter.
Fig. 9 c is a kind of front view of the 3rd embodiment of parts, and these parts can be used in the stringer compression according to arteriovenous blood stream access of the present invention.
Fig. 9 d is a kind of front view of the 4th embodiment of parts, and these parts can be used in the stringer compression according to arteriovenous blood stream access of the present invention.
Fig. 9 e is a kind of front view of the 5th embodiment of parts, and these parts can be used in the stringer compression according to arteriovenous channel of blood flow of the present invention.
Fig. 9 f is a kind of front view of the 6th embodiment of parts, and these parts can be used in the stringer compression according to arteriovenous blood stream access of the present invention.
Fig. 9 f ' is the part sectional side elevation that is installed on Fig. 9 f parts in a kind of delivery catheter.
Fig. 9 f " is the perspective views of a kind of Fig. 9 f parts in it is installed in its delivery catheter the time.
Fig. 9 f is the sectional side elevation that partly is expanded to the outer Fig. 9 f parts of its delivery catheter.
Fig. 9 f " " is the cross-sectional figure that fully is expanded to the outer Fig. 9 f parts of its delivery catheter.
Figure 10 a is the perspective view that a kind of intravascular of the present invention is organized first embodiment of break-through parts of vessels.
Figure 10 b is the sectional side elevation by the 10b-10b line of Figure 10 a.
Figure 10 c is the sectional side elevation by the 10c line of Figure 10 a.
Figure 10 d is the cross-sectional figure by the 10d-10d line of Figure 10 a.
Figure 10 c ' is the sketch map of a kind of optional seal wire/sheath propulsion plant, and this device can be incorporated into any embodiment that intravascular of the present invention is organized the break-through conduit.
Figure 10 c " be parts of vessels organize the just schematic representation of apparatus of Figure 10 c ' when break-through is organized of break-through element.
Figure 10 c be this organize the break-through element the break-through tissue and enter a kind of vessel lumen or open cavity after the sketch map of Figure 10 c parts.
Figure 11 a is the sectional side elevation at hand-held composition position of organizing second embodiment of break-through parts of vessels by intravascular of the present invention.
Figure 11 b is the part sectional side elevation of distal portions of organizing second embodiment of break-through parts of vessels by intravascular of the present invention.
Figure 11 c is the sectional side elevation of Figure 11 b parts during the display organization break-through operation phase I.
Figure 11 c is the sectional side elevation of Figure 11 b parts during the display organization break-through operation second stage.
Figure 11 d is the amplification sectional side elevation of the sections 11d of Figure 11 c.
Detailed description of the preferred embodiments
Following detailed description and its mentioned accompanying drawing only are for the purpose of describing certain currently preferred embodiments of the present invention provides, and are not intended to by any way and limit the scope of the invention.In fact, detailed description that is proposed below it will be appreciated that and example only are the example or the explanations of some method that can be utilized or put into practice as the present invention.These examples and explanation also are not intended to limit and describe all possible embodiment of the present invention and example, but are intended to set forth the present invention can be applied to some but not all application.A. method ⅰ of the present invention. the revascularization method
In a broad sense, revascularization method of the present invention provides a kind of and has set up one or the method for many paths 10, can flow out or flow out at least one blood vessel by this path blood.As a rule, the flow through blood of this path will preferably contain pO greater than about 50 2
In some cases, the outer path 10 of this blood vessel will be used for the obstruction of tremulous pulse, and impaired or ill sections adds bypass.In certain embodiments of the invention, (for example has only one first blood stream access, the path that begins from the tremulous pulse that blocks the upstream) can be formed at an obstruction, impaired or ill tremulous pulse (or another not impaired tremulous pulse or a kind of morphological structure such as chambers of the heart that is full of blood), and between vein, thereby allow arterial blood through this vein reverse flow, so that by vein blood vessel system reverse perfusion tissue.In other embodiments of the present invention, one or many second blood stream accesses also can be formed between the tremulous pulse and this vein of obstruction, the downstream part that blocks, can be subsequently enter or reenter the tube chamber of this tremulous pulse so that enter the arterial blood in quiet lumen chamber at the downstream part that blocks by first blood stream access, thereby residue (that is, not blocking) part perfused tissue by the tremulous pulse that gets clogged.
Though it is distinctive that the internal anatomy that provides among Fig. 1 a and the 1b is a cardiovascular system, it will be appreciated that the inventive method can be applicable to the blood vessel of whole body and the treatment coronarius that is not necessarily limited to block (for example, burst zone, aorta iliac artery zone, etc.).
With reference to accompanying drawing, Fig. 1 a and 1b provide the human heart normal blood vessels anatomical detailed icon, and wherein coronary artery is substantially parallel and be adjacent to Coronary vein.Fig. 1 a, the special anatomical structure that shows among 1b and the 1e are according to following legend labelling:
The A aorta
The AIV anterior interventricular vein
The CA coronary artery
The CV Coronary vein
The CS coronary sinus
CIR rotates tremulous pulse
The IVC postcava
The LAD left anterial descending artery
The SVC superior vena cava
The PA pulmonary artery
The PV pulmonary vein
The TA adventitia
Film among the TM
The TI inner membrance
GCV heart large vein
Fig. 1 c-1d sets forth a special applications of the present invention, wherein blocks the coronary artery that OB is positioned at the left front part of heart.As shown in the figure, the coronary arteries CA of obstruction is positioned at and is adjacent to, and is parallel to usually, a Coronary vein CV place.The first blood stream access 10a is formed at coronary arteries CA and closes between the Coronary vein CV, is positioned at the upstream end of obstruction of artery OB.And in the demonstration of Fig. 1 C, optional second blood stream access 10b is formed between the tube chamber of the tube chamber of Coronary vein CV and coronary arteries CA, is positioned at the downstream part that blocks OB.And, in these figure, having shown selectable thromboembolism element 12a, 12b is placed in the site of the far-end of the first blood stream access 10a near-end and the selectable second blood stream access 10b in the tube chamber of Coronary vein CV.These selectable thromboembolism elements are used to guide the artery blood flow that enters coronary arteries CA by the first blood stream access 10a, a sections by contiguous Coronary vein CV, and by the second blood stream access 10b, so that arterial blood reenters the tube chamber of coronary arteries CA in the downstream of blocking OB.Selectable thromboembolism element 12a, 12b can be to be enough to blocking-up or to stop any of mobile parts or combination, these parts such as coil; Hemostatic material such as collagen, gel foam TMOr fibrin, coated Si Tante is film or framework fixedly, knock-down sacculus, valve structure as the folder, fastener or bolt, etc.The function that these elements played can comprise ligation by making in all sorts of ways in addition, and welding is condensed, or other operation method is finished.
As shown in the cross-sectional view of Fig. 1 d, each bar blood stream access 10 of the present invention be basically tube wall by a tremulous pulse (as coronary arteries CA) by contiguous vein (as Coronary vein CV) tube wall and by being positioned at the interstice tunnel that any connective tissue between coronary arteries CA and Coronary vein CV or film sex organization extend.In this way, each bar blood stream access 10 is as a conduit between the tube chamber of coronary arteries CA and Coronary vein CV.
Fig. 1 e is the sketch map of a part that is called the cardiovascular system of Brouck-Moscheau triangle.As shown in the figure, the Brouck-Moscheau triangle rotates coronary artery CIR by the left front coronary artery LAD that falls, and anterior interventricular vein AIV and heart large vein GCV limit.The obstruction that atheromatous plaque formation is caused is common in the proximal part of left anterial descending artery LAD and/or rotation tremulous pulse CIR.Revascularization method of the present invention can be used for treating this obstruction of left anterial descending artery LAD and/or rotation tremulous pulse CIR by forming suitable blood stream access 10 between tremulous pulse around the Bouck-Moscheau triangle and vein.For example, appear in the proximal part of left anterial descending artery LAD if block, then can between heart large vein GCV and rotation tremulous pulse CIR, form the first blood stream access 10a and block downstream part and form the second blood stream access 10b being positioned between artery A IV between left anterial descending artery LAD and cup.A kind of tube chamber blockage element 12 can place heart large vein GCV, the first blood stream access 10a proximal end and/or place the anterior interventricular vein AIV second blood stream access 10b far-end, pass through the first blood stream access 10a so that come the arterial blood of spinning tremulous pulse CIR, by heart large vein GCV, flow by anterior interventricular vein AIV, and enter left anterial descending artery LAD, block downstream part.In addition, come across in the situation of rotation tremulous pulse CIR at obstruction, the first blood stream access 10a and the second blood stream access 10b can be conversely, so that will be by anterior interventricular vein AIV by the mobile blood of left anterial descending artery LAD, flow and enter among the rotation tremulous pulse CIR downstream part of obstruction by heart large vein GCV.According to these examples, it will be appreciated that revascularization method of the present invention can use in the following manner, promptly obtain arterial blood and this arterial blood is sent into another tremulous pulse from a tremulous pulse or from any other source (for example, left ventricle).And, according to revascularization method of the present invention, should understand that the second blood stream access 10b can be cancelled at least in some cases and arterial blood can offer the ischemic area of cardiac muscle by the reverse perfusion through anterior interventricular vein AIV or heart large vein GCV.
It will be appreciated that in some of revascularization method of the present invention are used the outer path 10 of blood vessel can comprise a kind of interstice tunnel that primary importance on the same vessel extends to the second position.As shown in Fig. 1 f, have and block OB and be formed at wherein a blood vessel BV and can utilize path of the present invention to form conduit 100 to add bypass, it is this that to add bypass be by with a kind of vascular wall of organizing break-through element 102 to pass to block upstream end, by adjacent tissue, and subsequently by blocking the vascular wall of downstream part.In this way, interstice's path 10 shown in Fig. 1 f ' forms a bypass manifold block OB in blood vessel BV around.
ⅱ. perform a surgical operation or the method for interventional procedure at the blood vessel external position
Except that above-mentioned revascularization method, the present invention also comprises and is used for the method that blood vessel external position is in vivo implemented various operations or interventional procedure.These methods of the present invention by from a blood vessel to a kind of blood vessel external position (as organ, tissue, body cavity, etc.) form one or many outer paths of blood vessel and send into by the outer path of this blood vessel subsequently and be used for implementing device and finish in one or more operation that the blood vessel external position is finished desired operation or interventional procedure.Can comprise according to the operation of this method execution of the present invention or the type of interventional procedure:
Transport therapeutant
But transporting of flow medicinal;
The implantation of a kind of implantable medicine vehicle (for example, microsphere, etc.);
Therapeutic treatment is fluidic to be transported;
Be used to continue the implantation near conduit of administration;
Hereditism's material, cell, microorganism or viral vector, the implantation that waits.
Interim or permanent expansion of parts
The implantation of stimulator (electricity or physics);
The implantation of sensor;
The implantation of electrode;
Emitter, the implantation of accepter or responder;
The implantation of supporting element (smooth like that spy is film fixedly);
The implantation of label (as radiation video picture visable indicia thing, or solution).
Tissue resection, stereotomy or wear down art
Tissue wears down art or Destruction;
The tissue (as, nerve, fiber) cutting or crosscut;
Tumor, the excision of illing tissue etc. and removal;
The expansion of interior source tissue is upheld or other is revised to recover open, flow, and configuration,
Or function.
Sampling is used
The sampling of tissue (as, biopsy);
The sampling of solid matter (as, calculus, tophus, etc.);
Monitoring is used
Be determined at the pressure that the target area can be surveyed, pH, temperature, oxygen saturation, solution gas
The dividing potential drop of body, ECG, EEG, excitation potential, or other variable.
The purpose that Fig. 2-2f is provided is to be described in further detail and to illustrate some special intervention and/or the operation techniques that can implement according to this embodiment of the present invention.Fig. 2 shows the sketch map of human body, one of them path of the present invention forms pipe guide 100 and (is for example inserted a blood vessel by percutaneous, femoral vein) and pass through caval vein, internal jugular vein and great cerebral vein advance to the desired position of the outer target area (for example, the ventricles of the brain) of adjacent blood vessel.Subsequently, organizing break-through element 102 to pass the cerebral blood vessel tube wall at distal portions place of conduit 100 and this tissue break-through element from conduit 100 passes contiguous cerebral tissue and advances to target location T outside the blood vessel the brain.In this way, the outer path 10 of blood vessel forms between the T of target location outside blood vessel at cerebral blood vessel.When needed, at first can carry out cutting tissue according to the path correcting device and the method that are shown in Fig. 8 a-8h and describe in detail hereinafter, expansion or revise by the path 10 of organizing break-through element 102 to form.
Fig. 2 a is the enlarged drawing that target area T and path form the adjacent blood vessel BV that parts of vessels 100 entered.The break-through element 102 of organizing that initial path forms parts of vessels 100 is advanced outside the conduit 100, by the tube wall of blood vessel BV, and by the tissue between blood vessel BV and target area T.That uses in this kind application organizes tube chamber of break-through element 102 preferred combination 114, the second seal wire GW 2Can advance to target area T by this tube chamber.Subsequently, organize break-through element 102 to form conduit 100 and withdraw from and remove with path, and with the second seal wire GW 2Stay the appropriate location.
Described in Fig. 2 a, a kind of second seal wire GW that can preset with tailing edge near sleeve pipe 103 2Advance, so that trocar 103 is by the vascular system extension, by the target approach zone T by the outer path 10 of the blood vessel of organizing break-through element 102 to form.This can be used as the importing that conduit is used for medicine subsequently near sleeve pipe, the implantation of parts, sampling, monitoring, the expansion of operation device or perform a surgical operation or other application of the method for interventional procedure at the blood vessel external position according to above-mentioned.
Fig. 2 b-2f sets forth can be according to a few class particular instances of blood vessel outer operation that this implements on the one hand of the present invention or interventional procedure.
With reference to Fig. 2 b, a kind of subcutaneous shedding motion 105 can be placed in the near-end near sleeve pipe 103, and can be used for through this near sleeve pipe 103 injection or (for example extract flowable mass out, medicine, therapeutic treatment fluid, radiation video picture comparative solution, cell, hereditism's material, microorganism or viral vector etc.), target approach zone T.In addition, the periodic monitoring that shedding motion 105 and sleeve pipe 103 can be used to finish pressure or other condition at target area T (for example, by inserting shedding motion 105, can obtain the pressure reading at T place, target area) with fluid filled sleeve pipe 103 and with a pin that is connected to pressure transducer.Therefore, Fig. 2 b has illustrated and has had the inherence that is positioned at subcutaneous injection openings 105 and can be used to continuously method with flowable mass injection/extraction target area T near sleeve pipe 103.Can comprise the handkerchief king's evil by the particular example that medicine is infused to repeatedly the disease type of specific target areas T treatment in the body, epilepsy, hypertension, tumor, depression, the A Caimo disease, the sleep illness, the behavior illness, the dyskinesia, etc.In addition, can be used as a kind of regular infusion substitution fluid or solution of being used for to realize the instrument of all kinds replacement therapy near sleeve pipe 103 and injection openings 105.These are used parts shown in also available Fig. 2 c and implement.
Fig. 2 c shows another kind of the arrangement, wherein should be taken out from abdomen and is used as the conduit of interim parts 106 being sent into target area T near sleeve pipe 103.These parts 106 can be connected to the energy that can send some form to the parts 106 or the device outside 107 of receiving information from parts 106.The example of the type of spendable device outside 107 comprises, but is not necessarily limited to signal of telecommunication generator, electrotome device, radiation frequency signal generator, cryogenic system, ultrasonic generator, oscillographic type, monitor, chart recorder, galvanometer, laser, optical viewer, Other Instruments, etc.The radio frequency cutting that the particular example that can be sent to the treatment type of target area T by the parts 106 of interim placement comprises tissue (for example, nerve tract in the heart or cause the arrhythmia conductive beam) the low temperature disorganization (for example, tumor), electric cautery (for example, for hemostasis or wear down tissue), etc.The monitoring that several classes can be used with the parts 106 of interim placement or the example of information reclaimer operation comprise local EEG algoscopy, local ECG algoscopy, the galvanometer reacting record, oxygen saturation is measured, the partial pressure that is dissolved in the fluid is measured, pH measures, the determination of electrode of special electrolyte or other chemical substance concentration, etc.
Fig. 2 d shows a kind of application of the present invention, wherein is used to the drain fluids constantly from target area T near sleeve pipe 103.In this mode, be provided with many outlet apertures 109 near the near-end of sleeve pipe 103 so that the excess fluid of in the T of target area, collecting by near the tube chamber of sleeve pipe 103 to the near-end drain and drain into outside the outlet aperture 109.The proximal part that has outlet aperture 109 to form therein near sleeve pipe 103 can from abdomen, take out so that excess fluid by drain extremely a kind of container or vessel in external placement, another position of (as peritoneal cavity) be so that excessive fluid can flow into other zone of this health in the perhaps alternatively implanted body, and the physiological function by nature is absorbed and health is not caused damage or harm there.An example of this application is to use sleeve pipe 103 as a kind of internal shunt or from the excessive cerebrospinal fluid of ventricular drainage to the intravital second position (as, peritoneal cavity).Because sleeve pipe 103 is to implant by vascular system with by the outer path 10 of the blood vessel that produces according to the present invention, implement but implant the technology percutaneous that sleeve pipe 103 uses, typically do not need big operative incision other method of implanting the fluid conduction by-passing parts that is used for the treatment of hydrocephalus and other disease and do not resemble to utilize.
Fig. 2 e shows another kind of special applications of the present invention, wherein extends from blood vessel BV near sleeve pipe 103, by the outer path 10 of blood vessel of the present invention and enter the tube chamber 111 of the second tubulose morphology path or conduit, the target T in promptly should using.Tubular passageway or conduit that several classes can form the target T in this application of the present invention comprise blood vessel, Genito-urinary pipeline, external secretion pipeline, endocrine pipeline and lymph pipeline.After in the chamber 111 that is placed in target pipeline or path T near sleeve pipe 103, any above-mentioned described application of the method all can be used, and comprises the extraction of sample or the infusion of medicine, the expansion of parts, etc.
