DE19603178A1 - Blood vessel port for haemodialysis - Google Patents

Abstract

A blood vessel port, especially for haemodialysis, has a double needle dialysis unit attached at a suitable location to be connected to a suitable artery or vein, end-to-end or in bypass, for a connection and transcutaneous opening of the blood vessel stretch. The blood vessel opening can be modified also for a single-needle dialysis. The connection can be through a prosthesis of "Goretex" (RTM; treated fabric). The stress breaker is of silicon. In a percutaneous implant, the components can be coated with a biopolymer, with a perforated anchor plate of titanium worked by a laser.

Description

Vascular ports for in particular intravenous application of Medicines have been known for a long time.

The puncture needles used allow through its thin outer diameter has multiple perforations the commonly used silicone membrane, however also punched-out areas and thus microembolism of Foreign material cannot be imposed safely.

Vascular port would be a matter of course in dialysis also useful, especially with a separate one arterial and venous port or a single-needle port, being assured the possibility of the above Risk of embolism from foreign material is avoided.

To achieve the required hemodialysis flow of approx. 300 ml / min. According to the current status of the Technique on the one hand created arteriovenous shunts and on the other hand, the puncture needles used in their Diameter designed so that the required flow deal with.

Clinically, there are visually unsightly venous dilates The patient is treated by the continuous flow noise in the shunt area bothered.

It therefore makes sense to design a port which is both end-to-end or bypassed with the respective preferred artery and / or vein is connected and in the Non-dialysis time on the one hand the unimpeded blood flow in the Vessel guaranteed, but the (port) on the other hand to Time of dialysis both the arterial and / or the allows venous access, with the single-needle  Dialysis with a cannula both vessels directly or in the bypass are reachable.

The prerequisites for this are:

• 1. The puncture cannula should be the tried and tested inside keep knife,
• 2. Port and cannula must ensure that none Granulation punchings get into the bloodstream,
• 3. the cannula must be sealed in its receptacle,
• 4. The cannula must have access to the active position keep each container open,
• 5. After the dialysis has ended, the port flow must be secure be sealed,
• 6. the port must be simple,
• 7. The port must be tissue-lined.
• 8. The port should be suitable with a percutaneous one To correspond to the implant.

It goes without saying that the port is therefore e.g. B. from fabric-lined material such as B. Pure titanium, wherein used plastic is rot-resistant its desired Properties (e.g. with seals) preserved.

The invention fulfills the requirements mentioned both for double-needle dialysis and for single-needle dialysis and will now be explained in more detail by way of example with reference to claims 1-41 and FIGS. 1-10.

It shows

Fig. 1 in a schematic sectional view of a preferred vessel port for hemodialysis in the sense of the double-needle dialysis, but could also be sectional view of a single-needle dialysis ports, Fig. 2 in a schematic sectional view of an alternative vessel port for the preferred double Needle dialysis (also applicable for single-needle dialysis), here as a monoport in the area of its opening or closing mechanism,

Fig. 3, in a schematic sectional view of a possible sealing element for the cannula shaft

Fig. 4 in a schematic representation an alternate seal member in the plan view and in cross section with an O-ring,

Fig. 5 in a schematic sectional view and in detail the preferred closure cone (pin) for the double-needle dialysis at a Mono port or as a dual port in detail,

Fig. 6 in a schematic sectional view of a preferred locking bolt for single-needle dialysis,

Fig. 7, in a schematic sectional view of a preferred end-to-end anastomosis,

Fig. 8 shows a preferred variant of the cannula in a schematic sectional illustration,

Fig. 9 shows a simplified variant port in a schematic sectional illustration,

Fig. 10 in a schematic "section" representation of a connection of port and percutaneous implant in use in the single needle method.

Fig. 1 shows a schematic partial sectional view of a preferred vascular port for hemodialysis in the sense of double-needle dialysis. The port ( 1 ) is conceivable in the section shown as a monoport, which means that it can only be anastomized with a vessel ( 7 , 7 '). However, it can also represent only one side of a double port for the simultaneous anastomization of the artery ( 7 ) and vein ( 7 ′).

We can recognize the inlet funnel ( 20 ) of the cannula holder ( 3 ) with locking bolt ( 12 ), bolt latch ( 71 ) and spring element ( 13 ) in the insert part ( 94 ). Here, other execution examples such as ball bolts or the like are conceivable and not an essential element of the invention.

