CN220141879U - Artificial blood vessel for full aortic arch replacement stent trunk - Google Patents
Artificial blood vessel for full aortic arch replacement stent trunk Download PDFInfo
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- CN220141879U CN220141879U CN202321543548.1U CN202321543548U CN220141879U CN 220141879 U CN220141879 U CN 220141879U CN 202321543548 U CN202321543548 U CN 202321543548U CN 220141879 U CN220141879 U CN 220141879U
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- blood vessel
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- 210000004204 blood vessel Anatomy 0.000 title claims abstract description 64
- 210000002376 aorta thoracic Anatomy 0.000 title claims abstract description 47
- 239000002473 artificial blood Substances 0.000 title claims abstract description 41
- 210000000709 aorta Anatomy 0.000 claims abstract description 12
- 238000000034 method Methods 0.000 claims description 6
- 230000002792 vascular Effects 0.000 claims description 6
- 210000003270 subclavian artery Anatomy 0.000 abstract description 17
- 208000032843 Hemorrhage Diseases 0.000 abstract description 12
- 208000034158 bleeding Diseases 0.000 abstract description 12
- 230000000740 bleeding effect Effects 0.000 abstract description 12
- 230000004087 circulation Effects 0.000 abstract description 12
- 238000004904 shortening Methods 0.000 abstract description 5
- 230000003872 anastomosis Effects 0.000 description 10
- 230000003788 cerebral perfusion Effects 0.000 description 5
- 230000010412 perfusion Effects 0.000 description 5
- 238000007789 sealing Methods 0.000 description 5
- 230000002146 bilateral effect Effects 0.000 description 4
- 239000008280 blood Substances 0.000 description 4
- 210000004369 blood Anatomy 0.000 description 4
- 210000002168 brachiocephalic trunk Anatomy 0.000 description 4
- 210000001168 carotid artery common Anatomy 0.000 description 4
- 238000013461 design Methods 0.000 description 4
- 210000002416 recurrent laryngeal nerve Anatomy 0.000 description 4
- 210000001364 upper extremity Anatomy 0.000 description 4
- 208000027418 Wounds and injury Diseases 0.000 description 3
- 210000000038 chest Anatomy 0.000 description 3
- 230000006378 damage Effects 0.000 description 3
- 208000014674 injury Diseases 0.000 description 3
- 210000001765 aortic valve Anatomy 0.000 description 2
- 210000004191 axillary artery Anatomy 0.000 description 2
- 230000017531 blood circulation Effects 0.000 description 2
- 230000002349 favourable effect Effects 0.000 description 2
- 230000023597 hemostasis Effects 0.000 description 2
- 238000012986 modification Methods 0.000 description 2
- 230000004048 modification Effects 0.000 description 2
- 208000025494 Aortic disease Diseases 0.000 description 1
- 206010058178 Aortic occlusion Diseases 0.000 description 1
- 208000002251 Dissecting Aneurysm Diseases 0.000 description 1
- 208000010496 Heart Arrest Diseases 0.000 description 1
- 206010021143 Hypoxia Diseases 0.000 description 1
- 206010053159 Organ failure Diseases 0.000 description 1
- 208000007474 aortic aneurysm Diseases 0.000 description 1
- 206010002895 aortic dissection Diseases 0.000 description 1
- 230000009286 beneficial effect Effects 0.000 description 1
- 238000004891 communication Methods 0.000 description 1
- 238000001816 cooling Methods 0.000 description 1
- 210000004351 coronary vessel Anatomy 0.000 description 1
- 238000010586 diagram Methods 0.000 description 1
- 230000000694 effects Effects 0.000 description 1
- 230000007954 hypoxia Effects 0.000 description 1
- 230000003993 interaction Effects 0.000 description 1
- 208000028867 ischemia Diseases 0.000 description 1
- 230000003902 lesion Effects 0.000 description 1
- 210000003291 sinus of valsalva Anatomy 0.000 description 1
- 238000001356 surgical procedure Methods 0.000 description 1
- 210000002978 thoracic duct Anatomy 0.000 description 1
- 238000002054 transplantation Methods 0.000 description 1
- 238000013022 venting Methods 0.000 description 1
Abstract
The utility model provides an artificial blood vessel used in a trunk replacement stent trunk operation, which comprises a descending aortic stent blood vessel section and an aortic arch branch vessel artificial blood vessel section, wherein the descending aortic stent blood vessel section and the aortic arch branch vessel artificial blood vessel section are directly connected, a stent I is attached to the inner side wall of the descending aortic arch stent blood vessel section, the top and the side parts of the aortic arch branch vessel artificial blood vessel section are respectively connected with a crown top branch pipe, a crown top branch pipe II and a crown side branch pipe, the crown top branch pipe I, the crown top branch pipe II and the crown side branch pipe are respectively communicated with the inside of the aortic arch branch vessel section, the crown top branch pipe I is of a bifurcation structure, a stent II is arranged in the crown top branch pipe II, and a circle of needled operation suture is arranged on the outer side wall of the aortic arch vessel artificial blood vessel between the crown top branch pipe I and the crown top branch pipe II. By adopting the artificial blood vessel structure, during operation, the left subclavian artery is placed into the true cavity through the bracket of the top branch pipe of the arch part, and the pre-sewn suture with the needle is directly sewn and knotted with the aortic arch distal end of the self-body aorta, so that the aims of avoiding free left subclavian artery, enabling the anastomotic stoma to rapidly seal and stop bleeding, reducing bleeding risk and shortening body stop circulation and operation time are fulfilled.