Fig. 2 f illustrates the another kind of particular example of application of the present invention, wherein pass through vascular system near sleeve pipe 103, extend by the outer path 10 of blood vessel of the present invention, and enter a target area T, so that one or more operating theater instruments 113 can be sent to target area T perform a surgical operation to be implemented among the T of target area (for example, little operation) operation.The control system 115 of being taken out from abdomen in this way, can be connected to operating theater instruments 113 and be used in the desired operation and the processing of exercising operating theater instruments 113 among the T of target area.
ⅲ. the type of path
Fig. 3 a-3f and detailed description proposed below have been described some type according to the outer path 10 of blood vessel of the present invention's formation.Shown in Fig. 3 a-3f and the following detailed description, only only proposed, and be not intended to limit and describe all possible type according to the adaptable path 10 of the present invention as the example of the type of the path that can form.In addition, will be appreciated that, be formed between a vein and the tremulous pulse although indicate path 10 shown in Fig. 3 a-3f, the multiple correction of the path that Fig. 3 a-3f illustrates can be widely used in according to the outer path 10 of the blood vessel of any or all of type of the present invention's formation, as long as the suitable words of this correction.In fact, shown in Fig. 3 a-3f and the path 10 of following detailed description be not limited between tremulous pulse and the vein, and can be widely used in all paths 10 of the present invention.
Shown in Fig. 3 a, path 10 comprises fixedly film of Fei Sitante, and (Fig. 3 a) in the tunnel of unlined interstice.In addition, shown in Fig. 3 b-3f, this path 10 can be equipped with various types of surfaces to revise or auxiliary device, tubular liner (Fig. 3 b), stringer constraint clip (Fig. 3 c) or be confined to the fixing fixing film graft (Fig. 3 d) of film or Si Tante of Si Tante within the path 10 for example, or from the fixing fixing film graft (Fig. 3 e-3f) of film or Si Tante of the Si Tante that exceeds path 10.
With reference to Fig. 3 a, shown the path 10 that extends between two Herba Wedeliae Wallichii especially, fixedly material or device in the path 10 are revised, are arranged in film, lining, tubing, bag quilt, valve, surface without any Si Tante for it.In this, this Fei Sitante fixedly film, unlined, uncorrected path 10 only be a tunnel that extends two intervascular interstices (for example,, a puncture channel or a tunnel), thus blood can be flow to the tube chamber of another blood vessel by the tube chamber of a blood vessel.
Fig. 3 b has shown that one is formed at two paths 10 between the blood vessel, has a tubular liner 20 to be placed in one.This interior lining 20 can comprise one section inflexible or easily curved plastic tube, one deck bio-capacitivity polymer coating, the cell that one deck is different from the surrounding tissue type (for example, endothelial layer biological tissue graft etc.), one deck can pass through bars such as laser treatment, electric cautery and form the tissue of revising thickness, or any and Fei Sitante fixedly film and the different material of not lined path 10 inner surface types own.This linings 20 in the path 10 can be used to: a) the facilitation blood flow with laminar flow but not end stream by path 10, or b) avoid the unnecessary path blockade that shrinks naturally because of muscle on every side or organize in path 10 and grow.At lining 20 is by the wall of path 10 (is for example used flowable mass or energy, produce that controllable histochemistry is burnt or the chemical substance of biocompatible polymer bag quilt, the endotheliocyte suspension, or the like) and in the situation about forming, with reference to parts of the present invention, can be by using such as Fig. 8 h-8h " shown in and the following parts of describing more comprehensively finish these flowable mass of application in the wall of path 10.
Fig. 3 c shows path 10, has wherein settled stringer restraint device 22 so that the opposite end of stringer compressing path 10 is near each other, is positioned at intervascular any tissue (for example, loose connective tissue) compact thereby make.This stringer restraint device 22 also can be placed, and comes for path 10 provides the radiation-like support, and/or keeps open state.The blood vessel that is connected at path 10 (for example is positioned at organ surface, be positioned at the coronary artery and the vein of heart surface) or be positioned at spongy or open texture (for example, when having open space loose connective tissue) or between tremulous pulse and vein, in of the present invention these were used, the application of restraint device 22 stringers compressing path 10 may particular importance.The existence of these sponge shapes or open texture can allow to flow in blood in the path 10 and infilter these tissues or space between tremulous pulse and the vein, thereby may cause hematoma to form.Can be used to the stringer compressing blood stream access 10 shown in Fig. 2 c or the example of the particular type of the restraint device 22 of facilitation by connecting two blood vessels to side-to-side anastomosis, be illustrated in Fig. 9 a-9f, and more fully be described in hereinafter with reference to 9a-9f.
Fig. 3 d shows path 10 of the present invention, have a non-protruding Si Tante fixedly film or Si Tante fixedly film graft 24 place within the path 10.This Si Tante fixedly film or Si Tante fixedly film graft 24 can comprise a pressure bolt shape Si Tante expansible or expansion voluntarily fixedly film or framework, and selectively, can be covered such as continuous tube element by the pliable and tough sections of the politef (ePTFE) of Woven polyester or expansion.Settle this Si Tante fixedly film or Si Tante fixedly film graft 24 in path 10, can be in open basically shape in order to keep path 10, cross path 10 with facilitation non-turbulent flow blood flow stream.Si Tante fixedly film or Si Tante fixedly film graft 24 can form by any suitable material, comprise, but be not limited to, the various types of pressure silk screen expansible or expansion voluntarily or the lane of braiding mutually.Under the Si Tante situation that fixedly film graft 24 is employed, Si Tante fixedly the tube graft on the film graft 24 to cover can be successive or part, thereby Si Tante fixedly film some be capped.
Be to be understood that, fixedly the film graft is (for example as the Si Tante that uses a protrusion, the Si Tante that is capped is film 26 or 28 fixedly) time, can unnecessaryly settle optional thromboembolism element 12 again within the Si Tante vessel lumen that fixedly film graft 26,28 extends in it, because the Si Tante fixedly outer covering of tubulose on the film graft will be used to limit a closed flow-catheter by vessel lumen, and will block blood flow basically by that part of internal blood vessel, therefore do not need independent thromboembolism element 12.
Fig. 3 d ' demonstration Si Tante is film or the fixedly correction of film graft 24a of Si Tante fixedly, comprise a flange 25 and/or from the fixing fixedly end of film graft 24a or the vertical protrusion 27 that two ends extend of film or Si Tante of Si Tante, with keep Si Tante fixedly film graft 24a in path 10, be in fixed basically stringer position.
The Si Tante that Fig. 3 e shows semi-convex or projection is the fixing film graft 26 of film or Si Tante fixedly, it can according to the Si Tante of the non-projection shown in Fig. 3 d fixedly film or Si Tante fixedly the same manner of film graft 24 be set up, but with different shown in Fig. 3 d be that it protrudes outside path 10 ends or extends, enter artery A and venous adjoins part.Shown in Fig. 3 e, when expansion like this, this Si Tante fixedly film or Si Tante fixedly film graft 26 will take the serpentine shape basically, with facilitation stratiform, non-turbulent blood flow along desired direction by path 10.The dotted lines of Fig. 3 e has been illustrated fixedly fixing " semi-convex " embodiment of film graft 26 of film or Si Tante of Si Tante, wherein, the one end aligns with an end of path 10, and its other end extends into contiguous path 10 anatomical structures (for example, vein) simultaneously.Si Tante is fixing this " semi-convex the " embodiment of film graft 26 of film or Si Tante fixedly, can be employed, thereby do not block any blood flow that may pass artery A, and, for those block OB be incomplete patient and still some artery blood flow for the patient of artery A, availability will be arranged especially.For blocking OB is complete other patient, use Si Tante fixedly film or Si Tante fixedly " protruding " fully scheme of film graft 26 is possible proper, shown in the dotted lines among Fig. 3 e, wherein, these this smooth move fixing film or Si Tante fixedly film graft 26 extend from two ends of path 10, enter contiguous anatomical structure (that is, vein and tremulous pulse).
Fig. 3 f shows the fixedly fixing film graft 28 of film or Si Tante of another protruding Si Tante, it extends through article one blood stream access 10a, and its other projection is passed the optional second blood stream access 10b of artery A and vein V neighbouring part, form continuous " U " shape conduit thus, by its official jargon, the non-end bleed stream of stratiform can pass through path 10a and 10b.
Be to be understood that, one or more valves also can be formed at fixedly fixing any one embodiment of film graft 24,26,28 of film or Si Tante of Si Tante, or in the tubular liner 20, or in the longitudinal restraint device 22, or in the path 10, with the facilitation blood flow with desired direction by path 10, reduce simultaneously or avoid blood along backflowing by path 10 with the opposite direction of desired direction.
ⅳ. be used between two blood vessels, forming the blood vessel method of wearing of path
Fig. 4 a-4e and detailed description subsequently propose for illustrating some method, and these methods can be used to form path 10 outside the blood vessel between two blood vessels, to finish some revascularization method of the present invention.Shown in Fig. 4 a-4e and detailed description subsequently and be not intended to limit and illustrate all possible method that can be used for forming path 10, and only provided the example of the present known method that is used for these operations.In addition, although in the application of illustrating shown in Fig. 4 a-4e, blocking OB is present in the blood vessel, illustrated basic skills can be applied in the multiple revascularization method among these figure, in these methods, the formation of path 10 is not the purpose that is used to walk around obstruction, perhaps wherein blocks OB and is positioned at the position that forms the place away from path 10.In addition, should be appreciated that method that Fig. 4 a-4c illustrates needn't be formed between two blood vessels or tremulous pulse and vein between.In fact, these methods can be applied between any blood vessel and any other hollow anatomical structure, and can be used as vein to vein, tremulous pulse to tremulous pulse or vein to arterial passageway 10.
Fig. 4 a shows a kind of method, and wherein, conduit 100 moves forward into an artery A by tube chamber, organizes break-through element 102 to pass from conduit 100, by the artery A tube wall, by the tissue between artery A and the vein V, by the venous tube wall, forms the first path 10a.After forming the first blood stream access 10a in this way, seal wire can be by organizing break-through element 102 or by conduit 100, and by the new first path 10a that forms.Then, stop using and organize break-through element (for example, returning in the conduit 100), with conduit forward,, enter the vein tube chamber, cross and adjoin the position of blocking OB in the artery A by the first path 10a along seal wire.Then, be arranged at distal end of catheter under the situation of vein tube chamber, will organize break-through element 102 to pass conduit 100 forward once more, form extend through wall of vein, any between vein and artery A tissue and second blood stream access 102 of artery A wall.Then, can will organize break-through element 102 to return in the conduit 100 once more, and conduit can be withdrawed from from blood vessel and withdraw from external.In this way, the method shown in Fig. 4 a has finished forming the first blood stream access 10a in obstruction of artery OB upstream and forming the second blood stream access 10b in the obstruction of artery downstream.
Fig. 4 b has shown a kind of interchangeable method, wherein, conduit 100 is moved forward into a vein tube chamber by tube chamber, and distal end of catheter is placed near the position that will form the first blood stream access 10a.Then, will organize break-through element 102 to pass conduit 100, form by any tissue between vein V tube wall, vein V and the artery A and the first blood stream access 10a of artery A tube wall.Then, stop using and organize break-through element 102 (for example, returning in the conduit 100), and with conduit further forward, reach up to distal end of catheter near the position of the second blood stream access 10b that will form by vein V.Then, will organize break-through element 102 to pass conduit 100 once more,, form desired alternate path 10b by tissue between vein V tube wall, vein V and the artery A and artery A tube wall.Then, stop using once more and organize break-through element 102 (for example, returning in the conduit 100) and conduit 100 can be withdrawed from vein tissue and shift out.In this way, the method for describing as Fig. 4 b only by the intubate of vein V with through the lumen catheter art, has finished forming the first blood stream access 10a in obstruction of artery OB downstream and forming the second blood stream access 10b in obstruction of artery OB upstream.
Fig. 4 c is depicted as another kind of optionally method, and conduit 100 moves forward into an artery A through tube chamber, and conduit 100 far-ends place near the position that will form the first blood stream access 10a.Then, organize break-through element 102 to pass conduit 100,, form the first blood stream access 10a by any tissue between arterial wall, artery A and the vein V and vein V tube wall.Then, stop using and organize break-through element 102 (for example, returning in the conduit 100), and with conduit further forward, pass and block OB, near conduit 100 far-ends reach the position that will form the second blood stream access 10b by the artery A tube chamber.Conduit 100 advances by blocking this of OB, typically needs earlier a seal wire to be passed through to block OB, subsequently conduit 100 is passed forward with facilitation and blocks OB.Blocking OB is part, or obturator is soft to the situation that can allow seal wire to pass through under, thisly in advance seal wire can be finished by the approach of obstruction OB.Yet, be complete blocking OB, or form under the situation of calcified plaque or other hard material that the method shown in Fig. 4 c may be infeasible, in this case, the operator typically selects one of method shown in Fig. 4 a or the 4b.Yet, successfully passed at conduit 100 shown in Fig. 4 c under the situation of obstruction OB, to will organize break-through element 102 to pass conduit 100 once more,, form the second blood stream access 10b by any tissue between tremulous pulse 10a tube wall, artery A and the vein V and vein V tube wall.Then, stop using and organize break-through element 102 (for example, returning in the conduit 100), conduit is withdrawed from arterial tissue and shifts out external.In this way, the method shown in Fig. 4 c according to the present invention, has finished forming the first blood stream access 10a and the second blood stream access 10b.
In the another kind of optionally method shown in Fig. 4 d, wherein provide the conduit 100 that has positive pressure pump 104, be used for conductive pipe to pump into barotropic fluid (as saline), and overflow by a plurality of malleations outlet apertures 106 that nearly conduit 100 distal tube bodies form.106 places form a near-end closure elements 108 (for example, sacculus of blocking lumen of vessels fully) at the contiguous malleation outlet of conduit aperture.An independent far-end sealing (as, sacculus) 110 is placed the upstream end slightly of the position that will form the second blood stream access 10b in the vein V tube chamber.Reach near the position that will form the second blood stream access 10b up to distal end of catheter with conduit 100 forward, by the vein V tube chamber.Then, near-end closure elements 108 is launched (for example, inflating), thereby malleation on the adjacent pipes 100 is exported the vein V complete closed of aperture 106.Then, barotropic fluid (for example, saline) is overflowed by conduit cavity and by malleation outlet aperture 106, cause pressure P in the vein V 1Rise the average pressure P in the preferably basic and artery A 2Equate.Pressure forms in this vein V tube chamber, and for the existence of distinguishing various vein side shoot SB provides feasible method, the vein side shoot may need ligation, close or thromboembolism, significantly loses blood to avoid any in the vein bypass duct of new formation.In addition, organizing break-through element 102 to pass conduit 100, by vein V tube wall and artery A tube wall, when forming path 10 of the present invention, the pressure of vein V intracavity forms and can keep.Vein V internal pressure P 1With the intra-arterial pressure P 2This equate, also be used to after path 10 forms, avoid blood to gush fast or flow to the vein V tube chamber from the artery A tube chamber.
In the another kind of optionally method shown in Fig. 4 e, first conduit 100 is advanced artery A, second conduit advances vein V.In some cases, first, second conduit 100 is placed relative basically position, shown in Fig. 4 e.Then, as shown in the figure, organize break-through element 102 between artery A and vein V, to form first and second to be equipped with blood stream access 10a, 10b with each conduit 100.Then, stop using and organize break-through element 102 (for example, returning in the conduit 100), and conduit 100 is withdrawed from blood vessel and shifts out external.In this way, the method shown in Fig. 4 e according to the present invention, has been finished the formation of the first and second blood stream access 10a and 10b between desired blood vessel.
V. control, aiming and guiding are used for forming the method and apparatus of organizing break-through element and/or accessory of the outer path of blood vessel
The example of Fig. 5 a-5l display device, when organizing break-through element 102 from conduit 100 of the present invention forward, when forming the outer path 10 of desired blood vessel, this device is used to orientation, aiming, control and/or transmitting tissue's break-through element 102.Usually, these orientations, aiming, control and guiding device are used to positioning catheter 100, thereby, when organizing break-through element 102 to pass conduit 100, will touch and penetrate the tube wall of the blood vessel that conduit 100 is positioned at.Be to be understood that, the diagram that Fig. 5 a-5l proposes, and detailed description subsequently, only provided the example of using various orientation of the present invention, aiming, control and/or guiding device, and do not meant that limit shows or described and can be used for all possible device of these purposes.In addition, should be understood to, any or all of shown in Fig. 5 a-5l and device as described below, can with other any combination of elements of the present invention described herein, form one " system ", thus, path of the present invention forms conduit 100 and can be directed, aims at, controls or guide.
Fig. 5 a shows a kind of method, and wherein, Active Imaging parts 50 are placed in same the blood vessel at conduit of the present invention 100 places.This Active Imaging parts 50 can comprise the image-forming block that the conduit of any adequate types is held, and include, but not limited to intravascular ultrasound device (IVUS conduit), doppler equipment, and angioscopy, or the like.In many cases, Active Imaging parts 50 will have a sensor (for example, sonac, sonic sensor, imaging-accept camera lens, or the like) ad-hoc location formed thereon.Expect that typically this sensor 52 is placed in closely adjacent position of organizing break-through element 102 by blood vessel wall, so that provide to organizing desired observation, aiming and the guiding of break-through element 102.Be to be understood that, Active Imaging device 50 can be installed on path and form on the conduit 100, or is formed at path and forms within the conduit 100, can be stated from single track in the conduit 100 or the side pipe (Fig. 9-10), in the body that perhaps can be positioned complete independence and separate, shown in Fig. 5 a.Form the distal portions of settling Active Imaging parts 50 in the conduit 100 at least at path, the path that embodies this method forms the embodiment of conduit 100, is shown in Fig. 9-10 especially, and is illustrated as follows comprehensive description with reference to these.