Bolt ( 12 ) in the exemplary embodiment is limited sealing against the drill outlet ( 83 ) and has a preferred orientation bevel ( 93 ) for cannula tip ( 21 ), which in turn requires that it is rotationally stabilized ( 91 , 92 ).

In the subsequent sealing element ( 4 ), it should be noted that chamfer ( 99 ) for the cannula tip ( 21 ) represents the easier entry into the undersized lumen ( 100 ) of the sealing element ( 4 ) preferred here. When the cannula ( 2 ) is advanced into the cannula receptacle ( 3 ), this expands the sealing clip ( 95 ) and via the slit ( 97 ) and the recess perpendicular to it in the slit ( 97 ) or O-ring receptacle area, ie in the course the O-ring receptacle (no reference number), the cannula shaft ( 24 ) is securely sealed in the cannula receptacle ( 3 ) via the O-ring ( 96 ). It is alternatively conceivable that the sealing element ( 4 ) is arranged over the locking bolt, which brings about a considerable reduction in the height of port ( 1 ).

When the needle tip ( 21 ) engages in the recess ( 75 ) of the element ( 25 ), which is arranged in a rotationally stabilized manner ( 81 , 82 ), this presses with its mandrel end ( 76 ) onto ball ( 30 ), which in turn rests in the recess ( 29 ) and in the non-dialysis time on the elastic sealing element ( 78 ), adjacent to the step circulation ( 77 ), exerts pressure via spring ( 6 ) in recess ( 87 ), so that a secure seal is ensured by the elasticity of element ( 78 ).

Recess ( 29 ) is arranged obliquely in the cone ( 5 , 5 '), so that cone bolts ( 64 , 64 ') are ultimately raised so far by cannula ( 2 ) with their rotational movement by 180 degrees via ball ( 30 ) and the port Blood vessel section ( 8 ) is opened so far that a sufficient dialysis flow via cannula recess ( 71 ) can be achieved via cannula ( 2 ).

When the cannula ( 2 ) is removed, the blood vessel opening of the port blood vessel segment ( 8 ) closes immediately ( 5 , 26 ) and seals it securely ( 78 ).

On the port housing ( 18 ) and the rotation stabilization ( 79 , 80 ) of the conical bolt ( 64 , 64 ') should only be discussed in passing.

It is worth mentioning, however, that an individual fixation element ( 11 ') with fixationsaus savings ( 14 ) at port ( 1 ) can be fixed via guide ( 10 ), so that the optimal fastening ( 14 ) of the port ( 1 ) on a preferably firm tissue surface ( 70 ) is possible.

Fig. 2 shows a schematic representation of an alternative vascular port ( 1 ') for double-needle dialysis on average as a monoport in the region of the opening and closing mechanism preferred here. However, the port ( 1 ') itself is also suitable for single-needle dialysis with a suitable sealing cone.

In the port housing ( 18 ') port blood vessel section ( 8 ) can be seen cut 90 degrees to its course and closed by cone ( 5 '') with cone bolt ( 64 '') via spring ( 6 ') in recess ( 88 ).

The cannula ( 2 ) engages in the recess ( 67 ) via a slope ( 86 ) and causes the conical seal ( 5 ′ ′, 98 ) to be opened by rotating it 180 degrees, which thus provides sufficient flow for dialysis via the cannula ( 2 , 71 ) guaranteed. In the variant presented cone ( 5 '') is additionally sealed via O-ring ( 63 ).

In Fig. 2 is still to the rotation stabilization ( 60 , 61 ) of tapered bolts ( 64 ''), the radius ( 15 '), as well as that of ( 15 ) of Fig. 1 for the port flow by excluding one Level is rheologically harmless. The risk of thrombosis can thus also be controlled.

Fig. 3 shows a schematic sectional view of an alternatively possible sealing element for the cannula shaft. In this case, the circularly expandable spring element ( 4 ), which is mounted on an O-ring ( 4 '), whose lumen ( 73 ) is wider than that ( 22 ) of element ( 4 ), is particularly worth mentioning in recess ( 72 ). The springs ( 4 '') lie flat on top of each other and are preferably wound from square wire.

It should also be noted on chamfer ( 23 ) of the spring element ( 4 ''), which facilitates the threading of the needle tip ( 21 ) into the lower-lumen ( 22 ) seal ( 4 ) against the cannula shaft.