Description
Technical Field
The utility model relates to the technical field of medical equipment, in particular to an artificial blood vessel used in trunk-aortic arch replacement stent trunk surgery.
Background
Aortic diseases involving aortic arch such as aortic aneurysms and aortic dissection often require the use of vascular prostheses to replace the native aortic arch with parallel stent-trunk technique.
At present, the artificial blood vessels are of a plurality of types, but the operation requires that the body circulation blood flow is stopped firstly, then the stent blood vessel is placed into the descending aorta, and then the stent blood vessel, the artificial branch blood vessel and the autologous aorta are anastomosed, so that the anastomosis difficulty is high, the operation time is long, and the anastomotic stoma is easy to bleed. However, after the circulatory blood flow of the body is stopped for a long time, the body is subjected to ischemia and hypoxia injury, and organ failure can be caused by serious injury; and bleeding at the anastomotic stoma is extremely difficult to stop bleeding, and during the period, patients easily lose excessive blood volume to cause illness state crisis. The operation also needs to free the left subclavian artery, the anatomical position is deep, the free is difficult, and the recurrent laryngeal nerve and the chest catheter are easy to be damaged, thereby bringing corresponding complications to the operation.
Disclosure of Invention
In order to solve the technical problems, the utility model provides an artificial blood vessel for a full aortic arch replacement stent trunk operation, which is characterized in that the artificial blood vessel anastomotic to a left subclavian artery is arranged to be an artificial blood vessel with a stent, so that the free left subclavian artery is avoided, and the suture is directly sewn and knotted with an autologous aortic arch aorta through a pre-sewn needle-carrying suture, thereby realizing the purposes of quickly sealing an anastomotic stoma to stop bleeding, reducing bleeding risk and shortening the body stop circulation time, and effectively solving the technical problems existing above.
The utility model discloses a purpose and an effect of an artificial blood vessel used in a full aortic arch replacement stent trunk, which are achieved by the following specific technical means:
the artificial blood vessel comprises a descending aortic stent blood vessel section and an aortic branch vessel artificial blood vessel section, wherein the descending aortic stent blood vessel section and the aortic branch vessel artificial blood vessel section are directly connected, a stent I is attached to the inner side wall of the descending aortic stent blood vessel section, the top and the side parts of the aortic branch vessel artificial blood vessel section are respectively connected with a crown top branch pipe, a crown top branch pipe II and a crown side branch pipe, the crown top branch pipe I, the crown top branch pipe II and the crown side branch pipe are respectively communicated with the inside of the aortic branch vessel section, the crown top branch pipe I is of a bifurcation structure, a stent II is arranged in the crown top branch pipe II, and a ring of needled surgical suture is arranged on the outer side wall of the aortic artificial blood vessel between the crown top branch pipe I and the crown top branch pipe II.
The first branch pipe at the top of the bow part is a branch structure extending section which is respectively connected with a first branch pipe and a second branch pipe, and the first branch pipe and the second branch pipe are of a thread-shaped structure or a corrugated structure.