Be used to observe, a kind of interchangeable method of aiming and transmitting tissue's break-through element 102 is shown in Fig. 5 b, wherein Active Imaging parts 50 are placed in path and form organizing in the blood vessel that break-through element 102 will pass through of conduit 100.Shown in Fig. 5 b, the sensor 52 of Active Imaging parts 50 can be placed in the position of the closely adjacent path that will form 10, thereby, organize break-through parts 102 from conduit 100 to Active Imaging parts 50 sensor 52 when extending, sensor can aim at and guide it.
Fig. 5 c shows another interchangeable method, except that original Active Imaging parts 50, merges and uses second imaging device 54 (for example, passive or association's aggressive device).This second imaging device can be formed at path and form on the conduit 100, or organizes on one's body 102 of the break-through elements, and can be with original imaging device 50 communications or by its impression.Image-forming block 50 originally has a sensor 52, is placed in path and forms in the adjacent blood vessel of conduit 100 place blood vessels.Active Imaging parts 50 will be experienced or communications with second imaging device 54, thereby the direct method of observation, aiming and transmitting tissue's break-through element 102 is provided.In this embodiment, second imaging device 54 can comprise can be inquired by Active Imaging parts 50, the material or the device of any adequate types of video picture or resolution.For example, the sensor 52 of Active Imaging parts 50 may comprise a radio frequency emissions device, second imaging device 54 that path forms on the conduit 100 may comprise a radio frequency transponder, can be inquired, and the radio signal that will send the radio frequency emissions device of Active Imaging device 50 is sent answer signal.Selectively, at Active Imaging parts 50 is in cryptoscope, intravascular ultrasound (IVUS) parts or Doppler's the embodiment, second imaging device 54 that is positioned on the path formation conduit 100 can comprise a wireless sign of non-conducting, reflecting surface or sound aperture, thus, can be with radio wave, sound or ultrasonic energy reflected back Active Imaging parts 50.Be formed at conduit 100 bodies or organize on the break-through element 102,,, description is arranged in 897 (Hurwitz) numbers at United States Patent (USP) the 4th, 977 with the example of the type that strengthens its sound aperture that is manifested by Active Imaging parts 50 or surface.
Fig. 5 d shows a system, wherein, the path that magnet 57a, 57b are placed in correction forms among the conduit 101a, be used for collaborative have a sharp distal tip 107 organize break-through seal wire 103, form path 10 between shown two blood vessel BV1 and BV2, each bar of conduit 101a, 101b has magnet 57a, 57b to be positioned over the one side.Article one, hollow tube chamber 109 extend through each magnet and be formed at the contiguous insert of catheter body inside, in this mode, the opening of answering in magnet 57a, the 57b can be positioned to each other directly aligning, utilizes the captivation of magnet 57a, 57b to finish this linable position.Then, have sharp distal tip 107 organize break-through seal wire 103 to be pushed to before, by the guidewire lumen 109a of the first conduit 101a, pass the tube chamber opening in the magnet 57a of conduit 101a, by article one blood vessel BV 1Tube wall, by article one blood vessel BV 1With second blood vessel BV 2Between any tissue, by second blood vessel BV 2Tube wall, enter the tube chamber opening that another path forms the magnet 57b of conduit 101b.In this way, organize break-through seal wire 103 will form article one blood vessel BV 1With second blood vessel BV 2Between path 10.Should be appreciated that the distal tip 107 of organizing break-through seal wire 103 can comprise the sharp distal tip that can return in the seal wire, thereby after conduit 101a, 101b withdrawed from, seal wire GW can stay in the blood vessel.Can be alternatively, organize break-through seal wire 103 can be laser silk, heated filament or other any kind be suitable for forming desired path 10 organize the break-through element.
Fig. 5 e-5e display packing and device, by these method and apparatus, form the passive radiation video picture imaging visible mark of formation on the conduit 100 at path of the present invention, before path 10 forms outside each blood vessel, can be used to realize the accurate rotation location of conduit 100.Fig. 5 e shows that in the mode of plan, a path forms conduit 100 and is placed in article one blood vessel BV 1In, plan according to the present invention, from article one blood vessel BV 1Enter contiguous target T (for example, a body cavity, a Youth League organization or another blood vessel), form a path 10.A radiophotography device 118, as cryptoscope or X line parts and so on, being used to provides article one blood vessel BV1 and second blood vessel BV on screen 120 (for example, X-ray film box or fluorescent screen) 2Radiation image.
Conduit 100 of Fig. 5 e ' demonstration has radiophotography visible (for example, do not see through ray or radiate shinny) labelling 122a, 122b stringer separately to be placed in the opposite side of conduit 100 at this conduit 100.As shown in the figure, these radiophotography witness marking 122a and 122b are preferably placed at, for the height H of conduit 100, and the position of equal height, but stringer is separately.Therefore, shown in the bottom square frame of Fig. 5 e ', directly connect the method for being aligned with the corresponding height scale by making these radiophotography witness markings 122a, 122b on screen 120, conduit 100 can accurately be rotated the location.
" the passive marker system that has shown another kind of type, it can be used to obtain the accurate rotation location of conduit 100 to Fig. 5 e.With reference to Fig. 5 e ", a side that forms conduit 100 at path has a ring-type radiophotography witness marking 124, and a plate-like or point-like radiophotography labelling 126 is arranged at opposite side, and is directly relative with ring-shaped mark 124.In this way, by plate-like or point-like labelling 126 are become in the accurate rotation location that is shown as the method acquisition conduit 100 that is positioned within the ring-shaped mark 124 on the screen 120.
Also have another can be used to obtain the localized radiophotography visible mark of conduit 100 accurate rotations and be shown in Fig. 5 e .With reference to Fig. 5 e , the conduit 100 that is provided has two (2) individual big or small basically identical radiation to see through aperture 128a, 128b, is positioned at the opposite flank on the conduit 100, mutually directly relatively.In this way, by rotary guide pipe 100, seeing through aperture 128a and 128b until first and second radiation becomes and directly connects being aligned mutually, thereby as illustrated in the side frame of Fig. 5 e , see that at screen 120 they seem a single opening, thereby can obtain the accurate rotation location of conduit 100.
Fig. 5 f-5f ' shows a kind of mode, and wherein, path forms and forms a ultrasonic witness marking 130 on the conduit 100, and it realizes the accurate rotation location of conduit 100 in conjunction with the ultra sonic imaging pick off 132 of using an external placement.Such as shown in the figure, ultrasonic witness marking 130 is formed on the ad-hoc location of conduit 100, and this ad-hoc location has known relationship with position and the direction of organizing break-through element 102 will pass conduit 100.External supersonic imaging sensor 132 places on the health, thereby path forms the blood vessel BV that conduit 100 is positioned at 1With conduit 100 organize the target that break-through element 102 will penetrate (for example second blood vessel, piece of tissue, or other target location), can both video picture.Then, rotary guide pipe 100, up to ultrasonic witness marking 130 by pick off 132 clear and video pictures fully.The location of this ultrasonic witness marking 130 is used to determine that conduit is positioned over its suitable spin orientation, makes to organize the break-through element to penetrate target T.
" mode of illustrating; wherein; the passive marker that path forms on the conduit 100 is used to magnetic resonance video picture (MRI) system combined; the accurate stringer of realization conduit 100 and rotation location; also be used for determining the blood vessel at conduit 100 places and the distance between the target T; put forward a kind of altogether method thus, determine to organize break-through element 102 is at blood vessel BV to Fig. 5 g-5g 1And form required path and required mobile distance between the target T.In this embodiment, conduit 100 bodys are by forming by the material that MRI shows.In addition, at the ad-hoc location of conduit 100 bodys, form recognizable MRI labelling 134.This labelling may comprise an induction coil 134a or a little material block 134b, and it is different from the material of conduit 100 bodys, so that show especially on MRI.
Especially with reference to Fig. 5 g ', place on the conduit 100 induction coil 134a or the ad-hoc location in the wall, and extend through the silk 135 that conduit arrives an external position and link to each other with one, they can be connected to suitable power supply there, oscillograph and/or other monitoring system.Thus, electric current, phase place and the amplitude of the electromagnetic field among the coil 134a can be monitored.In this way, the moving of the conduit 100 in MRI scanning device 135 scopes will cause coil 134a form variable of MRI system but change the position in the known magnetic field.In this way, conduit 100 moving each time in the MRI field will cause electric current, phase place and oscillation amplitude change.Then, from current phase and the amplitude information that coil 134a receives, be used to determine the exact position of coil 134a with respect to target T.And, if becoming, coil 134a is positioned will show that conduit 100 has vertically shifted out desired plane outside the shown specific plane of MRI scanning device 135.In this way, coil 134a can be used to the accurately vertical and spin orientation of conduit 100.And the information that obtains from coil 134a can be used to determine the definite distance between coil 134a and the target T, and information is provided thus, makes the operator can be with the method for the length of the path 10 that is fit to form, and break-through element 102 is organized in control.
Especially with reference to Fig. 5 g ", an alternate MRI labelling 134b comprises an independently material, it is different from the material of conduit 100 bodys, and can be shown by MRI.In this way, the displayable labelling 134b of MRI can accurately be shown in the MRI video picture, and can be used to adjust visually conduit 100 with respect to the stringer between the target T or spin orientation and location.And the distance between observed sign 134b and the target T availablely is used to make the operator can control the path of organizing break-through element 102, with the blood vessel BV at conduit 100 places 1And between the target T, form the path 10 of desired length.
Fig. 5 h-5l has shown the example of " initiatively " imaging device particular type, and it can form conduit 100 with path and be associated, is mounted thereon or be incorporated into wherein, the accurate spin orientation of facilitation conduit 100 in blood vessel.
With reference to Fig. 5 h, the a kind of of Active Imaging device is doppler equipment 136, it can form conduit 100 with path and be associated, is installed on wherein or be incorporated in it, for example be incorporated in a kind of parts that can obtain from commercial channels, Smart Needle by name, CardiovascularDynamics, Inc, Sunnyvale, California.
With reference to Fig. 5 h, doppler equipment 136 is installed on the conduit 100 or is placed in one, and by the direction from the side major axis of conduit 100 (for example, perpendicular to) aiming or guide.Doppler equipment 136 is useful when location and the fluid of discrimination objective T or other material mobile.Therefore, when target T comprised fluid or other flow of matter in interior blood vessel or other anatomical structure, the embodiment shown in Fig. 5 h was useful.The signal amplitude that provides by doppler equipment 136 and other recognizable information, make the operator can: a) longitudinal register conduit, thereby the flow performance (for example, the downstream of an obstruction and a tremulous pulse) that doppler equipment 136 shows in the desired destination T; B) spin orientation conduit makes the Doppler signal amplitude reach peak value, thereby shows the mobile center (for example, the center of lumen of vessels) in the doppler equipment 136 run-home T.And c) determines distance between the mobile center in doppler equipment 136 and the target T.Mobile center in doppler equipment 136 and the target T (for example, the tract center) this of distance determined between, the operator can be controlled organize break-through element 102, thereby, organize break-through element 102 will from 100 in conduit by or extend desired distance, form the path 10 at the mobile center (for example tract) of a target approach thus, and be unlikely to move too far away and the oppose side wall of the target T that may puncture or bore a hole.
Be placed in article one blood vessel BV at conduit 100 1After interior, doppler equipment 136 will be activated, and conduit 100 will be moved by stringer, and/or rotation, desired the flowing in the part that be shown until Doppler signal display-object T, and Doppler signal amplitude peaking, thereby, show that doppler equipment 136 is directly and target T aligning.Then, the output of the frequency of doppler equipment 136 may change, and the frequency of generation peak amplitude reaction will be represented the distance between doppler equipment 136 and the target T.In this embodiment, target T must be a blood vessel or the anatomical structure that stream material is arranged in other, thereby can be distinguished by sound (for example, Doppler) device.
In Fig. 5 i embodiments shown, an intravascular ultrasound imaging device 138 is placed in the ad-hoc location that path forms conduit 100 1 sides of conduit 100.This ad-hoc location of supersonic imaging device 100 preferably has known air line distance and rotary distance from the position of organizing break-through element 102 will pass conduit 100.Be positioned over article one blood vessel BV at conduit 100 1After interior, can rotary guide pipe 100, up to target T (as, blood vessel, the target location that tissue or other can show by ultra sonic imaging of beating) direct shape being aligned, and directly shown by Vltrasonic device 138, thereby expression conduit 100 is vertically reached spin orientation, makes and organizes break-through element 102 to pass article one blood vessel BV with achieving one's goal 1Tube wall, and target approach T.
Mode shown in Fig. 5 j wherein, is used first emitter/accepter circuit 140a and second transmitter line 140b and is finished the accurate spin orientation that path forms conduit 100.As shown in the figure, form at path on the ad-hoc location of a side of conduit 100, first emitter or accepter circuit 140a are placed on the conduit, or place in its wall.This first emitter or accepter circuit 140a be closely adjacent position of organizing break-through element 102 will pass conduit 100 preferably.Second emitter or accepter circuit 140b are positioned over (for example, second blood vessel, destination organization or path form other position of organizing the break-through element to penetrate of conduit 100) among the target T.Enter article one blood vessel BV at conduit 100 1After, rotary guide pipe, emitter or one of accepter circuit 140a, 140b send signal simultaneously, thus sort signal can be launched another acceptance of device or accepter circuit 140a, 140b.In this way, continue rotary guide pipe, the signal amplitude of accepting up to emitter/accepter 140a, 140b reaches peak value, thus, represent that the first emitter/accepter circuit 140a and the second emitter accepter circuit 140b are in immediate point, thus, prompting conduit 100 is on the position of desired spin orientation in article one blood vessel BV1.In addition, one of accepter circuit 140a, 140b or whole 2 can be placed on different blood vessel BV 1And/or in the T of target area, when the signal between the circuit 140a, the 140b that monitor is so represented, realize blood vessel BV 1The desired stringer location of inner catheter 100.
Fig. 5 k shows interchangeable layout, and wherein, induction coil 142 is positioned at path and forms on the conduit 100 or the ad-hoc location of its wall, and this position is with to organize break-through element 102 will pass the position of conduit 100 corresponding.A transmitter line 144 is positioned over (for example, second blood vessel, other position of organizing 102 plans of break-through element to pass of destination organization or conduit 100) within the target T.Give transmitter line 144 with energy, thereby launch an electromagnetic signal, and induction coil 142 has also obtained energy.Then, rotary guide pipe 100, the phase place of the signal in induction coil 142 and amplitude prompting induction coil 142 is positioned at the closest approach of it and transmitter line 100, thus, confirm that conduit 100 is placed on suitable spin orientation, organize break-through element 102 from conduit 100 processes, by article one BV to cause 1Tube wall, target approach T.
In the mode that Fig. 5 l illustrates, the first and second magnet 146a-146b are used to realize that path forms the accurate rotation location of conduit 100.The first magnet 146a is positioned over path and forms on the conduit 100 or the ad-hoc location in its wall, and this position is with to organize break-through element 102 will pass the position of conduit 100 corresponding.The second magnet 146b is positioned on another conduit 148 that penetrates target T (for example, second blood vessel, destination organization or other position of organizing break-through element 102 to pass).Path forms conduit 100 and is rotated, or is allowed to rotate voluntarily, is connected a line up to the first magnet 146a with the second magnet 146b, and it is approaching as much as possible mutually, thus, show that path forms conduit 100 and is placed on correct spin orientation, make and organize break-through element 102 to pass article one blood vessel BV 1, target approach T.B. parts of the present invention
Fig. 6 to 12 shows parts of the present invention, and they can be used for forming the outer path 10 of blood vessel according to the present invention, perhaps revise or equip this path 10.Be to be understood that, shown in Fig. 6-12 and detailed description proposed below, only be intended to describe and the embodiment of some example of diagram and at present preferred parts, and be not intended to exclusive list and describe the whole possible parts or the embodiment of the tangible form that the present invention may take.
ⅰ. facilitation organizes the break-through element to withdraw from the scheme that withdraws from of catheter body
Fig. 6 a-6i has shown the example of arranging and equipping, thus, what form the outer path 10 of blood vessel when the present invention is used to begin organizes break-through element 102, can form conduit 100 by the path that is positioned at lumen of vessels withdraws from, and make the blood vessel wall of organizing break-through element 102 to pass conduit 100 places, thereby set up the outer path 10 of desired blood vessel.
Detailed description to Fig. 6 a-6i proposed below relates to the dissimilar break-through elements 102 of organizing.This paper uses term " tissue break-through element " and means and comprise that the whole of extending element, parts or the device that can be used for the break-through tissue, energy stream (for example, heat, laser beam etc.) may types.Therefore, organize break-through element 102 " to wear " when going out conduit 100 when being described to, this description will must not mean that solid-state components pass catheter tube, but also can comprise can generate the mode and the direction of the outer path 10 of desired blood vessel, the operation of organizing feedthrough or energy from catheter tube (for example flow, passing heat, laser).In addition, should be appreciated that the description relevant that Fig. 6 a-6i is shown and provide, and be not intended to and describe or illustrate the present invention and can be used for making and organize break-through element 102 to pass whole possible arrangement or device that path forms conduit 100 with these figure.What in addition, the following detailed description related to that some comprises " pre-bending resilient element " organizes break-through element 102.Term " pre-bending resilient element " means a kind of element, will take the shape of bending or curve when it is not restrained, but has enough elasticity, can be return and be constrained in parts of vessels 100 intracavity, and does not cause the moulding distortion of element.Can be used to form of the present invention some organize the examples of materials of the pre-bending resilient element of break-through element 102, be included in body temperature or resilience, elasticity or hyperelastic material arranged under with the temperature that is employed at these parts.The example of these materials comprises some rustless steel, and some plastics and some superelastic alloy and polymer are as Nitinol.