Fig. 4 and section 4 A show a schematic Dar position an alternative sealing element, preferably by two flat ground and slotted ( 65 , 65 ') clasp metal ( 4 ''') the actual sealing function on O-ring ( 4 ') in the recess ( 72 ) through their slot displacement and their mutually flush fit. When stretched through the cannula shaft ( 24 ), they create a sealing effect. In addition, reference is to be made to chamfer ( 89 ) according to FIG. 3, as well as to the under-tolerated lumen ( 90 ).

However, the seal alternatives according to Fig. 3, 4, 4A appear only makes sense if it is possible to seal the existing gap of substantially sealing elements (spring, spring clips) against the receptacle (72).

Fig. 5 shows a schematic representation and in detail of the preferred locking pin cone ( 5 ) for the double-needle dialysis of port ( 1 ) in section with a monoport.

It is worth mentioning port blood vessel section ( 8 ), which is sealed by cone 5 ( 5 , 26 ) and which ( 5 ) provides an optimal blood flow through recess ( 15 ). The cone ( 5 ) and cone holder ( 26 ) are ground. At the same time, Fig. 5 shows the laterally inclined recess ( 29 ).

Fig. 6 shows a schematic sectional view of the preferred locking bolt for the single-needle dialysis of port ( 1 ). The figure differs essentially from Fig. 5 by two port blood vessel sections (8) radii ( 15 ) of the bolt ( 5 ').

Fig. 7 shows a schematic representation of a possible end-to-end anastomization ( 84 ) by plug element ( 69 ) in the housing ( 18 , 18 ') with the vascular alternatives ( 7 , 7 ').

Fig. 8 shows a schematic representation of a possible cannula in section and in detail. We recognize cannula ( 2 ) with shaft ( 24 ), cut ( 70 ), cannula tip ( 21 ) and the cut ( 71 ) which is diametrical to cut ( 70 ), which, after turning the cannula ( 2 ) by 180 degrees, provides sufficient flow for dialysis guaranteed.

Fig. 9 shows a simplified sectional view of a simplified port variant in the application of the single-needle method.

In the double-needle procedure, either two modified ( 1007 ,...) Ports ( 1001 ), i.e. e.g. only one blood vessel segment ( 1008 , 1029 ) with an optimal position with appropriate vascular anastomization ( 69 , 84 ), or a double port are used with two inlet funnels ( 1003 ) for the respective cannula holder ( 1018 , 1028 ) with otherwise largely identical components or minor modification ( 1007 ,...) simultaneous anastomization ( 69 , 84 ) with the preferred artery ( 7 ) and vein ( 7 ′ ) End-to-end or bypass allowed.

This ( 1001 ) has the known inlet funnel ( 1003 ) from FIG. 1, a modified bolt ( 1004 ) with bolt extension ( 1025 ), in the passage ( 1005 ) of which sealing element ( 1026 ) is integrated in such a way that through the cannula tip ( 21 ) No violation of the preferred O-ring ( 1026 ) occurs if the rotary-oriented cannula ( 2 ) is used to move the bolt ( 1004 ) against the spring force ( 1017 ) into the bolt latch ( 1022 ) by pressing on the recess ( 1027 ).

The cannula ( 2 ) now enters the cannula receptacle portion ( 1018 ) and, with further feed, the cannula receptacle portion ( 1028 ) which is fixed in the preferred silicone sealing piston ( 1007 ) via the sleeve ( 1006 ). Silicone sealing piston ( 1007 ) is sealed against the port recess ( 1030 ) ( 1014 ), guided ( 1012 ) and securely seals the blood vessel sections ( 1008 , 1029 ) via the leaf spring ( 1010 ) preferred here ( 1029 ). At the same time, the piston ( 1007 ) is sealingly ( 1021 ) supported on the port portion ( 1060 ), so that a rheologically unimpeded blood or dialysis flow over the blood vessel sections ( 1008 , 1029 ) is ensured.

When the cannula ( 2 ) is advanced further, the leaf spring ( 1010 ) is activated via the cannula receiving element ( 1009 ) and the piston ( 1007 ) is moved around the free distance ( 1032 ), as a result of which the leaf spring ( 1010 ) is stored in the base recess ( 1016 ). Bolzen ( 1004 , 1025 ) takes over with a holding plaster that may be necessary to hold the cannula ( 2 ) in the end position, in the blood vessel section ( 1008 ) as well as the sealing surface ( 1021 ) are opened so far ( 1029 ,...) That sufficient dialysis flow is ensured.

So that the undisturbed blood or dialysate flow compared to the port variants ( 1 , 1 ') is optimal.

Port ( 1001 ) is sealed at the bottom ( 1015 ).