By adopting the artificial blood vessel structure, the blood vessel section of the constrained descending aortic stent is inserted into the vacuum cavity of the descending aorta in a contracted state, and the top branch pipe II of the constrained arch is inserted into the vacuum cavity of the left subclavian artery in a contracted state and released. Subsequently, the needled surgical suture is sutured to the aortic wall of the native aortic arch in a loop and knotted. Then, the anterior perfusion is carried out through the branch pipe at the side of the arch part, the circulation of the lower half body and the left upper limb is recovered, the anastomosis of the left common carotid artery and the branch pipe II is completed, and the bilateral cerebral perfusion is recovered; and then the proximal end of the structure is anastomosed with the distal end of the artificial blood vessel at the proximal end of the aorta which is treated originally, and finally the anastomosis of the innominate artery with the branch pipe I is completed.
The first stent is uniformly distributed on the inner wall of the blood vessel section of the descending aortic stent, the supporting strength of the blood vessel section of the descending aortic stent is improved, and the first stent consists of a plurality of independent closed wavy rings.
The second bracket is uniformly distributed on the inner wall of the second arch top branch pipe, the supporting strength of the second arch top branch pipe is improved, the second bracket is composed of a plurality of independent closed wavy rings, and the length of the second bracket is matched with the length of the second arch top branch pipe.
The first stent is provided with different circumferences, is convenient for adapting to descending aortic stent blood vessel sections with different diameters, has wavy annular design, has stable structure and is convenient for tightening, binding and releasing.
The surgical suture with the needle is uniformly distributed on the circumference of the artificial blood vessel section of the aortic arch with branch between the first top branch pipe and the second top branch pipe.
The descending aortic stent vessel section, the arch branched aortic artificial vessel section, the arch top branch pipe I, the arch top branch pipe II, the arch side branch pipe equipartition branch pipe I and the branch pipe II are of a thread-shaped structure or a corrugated structure.
The diameter of the artificial blood vessel is 22mm-32mm, the length is 220mm-400mm, wherein the length of the blood vessel section of the descending aortic stent is 100-200mm, and the length of the artificial blood vessel section of the aortic arch with branches is 80-200mm. The diameter and the length of the artificial blood vessel are designed in an indefinite range, so that the artificial blood vessel is favorable for specific operation of different operation cases, and has wide application range.
The diameter of the first arch top branch pipe is 15mm-25mm, and the length is 40mm-100mm; the diameters of the branch pipe I, the branch pipe II, the arch top branch pipe II and the arch side branch pipe are 6mm-18mm, and the lengths are 80mm-140mm. Different diameters and lengths are set, so that different surgical cavity volumes and different surgical cases can be adapted.
The diameter of the second arch top branch pipe is 6-18 mm, the length of the second arch top branch pipe is 10-60 mm, the second bracket is arranged in the second arch top branch pipe, and the length of the second bracket is adapted to the length of the second arch top branch pipe. The second branch pipe at the top of the bow part is placed into the left subclavian artery during operation, so that free anastomosis of the left subclavian artery is reduced, corresponding complications are avoided, and operation time is shortened.
The joint of the second arch top branch pipe is close to the side of the surgical suture with the needle, and the first bracket is positioned at the side of the joint of the second arch top branch pipe. The joint of the arch top branch pipe II is provided with no bracket I. This is provided to prevent vessel occlusion.
The surgical suture with the needle is uniformly distributed between the arch top branch pipe I and the arch top branch pipe II. The pre-sewn needle suture is directly sewn and knotted with the aortic arch distal end of the self-body aortic arch, so that the purposes of rapidly sealing an anastomotic stoma to stop bleeding, reducing bleeding risk and shortening the body stop circulation time are achieved.
The blood vessel section of the descending aorta stent is in a cylindrical structure or a conical structure.
The stent is arranged in different circumferences, is convenient for adapting to descending aortic stent blood tube sections with different diameters, has wavy annular design, has stable structure and is convenient for tightening, binding and releasing.