Path shown in Fig. 6 a forms in the embodiment of conduit 100a, and tube chamber 112a extends by conduit 100a stringer, and 114 places stop in distal orifice.Organize break-through element 102 to comprise the pre-bending resilient element of above-mentioned definition.In the time of in returning tube chamber 112, organize this embodiment of break-through element 102 to take the shape of straight basically, non-bending or minimum bend, to adapt to the perisporium of conduit 100a.Yet, when organizing break-through element 102 to pass the outlet aperture 114a of conduit 100a far-end forward, organize break-through element 102 will take its pre-bending shape, thereby organize the far-end of break-through element 102 will pass the vascular wall at conduit 100a place.Should be appreciated that about this embodiment, and all other embodiments of the present invention described herein, organize the break-through element 102 can be by moulding to form the path 10 of Any shape or size.Therefore, organize break-through element 102 to comprise in the embodiment of a pre-bending resilient element therein, the pre-bending shape of organizing the break-through element can be full curve, part straight line, part curve, multiple curve, or be suitable for forming any other pre-bending shape of the outer path 10 of initial blood vessel of desired size and shape.And, as following will be more detailed as described in, may use different types of path correcting part, remove the size and/or the shape of tissue, expansion, expansion or correction path, organize the original via that forms after 102 break-through first time of break-through element thereby the shape of the final path 10 that produces may be different from basically.
The path that Fig. 6 b shows forms parts of vessels 100b, has a stringer to extend and end at the tube chamber 112 of distal side wall outlet aperture 114b.Sidewall aperture 114b and tube chamber 112b to side surface between, a deflector surface 115 is formed in the pipeline 112b.Organizing break-through element 102 when returning tube chamber 112b with what flexible material was made, is straight shape basically.Yet when along distal direction forward the time, the far-end of this tissue break-through element 102 will be by deflector surface 115 deflections, and pass conduit 100b tube chamber by sidewall aperture 114b.In this way, organize the break-through element can pass the body of conduit 100b with side direction with respect to the longitudinal axis LA of conduit 100b.
Fig. 6 c shows that parts of vessels 100c has a tube chamber 112c who extends and end at distal side wall outlet aperture 114c along the longitudinal axis.Organizing break-through element 102 can be a pre-bending resilient element, and when returning to the tube chamber 112c of conduit 100c fully, is straight shape basically.Yet, when this tissue break-through element 102 along distal direction forward the time because it seeks the tropism of its pre-bending shape, the far-end of this pre-bending resilient element 102 will be located voluntarily, and pass outlet aperture 114c, and do not need the mentioning or deflection of any surface on the tube chamber 112c wall.
Fig. 6 d and parts of vessels 100d of 6d ' demonstration, it has the tube chamber 112d of a longitudinal extension, ends at remote outlet aperture 114d.A chopping block element 180 is placed in conduit 100d far-end the place ahead distance at interval, and contacts with conduit by integrating the pillar 182 that forms.Chopping block element 180 has a far-end dull face 184 and deflector surface 186 to be formed at its nearside, with the direct aligning of remote outlet aperture 114d of the tube chamber 112d of conduit 100d.In the present embodiment, organize break-through element 102 to comprise a pliable and tough element, or resilience, pre-bending element, and as shown, take shape straight basically or minimum bend, to adapt to and can return to the chamber 114d of conduit.Yet, when break-through element 102 passes the distal openings 114d of conduit, organize the distal tip of break-through element 102 will encircle deflector surface 186 to chopping block element 180, and pin thereby be deflected, be directed or produce bending or become curve, thereby organize the break-through element will pass blood vessel BV as shown like that at side direction 1Tube wall.
Preferably, the deflector surface 186 of chopping block element 180 is mutually not continuous with the inner surface of the tube chamber 112d of conduit 100d.
The another embodiment of parts of vessels 100e shown in Fig. 6 e, wherein parts of vessels 100e comprises that a returnable outer catheter sheath 190 and one extend 192, one pre-bending resiliences of inherent element pipe 194 and is formed in the element 192 or is installed in its distal portions.Extending inherent element 192 has far-end blunt nosed 196, and forms one within it and extend side opening 198, thereby when outer catheter sheath 190 when quilt is return on proximal direction, as shown in the figure, pre-bending resilience tube element 194 will outwards be ejected into the side curved shape of its pre-bending.The break-through element 102 of organizing in the present embodiment can be a pliable and tough element or pre-bending resilient element, and during distal openings 114e in it passes forward on tube element 194 far-ends, it will take the pre-bending shape.In this way, when catheter sheath 190 was return on proximal direction, pre-bending tube element 194 can form first jiao of A 1, when the pre-bending resilience organized break-through element 102 to pass the distal openings 114e of pre-bending tube element 194 forward, it can form second jiao of A 2Thereby,, between the longitudinal axis LA of the direction of organizing the aiming of break-through element 102 distal tips and conduit 100e, first jiao of A 1With second jiao of A 2To unite, the result forms third angle A 3As above institute explains in detail, organize the distal tip of break-through element 102 and the angle A3 between the conduit 100e longitudinal axis LA must not specify or define and organize break-through element 102 will form path 102 corner cut degree really.In fact, organizing break-through element 102 can be any suitable shape, comprises forming the full curve shape of full curve path.
Fig. 6 f has shown the another embodiment of parts of vessels 100f, wherein, parts of vessels 100f comprises the tubulose epitheca 202 that can return on proximal direction, and the inherent element 204 of extension with the blunt nosed 206 and lateral openings formed thereon 208 of far-end.Organize preferably pre-bending resilient element that is installed in the extending element 104 of break-through element 102, closely adjacent lateral opening 208, thereby, when conduit epitheca 202 covers lateral opening 208 forward, organize break-through element 102 will take shape straight basically or minimum bend, so that adapt to the inner chamber 112f of parts of vessels 100f, and be restrained in it.Yet, when epitheca 202 is return with exposed side opening 208, organize break-through element 102 its pre-bending shape of will outwards rebounding on proximal direction, thereby, organize the far-end of break-through element to point to, or will exactly touch the tube wall of the blood vessel BV that parts of vessels 100f will insert.At least in certain embodiments, organize the break-through element on distal direction, to be pushed to subsequently before, thereby pass blood vessel wall and any desired extravascular tissue, form the outer path 10 of blood vessel according to the present invention.
Fig. 6 g shows the another one embodiment, and path forms parts of vessels 100g and comprises a tubular conduit body, and it has cavity 112g stringer to extend through, and is opened on distal openings 114g.The far-end body of conduit 100g can be to the side bending, shown in the dotted lines of Fig. 6 g.This bending of parts of vessels 100g in the side will cause that outlet aperture 114g becomes the tube wall that points to parts of vessels 100g place blood vessel, thereby, organize break-through element 102 to pass the distal openings 114g of parts of vessels 100g subsequently forward, cause organizing break-through element 102 to contact and pass the tube wall of parts of vessels 100g place blood vessel BV.Maybe can cause at marmem, wire drawing, anti-solenoid the catheter tip bending any other suitable machinery, device or material in the presence of, the bendable distal end of conduit 100g can become its curve or crooked shape by its straight shape.
Fig. 6 h shows that path forms another embodiment of parts of vessels 100h, and it comprises a tubular conduit 100h, it have one can pass therethrough organize break-through element 102.One can fill the side that sacculus 210 is formed at parts of vessels 100h, relative with the position of the outer path 10 of the blood vessel that will form on the blood vessel BV tube wall.Organize break-through element 102 march forward before or march forward during, the full of sacculus 210 incited somebody to action: a) when organizing break-through element 102 to pass the tube wall of blood vessel BV forward, stop or prevent that conduit 100h from rebounding and press to the oppose side wall of blood vessel BV, and b) is used for stable and keeps the distal portions of parts of vessels 100h in the tube chamber of blood vessel BV, to be in the position of basic fixed, thereby, when organizing break-through element 102 to march forward or to pass blood vessel BV tube wall, can use enhanced strength or pressure thereon.In the embodiment shown in Fig. 6 h, parts of vessels has a remote outlet opening 114h, and organizing break-through element 102 is pre-bending resilient elements, and when passing remote outlet 114h, it takes the shape of lateral thrust or curve.Yet, should be appreciated that the side sacculus 210 shown in Fig. 6 h can or unite use with the conduits join of any kind shown in Fig. 6 a-6i, comprise that those wherein organize the break-through element to pass the side outlet aperture of conduit part 100h sidewall.
Fig. 6 i shows another embodiment, and path forms parts of vessels 100i and comprises an extension, flexible, tubular conduit body, and it has a hollow tube chamber 114i who extends longitudinally; Be installed on the bluff body tip element 212 of tubular conduit body far-end with a rotation.Distal tip element 212 has a crooked tube chamber 214 to extend through, and the tube chamber 114i of its near-end and conduit 100i connects being aligned, and its far-end ends at the side outlet aperture 114i of distal tip element 112 1 sides.The break-through element 102 of organizing in the present embodiment can comprise a pliable and tough element or resilience pre-bending element.In either case, organize break-through element 102 to advance to the centre position earlier, wherein, organize the distal tip of break-through element to place in the crooked tube chamber 214 of distal tip element 212.When organizing break-through element 102 to be in this centre position, organize break-through element 102 to be rotated.Because its CONTACT WITH FRICTION in the crooked tube chamber 214 of distal tip element 121 organizes this rotation of break-through element 102 will cause that distal tip element 212 rotates simultaneously.In this method, organizing the part of break-through element 102 to advance and rotate can be used for as a kind of method, rotate mobile distal tip element 212, to adapt to the spin orientation of side outlet aperture 114i, organize the lateral of break-through element thereby guide with expectation, in the place of expectation, form the outer path 10 of blood vessel of the present invention.In this way, behind the spin orientation of the distal tip element 212 that reaches expectation, organize break-through element 102 further to pass side outlet aperture 114i forward, will make the tube wall of organizing the break-through element to pass the blood vessel BV at conduit 100i place, form the outer path 10 of blood vessel of expectation.
ⅱ. can be incorporated into the type of organizing the break-through element that path forms conduit
Following Fig. 7 a-7m and the relevant detailed description that hereinafter proposes, plan to describe and illustrate can be according to some type of the present invention's application organize break-through element 102.Should be familiar with and understand, below describe and the particular type of organizing break-through element 102 of Fig. 7 a-7m demonstration, and be not intended to exclusive list and describe the applicable all possible type of organizing break-through element 102, but be intended to provide the adaptable example of organizing the type of break-through element 102.Explain that as above term " tissue break-through element " is not limited to solid-state components, also can comprise different devices, parts or energy stream.And term " resilience, pre-bending element " should be explained according to the definition of this term set forth above.
With reference to Fig. 7 a-7m, shown can be used for that path of the present invention forms conduit 100 organize the dissimilar of break-through element 102.These organize break-through element 102 to be designed to pass the flexible conduit body, penetrate the vascular wall at conduit 100 places, pass adjacent blood vessel in case of necessity and organize outward, form the outer path 10 of the desired blood vessel of the present invention.
Fig. 7 a and 7a ' have shown first embodiment of organizing break-through element 102a.This organizes break-through element 102a to comprise one by flexible material, the Microlumen.Inc. that can obtain from commercial channels for example, Tampa, distal tip 300 sharp-pointed, that the tilt extension that the polyimides of Florey Dazhou City (Polyimide) pipe is made, that flexible pin and one are formed thereon.An optional tube chamber 302 can extend along break-through element 102a stringer.Pre-bending, resilient element 304, perhaps wire drawing, stringer are placed in to be organized in the break-through element 102a.
In the time of within element 102a returns to path formation conduit 100 tube chambers, resilience pin element 304a will be caused to take shape straight basically or minimum bend, adapt to the shape of conduit cavity, allow to organize break-through element 102 to be return fully and enter conduit cavity.Yet, when organizing the break-through element to expose or to pass path formation conduit 100 forward, the distal portions of pre-looper element 304 will be crooked or curved in the side, make thus whole flexible organize break-through element 102a take Section line as Fig. 7 a indicating lateral thrust or the shape of curve.In this way, pre-bending resilience pin element 304 will cause that the pliable and tough or flexible break-through element body of organizing takes the lateral thrust expected or the shape of curve.In some cases, the pliable and tough body that this arrangement also can allow to organize break-through element 102a is organized break-through element intravasation tube wall or adjacent tissue around pre-bending resilience pin element 304a rotation or rotation with facilitation or reinforcement propelling.
It comprises a flexible extension near-end long handle 306 another embodiment of Fig. 7 b display organization break-through element 102b, and it has a rigidity, sharp distal tip element 308 to be placed on near-end long handle 306 far-ends or adds wherein.In this embodiment, organize the near-end long handle 306 of break-through element 102b enough pliable and tough and flexible, with the dissection curve that travels distortion or the curve in the conduit cavity, simultaneously rigidity distal tip part 308 is formed by rigid material, as rustless steel, thereby keep the extravascular tissue that sharp-pointed basically distal tip 310 penetrated and passed vascular wall and expectation, form the outer path 10 of blood vessel according to the present invention.
It comprises the real property of an extension or the pin that has sharp distal tip 312 of hollow another embodiment of Fig. 7 c display organization break-through element 102c, form by the pre-bending resilient material, as the super-elastic property Nitinol, or in the temperature range that when organizing break-through element 102c normally to use, may run into, resilience, elasticity or hyperelastic other alloy have been shown as.This embodiment of organizing break-through element 102c that forms by the pre-bending resilient material, in the time of in the tube chamber 112 that returns to path formation conduit 100, shape straight basically or minimum bend will be taked, thereby the whole break-through element 102c that organizes can return tube chamber 112 fully.Yet, when organizing break-through element 102c to pass the outlet aperture 114c of conduit 100 forward, organize break-through 102c will take its pre-bending shape, thereby it is crooked or tortuous in the side, longitudinal axis LA with respect to conduit forms angle A, thus, help organizing the distal portions of break-through element 102c to pass vascular wall forward and appoint, to form according to the outer path 10 of the desired blood vessel of the present invention to adjacent tissue.
Fig. 7 d shows, organize break-through element 102d another embodiment it comprise a hollow needle with seal wire path tube chamber 316 that sharp-pointed (for example, cutting sth. askew) distal tip 314 and longitudinal extension pass through.Should be appreciated that to enumerate with the break-through element of organizing of above detailed description according to Fig. 6 a-6i to pass the different of scheme, hollow needle can be formed by pre-bending, resilient material or flexible material.The embodiment of the piercing element 102d that Fig. 7 d shows has the seal wire of permission GW by seal wire path tube chamber 316 progressive advantages.According to the manner, seal wire GW can be on distal direction intermittence forward, maybe can be placed in and continue under the pressure of far-end, thereby, when the sharp distal tip 314 of organizing break-through element 102d enters the tube chamber of another blood vessel or other cavity, seal wire GW will be very forward fast on distal direction, indicate thus to organize the sharp distal tip 314 of break-through element 102d to enter this vessel lumen or cavity.Therefore, in revascularization method of the present invention, when forming the outer path 10 of two intervascular blood vessels, or outside other blood vessel of the present invention in the step, when forming the outer path 10 of blood vessel between the target T that a blood vessel and comprises another blood vessel or other hollow body cavity, this embodiment of break-through element 102d is particularly useful.The pressure that puts on the sensing far-end of seal wire GW can apply by hand, or uses as Figure 10 c ', 10c " with shown in the 10c and the pressure of following comprehensive detailed description apply safety device.
Fig. 7 e also shown organize break-through element 102e another embodiment it comprise a real property pin that sharp-pointed (for example, cutting sth. askew) distal tip 318 is arranged.Shown in Fig. 7 e ', the piercing element 102e of the present embodiment can be by a successive real property extending element, and for example a silk forms.Can be alternatively, as Fig. 7 e " shown in; the present embodiment organize the break-through element can comprise one to have the hollow tube chamber 114e that stringer extends through " outer tubular element 102e "; and one can coaxial insertion piercing element 102e the removable real property stylet element 320 of " hollow tube chamber 114e "; thereby; tubulose break-through element 102e " will form a reality needle construction basically together with reality stylet element 320, with the real property extension piercing element 102e ' structural similarity shown in Fig. 7 e '.
It is constituted jointly another embodiment of Fig. 7 f display organization break-through element 102f by 2 parts, extension reality with the sharp cannula needle tip 324 that is formed at its far-end or tube element 322 and one around, can vertical progressive epitheca 326.The distal portions of epitheca 326 can be tapered, and do not show, thereby it can cover and protect the sharp cannula needle tip 324 of extending element 322.Yet when when vascular wall or other tissue march forward, sharp cannula needle tip 324 will expose outside epitheca 326 distal openings, thereby penetrate and advance by vascular wall and/or other tissue.When trocar tip entered another vessel lumen or other hollow body cavity, epitheca 326 can respond the intermittence that puts on the epitheca 326 or the pressure that points to far-end continuously and forward.The pressure of this sensing far-end can apply by hand, or with " applying safety component with the lasting pressure that reaches following comprehensive description shown in 10 applies as Figure 10 c ', 10c.
The another embodiment of Fig. 7 g display organization break-through element 102g comprises that has the extension linear element 328 that energy emission distal tip 330 is formed at its far-end.One or more energy emission filament or element 332 can send from tube element 328, and link to each other with energy emission distal tip 330, thereby discharge the energy of expectation form to distal tip 330.According to the manner, energy emission distal tip can be launched the energy of any suitable type, these energy with excision, cutting or facilitation according to method pushing member 328 of the present invention by blood vessel and other extravascular tissue.Can comprise heat (for example, resistance heat or LASER HEAT form " thermal spike portion "), one pole electrotome (electrocautery), bipolar electrotome, ultrasonic from the example that energy is launched the kind of energy of distal tip 330 emission, or the like.