When the cannula ( 2 ) is slowly removed, the port ( 1001 ) is simultaneously flushed until the piston ( 1007 ) extends the blood vessels ( 1008 , 1029 ) and the port is securely closed over the surface ( 1021 ).

The guides ( 1012 ) are intended to guarantee that the pistons ( 1007 ) do not tilt.

When the cannula ( 2 ) is finally removed, the bolt ( 1004 ) which has been flipped back has a restricted sealing function and prevents tissue and tissue fluid from penetrating into the cannula receptacle ( 1018 , 1028 ).

Finally, it should be mentioned that port ( 1001 ) can be fixed on the tissue support via the plate recesses ( 23 ).

Fig. 10 shows a schematic "section" representation of the connection from the modified single-needle port ( 1001 ) to a possible percutaneous implant. Port ( 1001 ) is only changed to the extent that the receiving funnel ( 1003 ), bolt ( 1004 , 1025 ), spring ( 1017 ) and bolt latch ( 1022 ) are no longer required.

We recognize tegument ( 1052 ) through which the skin passage element ( 1034 ) protrudes with a connector ( 1054 ), has an epidermal ( 1036 ) and a subepidermal ( 1037 ) portion and is preferably made from bioactive material. The skin penetration element ( 1034 ) is enclosed by stress breaker ( 1033 ), which is preferably made of silicone with optimal dimensions and is fixed to the skin penetration element ( 1034 ) by at least one recess ( 1042 ) or at least one corresponding circumference ( 1042 ). The circular outer stress breaker recess ( 1044 ) fixes the elastic anchoring plate ( 1038 ), which is recognizably wavy ( 1040 ) contoured and perforated ( 1039 ), whereby the perforations ( 1039 ) in the illustration have already grown connective tissue ( 1053 ) and an additional hold of the anchoring plate ( 1038 ).

The cut of the skin passage element ( 1034 ) makes it clear that the transition element ( 1041 ) as a largely lumen-constant tube element with longitudinal elasticity is fixed seamlessly in the skin passage element ( 1034 ) and opens into the modified port ( 1001 ) with an optimized length and is anchored there.

At the same time, it can be seen that the catheter ( 1048 ) advanced in port ( 1001 ) is secured by means of a union nut ( 1032 ) against sliding out of the port catheter receptacle by means of the clamping action of the socket ( 1054 ).

The port ( 1001 ) itself is only shown in its housing outline.

That the insertion of the catheter into the socket ( 1054 ) requires special precautionary measures with regard to sterility, just like the entire handling of the implant ( 1031 ), and here the skin passage element ( 1043 ) is addressed, actually requires no special notice.

In conclusion, it should be noted that only one possible embodiment has been described and that further alternatives can be found in the claims.

Claims (42)