The utility model at least comprises the following beneficial effects:
simultaneously, the blood vessel section of the constrained descending aortic stent is inserted into the vacuum cavity of the descending aortic in a contracted state, and the top branch pipe of the constrained arch is inserted into the vacuum cavity of the left subclavian artery in a contracted state and released. Subsequently, the needled surgical suture is sutured to the aortic wall of the native aortic arch in a loop and knotted. Then, the anterior perfusion is carried out through the branch pipe at the side of the arch part, the circulation of the lower half body and the left upper limb is recovered, the anastomosis of the left common carotid artery and the branch pipe II is completed, and the bilateral cerebral perfusion is recovered; and then the proximal end of the structure is anastomosed with the distal end of the artificial blood vessel at the proximal end of the aorta which is treated originally, and finally the anastomosis of the innominate artery with the branch pipe I is completed.
By adopting the artificial blood vessel structure, during operation, the suture with the needle is directly sewn and knotted with the aortic arch distal end of the autologous aortic arch, thereby realizing the purposes of quick sealing hemostasis of the anastomotic stoma, reducing bleeding risk and shortening the body stop circulation time. By arranging the artificial blood vessel with the bracket in the left subclavian artery, the risks of avoiding free left subclavian artery, injury of recurrent laryngeal nerves and chest catheters are avoided, and the operation time is shortened.
Description of the drawings:
FIG. 1 is a schematic diagram of the structure of the present utility model;
fig. 2 is a schematic structural view of the stent of the present utility model.
Detailed Description
Embodiments of the present utility model are described in further detail below by way of examples. The following examples are illustrative of the utility model but are not intended to limit the scope of the utility model.
In the description of the present utility model, unless otherwise indicated, the meaning of "a plurality" is two or more; the terms "coaxial," "bottom," "one end," "top," "middle," "another end," "upper," "one side," "top," "inner," "front," "center," "two ends," and the like are used in an orientation or positional relationship based on that shown in the drawings, merely to facilitate describing the present utility model and to simplify the description, and do not indicate or imply that the devices or elements referred to must have a particular orientation, be constructed and operated in a particular orientation, and thus should not be construed as limiting the present utility model. Furthermore, the terms "first," "second," "third," and the like are used for descriptive purposes only and are not to be construed as indicating or implying relative importance.
In the description of the present utility model, unless explicitly stated and limited otherwise, the terms "mounted," "configured," "connected," "secured," "screwed," and the like are to be construed broadly and may, for example, be fixedly connected, detachably connected, or integrated; can be mechanically or electrically connected; either directly or indirectly through intermediaries, or in communication with each other or in interaction with each other, unless explicitly defined otherwise, the meaning of the terms described above in this application will be understood by those of ordinary skill in the art in view of the specific circumstances.
Examples:
the utility model provides an artificial blood vessel used in a trunk replacement stent trunk, which comprises a descending aortic stent vessel section 9 and an aortic arch branch vessel section 8, wherein the descending aortic stent vessel section 9 and the aortic arch branch vessel section 8 are directly connected, a stent I5 is attached to the inner side wall of the descending aortic stent vessel section 9, the top and the side parts of the aortic arch branch vessel section 8 are respectively connected with a top arch branch pipe 6, a top arch branch pipe II 3 and a side arch branch pipe 7, the top arch branch pipe I6, the top arch branch pipe II 3 and the side arch branch pipe 7 are respectively communicated with the inside of the aortic arch branch vessel section 8, a stent II 10 is arranged in the top arch branch pipe II 3, and a circle of needle-carrying operation suture 4 is arranged on the outer side wall between the top arch branch pipe I6 and the top arch branch pipe II 3.
Further, the first branch pipe 6 at the top of the bow part is in a bifurcation shape, the extension section is respectively connected with the first branch pipe 1 and the second branch pipe 2, and the first branch pipe 1 and the second branch pipe 2 are in a thread-shaped structure or a corrugated structure.
By adopting the artificial blood vessel structure, the blood vessel section 9 of the constrained descending aortic stent is inserted into the vacuum cavity of the descending aorta in a contracted state, and the top branch pipe 3 of the constrained arch is inserted into the vacuum cavity of the left subclavian artery in a contracted state and released. Subsequently, the needled surgical suture 4 is sutured to the aortic arch wall of the autologous aortic arch for a single loop and knotted. Then, the anterior perfusion is carried out through the branch pipe 7 at the side of the arch part, the circulation of the lower half body and the left upper limb is recovered, the anastomosis of the left common carotid artery and the branch pipe II 2 is completed, and the bilateral cerebral perfusion is recovered; and then the proximal end of the structure is anastomosed with the distal end of the artificial blood vessel at the proximal end of the aorta which is treated originally, and finally the anastomosis of the innominate artery with the branch pipe 1 is completed.