It comprises the another embodiment of Fig. 7 h display organization break-through element 102h one and extends tube chamber 112 and rotatable path that places its far-end that 100, one stringers of flexible conduit extend through and taper off to a point 336.Rotatable actuating member 338 is extended by tube chamber 112 stringers of conduit 100, advances when organizing break-through element 102h to pass vascular wall or other to organize in expectation, operates this rotatable actuating member with rotation distal tip 336.The distal tip 336 of rotation can be any suitable shape, to form the tunnel that passes through tissue or the path of intended shape when rotated.In this, the outer surface of rotation most advanced and sophisticated 336 can be equipped a sharp-pointed screw blade or screwing element spare 337 or other tissue and cut or expanded device, with facilitation rotatable most advanced and sophisticated 336 desired organize rotary drilling, cutting or expansion.
Fig. 7 i shows the embodiment that another organizes break-through element 102i.In the present embodiment, organize break-through element 102i to comprise and one come pulse or continuous laser from what be formed at that aperture in the conduit 100 or lens cover that mouthful 114i sends.Laser transport element 340 such as optical fibers extends by tube chamber 112 stringers of conduit 100, end near reflecting surface 341 places such as mirror, and aligning with it, the laser that self-excitation photo-conduction cell 340 far-ends are sent be reflected out thus side aperture or opening 114i.Therefore, in this specific embodiment, organize break-through element 120i to be formed by solid matter or the extensible feedthrough of organizing, but comprise and can vaporize or cut vascular wall and other extravascular tissue, to form the pulse or the continuous laser beam of the outer path 10 of the desired blood vessel of the present invention.
Should be appreciated that the break-through element 102i that organizes in the present embodiment can be by with the distinct methods correction.For example, at reflecting surface 341 places, a Continuous Energy guide (for example, optical fibers) can be extended by catheter tube, end in the outlet or lens on the duct wall, thereby energy stream (for example, laser) will pass from the conduit side.Replacedly, energy discharger can be placed on the duct wall or place in it, thus energy stream that can direction emission expectation outside the side of conduit.In addition, the special embodiments shown of Fig. 7 i and above-mentioned its variation will be not limited to the laser energy, also can use any suitable energy stream, comprise heat, ultrasonic, laser, or the like.
Fig. 7 j shows another embodiment, organizes break-through element 102j to form conduit 100 with path of the present invention and combines.In the present embodiment, organize break-through element 102j to comprise that is extended a laser transport element, laser can be able to pass through along this, thus the far-end 343 that laser can will extend laser transport element 102j certainly sends.Extending laser transport element 102j can be pre-bending, thereby when it when the distal openings 114 of conduit 100 passes, it will be tortuous or crooked automatically in the side, thereby the tube wall of the blood vessel BV at contact conduit 100 places, in vascular wall and other extravascular tissue, form path 10 outside the blood vessel of expecting with permission from the laser energy of the far-end 343 of laser transport element 102j.In addition, should be appreciated that according to all be illustrated in Fig. 6 a-6i and as above describe comprehensively the suitable outlet scheme of break-through element 102 in a organized way, multiple other outlet scheme can be applicable to laser transport element 102j, for example, be formed at the sidewall aperture of conduit 100.
Fig. 7 k shows the another embodiment of organizing break-through element 102k that can be used for path formation conduit 100 of the present invention.Organize break-through element 102k shown in Fig. 7 k, comprise that is extended a hollow needle, it has tube chamber 316 stringers to extend through and a sharp distal tip.A vacuum source (for example, suction pump) 344 near-ends that are attached to the tube chamber 316 of organizing break-through element 102k, thereby break-through blood vessel BV or other tissue will drag or draw tissue to enter tube chamber 316 when forming outside the blood vessel of the present invention path 10 before the far-end of organizing the break-through element is pushed to.One is optionally sealed cuff 317, it can comprise that one is installed on and organizes outside the break-through element 102k, face and most advanced and sophisticated the filled ring-type sacculus of some distances that separates of the sharp distal on it, can be positioned over and adjoin blood vessel BV tube wall, thereby form sealing, it will avoid tube chamber 316 to use suction pumps and cause from blood vessel BV tube chamber and spill or sucking-off blood.In this way, when organizing break-through element 102k to pass vascular wall tissue or other extravascular tissue forward, optionally seal the far-end that cuff 317 can facilitation draws vascular wall BV or other extravascular tissue or suck tube chamber 316.
Fig. 7 l has shown another embodiment of organizing break-through element 102l that can be used for path formation conduit 100 of the present invention.With reference to Fig. 7 l, provide one to organize break-through element 102l, combine with normal structure break-through element 102, for example have the real property or the hollow needle at sharp distal tip and have hollow tube chamber 349 that resilience, pre-bending distal portions 347 and stringer extend through around tubular sheath 346.In before the sheath 346 of break-through element 102 is pushed to along the tube chamber 112 of conduit 100 in a organized way.When the distal portions 347 of sheath 346 passed the distal openings 114 of conduit 100 forward, the pre-bending distal portions 347 of sheath was to automatic bending in side or bending, shown in the dotted lines of Fig. 7 l.Then, before pliable and tough or pre-bending organizes break-through element 102 to be pushed to along the tube chamber 349 of sheath 346, pass tube wall or other extravascular tissue of blood vessel BV, form the outer path 10 of required blood vessel according to the present invention.Randomly, vacuum source 345 can be connected with the near-end of the tube chamber 349 of sheath 346, contact with the distal portions 347 of sheath 346 with tractive blood vessel BV tube wall, thereby facilitation is organized break-through element 102 to advance and passed vascular wall or other tissue.
The another embodiment of Fig. 7 m display organization break-through element 102m.With reference to Fig. 7 m, the conduit 100 that provides has a sidewall opening 114 and is formed at hollow tube chamber 112 stringers of its neutralization and extends through, and ends at sidewall opening 114.One such as the hollow of tip or reality pin organize break-through element 102, can march forward by the tube chamber 112 of conduit 100 and pass sidewall opening 114.A vacuum source 350 (for example, suction pump) is positioned over the near-end of tube chamber 112, and shown in Fig. 7 m, suction pump is used to tractive blood vessel BV tube wall and contacts with side aperture 114 downwards.This blood vessel BV tube wall that is caused by suction pump contacts with side aperture 114, and facilitation organizes break-through element 102 to realize forward and pass blood vessel BV tube wall, forms according to the outer path 10 of the desired blood vessel of the present invention.And this absorber adheres to the tissue that helps to keep being threaded into and is in tight state, thereby these tissues of facilitation break-through.
ⅲ. the path correcting device
Fig. 8 a-8h and detailed description proposed below have shown polytype device, can be used for handling, enlarge, removing tissue, expansion, arrangement, bag quilt or correction originally by the outer path 10 of the blood vessel of organizing break-through element 102 to form.Should be familiar with and understand, shown in Fig. 8 a-8h and the following detailed description be to be intended to describe and illustrate, the representative example of available path correcting device type according to the present invention, rather than be intended to all enumerate and describe available each possible path correcting device according to the present invention.
Fig. 8 a shows first kind of embodiment of path correcting device 500a, and it comprises an extension linear element, has a ring-type sharp distal cutting tip 502 and hollow tube chamber 504a stringer to extend through at its far-end.The path correcting device 500a of the present embodiment can be along passing by the seal wire GW of the original via of organizing break-through element 102 to form or passage forward, thereby ring-type distal cut tip 502 is with resection organization or enlarge by the original via of organizing break-through element 102 to form or passage, so that the blood vessel that desired size and shape be provided path 10 outward.Be to be understood that, suction pump or vacuum tube can be used for the far-end tube chamber 504a of the path correcting device 500a of the present embodiment, excavate tissue with facilitation distal cut tip 502, thereby, the tissue of ring-type distal cut tip 502 cuttings will be pulled with the direction towards near-end and enter tube chamber 504a, and can be collected to carry out pathologic finding subsequently by a suitable collecting pipe.
Fig. 8 b shows another embodiment of path correcting device 500b, and it comprises a tapered dilator, and it has a columniform basically proximal part 506 and a tapered distal portions 508.Hollow tube chamber 504b extends by the path correcting device 500b stringer of the present embodiment, thereby the seal wire GW that path correcting device 500b can form original via that element 102 forms or passage by path along an insertion forward.As this path correcting device 500b forward when the path by this initial formation or passage, tapered distal portions 508 will expand path or passage reach device 500b proximal part 506 than major diameter.An optional energy emission band 510 can be placed in the proximal part 506 of device 500b, thereby at device 500b when passing forward, it sends the surface that heat or other energy are further revised path 10.
Fig. 8 c shows the third embodiment of path correcting device 500c, it comprises an extension linear element, it has a ring-type sharp distal cutting tip 512 similar to the distal cut of the embodiment shown in above Fig. 8 a most advanced and sophisticated 502, but (for example be fit to emitted energy more, heat, vibrations, laser etc.).In the embodiment of this device 500c, energy conduction silk or element 514 extend through the tubulose proximal part of device 500c, and link to each other with ring-type distal cut most advanced and sophisticated 512, thereby, conduct electrical power, ultrasonic vibrations or any other suitable form of energy promote vascular wall or other extravascular tissue that distal tip 512 arrives expectation to distal tip 512 with facilitation.The hollow tube chamber 504 that through-going device 500c forms allows device 500c along being placed in by the original via of organizing the break-through element to form or the seal wire in the passage forward.At device 500c when advancing, electric current or other energy will be by energy conduction silk or elements 514, thereby, send path that heat or other energy can facilitation device 500c pass tissue and advance by distal tip.Be to be understood that, a vacuum source (for example, suction pump) can be attached to the near-end of tube chamber 504c, further facilitation device 500c passes the path of tissue and advances, and any tissue of diging up of tractive is by tube chamber 504c, thereby the tissue of removal can be collected in the collecting pipe, is sent to and does corresponding pathological study.
Fig. 8 d shows the 4th kind of embodiment of path correcting device 500d, and it comprises one and extends tubular conduit 516, and it has hollow tube chamber 504d stringer to extend through, and has a ring-type sacculus 518 to be placed in its outer surface.One independently the full tube chamber (not shown) of sacculus will extend through the proximal part of conduit 516, to allow full fluid to be injected into sacculus 518 the insides or to be drawn out of.The path correcting device 500d of the present embodiment can organize original via that the break-through element causes or the seal wire GW in the passage along placing, and is pushed away forward, in not full sacculus 518 places this initial path or passage that forms.Then, sacculus 518 can be by full, with expansion or stretch initial path or the passage that forms, provides the outer path 10 of blood vessel of the correction of a diameter with expectation and/or shape.
Fig. 8 e shows the 5th kind of embodiment of path correcting device 500e, and it comprises one and extends the flexible catheter body, it by the linable proximal part 520 of mutual stringer ' and distal portions 520 " form." cutting that extend by two (2) bars mutually, flexible threads 522 is connected for near-end and distal portions 520 ' with 520.Hollow tube chamber 504e extend through the near-end 520 of device 500e ' and far-end 520 " part, thereby, organize path that break-through element 102 initially causes or the seal wire GW in the passage along being inserted in, before device 500e can be pushed to., a drawing silk (not shown), or seal wire itself can be contained within the proximal part 520 of catheter body " in, thereby the distal portions of catheter body can be pulled to near-end, reduce thus catheter body proximal part 520 ' and distal portions 520 " between the gap.This will cause that cutting silk 522 outwards arches, shown in the ghost line of Fig. 8 e.In operation, device 500e will along seal wire GW and pass the path of initial formation or passage forward.Then, the distance between the distal portions 520 of catheter body " is pulled to proximal direction, has shortened catheter body proximal part 520 ' far-end and distal portions 520 " causes that thus cutting silk 522 outwards arches.Alternatively, electric current can be by the cutting silk so that strengthen the dissection of silk.Then, device 500e will withdraw from by path or the passage of organizing break-through element 102 initially to form to proximal direction, thereby, the cutting silk 522 that outwards arches will enlarge initial path or the passage that forms, thus, according to the present invention, path or passage are become the blood vessel outer path 10 of the slit sample that has enlarged.
Fig. 8 f shows the 6th kind of embodiment of path correcting device 500f, and it comprises one and extends long handle element 530, has settled one on its far-end and has retracted cutter sweep 532.Retract cutter sweep 532 and comprise a stiffener with passivity distal surface 534 and ring-type proximal cut edge 536.Hollow tube chamber 504f stringer extends through long handle 530 and retracts cutting element 532, thereby, along being inserted in, before device 500f can be pushed to by the original via of organizing break-through element 102 to form or the seal wire GW in the passage.After retracting cutting element 532 and all entering in the path of initial formation or the passage, it will be return to proximal direction, thereby proximal cut surface 536 is with resection organization, so that enlarge or remove the tissue of path.Selectively, when retracting element 532 and return, cutting surface 536 can be rotated, and is beneficial to cut and organize.And, selectively, a ground chopping block (not shown) can be placed on path 10 to side, so that the subtend pressure of relative cut edge 536 to be provided, facilitation retracts cutting element 532 and cuts and organizes thus.Tissue by excise from channel wall on proximal cut surface 536 will be collected in the inner chamber 538 that retracts cutting element 532.
Fig. 8 g shows the 7th kind of embodiment of path correcting device 500g, and it comprises one and extends long handle 540, has settled one to push away preceding cutting element 542 on its far-end.Article one, hollow tube chamber 504g stringer extends through long handle 540 and cutting element 542, thereby along inserting by the original via of organizing break-through element 102 to form or the seal wire GW within the passage, device 500g can preceding be pushed away.Cutting element 542 comprise have the distal portions 542 of cylindrical outer surface basically ' and have the proximal part 542 that outwards reduces outer surface gradually ".Sharp-pointed ring-type cut edge 544 be formed at distal portions 542 ' far-end, thereby, when device 500g when distal direction advances, cut edge 544 will downcut a columniform basically tissue, thereby enlarge path or the passage that installs the initial formation that 500g passes forward.Selectively, when device 500g advanced, sharp-pointed ring-type cut edge 544 can be rotated.And.Available chopping block (not shown) can be placed on path 10 to side, provide buffer brake with relative cut edge 544, thereby help device 500g and cut and organize.
Fig. 8 h shows the 8th kind of embodiment of path correcting device 500h, and it includes the extension linear element 550 that tube chamber 504h stringer extends through.A plurality of excessive apertures 554 are formed at tube element 550, and its scope is confined to the spacer segment distance apart from tube element 550 far-ends.And distal guide wire outlet hole-shaped is formed in the far-end of element 550, thereby, organize original via that break-through element 102 forms or the seal wire GW in the passage along being inserted into, before device 500h can be pushed to.Near-end and far-end sealing sacculus 552 ', 552 " be formed at the outer surface of tube element 550, be positioned at the nearside and the distally of excessive aperture 554.As Fig. 8 h " shown in, tube element 550 can be along seal wire GW forward, but within excessive aperture 534 is placed in the handled path 10 of quilt streaming flow material.Then, annular enclosed sacculus 552 ', 552 " will be by full, with the opposite end of closed access 10.Then, the flowable mass of expection will be by the tube chamber 504h of tube element 550, and thus, it flows out excessive aperture 554, and be full of still be closed sacculus 552 ', 552 " within the path 10 that is sealed.After flowable mass had been realized desired processing to path 10 walls, negative pressure can be applied to tube chamber 504h, to draw back flowable mass within path 10.Then, sealing sacculus 522 ', 522 " will be removed full, and device 500h will be return and shift out path 10.A kind of interchangeable correction of Fig. 8 h ' demonstration, device 500h ', wherein do not form the excessive aperture 554 of fluid on the tube element 550, but element body that extends through tube element 550 such as the energy conduction element (not shown) of silk, and on tube element 550 sealing sacculus 552 ', 552 " electrode will be installed in the zone between; electrotome device; heat-resistor; laser or other energy discharger; thereby; according to above-mentioned with reference to Fig. 8 h and 8h " mode, as device 500h " become when being positioned within the path; sealing sacculus 552 on the tube element 550 '; 552 " between outer surface with heating or emitted energy, this handles the wall of path 10.
ⅳ. for stringer compressing that is formed at the outer path of two intervascular blood vessels and/or the device of supporting
Path 10 is formed at (as in many above-mentioned revascularization steps) in two (2) the intervascular application outside blood vessel of the present invention, exist spongy between blood vessel wall or open texture may cause problem, promptly the blood flow by path 10 may be easy to infiltrate through this spongy or open texture, and blood spills and/or hematoma forms thereby produce.
Stoping the method for the gap infiltration of blood between tissue or near blood vessel wall is to insert stringer path [22 in path 10, thereby prevents that blood is to wherein infiltrating.And this stringer [22 of configuration can additionally provide structural support in the path in path 10, to keep the opening and prevent because near the motion of tissue makes the path bending or closes of path.Yet, it will be appreciated that any this stringer [22 will so make up to provide and prevent that blood from infiltrating near enough stringer compressings of tissue, but this compressing can not cause the undue compressing of tissue again and cause endogenous ischemia and possible tissue necrosis.Fig. 9 a-9f points to the example of special stringer [22, and this device can be placed in the outer path of blood vessel of the present invention in case the tissue of hemostasis liquid permeates and/or provide path interior structural support.Should be understood that, Fig. 9 a-9f and as detailed below and be not intended to the institute of enumerating and describe stringer [22 used according to the present invention fully might type.Rather do not say that these figure and following detailed description only are some examples of spendable stringer [22 types.
The application of the stringer [22 that is shown in Fig. 9 a-9f and describes hereinafter is not necessarily limited to the outer path 10 of blood vessel of the present invention, but also can unite use with other method, be used to form the adjacent tubular morphology path such as the blood vessel of health, side side connection between fallopian tube etc. (as, anastomosis).
First embodiment of Fig. 9 a-9a ' demonstration stringer [22a, it comprises one first circular element 600 and one second circular element 602, and they can directly be united mutually with interconnection so that the stringer compressing centers on two blood vessel BV 1And BV 2Between blood vessel wall and other tissue of the path 10 that forms.First circular element 600 has many lower limb linear elements 604 that stretch out from the one side.Second element 602 has many apertures 606 of accepting, and the position of these apertures and structure are fit to accept lower limb linear element 604 in wherein.Each lower limb linear element 604 forms the adapter of a bayonet shape adapter 608 or other type therein, so that lower limb linear element 604 inserts when accepting aperture 606, adapter 608 will constrain in accepts in the aperture 606 respective element that forms or surface so that pin and fix first and second circular elements 600,602, this fixed form causes blood vessel BV 1And BV 2Tube wall part and other stringer compressing around the tissue placed in the middle of path 10.