1. vascular port, in particular for hemodialysis, characterized in that in double-needle dialysis this ( 1 ), fixed at a suitable point ( 14 , 14 '), both end-to-end or in the bypass with a suitable artery ( 7 ) and a suitable vein ( 7 ′) can be anastomized ( 69 ) and the respective port blood vessel section ( 8 ) opened transcutaneously ( 5 , 5 ′ ′), the elements ( 5 , 5 ′ ′) being modified if necessary ( 5 '') are also suitable for single-needle dialysis. 2. vascular port, in particular for hemodialysis, characterized in that in the double-needle dialysis both the suitable artery ( 7 ) and the suitable vein ( 7 ') at each optimal location with a securely fixable separate port either end-to -Anastomizable ( 69 ) at the end or in the bypass and the respective port-blood vessel section ( 8 ) can be opened transcutaneously. 3. vascular port, in particular for hemodialysis, characterized in that in the case of single-needle dialysis the corresponding port ( 1 , 1 ') is optimally positioned and fixed ( 14 , 14 ') either end-to-end or in the bypass with the suitable artery ( 7 ) and vein ( 7 ′) can be anastomized ( 69 ) and is suitable for opening the port blood vessel sections ( 8 ) transcutaneously ( 5 ′, (modified 5 ′ ′)) so that this can be done simultaneously with a cannula ( 2 ) succeeds, the assemblies used by ( 1 , 1 ') can also be used with little modification for double-needle dialysis. 4. vascular port, in particular for hemodialysis, characterized in that it ( 1001 ), fixed at a suitable location ( 1023 ), both end-to-end or in a bypass with a suitable artery ( 7 ) and with a suitable vein ( 7 ') Can be anastomized ( 69 ) and the respective blood vessel segment ( 1008 ) opened transcutaneously ( 1007 ,...), The element ( 1007 ) also being suitable for single-needle dialysis, in addition to which the port ( 1001 ) is suitable is to be connected to a percutaneous implant device (), which enables percutaneous vascular access without a cannula. 5. vascular port according to at least one of claims 1-4, characterized in that the vascular port ( 1 , 1 ',...) Is suitable in the arteries ( 7 ) - and / or veins ( 7 ') end-to-end To be integrated at the end or in the bypass that it has at least one closable ( 12 , 13 ,...) Cannula access ( 3 ), that the fixable ( 4 ,...) And preferably sealed ( 4 ,...) In the cannula access ( 3 ). .) Cannula ( 2 ) is suitable for opening and keeping the secure port closure ( 15 , 15 ') to the respective bloodstream ( 7 , 7 ') against a securing closing force ( 6 , 6 ') so that the blood and hemodialysate flow via the dialysis machine is normally possible with two cannula accesses ( 3 ) or in the single-needle method with one cannula access ( 3 ), and that when the cannula ( 2 ) is removed, the bloodstream (s) ( 7 , 7 ′) immediately seals ( 78,...) is closed / are, the cannula / n (2) is suitable / are the port interior to rinse final en. 6. vascular port according to at least one of claims 1-5, characterized in that port variants ( 1 , 1 ',...) Consist of tissue inert materials and preferably with sensibly shaped fixation elements ( 9 ) for a preferably pressure-absorbing tissue support ( 70 ) individually provided are ( 10 , 11 ') or standard suitable fixation elements ( 11 ). 7. vascular port according to at least one of claims 1-6, characterized in that the closable ( 12 , 13 ,...) Cannula access ( 3 ) is preferably and at least partially shaped to fit the cannula ( 2 ), that it is preferably with a Lockable ( 91 , 92 ) bolt ( 12 ) or the like. Lockable ( 13 ) is that it preferably has at least one additional sealing element ( 4 , 95 ,...) for the cannula ( 2 ) and that it is suitable by means of the respective cannula ( 2 ) via a preferred conical bolt recess ( 29 , 67 ) or the like. At least one preferred sealing cone ( 5 , 5 ', 5 '') to move, which is suitable for releasing the flow to the cannula ( 2 ) ( 71 ). 8. vascular port according to at least one of claims 1-7, characterized in that with an open port closure ( 5 , 5 ', 5 '', 26 , 26 ', 98 ) of the pressure-dependent blood and dialysate flow through the dialyzer through the cannula / n ( 2 ) is made possible, while when the port closure is closed ( 5 , 26 ,...) The preferred cone seal ( 5 , 5 ', 5 '',...) Does not affect the blood flow rheologically ( 15 , 15 ') by cone bolts ( 64 , 64 ', 64 '') is rotationally stabilized ( 79 , 80 , 60 , 61 ). 9. vascular port according to at least one of claims 1-8, characterized in that all essential port elements ( 3 , 64 , 64 ', 64 '', ...) are accommodated in a correspondingly dimensioned port housing ( 18 , 18 '). 10. vascular port according to at least one of claims 1-9, characterized in that the vascular access ( 3 ) preferably funnel-shaped ( 20 ) in the fitting part ( 94 ) begins, and that the preferred and rotationally stabilized ( 91 , 92 ) locking bolt ( 12 ) z. B. spring-loaded ( 13 ) is suitable for releasing ( 93 ) the actual vascular access ( 3 ) by means of the cannula tip ( 21 ). 