The first stent 5 is uniformly distributed on the inner wall of the blood vessel section 9 of the descending aortic stent, the supporting strength of the blood vessel section 9 of the descending aortic stent is improved, and the first stent 5 consists of a plurality of independent closed wavy rings.
The second bracket 10 is uniformly distributed on the inner wall of the second arch top branch pipe 3, the supporting strength of the second arch top branch pipe 3 is improved, and the second bracket 10 is composed of a plurality of independent closed wavy rings.
The first stent 5 is provided with different circumferences, is convenient for adapting to descending aortic stent blood tube sections with different diameters, has wavy annular design, has stable structure and is convenient for being contracted, stored and released.
Further, the descending aortic stent vessel section 9, the arch branched aortic artificial vessel section 8, the arch top branch pipe I6, the arch top branch pipe II 3, the arch side branch pipe 7, the branch pipe I1 and the branch pipe II 2 are all in a threaded structure or a corrugated structure.
The diameter of the artificial blood vessel is 22mm-32mm, the length is 220mm-400mm, wherein the length of the blood vessel section 9 of the descending aortic stent is 100-200mm, and the length of the artificial blood vessel section 8 of the aortic arch with branch is 80-200mm. The diameter and the length of the artificial blood vessel are designed in an indefinite range, so that the artificial blood vessel is favorable for specific operation of different operation cases, and has wide application range.
Further, the diameter of the arch part top branch pipe I6 is 15mm-25mm, and the length is 20mm-100mm; the diameter of the branch pipe I1, the branch pipe II 2 and the arch part side branch pipe 7 is 6mm-18mm, and the length is 80mm-140mm. Different diameters and lengths are set, so that different surgical cavity volumes and different surgical cases can be adapted.
Further, the diameter of the arch top branch pipe II 3 is 6mm-18mm, the length is 10mm-60mm, the bracket II 10 is arranged in the arch top branch pipe II, the length of the bracket II 10 is adapted to the length of the arch top branch pipe II 3, and the bracket blood vessel is arranged in the left subclavian artery, so that free left subclavian artery is avoided, the risk of damaging recurrent laryngeal nerves and chest catheters is avoided, and the operation time is shortened.
Further, the joint of the arch top branch pipe II 3 is close to the side of the surgical suture 4 with the needle, and the first bracket 5 is positioned at the side of the joint of the arch top branch pipe II 3. The joint of the arch top branch pipe II 3 is provided with no bracket I5. This is provided to prevent vessel occlusion.
Further, the surgical suture 4 with needle is evenly distributed on the outer side wall between the first arch top branch pipe 6 and the second arch top branch pipe 3. The pre-sewn needle suture is directly sewn and knotted with the aortic arch distal end of the self-body aortic arch, so that the purposes of rapidly sealing an anastomotic stoma to stop bleeding, reducing bleeding risk and shortening the body stop circulation time are achieved.
Further, the descending aortic stent vessel section 9 has a cylindrical structure or a conical structure.
The first stent 5 is provided with different circumferences, is convenient for adapting to descending aortic stent blood tube sections with different diameters, has wavy annular design, has stable structure and is convenient for tightening, binding and releasing.
Working principle: during operation, the right side axillary artery cannula is used for perfusion, and after heart arrest, the near-heart end lesion of the aorta can be treated firstly in the period of cooling, such as the operations of aortic root replacement and coronary artery opening transplantation, aortic valve and ascending aorta replacement of the reserved aortic sinus, root replacement of the reserved aortic valve or simple ascending aorta replacement, and the like. After the operation of the proximal end of the ascending aorta is finished, the circulation is stopped at a deep low temperature, the aortic arch is cut through the unilateral cerebral perfusion of the right axillary artery, the aortic artificial blood vessel is taken, meanwhile, the blood vessel section 9 of the constrained descending aortic stent is inserted into the vacuum cavity of the descending aorta in a contracted state, and the top branch pipe 3 of the constrained arch is inserted into the vacuum cavity of the left subclavian artery in a contracted state and released. The needled surgical suture 4 is then sutured to the aortic arch wall of the autologous aortic arch for a single loop and tied.