Fig. 9 b-9b shows second embodiment of stringer [22b, it comprises resilience (as a super bullet) coil that has been bent into the configuration shown in Fig. 9 b, this coil have two upper arcuate fragments 610 ', 610 " and two lower arcuate fragments 612 ' and 612 ", as shown in the figure.Device 22b is installed in the tube chamber 614 of tubular conduit 616 at first.Inner conduit element 618 distal portions internal diameters reduce, this part is placed the chamber 614 of outer conduit 616 coaxially, so that the lower arcuate part 612 that the stringer of device 22b is extended ', 612 " be hunted down and reduce by the far-end that frictional force constrains in inner tubular conduit 618 between the surface of internal cavity of the outer surface of diameter parts and outer conduit 616, shown in Fig. 9 b '.Outer conduit 616 is initial by path 10 insertions, device 22b launches therein, subsequently inner conduit 616 is advanced to a distant place, with upper arcuate part 610 that stringer is extended ', 610 " release outside the distal openings of conduit 616; so as to make upper arcuate part 610 ', 610 " thereby outside crooked first blood vessel BV that are positioned at of resilience 1The surface, chamber.Subsequently, with inner conduit 618 pull back with discharge the lower arcuate part 612,612 that stringer extends ', 612 "; form the frictional force constraint and be trapped in inner conduit 618 and 616 of outer conduits, and withdraw from outer conduit 616 so that lower arcuate part 612 ', 612 " can pass the open distal end of conduit 616 and outwards resilience crooked in case near and retrain the second blood vessel BV 2Tube wall and therebetween spongy or open texture, referring to Fig. 9 b.The ring-type line elements that forms device 22b can be any suitable resilience types of material, and preferable material can be included in Nitinol or the polymer that shows superplasticity or height bendability characteristics in mammalian body in the temperature range that will run into during device 22b launches and implants.
Fig. 9 c shows the 3rd embodiment of the stringer [22c that comprises one first annular balloon 620 and one second annular balloon 622.First and second annular balloon, 620,622 mutual stringer alignings also are connected by many stringer connecting elements 624.Device 22c is placed in the path at first and the chamber face that makes first annular balloon 620 that fills be close to the first blood vessel BV1 is placed and second annular balloon 622 of going to fill is close to the chamber face of the second blood vessel BV2 and places, and connecting element 624 extends by path 10 stringers.Subsequently, first and second annular air-pockets 620,622 are filled so that the stringer compressing centers on the blood vessel BV of path 10 1With tube wall part and the therebetween tissue part of BV2, shown in Fig. 9 c.Annular balloon element 620,622 can be with gluey or can medical polymer material full, and these materials will solidify after full wholly or in part at ring-type sacculus element 620,622, thus avoid along pipeline spill or annular balloon element 620,622 goes to fill.
Fig. 9 d shows the 4th embodiment of stringer [22d, and it comprises a ring-type first magnet 626 and ring-type second magnet 628, and they connect by many stringer Connection Elements 630.This device 22d is deployed in the path 10 at first, so that first annular magnet 626 is close to the first blood vessel BV 1Chamber surface place and second annular magnet 628 is close to the second blood vessel BV 2Chamber surface place.These annular magnet 626, thus 628 is connected magnet by 630 contacts of magnetic force move toward one another and stringer connecting element and stringer ground, thus oppress blood vessel BV around path 10 1, BV 2Tube wall part and therebetween any tissue.
Fig. 9 e shows the 5th embodiment of stringer exemplary pressure components 22e, and it comprises can inwardly be oppressed and and first circular element 632 and second circular element 634 that connect full by the quilt of first and second sacculus 640,642.At least one connecting element 636 stretches out from the inboard of first circular element 632.In second circular element 634, form at least one correspondence and accept the aperture (not shown), and this size and the structure of accepting aperture is fit to accept connecting element 636, but and is connected with formed sawtooth or other composition surface on the connecting element 636.Device 22e so places in path 10, at first go to insert conduit 638 when full at sacculus 640,642, by path until top loop linear element 632 near the first blood vessel BV 1The surface, chamber, and second circular element 634 is near the second blood vessel BV 2The surface, chamber.Subsequently, air bag 640,642 is filled simultaneously to order about in the circular element 632,634 to move toward one another.When circular element is inwardly driven, the lower limb 636 of first circular element 632 will further move forward into the aperture of accepting of second circular element 634, and the sawtooth on the lower limb 636 is will be by frictional force restrained and be fixed on this acceptance in the aperture (not shown).When reaching to blood vessel BV 1, BV 2Wall and therebetween and during around the desired amount compressing of the tissue of path 10, sacculus 640,642 can go to fill, and the conduit 638 that will have an air bag 640,642 that fills removes, and device 22e is stayed appropriate location in the path 10.
Fig. 9 f-9f " " shows the 6th embodiment of stringer [22f, can be according to the present invention, and it is placed in is formed at two blood vessel BV 1, BV 2Between the outer path 10 of blood vessel in.As shown in the figure, this device 22f comprises many substantially parallel, extend, pre-bending resilience silk elements 646, is arranged as cylindricality usually.Randomly, the column Connection Element 648 that is formed by rigidity or flexible material can be connected to each single silk element 646, so that they keep desired columnar arrangement.Each element 646 all is pre-bending, thereby when pressurized not, the opposite end of each element 646 is with outwardly-bent and make an element become " C " shape configuration substantially, as Fig. 9 f " in shown in the dotted lines.During beginning, 22f is placed in the chamber 652 of tubulose delivery catheter 650 with device.An inner tubular duct element 654 is placed coaxially the chamber 652 of delivery catheter 650.This inner conduit 654 has the distal portions 656 that external diameter reduces.Device 22f is positioned in the tube chamber 652 of conduit 656, thereby each single silk element 646 is limited and is fixed with vertical substantially configuration.The near-end of silk element 646 is trapped between the internal chamber wall on surface and outer conduit 650 outside the distal portions 656 of inner conduit 654, shown in Fig. 9 f '.Device 22f is so implanted in the path 10, at first conduit 650 is put into path 10, so that the delivery catheter far-end and the first blood vessel BV 1The surface, chamber concordant, shown in Fig. 9 f '.Subsequently, inner tubular conduit 654 is advanced so that the far-end of silk element 646 exceeds the far-end of outer conduit 650 to distal direction, thus make the far-end of an element 646 outwardly-bent and near or repressive the first blood vessel BV that inserts 1The surface, chamber, as shown in Fig. 9 f .Subsequently, inner conduit 654 is retreated a little to proximal direction,, and be trapped between the inner chamber face of the distal portions 656 of inner conduit 654 and exterior tube 650 so that the near-end lens of silk element 646 discharge from CONTACT WITH FRICTION.Subsequently, whole conduit 650 is withdrawed to proximal direction, thus with whole device 22f from around the restriction of conduit 650 discharge, and allow the near-end of silk element 646 crooked and near or repressive the second blood vessel BV that inserts 2The surface, chamber, shown in Fig. 9 f .In this way, device 22f can be at the zone compressing blood vessel BV around path 10 1, BV 2Tube wall and any therebetween tissue.In addition, as shown in Fig. 9 f , it will be appreciated that, in the embodiment that adopts column connecting element 648, this column connecting element can comprise one section synthetic or biological restoration graft materials so that forming one deck in path 10 is the liner of column substantially, as shown in Fig. 9 f " ".
It will be appreciated that, though device 22f is described to a pre-bending resilient structures hereinbefore, but silk element 646 also can be formed by ductile metal or other pressure deformable material, and in importing intubate 650, be equipped with a kind of suitable warp tool such as expandable balloon, thereby provide desired pre-bending " C " configuration so that make the end of linear element 646 when passing intubate conduit 650, make its pressure distortion by wish.
ⅴ. a kind of preferred path forms conduit and system
Figure 10 a-11d shows that preferred path forms two kinds of basic embodiments of conduit, and the device that accompanies, and according to the present invention, they combine and form path formation system.Figure 12 a-13b provides a method for optimizing to utilize path shown in Figure 10 a-11d to form conduit and system with at two adjacent blood vessel BV 1, BV 2Between form the substep diagram of the outer path 10 of blood vessel.
With reference to Figure 10 a-10c, shown that preferred path forms first embodiment of pipe guide 100p, it comprises a flexible conduit body 700 that the extension in a chamber 702 is arranged, and this catheter body is passed in these chamber 702 stringers, and ends at a remote outlet aperture 704 at the far-end of this catheter body.Any suitably organizing in the chamber 702 that break-through element 102 is configured in catheter body 700 that comprises shown in Fig. 7 a-7k and describe hereinbefore.Will be appreciated that, the configuration in outlet aperture 704 and chamber 702 can be corrected to be fit to the organizing break-through element to pass any suitable outlet scheme of outlet aperture 704, is included in special those break-through element outlet schemes that show and describe in detail hereinbefore among Fig. 6 a-6i.
Flexible catheter body 700 is preferably by flexible polymer material such as nylon, pebax, and polyethylene etc., or ductile metal tubing such as thin-walled hypotubing form.Metal braid or other reinforcement material can be embedded on the wall of catheter body 700 or be formed in its wall, structural reinforcing to be provided and catheter body 700 can be rotated or distortion and unsuitable distortion or curl.In addition, organizing break-through element 102 to comprise in the embodiment of a pre-bending resilient element or pin, inflexible pipe fastening element 701 can be set near the distal portions in chamber 702 of catheter body 700, shown in Figure 10 b, so that the pre-bending distal portions for break-through element 102 provides rigid constraint when break-through element 102 is retracted into the chamber 702 of catheter body 700.The existence of this conduit fastening element 701 can prevent to organize any sharp distal head damage on the break-through element 102 or puncture into the soft relatively plastic material of making catheter body 700.
Portion of the handle 706 is installed in the near-end of flexible conduit body 700.Portion of the handle 706 comprises an outer rigid housing, form therein one basic for column, hollow cavity 712.Organize the proximal part of break-through element 102 to extend into the cavity 712 of portion of the handle 706.An activation button 710 is connected with organizing break-through element 102, as shown in Figure 10 c.Activation button 710 can be pressed and advance to cause that organizing break-through element 102 to pass exports aperture 704, reaches the purpose that forms the outer path 10 of blood vessel of the present invention to distal direction.Subsequently, activation button 710 can retreat to proximal direction, so that organize the break-through element to be retracted in the chamber 702 of flexible conduit body 700.
Randomly, a kind of imaging catheter side pipe 720 can be connected in the distal portions of flexible conduit body 700, and this imaging catheter side pipe 720 comprises an extension, has a chamber 722 to extend along its stringer in this extension.At next-door neighbour's outlet aperture 704 places, there is a window 724 to be formed at the upper side wall of side pipe 720.A kind of imaging catheter 50, for example commercially available from BostonScientific/ cardiovascular imaging company, Massachusetts; The pleasonton of Endosonics company, California: and Hewlett-Packard, North Andover, the blood people ultrasound catheter of several models of Massachusetts, can be inserted in the chamber 722 of side pipe 720, so that sensor part 52 (for example, the part of emission of imaging ultrasound ripple and acceptance) is placed in window 724 sides.Make the material of side pipe 720 preferred a kind of prevent the kind of energy that imaging catheter 50 utilized (as, ultrasonic) material that transmits, but window 724 can be an open bore, or is covered by a kind of material that can be penetrated by the energy that imaging catheter 50 is utilized.By this way, the sensor part 52 of imaging catheter 50 will only be accepted and the be in line image in the zone of arranging of window 724.In addition, window 724 is excellent for right angle configuration and be restricted to side pipe 720 sidewalls of the outlet aperture 704 of next-door neighbour's flexible conduit body 700.In this way, the specific size of this window 724, structure and position, can allow user to finish the accurate rotation location of pipe guide 100p as follows, promptly, by rotary apparatus 100p simply (for example up to destination organization, other blood vessel) can be through window 724, clearly see by imaging catheter, thereby indicate that 704 location, young hole are correct, so that organize break-through element 102 can cause organizing break-through element 102 to pass the blood vessel wall at pipe guide 100p place, and enter destination organization (for example, other blood vessel) through passing subsequently of aperture 740 of outlet.And this location of window 724 will allow pipe 50 to be used to the actual motion and the break-through of tissues observed break-through element 102, thereby guarantee that the outer path of blood vessel forms in desired position.
Form another selection of window 724 as can be in side pipe 720 isolating position, the far-end of side pipe 720 can be positioned at organizes break-through element 102 to pass near the position of catheter body 700, and the sensor part 52 of imaging catheter 50 can be stretched out and reach beyond the far-end of side pipe 720 simply, thereby makes its clearly expansion and motion of display organization break-through element 102.In this can select to be provided with, the visual field that imaging catheter 50 shows will no longer be subjected to the restriction or the constraint of window 724, and imaging catheter 50 can be to comprehensive 360 ° of scope imagings around the far-end of side pipe 720.Thereby, the labelling apparatus of any suitable type or marker material can be formed at pipe guide 100p or organize on the break-through element 102p, so that make before organizing break-through element 102 imaging catheter 550 can be used for exercising desired function placing or start, promptly determine the correct rotation location of pipe guide 100p.
In addition, as mentioned above, guidewire lumen 726 can be by organizing 102 stringers of break-through element to extend and can ending at a seal wire outlet aperture 728 of organizing break-through element 102 far-ends to form at far-end.In this way, seal wire GW can be by organizing break-through element 102 to extend and can advancing to outside the seal wire outlet aperture 728.
Be provided in the embodiment of organizing break-through element 102 of guidewire lumen 726 and seal wire outlet aperture 728 at far-end, the existence of seal wire GW can be used as a kind of means and organizes the far-end of break-through element 102 when to penetrate target vessel lumen or other chamber or open area with accurate mensuration in the chamber 726.For finishing this point, when organizing break-through element 102 to pass the wall of blood vessel at pipe guide 100p place and during any other extravascular tissue that passes that path 10 will pass through, the pressure to distal direction successive or that be interrupted will be added on the seal wire GW.As long as the end of organizing break-through element 102 is near tissue, seal wire GW just can not expose or pass distal guide wire outlet aperture 728, and correspondingly, the pressure to distal direction that is applied to seal wire GW will run into because the resistance that exists the tissue near seal wire outlet aperture 728 to cause.Yet when organizing break-through element 102 target approach lumen of vessels or other open space, owing to the pressure that has applied to it to distal direction, seal wire outlet aperture 728 will be opened immediately, and seal wire GW will pass seal wire outlet aperture 728 fast.The far-end that the quick propelling of this seal wire GW is organized break-through element 102 with prompting operation person is target approach lumen of vessels or other open space in fact.At this moment, organize the propelling of break-through element 102 to stop wittingly, to avoid the organizing break-through element to penetrate any probability of oppose side wall or other tissue of open area opposite side that path 10 extends therein of target blood.
Figure 10 c '-10c provides and can integrate with path and form the device sketch map of conduit 100p with the pressure that seal wire GW given successive or the sensing far-end that is interrupted, as mentioned above, when target approach lumen of vessels or other open space of the far-end that is used to determine to organize break-through element 102.Consult Figure 10 c '-10c , device 800 comprises one or more spring 802 (springs), and these springs are connected to the part of the seal wire GW outside the near-end that protrudes in catheter body 700 by connecting element 804.It will be appreciated that device 800 can be integrated with in the inner chamber 712 of portion of the handle 706, or makes the individual of the near-end that can be installed in portion of the handle 706.
As shown in Figure 10 c, before the operation beginning, seal wire GW can freely stretch out the outlet aperture 728 of the far-end of organizing break-through element 102, thereby makes 802 one-tenth a kind of lax (for example, tightening up) states of spring element of device 800.
Figure 10 c " show; when organizing break-through element 102 to advance; the far-end of seal wire GW will keep concordant with outlet aperture 728 by tissue; and install 800 spring element 802 and will form tensioning (for example, being elongated) state to the pressure of the sensing far-end that adjacent tissue applied owing to the far-end of seal wire GW.
Figure 10 c shows, when the distal tip of organizing break-through element 102 appears in lumen of vessels or other open area, seal wire GW will advance to outside the seal wire outlet aperture 728 immediately, thus (for example, the shortening) state that allows that the spring element 802 of device 800 becomes to relax once more.Seal wire this advances suddenly and loosening of spring element 802 will show to the operator, organizes break-through element 102 to reach in lumen of vessels or other open space, and should stop further to advance organizing break-through element 102.
As mentioned above, should be familiar with and understand that the pressure applying means of description and demonstration is chosen wantonly among Figure 10 c '-Figure 10 c , needn't be included among the parts of vessels 100p.And, should understand and appreciate, drive seal wire GW constantly or discontinuously to distal direction and can manually finish (that is, manual operations), and do not need to use any device.
Figure 11 a-11d shows that preferred path forms conduit and the 100p of system and can be corrected the method for organizing break-through element 102f with the specific type that is adapted at showing among Fig. 7 f and describe in detail hereinbefore.This particular tissues break-through element can advance epitheca 326 to form by an inner piercing elements 322 and a stringer.
Figure 11 a-11d shows a kind of preferred pipe guide 100P ' through revising, above-mentioned embodiment as pipe guide 100P, this pipe guide comprises a flexible conduit body 700 (chamber 702 being arranged by this flexible body longitudinal extension), a portion of the handle 706 (having an inner chamber 712 to be formed at wherein), with an imaging catheter side pipe (having a chamber 722 and window 724 to be formed at wherein), all these describe in detail hereinbefore.