11. vascular port according to at least one of claims 1-10, characterized in that the sealing element ( 4 ) to the cannula shaft ( 24 ) preferably consists of at least two preferably wound turns ( 4 '') of a preferably ground square spring wire, the turns ( 4 ′ ′) lie coherently on one another, have an undersize in the lumen ( 22 ) suitable for the cannula diameter, are preferably ground in parallel at the end, preferably have a suitable chamfer ( 23 ) on the top side for the cannula holder ( 3 ) and in combination with at least one preferred O-ring ( 4 ') are suitable to securely seal the cannula shaft ( 24 ). 12. vascular port according to at least one of claims 1-11, characterized in that the sealing element ( 4 ) preferably from at least one slotted ( 65 ) and preferably ground spring washer ( 4 ''') with a suitable undersize ( 90 ) to the cannula shaft ( 24 ) there, preferably two flush and slot-offset spring washers ( 4 ''') with top-side chamfer ( 89 ) and at least one O-ring ( 4 ') are suitable to securely seal the cannula shaft ( 24 ). 13. Vascular port according to at least one of claims 1-12, characterized in that the sealing element ( 4 ) preferably consists of a slotted ( 97 ) spring ring ( 95 ) with an O-ring ( 96 ) which is undersized ( 100 ) to the cannula shaft ( 24 ) in the slot area ( 97 ) in the 90-degree direction is so slotted in the O-ring receptacle that the O-ring is suitable in the spreading phase for securely sealing against the cannula shaft. 14. vascular port according to at least one of claims 1-13, characterized in that the cannula ( 2 ) is suitable in a defined end position, preferably by rotating at least one element ( 25 , 30 ) or via recess ( 67 ) cone bolt ( 64 '') with a preferred sealing ring ( 63 ) in the cone area ( 5 , 5 ', 5 '') so that this ( 25 , 30 ) or this ( 5 '') is suitable for the port blood vessel section (s) ( 8 ) open to allow the flow through the cannula ( 2 ) ( 71 ). 15. vascular port according to at least one of claims 1-14, characterized in that for opening the port blood vessel sections ( 8 ) preferably optimally mounted and preferably spring-loaded ( 6 , 6 ') cone bolts ( 64 , 64 ', 64 '') are used , which are either ground in the cone area ( 5 , 5 ', 5 '') for the cone receptacle ( 26 , 26 ', 98 ) and / or corresponding to a preferred O-ring ( 63 ), which provide a reliable sealing function. 16. vascular port according to at least one of claims 1-15, characterized in that in the double-needle dialysis the respective cone bolt ( 64 , 64 '') preferably in the cone area ( 5 , 5 '') for sealing in the cone receptacle ( 26 , 98 ) is preferably ground. 17. Vascular port according to at least one of claims 1-16, characterized in that in the single-needle dialysis of the cone bolt ( 64 ') preferably in the cone region ( 5 ') for the cone holder ( 26 ') ground and in the cylinder region ( 66 ) with an O-ring ( 28 ) or the like. and is spring activated ( 6 ). 18. vascular port according to at least one of claims 1-17, characterized in that in the single-needle dialysis of the cone bolt ( 64 '') preferably in the cone area ( 5 '') for the cone receptacle ( 65 ) ground and in the cone area ( 5 '') Preferably additionally provided with an O-ring ( 63 ) or the like and spring-activated ( 6 '). 19. Vascular port according to at least one of claims 1-18, characterized in that the cone bolts ( 64 , 64 ', 64 '') in the region of the port blood vessel section / s ( 8 ) are optimally shaped ( 15 , 15 '). 20. Vascular port according to at least one of claims 1-19, characterized in that to open the port blood vessel sections ( 8 ), preferably in single-needle dialysis, the cone bolt ( 5 ') preferably a recess ( 29 ) for a preferred Ball element ( 30 ), which preferably by means of the cannula ( 2 ) z. B. via at least one auxiliary element ( 25 ) makes the conical bolt ( 64 , 64 ') movable and cancels the sealing function of element ( 78 ) on step ( 77 ), or that in an alternative variant recess ( 67 ) is suitable, preferably in Double needle dialysis to open the rotationally stabilized ( 60 , 61 ) cone bolt ( 64 '') preferably via the cannula tip ( 21 ), but with a modified cone bolt ( 64 ') in the range of ( 5 '') this variant also for single-needle dialysis is suitable. 21. Vascular port according to at least one of claims 1-20, characterized in that the port ( 1 , 1 ',...) Is suitable at the moment to close the port blood vessel path (s) ( 8 ) when the respective cannula ( 2 ) is so far away that its cannula shaft ( 24 ) is still sealed ( 4 ,...). 