Then, the anterior perfusion is carried out through the branch pipe 7 at the side of the arch part, the circulation of the lower half body and the left upper limb is recovered, the anastomosis of the left common carotid artery and the branch pipe II 2 is completed, and the bilateral cerebral perfusion is recovered; and then the proximal end of the structure is anastomosed with the distal end of the artificial blood vessel which is originally processed at the proximal end of the aorta. Rewarming, left heart and artificial endovascular venting, opening aortic occlusion forceps, and heart rewarming. And continuing to anastomose the innominate artery with the branch pipe 1 to finish the arch reconstruction operation.
By adopting the artificial blood vessel structure, during operation, the suture with the needle is directly sewn and knotted with the aortic arch distal end aorta, so that the quick sealing hemostasis of an anastomotic stoma is realized, the bleeding risk is reduced, the body stop circulation time is shortened, the free left subclavian artery is avoided by arranging the stented blood vessel in the left subclavian artery, the risk of damaging the recurrent laryngeal nerve and the thoracic duct is avoided, and the operation time is shortened.
The present utility model is not described in detail in the present application, and is well known to those skilled in the art.
The embodiments of the utility model have been presented for purposes of illustration and description, and are not intended to be exhaustive or limited to the utility model in the form disclosed. Many modifications and variations will be apparent to those of ordinary skill in the art. The embodiments were chosen and described in order to best explain the principles of the utility model and the practical application, and to enable others of ordinary skill in the art to understand the utility model for various embodiments with various modifications as are suited to the particular use contemplated.
Claims (6)
1. An artificial blood vessel for use in a full aortic arch replacement stent trunk, comprising: the device comprises a descending aortic stent vessel section (9) and an arch branched aortic artificial vessel section (8), wherein the descending aortic stent vessel section (9) and the arch branched aortic artificial vessel section (8) are directly connected, a stent I (5) is attached to the inner side wall of the descending aortic stent vessel section (9), an arch top branch pipe I (6), an arch top branch pipe II (3) and an arch side branch pipe (7) are respectively connected to the top and the side of the arch branched aortic artificial vessel section (8), the arch top branch pipe I (6), the arch top branch pipe II (3) and the arch side branch pipe (7) are respectively communicated with the interior of the arch branched aortic artificial vessel section (8), a stent II (10) is arranged in the arch top branch pipe II (3), and a loop of needled surgical suture (4) is arranged on the outer side wall of the arch branched aortic artificial vessel section (8) between the arch top branch pipe I (6) and the arch top branch pipe II (3).
2. A vascular prosthesis for use in a full aortic arch replacement stent-trunk procedure as claimed in claim 1, wherein: the first branch pipe (6) at the top of the bow part is of a bifurcation structure and is divided into a first branch pipe (1) and a second branch pipe (2), and the first branch pipe (1) and the second branch pipe (2) are of a thread structure or a corrugated structure.
3. A vascular prosthesis for use in a full aortic arch replacement stent-trunk procedure as claimed in claim 1, wherein: the descending aortic stent vessel section (9), the arch branched aortic artificial vessel section (8), the arch top branch pipe I (6), the arch top branch pipe II (3) and the arch side branch pipe (7) are all in a threaded structure or a corrugated structure.
4. A vascular prosthesis for use in a full aortic arch replacement stent-trunk procedure as claimed in claim 1, wherein: the joint of the arch top branch pipe II (3) is close to the side of the surgical suture (4) with the needle, and the bracket I (5) is positioned at the side of the joint of the arch top branch pipe II (3).
5. A vascular prosthesis for use in a full aortic arch replacement stent-trunk procedure as claimed in claim 1, wherein: the surgical suture (4) with the needle is uniformly distributed on the circumference of the artificial blood vessel section (8) with the branch aorta at the arch part between the first top branch pipe (6) and the second top branch pipe (3) in a circle.
6. A vascular prosthesis for use in a full aortic arch replacement stent-trunk procedure as claimed in claim 1, wherein: the descending aorta stent vessel section (9) has a cylindrical structure or a conical structure.
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CN202321543548.1U CN220141879U (en) | 2023-06-16 | 2023-06-16 | Artificial blood vessel for full aortic arch replacement stent trunk |
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CN202321543548.1U CN220141879U (en) | 2023-06-16 | 2023-06-16 | Artificial blood vessel for full aortic arch replacement stent trunk |
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