In this embodiment of pipe guide 100P ', portion of the handle 706 is corrected with in conjunction with the first and second activation button 710a, 710b.The first activation button 710a is connected to the pre-bending resilience inner member 322 that has sharp keen trocar tip 324 on its far-end.Second drives knob 710b is connected in a tapered flexible sheath 326, and this sheath can longitudinally advance on inner member 322 in the mode of above describing in detail, consults Fig. 7 f.Therefore, in this embodiment through changing of pipe guide 100P ', inner member 322 and the sheath 326 that centers on can utilize activation button 710a, and 710b advances independently and retreats.
It will be appreciated that, when the no any guidewire lumen of inner member 326, whether can choose wantonly apply successive or pressure from the sensing far-end that is interrupted to outer sheath 326 to realize identical tube chamber feedthrough signal function, consult Figure 10 c '-10c .Correspondingly, constant or interruption compression spring device 800 can be connected in this embodiment mesotheca 326 of parts of vessels 100p ', so that promote sheath 326 to distal direction with same procedure described in the seal wire GW among Figure 10 c '-10c , perhaps, also can finish (if desired) by manual technology.
Parts of vessels 100 and other parts described herein and device can be in many ways in conjunction with the unique system of implementing method of the present invention with formation.This system described herein should be understood that one or more combination of the described various functional ingredients that itemize.The ingredient of these systems can machinery each other or temporary transient relation in be used, realizing new method described herein, and can in possible any one of many combinations that can realize described target, use.This system can comprise on the size and is fit to put into blood vessel, and can be advanced into the catheter body at outer target of next-door neighbour's blood vessel or adjacent blood vessel target place.All right certain mode of this conduit is in conjunction with one or more described actives or Passive Location, to help conduit correct location with respect to target in blood vessel.And, thereby conduit can form path from the blood vessel to the target in conjunction with at least a break-through element of organizing.This system also can insert seal wire in the path in conjunction with a kind of size that has been designed, and this seal wire can import so that its inlet passage and the track that leads to target is provided by conduit.Native system also can be in conjunction with the arrangement of one or more parts that can place or insert by seal wire, and for example pipeline manufactures the instrument of keeping according to size or for other parts of finishing treatment or diagnosis terminal point.In addition, native system can comprise one or more various blood vessel blocking methods, allows blood fixed line again so that the blood vessel effectively relevant with the outer path of blood vessel of the present invention can be blocked or close.
ⅵ. path forms the operation of the preferred embodiment of conduit and system
Figure 12 a-12d provides the progressively diagram of the method for optimizing of first embodiment of organizing break-through parts of vessels and the 100p of system shown in use Figure 10-10c .
Figure 13 a-13b provides the progressively diagram of the method for optimizing of second embodiment of using preferred path to form parts of vessels and the 100p ' of system.
With reference to Figure 12 a-12d, imaging catheter 50 is inserted into the chamber 722 of side pipe 720 so that the imaging sensor part 52 of conduit 50 is placed near the window 724.In this way, imaging catheter 50 and path form parts of vessels 100 ' combine and formed according to one " system " of the present invention.Organizing break-through element 102 to be retracted into the chamber 704 of flexible conduit body 700 so that organize the distal tip of break-through element 102 to hide under the situation in the tubulose fastening element 701, the system that comprises pipe guide 100p and imaging catheter 50 is inserted into mammals patient's blood vessel, and propelling is placed in the contiguous second blood vessel BV until the far-end of catheter body 700 and the far-end of side pipe 720 2The first blood vessel BV at place 1In, purpose is to form the first blood vessel BV 1With the second blood vessel BV 2Between path 10.
Parts of vessels 100p is rotated subsequently until the wild IF of imaging that sees through window 724 by imaging catheter 50 and clearly sees the second blood vessel BV that path 10 will extend into 2This shows that parts of vessels 100t has placed correct spin orientation to form path 10 to allow to organize break-through element 102 in desired position, and makes it extend into the second blood vessel BV2.Subsequently, activation button 710 will be pushed ahead until the distal tip of organizing break-through element 102 and be begun to pass the first blood vessel BV 1Wall.Randomly, when organizing break-through element 102 to move on, the pressure of sensing far-end interruption or that continue can put on seal wire GW by hands (manually promptly) or by pressure applying means 800.
With reference to Figure 12 b, in case organize the distal tip of break-through element 102 to enter the second blood vessel BV 2Tube chamber, seal wire GW will advance to distal direction immediately, thus prompting operation person organizes the propelling of break-through element 702 to stop.At that time, the operator will no longer continue the propelling of activation button 710.
Subsequently, activation button 710 will be retreated to its most proximal end, so that will organize break-through element 102 to be retracted in the chamber 702 of catheter body 700, and allow seal wire GW keep extending the path 10 of new formation and entering the second blood vessel BV 2Tube chamber.
As shown in Figure 12 c, path forms parts of vessels 100p and can extract out and remove in body subsequently with the imaging catheter 50 that accompanies, and stays seal wire GW through the first blood vessel BV 1, pass path 10 and enter the second blood vessel BV 2Place.
As shown in Figure 12 d, a kind of path correcting device 500, for example the path correcting device 500 of any kind shown in Fig. 8 a-8h can be pushed ahead to revise (for example enlarge, cutting tissue is handled, bag quilt etc.) path 10 with tailing edge seal wire GB.
It will be appreciated that after step was finished shown in Figure 12 v, seal wire GW can stay in the path 10 original position to allow any required stante fixed mould (stents) shown in Fig. 9 a-9f, Si Tante is the film graft fixedly, or path restraint device 22 launches in path 10.
Figure 13 a-13e has illustrated and has been used to utilize path shown in Figure 11 a-11b to form the progressively method for optimizing through the correction embodiment of parts of vessels and the 100p of system.
At first, desired imaging catheter 50 is inserted into the chamber 722 of side pipe 720, forms " system " so that video picture conduit 50 and path formation pipe guide 100p ' combine and become a path.
Path forms conduit 100p and is positioned at the first blood vessel BV with the imaging catheter 50 that accompanies by the far-end that advances vascular system to catheter body 700 and side pipe 720 subsequently 1Be close to the second blood vessel BV 2The place will form a path 10 between these two blood vessels.Imaging catheter 50 is given energy by adding then so that the sensor part 52 of imaging catheter can be accepted image by window 724 in the wild IF of imaging.Image-forming block 100p ' is rotated the second blood vessel BV that will extend into until path 10 subsequently 2Pass through clearly imaging of imaging catheter 50 through window 724.This shows that the correct spin orientation of parts of vessels 100p ' and location obtain.And, but pipe guide 100p ' stringer is moved until observe the second blood vessel BV in the wild IF of imaging 2In desired flow performance, thereby show that parts of vessels 100p is in its correct stringer position.In addition, imaging catheter 50 can be used to determine the first blood vessel BV 1With the second blood vessel BV 2Between distance to organize break-through element 102f to form desired from the first blood vessel BV so that limit 1To the second blood vessel BV 2Path 10 and should unfolded distance.
Shown in Figure 13 a, by stringer ground with after locating rotatably, organize break-through element 102f to be extended to outside the catheter body 700, and begin to pass the first blood vessel BV at conduit 100p ' 1Wall advances.The position of organizing the epitheca 326 of break-through element 102f to be in slightly to retreat is so that the far-end that sheath 326 is extended at trocar tip 324 is desired through organizing break-through to finish.
In organizing the advancing of break-through element 102f shown in Figure 13 a, Manual pressure or can be used to apply the pressure that points to far-end to sheath 326 by installing 800 applied pressures.In this way, enter the second blood vessel BV when the trocar tip 324 of organizing break-through element 102f 2During the chamber, sheath 326 will advance immediately and enter the second blood vessel BV 2The chamber, thus the desired path 10 of prompting operation person has formed and should stop organizing being advanced further of break-through element 102f.
Figure 13 b is shown, enters the second blood vessel BV at sheath 326 2Behind the chamber, the band trocar tip element 322 of extension can be drawn out of and remove, thereby stays sheath 326 as the pipeline by path 10.
As shown in Figure 13 c, seal wire GW can pass the chamber of sheath 326 subsequently and enter the second blood vessel BV 2
Then, shown in Figure 13 d, path forms parts of vessels 100p ' and can extract out and remove from catheter body with the imaging catheter 50 that accompanies, thereby makes seal wire GW stay original position, and through the first blood vessel BV 1The chamber is passed path 10 and is extended into the second blood vessel BV 2
Afterwards, shown in Figure 13 e, the path correcting device 500 of any suitable type can advance along pre-aligned seal wire GW to reach desired path 10 correction effects.
It will be appreciated that the present invention is above only by describing in detail with reference to some particular and embodiment.The possible embodiment of institute of the present invention is described in limit under wraps, or each method that provides the present invention to be put into practice.In fact, one skilled in the art will recognize that, can carry out various interpolations, subdue, revise and change and do not leave the spirit and scope that the present invention means above-mentioned embodiment and embodiment.Thereby, should be intended to all this interpolations are subdued, correction and change are included in the scope of following claims.

Claims (94)

1. the method for a revascularization, described method comprises the following step:
A) form path outside the blood vessel between the second position on the primary importance on a blood vessel and the blood vessel, so that contain PO 2At least 50 blood flow is crossed the outer path of described blood vessel.
2. the process of claim 1 wherein that the described primary importance and the second position are positioned at least one cardiovascular.
3. the process of claim 1 wherein that the described primary importance and the second position are positioned on the same vessel.
4. the process of claim 1 wherein that the described primary importance and the described second position are positioned on the different blood vessel.
5. the method for claim 4, wherein said blood vessel is a tremulous pulse and a vein.
6. the method for claim 4, wherein said blood vessel is a vein and a vein.
7. the method for claim 4, wherein said blood vessel is a tremulous pulse and a tremulous pulse.
8. the method for claim 4, the outer path of wherein most described blood vessels is formed between described blood vessel.
9. the process of claim 1 wherein that the outer path of described blood vessel is to give to block, damage or ill blood vessel sections adds bypass and forms.
10. the process of claim 1 wherein that described primary importance is positioned on the tremulous pulse and the described second position is positioned on the vein, thereby make blood enter described vein by the outer path of described blood vessel from described tremulous pulse.
11. the method for claim 10 wherein enters described venous blood by the outer path of described blood vessel and is caused by described vein mobile so that by vein blood vessel system reverse perfusion tissue subsequently.
Flowed so that by vein blood vessel system reverse perfusion tissue 12. the method for claim 11, wherein said blood cause through this vein, this reverse perfusion be by:
B) position of path is blocked described vein and is flowed into described venous blood through described vein with path outside causing by described blood vessel outside contiguous described blood vessel, according to causing the described direction of reverse perfusion of organizing through the vein blood vessel system to flow.
13. the process of claim 1 wherein that path is to be formed at path outside first blood vessel and the intervascular article one blood vessel of second outside the blood vessel that forms in step a, so that contain PO 2At least 50 blood is from first blood vessel, flows and enters second blood vessel by the outer path of described blood vessel.
14. the method for claim 13, wherein said method also comprises following step:
B) between another blood vessel of described second blood vessel and heart, form the outer path of at least one, the second blood vessel and flow into another blood vessel subsequently through the outer path of described second blood vessel so that enter the blood of second blood vessel through the outer path of first blood vessel.
Flowed into other blood vessel 15. the method for claim 14, wherein said blood flow cause through the outer path of second blood vessel, its method is:
C) the path place blocks second blood vessel outside contiguous second blood vessel, flows back to described another blood vessel from described second blood vessel through path outside described second blood vessel to cause described blood.
16. the process of claim 1 wherein that one of described at least first and second positions are positioned on the blood vessel, this blood vessel is that wherein there is the part of obstruction, damage or an ill segmental vascular system in blood vessel.
17. the process of claim 1 wherein the following execution of step a of described method:
ⅰ) provide the path of the flexible conduit body that comprises extension to form parts of vessels, this flexible conduit body have one can pass through therefrom organize the break-through element, to pass the blood vessel wall that described catheter body is inserted;
ⅱ) described catheter body is inserted vascular system and place described catheter body so that organize the break-through element to be positioned to form near the position of the outer path of described blood vessel;
ⅲ) with described organize the break-through element from described catheter body by so that form path outside the described blood vessel according to the step a of described method.
18. the method for claim 17, wherein step ⅰ also comprises:
A kind of localization method is provided, be used to locate described first and second positions and determine parts of vessels direction in case conduit organize the break-through element from described primary importance by arriving the described second position, thereby form path outside the described blood vessel between the described second position on the described primary importance on a blood vessel and the blood vessel.
19. the method for claim 17, wherein the parts that provide among the step ⅰ organizes the break-through element also in conjunction with a chamber, with described when organizing the break-through element to produce outside the described blood vessel path seal wire can pass through this chamber, and wherein said method also comprises following step:
Make a seal wire by described chamber and allow described seal wire to keep and to extend in outside the described blood vessel in the path, thereby be ready to, on described seal wire, advance one or more other device subsequently through described path in the back of withdrawing from and remove of described conduit.
20. having tremulous pulse and vein to be formed at a kind of method that coronary vasodilator reproduces in wherein the mammals heart, described method comprises the following step:
The path formation conduit that is used for forming path outside the blood vessel between two blood vessels is provided;
Described conduit inserted peripheral blood vessel and described conduit is advanced into the blood vessel of heart;
Use described conduit between the cardiovascular at conduit place and another cardiovascular, to form at least one the first outer paths of blood vessel, so that blood path and flow into another blood vessel outside a blood vessel passes through blood vessel.
21. the method for claim 20, wherein said at least a path are formed at the dirty tremulous pulse and uniting as one between dirty vein of uniting as one, so that enter cardiac veins through the outer path of at least one described blood vessel from the blood of tremulous pulse.
22. the method for claim 21 is flowed by cardiac veins vascular system reverse perfusion heart tissue thereby wherein impel subsequently by vein from the arterial blood of heart arter inflow cardiac veins.
Flowed 23. the method for claim 22, wherein said arterial blood impel through vein, thereby pass through cardiac veins vascular system reverse perfusion heart tissue by rightabout the flowing of the blocking-up of path place outside adjacent blood vessel through vein.
24. the method for claim 21, wherein this method also comprises:
Use described conduit to form path outside at least one the second blood vessels from described cardiac veins to described heart arter, so that enter can flow through the subsequently outer path of described at least one the second blood vessels and enter the dirty tremulous pulse of uniting as one of the arterial blood of described cardiac veins, thereby by heart arter vascular system perfused hearts tissue.
25. the method for claim 20, wherein said method be in order to be embodied as one section obstruction, damage or diseased heart tremulous pulse sections add the purpose of bypass.
26. the method for claim 25, wherein said revascularization has the rotation tremulous pulse, and the heart large vein is implemented in the mammals heart of anterior interventricular vein and left anterial descending artery, purpose for block, damage or ill rotation tremulous pulse sections add bypass, wherein said method also comprises:
ⅰ. between left anterial descending artery and anterior interventricular vein, form path outside first blood vessel;
ⅱ. between position of downstream part of heart large vein and the obstruction of rotation tremulous pulse, impaired or ill sections, form path outside second blood vessel; With
ⅲ. make blood from left anterial descending artery path outside first blood vessel, flow into the heart large vein, and path enters the obstruction that rotates tremulous pulse through second blood vessel outside, the downstream part of impaired or ill sections through anterior interventricular vein.
27. the method for claim 26, wherein step ⅲ finishes by the blocking-up anterior interventricular vein chamber, position of path outside contiguous first blood vessel.
28. the method for claim 27, wherein step ⅲ also finishes by the position blocking-up heart large vein chamber of path outside contiguous second blood vessel.
29. the method for claim 28, wherein said revascularization has the rotation tremulous pulse, and the heart large vein is implemented purpose for blocking in the mammals heart of anterior interventricular vein and left anterial descending artery, impaired or ill left anterial descending artery sections adds bypass, and wherein said method also comprises:
ⅰ. between rotation tremulous pulse and heart large vein, form path outside first blood vessel;
ⅱ. at the obstruction of anterior interventricular vein and left anterial descending artery, form the outer path of second blood vessel between position of downstream part of impaired or ill sections;
ⅲ. impel blood from the rotation tremulous pulse, path through first blood vessel outside, through heart large vein inflow anterior interventricular vein, and path enters the obstruction of left anterial descending artery, impaired or ill sections downstream outside second blood vessel.
30. the method for claim 29, wherein step ⅲ finishes by the position blocking-up heart large vein chamber of path outside contiguous first blood vessel.
31. the method for claim 30, wherein step ⅲ also finishes by the blocking-up anterior interventricular vein chamber, position of path outside contiguous second blood vessel.
32. a method that is used for implementing in an individual internal object position medical procedure in the mammals body, described method comprises the following step:
A) settle a parts of vessels in blood vessel, these parts comprise:
ⅰ) has the flexible conduit body of a proximal end and a distal tip;
ⅱ) organize the break-through element for one, it can pass through to outside the primary importance on described catheter body, to form path outside the blood vessel at conduit place extends to a blood vessel of described blood vessel ectosome internal object position;
B) primary importance that makes catheter body is with respect to body internal object orientation for place, so that the primary importance of organizing the break-through element can be transported to catheter body forms the outer path of a blood vessel between described blood vessel and described body internal object position outward;
C) make that to organize the break-through element to pass through to catheter body outer to form the outer path of described blood vessel between described blood vessel and described body internal object position; With
D) path transports at least a operation device for carrying out said outside described blood vessel, and uses this operation device for carrying out said to implement described medical procedure in described body internal object position.
33. the method for claim 32, wherein said medical procedure are to carry a kind of flowable mass, and wherein said operation device for carrying out said comprises a tubular sleeve, can be transported to institute to described blood vessel external position by the described flowable mass of this sleeve pipe.
34. the method for claim 32, wherein said medical procedure is to implant a kind of implantable medicine vehicle, and wherein said operation device for carrying out said is a kind of being used for described medicine vehicle by the outer path transmission of described blood vessel, and described vehicle is implanted the implanting device of described blood vessel external position.