22. Vascular port according to at least one of claims 1-21, characterized in that the port ( 1 , 1 ') is suitable for receiving fixation elements ( 11 ') preferably in a guide ( 10 ) or the like which are suitable for themselves to optimally adapt to the anatomical situation or z. B. to be adapted by bending processes, and that alternatively the port ( 1 , 1 ') with a defined fixation element ( 11 ), which also represents the port bottom ( 68 ), is available in different shapes and dimensions, with perforations ( 14 , 14 ') are suitable to be fixed to the tissue support ( 70 ). 23. Vascular port according to at least one of claims 1-22, characterized in that the vascular anastomization ( 84 ) is preferably suitable via fixable plug-in elements ( 69 ) which are designed such that they of the arteries ( 7 ) - and / or veins ( 7 ') Meet size and form a preferably seamless transition ( 85 ) to the corresponding port blood vessel sections ( 8 ). 24. Vascular port according to at least one of claims 1-23, characterized in that ports ( 1 , 1 ',...) Are available, the port blood vessel lumen ( 8 ) of the respective anatomical situation / are. 25. Vascular port according to at least one of claims 1-24, characterized in that the port ( 1 , 1 ',...) In the bypass preferably with the respective vessel ( 7 , 7 ') via a Gore-Tex prosthesis or via another vascular prosthesis material can be anastomized. 26. Vascular port according to at least one of claims 1-25, characterized in that a cannula ( 2 ) which is preferably used has a perforation ( 71 ) diametrically to the cannula cut ( 70 ) which is suitable when the cannula ( 2 ) has to be rotated preferably 180 degrees to maintain the necessary dialysis flow. 27. vascular port, in particular for hemodialysis, characterized in that in single-needle dialysis in port ( 1001 ) cannula receiving part ( 1018 ) by means of a preferably below the funnel inlet ( 1003 ) preferred rotationally stabilized and spring-loaded ( 1017 , 1022 ) arranged bolts ( 1004 ) can be opened via recess ( 1027 ), so that the cannula shaft ( 24 ) can be securely sealed by means of a bolt extension ( 1025 ) with perforation ( 1005 ) and preferably a sealing element ( 1026 ), so that the cannula receiving part ( 1018 ) in the port housing ( 1002 ) is also sealed are like the blood vessel route portions (1008) are incorporated, wherein two blood vessel lines shares (1008) for the particular artery (7) or for the particular vein applied (7 '), in that in the recess (1030), the spring-loaded (1010) sealing element (1007 ) sealed ( 1014 ) so that it is rotationally stabilized so that it is suitable in the non-dialysis time due to the preferred spring ( 1010 ), via which a worked blood vessel stretch portions ( 1029 ) to complete the blood vessel stretches ( 1008 , 1029 ) in a securely sealing manner, as well as securely sealing the port portion ( 1031 ) ( 1021 ) and via cannula ( 2 ) the cannula receptacle portion ( 1006 , embedded and fixed in element ( 1007 )) 1009 ) to move with element ( 1007 ) against spring force ( 1010 ) ( 1032 ) in such a way that the blood vessel sections ( 1008 , 1029 ) are suitable to be opened ( 1029 ), which means that the sealing section ( 1021 ) is suitable, so far free to be ( 1032 ) that a sufficient dialysis flow is guaranteed directly via the cannula ( 2 ), with the bolt element ( 1004 , 1025 ) at least partially offering the possibility of holding the cannula ( 2 ) against spring force ( 1010 ) that the port ( 1001 ) sealed at the bottom with plate element ( 1011 ) ( 1015 ) closed ( 1020 ) is that guides ( 1012 ) are suitable for tilting element ( 1007 ) in the travel path ( 103 2 ) to rule out that ultimately recess ( 1016 ) is suitable for accommodating the leaf spring ( 1010 ) preferred here in the stretched state, and that there is the possibility via the plate recesses ( 1023 ) to fix port ( 1001 ) to the preferred tissue support. 28. Vascular port according to at least one of claims 1-27, characterized in that either two ports ( 1001 ) are used in double-needle dialysis, preferably only one blood vessel segment ( 1008 , 1029 ) being created, which is connected to the respective vessel ( 7 , 7 ') is optimally anastomized ( 69 , 84 ) or that a port housing contains the elements named and possibly modified ( 1007 ,...) Under two funnel receptacles ( 1003 ). 29. Vascular port according to at least one of claims 1-28, characterized in that the port ( 1001 ,...) With its elements ( 1018 , 1007 ,...) Is dimensioned and modified so suitable for each vessel ( 7 , 7 ') a preferably flexible transition element ( 1041 ) of a preferred percutaneous implant ( 1031 ) z. B. by screwing, jamming or the like. Preferably, funnel ( 1003 ), bolt ( 1004 , 1025 ) with spring ( 1017 ) in the spring holder ( 1022 ) can be dispensed with. 30. Percutaneous implant according to at least one of claims 1-29, characterized in that it ( 1031 ) for reducing movement-related damage to the implant-skin connection has at least one tissue-compatible stress breaker ( 1033 ), which on the one hand has at least one skin passage element ( 1034 ) with its supra-cutaneous ( 1035 ), epidermal ( 1036 ) and subepidermal portion ( 1037 ), on the other hand at least one subepidermal anchoring plate ( 1038 ) with perforations ( 1039 ) and / or surface enlargement by e.g. B. micro lacquers, profile design ( 1040 ) or the like. Includes, for each vessel ( 7 , 7 ') a preferably elastic transition element ( 1041 ), which, like any skin passage element ( 1034 ), is provided with a sterilizing inner coating, connect the percutaneous implant ( 1031 ) to port ( 1001 , ... ). 