35. the method for claim 32, wherein said medical procedure is to implant for radiocurable radioactivity material, and wherein said operation device for carrying out said is a kind of being used for this radioactivity material by the outer path transmission of described blood vessel, and described radioactivity material is implanted the implanting device of described blood vessel external position.
36. the method for claim 32, wherein said medical procedure are to implant a kind of stimulator device and wherein said operation device for carrying out said to comprise a kind of being used for described stimulator device by the outer path transmission of described blood vessel and be used for described stimulator device is implanted the implanting device of described blood vessel external position.
37. the method for claim 32, wherein said medical procedure are to implant a kind of sensor device and wherein said operation device for carrying out said to comprise and be used for described sensor device by the outer path transmission of described blood vessel and be used for described sensor device is implanted the implanting device of described blood vessel external position.
38. the method for claim 32, wherein said medical procedure are to implant a kind of electrode assembly and wherein said operation device for carrying out said to comprise and be used for described electrode assembly by the outer path transmission of described blood vessel and be used for described electrode assembly is implanted the implanting device of described blood vessel external position.
39. the method for claim 32, wherein said medical procedure is to implant a kind of emitter apparatus, and wherein said operation device for carrying out said comprises and is used for described emitter apparatus by the outer path transmission of described blood vessel and be used for described emitter apparatus is implanted the implanting device of described blood vessel external position.
40. the method for claim 32, wherein said medical procedure is to implant a kind of acceptor element, and wherein said operation device for carrying out said comprises and is used for described acceptor element by the outer path transmission of described blood vessel and in the implanting device of described acceptor element being implanted described blood vessel external position.
41. the method for claim 32, wherein said medical procedure is to implant a kind of transponder device, and wherein said operation device for carrying out said comprises and is used for described transponder device by the outer path transmission of described blood vessel and be used for described transponder device is implanted the implanting device of described blood vessel external position.
42. the method for claim 32, wherein said medical procedure are to implant a kind of supporting element device and wherein said operation device for carrying out said to comprise and be used for described supporting element device by the outer path transmission of described blood vessel and be used for described supporting element device is implanted the implanting device of described blood vessel external position.
43. the method for claim 32, wherein said supporting element is a kind of stante fixed mould, it at first takes a kind of compact configuration during path outside by this blood vessel, then expand into a kind of configuration of operating later on so that at least a morphological structure that is positioned at described blood vessel external position is produced structural support.
44. the method for claim 32, wherein said medical procedure are to implant a kind of labelling apparatus and wherein said operation device for carrying out said to comprise and be used for described labelling apparatus by the outer path transmission of described blood vessel and be used for described labelling apparatus is implanted the implanting device of described blood vessel external position.
45. the method for claim 44, wherein said labelling is formed by radiation video picture visual material.
46. the method for claim 32, wherein said medical procedure are that tissue wears down, and wherein said operation device for carrying out said is that a kind of tissue wears down device.
47. the method for claim 32, wherein said medical procedure is a disorganization, and wherein said operation device for carrying out said is a kind of disorganization device.
48. the method for claim 32, wherein said medical procedure are the tissue cuttings, and wherein said operation device for carrying out said is a kind of cutter sweep of organizing.
49. the method for claim 48, wherein medical procedure is the cross-section of nerve, and wherein said operation device for carrying out said is the nerves transected device.
50. the method for claim 32, wherein medical procedure is biological fluidic sampling, and wherein said operation device for carrying out said is can be by it with the sleeve pipe of biological fluid sample from the sucking-off of described blood vessel external position.
51. the method for claim 32, wherein medical procedure is the sampling of solid matter, and wherein said operation device for carrying out said is a kind of device of the solid matter sample being removed from described blood vessel external position of being used for.
52. the method for claim 51, wherein said medical procedure are a kind of biopsies, and wherein said operation device for carrying out said is a kind of a kind of biopsy instrument that tissue fragment is cut off and obtains from described blood vessel external position of being used for.
53. the method for claim 32, wherein said method also comprises:
After implementing described medical procedure, from vascular system, extract described conduit out.
54. the method for claim 32 also comprises:
A tubular sleeve is placed the outer path of described blood vessel and makes described tubular sleeve remain resident in path outside the described blood vessel after described tubular sleeve is extracted out and removed.
55. the method for claim 54, wherein said tubular sleeve in being present in extends to position in the body from described blood vessel external position, so as from described blood vessel external position to described second position drain fluids.
56. the method for claim 54, the tubular sleeve in wherein said being present in can be approaching from any external position, is transported to described blood vessel external position to allow desired material through described sleeve pipe.
57. the method for claim 56, wherein said sleeve pipe is through the outer path of described blood vessel, and through the vascular system extension, and be connected to can be from an external position approaching subcutaneous injection opening, to allow the flowable mass percutaneous injection to go into described injection openings and to be transported to described blood vessel external position by the sleeve pipe in described being present in.
58. the method for claim 53, wherein said method also comprises: after described medical procedure was finished, the opening of path from formed blood vessel closed outside the blood vessel.
59. the method for claim 58, closing by launching a kind of blood vessel wall shutoff device of opening described in its medium vessels undertaken, and this device is selected from one group of device being made up of following:
The energy emission element;
The cautery parts;
Suture part;
Order and close parts (stapling device);
Graft in the blood vessel;
Si Tante is the interior graft of film blood vessel fixedly;
Sacculus;
Coil;
Article one, blood coagulation produces material;
Microfibre collagen;
Gelatin (collagen sponge);
Cellulose gel; With
Its combination.
60. the parts of vessels that can insert blood vessel and can be used for forming the outer path of blood vessel, this path extends to an individual internal object position through the vascular wall that parts of vessels inserted, and described pipe guide comprises:
Flexible conduit body with near-end and distal tip;
The primary importance that can pass on the catheter body is worn with the tissue that forms the outer path of described blood vessel
Logical element; With
Be used at least determining the appropriate localized directional orientation tool of the spin orientation of catheter body, so that organize the break-through element to pass path outside the described blood vessel that will form between described blood vessel and described body internal object position subsequently from catheter body with primary importance on the facilitation catheter body.
61. the parts of claim 60, wherein said primary importance is that the outlet aperture and the described break-through element of organizing that form in described catheter body far-end can pass described outlet aperture, and wherein said when organizing the break-through element to be adapted at it to pass the described outlet aperture that is formed at described catheter body distal tip by the first direction bending, thereby the vascular wall that the break-through conduit is inserted.
62. the parts of claim 60, wherein said primary importance are outlet apertures that forms in described catheter body sidewall; The wherein said break-through element of organizing, blood vessel wall that can penetrating catheter inserted when passing the described outlet aperture that is arranged in described catheter body sidewall.
63. the parts of claim 60, the wherein said break-through element of organizing comprises a pliable and tough syringe needle that the extension of a sharp distal tip of tool and a pre-bending resilience pin element is installed therein, and described pin element can cause effectively that described pliable and tough syringe needle is by the first direction flexing.
64. the parts of claim 60, the wherein said break-through element of organizing is a kind of element of extension, and it comprises:
ⅰ) have distal tip pliable and tough near-end long handle and
ⅱ) form and be installed in the sharp tip element of tool on the far-end of described pliable and tough near-end long handle by rigid material.
65. the parts of claim 60, the wherein said break-through element of organizing comprises an elasticity pre-bending element that has the sharp distal tip of tool.
66. the parts of claim 65, wherein said syringe needle by a kind of be that hyperelastic material forms in inserting the mammals body time.
67. the parts of claim 66, wherein said elastic material are a kind of Nitinol.
68. the parts of claim 66, wherein said pre-bending resilient element is the hollow needle that stringer therein is extended with a cavity.
69. the parts of claim 66, wherein said pre-bending resilient element are a kind of entity pins.
70. the parts of claim 60, the wherein said break-through element of organizing is included in the extending element that has formed a cannula tip on its far-end, with one around the described pin arrangements of components and the pipe sheath that can move with respect to the stringer of described pin element.
71. the parts of claim 60, wherein saidly organize the break-through element to comprise one to have energy emission distal tip extending element formed thereon, described energy emission distal tip effectively emitted energy and facilitation described organize the break-through element through organizing break-through.
72. the parts of claim 60 wherein organize the energy emission distal tip on the break-through element to be selected from one group of energy discharger described, comprise:
The resistance heated tip;
One pole electrotome tip;
Bipolar electrotome tip;
The ultrasound emission tip element; With
The combination that it is possible.
73. the parts of claim 60 are wherein saidly organized the break-through element to comprise one to have and have the extending element that the far-end of cutter sweep is organized in a rotation formed thereon.
74. the parts of claim 60, the wherein said break-through element of organizing is a kind of energy stream that can pass the described exit opening that is formed in the described catheter body.
75. being selected from, the parts of claim 60, wherein said energy stream comprise one group of following kind of energy;
Laser;
Heat;
Ultrasonic; With
The combination that it is possible.
76. the parts of claim 60, wherein saidly organize the break-through element to comprise one to have an extending element that passes the tube chamber that wherein stringer extends, described tube chamber can be connected with negative pressure source, will organize this tube chamber of suction by the described far-end of break-through element of organizing.
77. the parts of claim 60, the wherein said break-through element of organizing comprises:
Pre-bending resilience pipe sheath with open distal end; With
Extending element with the sharp distal tip of tool, described extending element are positioned in the described pipe sheath and along it and push ahead, so that the sharp distal tip goes out cruelly outside the open distal end end of pipe sheath;
Described extending element is by enough pliable and tough and to adapt to the material of the pre-bending configuration of managing sheath constructed.
78. the parts of claim 60 also comprise:
Be connected in side pipe (car) device of at least one place distal portions of flexible conduit body, described side pipe device is fabricated can accept a kind of imaging catheter therein so that imaging catheter can be used for tissues observed break-through element passing with the primary importance on the catheter body.
79. the parts of claim 78, wherein said side pipe are by a kind of energy to the impermeable material of small part that image-forming block utilized to be formed, and wherein said side pipe also comprises:
The above primary importance place of next-door neighbour's catheter body forms and allows described image-forming block can observe the described window of organizing the break-through element to pass the described primary importance on the catheter body and pass conduit place vascular wall in described side pipe.
Described organizing on the direction that the break-through element can pass through when 80. the parts of claim 79, wherein said window are located in outside producing described blood vessel path;
Thereby described window comprises at least a portion of described directional orientation tool, thereby the orientation of described catheter body primary importance can see that until the imaging device that is arranged in side pipe drafting the target site that will form path controls by the rotary guide pipe parts, thereby guarantees to be in suitable spin orientation organizing the break-through element to pass outlet aperture dummy pipe parts.
81. the parts of claim 60, wherein catheter body is formed by flexible plastic material, and wherein around the part of described catheter body tube chamber, contiguous outlet aperture place has been placed a kind of rigid conduit fastening element, organizes when preventing to organize the break-through element to be retracted in the catheter body break-through element to rest on flexible plastic material contact condition with catheter body.
82. the parts of claim 60, it also comprises:
Be installed in a portion of the handle of described catheter body proximal end, described portion of the handle have one with the described activation button of organizing the break-through element to be connected, described activation button can be advanced advancing the described break-through element of organizing to leave described outlet aperture to first direction, and can retreat so that the described tube chamber of organizing the break-through element to be retracted into described catheter body to second direction.
83. comprise a kind of system that claim 60 path forms parts of vessels, its also combination:
Can with the common suitable localized imaging device that uses with primary importance on the further facilitation catheter body of described directional orientation tool.
84. the system of claim 83, wherein said imaging device is selected from following one to be formed as device, comprising:
Supersonic imaging device;
The doppler imaging device;
Radiation video picture imaging device;
MR imaging apparatus;
The magnetography device; With
The combination that it is possible.
85. the system of claim 84, wherein said device is a kind of imaging catheter.
86. the system of claim 85, wherein path forms the side pipe device that parts of vessels also comprises at least one place distal portions that is connected in the flexible conduit body, described side pipe device is fabricated so that accept imaging catheter therein, thereby makes imaging catheter can be used for tissues observed break-through element the passing through of primary importance from the catheter body; And,
Described imaging catheter is placed in the described side pipe device at least in part.
85. the system of claim 84, wherein said side pipe device is formed by the employed energy of a kind of picture conduit to the permeable material of small part, and wherein said side pipe device also comprises:
The above primary importance place of next-door neighbour's catheter body forms to allow described imaging catheter to observe the described window of organizing the break-through element to pass the primary importance on the catheter body and pass the vascular wall at conduit place in described side pipe device; And
Be arranged in the contiguous described window of described side pipe and sentence the visual field of the described imaging catheter observation of just restricted passage to described imaging catheter by the observable visual field of described window.
86. the system of claim 85, it is rotatable so that this parts of vessels can be seen the target area by described window until imaging catheter according to the wish rotation that wherein said path forms parts of vessels, thereby guarantees organizing the break-through element to pass that the primary importance on the leading body of primary importance is to be in correct position of rotation on the described catheter body.
87. comprise the system of the parts of vessels of claim 58, wherein organize the break-through element to comprise an extending element that has by the guidewire lumen of its stringer extension, so that seal wire can advance along described chamber when organizing the break-through element to form outside the described blood vessel path described, described system comprises:
Further with the parts of vessels of the bonded described claim 58 of flexible seal wire of extending, this seal wire can be by the described described guidewire lumen of organizing the break-through element.
88. stringer [, it can be used for stringer compressing and is formed at first and second the ducted parameatal tissue of lumen shape morphology is arranged, side-by-side so that the mutual aligning of described opening of the mutual side side of the wherein said first and second tubulose morphology passages, described stringer [comprises:
Can be positioned over round the first of the chamber near surface of the first tubulose morphology conduit of wherein opening;
Can be positioned over second portion round the second tubulose morphology catheter lumen near surface that is formed at opening wherein;
Described first and second parts are interconnection, so that tissue that centers on the linable first and second morphology catheter openings and the instrument that occupy any extravascular tissue are therebetween oppressed in stringer.
89. the stringer [of claim 88, wherein said first and second parts comprise the circular element that can place described chamber near surface.
90. the stringer [of claim 88, wherein first and second parts comprise the oppose end of the extension silk element that forms and extend through described first and second openings with columnar arrangement, the described oppose end of described silk element outwardly-bent in case near and retrain the surface, chamber of the described first and second morphology conduits.
91. the stringer [of claim 90, wherein said silk element is a pre-bending resilience silk element, and when also removing outside the constraint in being placed in described first and second openings, this element will be taked described curved configuration.
92. the stringer [of claim 90, wherein said silk element is a plastically deformable, and wherein said parts also comprise a pressure and apply instrument, this instrument after described silk element is placed in described first and second openings, can be used to crooked described silk element to side.
CN 96199063 1995-10-13 1996-10-11 Method and apparatus for bypassing arterial obstructions and/or performing other transvascular procedures Pending CN1204242A (en)

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CN107106237A (en) * 2014-11-18 2017-08-29 梅德瓦斯克公司 Medical treatment device for treating defective blood vessel, body cavity and body pipe
US10881460B2 (en) 2014-11-18 2021-01-05 MedV ASC AB Medical device for treatment of defective blood vessels, body cavities, and body ducts
CN108289659A (en) * 2015-11-25 2018-07-17 爪医疗有限公司 Tissue engaging device, system and method
CN108883251B (en) * 2016-01-15 2021-12-07 Tva医疗公司 Apparatus and method for advancing wire
CN114042224A (en) * 2016-01-15 2022-02-15 Tva医疗公司 Apparatus and method for advancing wire
CN108883251A (en) * 2016-01-15 2018-11-23 Tva医疗公司 Device and method for promoting wire
CN105615999B (en) * 2016-03-03 2018-06-08 福建省立医院 A kind of laser balloon catheter turned to and its application method
CN105616045A (en) * 2016-03-03 2016-06-01 福建省立医院 Interventional therapy device and method realizing steering and positioning fenestration through laser catheter
CN105615999A (en) * 2016-03-03 2016-06-01 福建省立医院 Reversible laser balloon catheter and method for applying same
CN105616045B (en) * 2016-03-03 2018-07-03 福建省立医院 The interventional therapy device and application method of steering and positioning fenestration are realized by laser catheter
CN113616417A (en) * 2016-03-09 2021-11-09 陀螺仪治疗学有限公司 Device for subretinal administration of therapeutic agents via curved needles
CN108712894A (en) * 2016-03-09 2018-10-26 轨道生物医学有限公司 Device through looper for applying therapeutic agent under retina
AU2017229763B2 (en) * 2016-03-09 2021-06-10 Gyroscope Therapeutics Limited Apparatus for subretinal administration of therapeutic agent via a curved needle
US11338084B2 (en) 2016-03-09 2022-05-24 Gyroscope Therapeutics Limited Apparatus for subretinal administration of therapeutic agent via a curved needle
CN106419990A (en) * 2016-10-27 2017-02-22 上海心玮医疗科技有限公司 Delivery sheath body and left atrial appendage occluder delivery system
CN109996580A (en) * 2016-11-11 2019-07-09 艾凡诺医疗公司 The device and method placed for couple inner gateway and conducting wire
US11207503B2 (en) 2016-11-11 2021-12-28 Avenu Medical, Inc. Systems and methods for percutaneous intravascular access and guidewire placement
US11826504B2 (en) 2017-04-10 2023-11-28 Limflow Gmbh Methods for routing a guidewire from a first vessel and through a second vessel in lower extremity vasculature
CN110403571A (en) * 2018-04-26 2019-11-05 广州医科大学附属第三医院(广州重症孕产妇救治中心、广州柔济医院) Poly- blood measuring instrument and its measurement method
CN110403571B (en) * 2018-04-26 2022-05-31 广州医科大学附属第三医院(广州重症孕产妇救治中心、广州柔济医院) Blood gathering measuring instrument and measuring method thereof
CN112221005A (en) * 2020-10-19 2021-01-15 湖北工业大学 Catheter intervention device for rapidly diagnosing acute pulmonary embolism and use method

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