31. Percutaneous implant according to at least one of claims 1-30, characterized in that stress breaker ( 1033 ) preferably consists of silicone-optimized Shore hardness, preferably at least one circular inner bead ( 1042 ) per lumen ( 1043 ) for the preferred skin passage element ( 1034 ) and preferably has at least one circular outer recess ( 1044 ) for anchoring plate (s) ( 1038 ). 32. Percutaneous implant according to at least one of claims 1-31, characterized in that the skin passage element ( 1034 ) and the anchoring plate ( 1038 ) preferably consist of preferably bioactive / m / n material / s, the respective material surface for the corresponding one Properly obtain tissue contact and / or contoured according to the task ( 1040 ). 33. Percutaneous implant according to at least one of the Claims 1-32, characterized, that the bioactive properties are preferred by bio alloplastic pretreatment like bioactive alloplastic adhesive coatings (e.g. Biopolymers u. Like.), is attainable. 34. Percutaneous implant according to at least one of claims 1-33, characterized in that the anchoring plate ( 1038 ) is preferably provided with perforations ( 1039 ) which ensure tissue growth ( 1053 ), and / or that an increase in surface area by appropriate contouring ( 1040 ), chemical treatment and / or for titanium z. B. by laser processing, preferably with the Eximer laser. 35. Percutaneous implant according to at least one of claims 1-34, characterized in that the tension-reducing anchoring plate ( 1038 ) has elastic properties, with thinned titanium z. B. is wavy contoured ( 1040 ) and preferably has an edge-defining circumferential bead ( 1045 ). 36. Percutaneous implant according to at least one of claims 1-35, characterized in that the respective transition element ( 1041 ) preferably has elastic properties, has an almost identical inner lumen ( 1046 ) in all movements, which is an optimal length with preferred longitudinal expansion possibility has, to the inner lumen ( 1047 ) of the skin passage element ( 1034 ) preferably has no step, has a connecting part to port ( 1001 ), is preferably bio-inert and suitable, z. B. a catheter ( 1048 ) or a blunt needle, preferably sealed in the skin passage element ( 1034 ), and which ( 1048 , ... ) Are suitable, in the port ( 1001 , ... ) The blood vessel sections ( 1008 , 1029 ) to open and z. B. with at least one supercutaneous union nut ( 1032 ) are able to keep open, preferably also the transition element ( 1041 ) by internal coating, such as. B. silvering, can be sterilized. 37. Percutaneous implant according to at least one of claims 1-36, characterized in that the catheter ( 1048 ) or the blunt cannula preferably has two eyes ( 1049 ) and an inner lumen ( 1050 ) in the region of the opened port lumen, which is suitable for the record required dialysis flow. 38. Percutaneous implant according to at least one of claims 1-37, characterized in that the skin passage element ( 1034 ) for the respective transition element ( 1041 ) preferably has a socket ( 1054 ) with a closure cap, which is suitable to remain securely closed in the nondialysis time . 39. Percutaneous implant according to at least one of claims 1-38, characterized in that the preferred connector ( 1054 ) is shaped and slotted so that the union nut is suitable for clamping a catheter ( 1048 ) or a blunt cannula. 40. Percutaneous implant according to at least one of claims 1-39, characterized in that the transition element is moved to port ( 1001 ,...) Or to skin passage element ( 1034 ) in such a way that a blunt cannula of suitable length is able to to be retracted into the port cannula receptacle, the cannula in this case preferably in the port cannula receptacle e.g. B. can be sealed by an O-ring. 41. Percutaneous implant according to at least one of claims 1-40, characterized in that the blunt cannula is preferred and that the entire percutaneous implant ( 1031 ) as well as the port ( 1001 ,...) On the cannula size, ie preferably on the Outside diameters are matched. 42. Vascular port, in particular for hemodialysis, characterized in that the ports ( 1 , 1 ′, 1001 ,...) Are modified in a suitable manner, with appropriately dimensioned catheters from their respective fixation site into at least one preferably large-lumen vessel (e.g. Subclavian vein), the respective blood vessel sections ending blind on one side of the port.