GR1010101B - Catheter - Google Patents

Abstract

The present inventions refers to a catheter, comprising a catheter shaft (2) that extends along a longitudinal axis (500), a first surgical tool (11), a first moving means (31) and a second surgical tool (12). The first surgical tool (11) and the second surgical tool (12) are movable relative to each other in the direction of the longitudinal axis (500). The first surgical tool (11) is movable on the catheter shaft (2) in the direction of the longitudinal axis (500) by the first moving means (31). The second surgical tool (12) may be movable on the catheter shaft (2) in the direction of the longitudinal axis (500) by a second moving means (32) or fixed on the catheter shaft (2).

Description

Catheter

Description

The present invention relates to a catheter. The catheter of the present invention can also be characterized as a medical catheter.

Catheters have been used for years in many human and animal medical applications as they provide access to the body in a minimally invasive manner.

For example, catheters are widely used in most endovascular applications. Due to their minimally invasive nature, the treatment of blood vessel diseases can be achieved without significant postoperative pain and the need for general anesthesia during the operation or long hospitalization of the patient. An intravascular catheter is known from WO 2016203277 A1.

It is an object of the present invention to propose a compact catheter with high design flexibility that can be used in various medical applications.

The solution to said object is achieved by a probe having the combination of features of the independent claim. The dependent claims contain advantageous embodiments and forms of the invention.

In particular, the catheter includes a catheter sheath, a first surgical tool, a second surgical tool, and a first drive means. The probe sheath extends along a longitudinal axis. The first surgical tool and the second surgical tool are movable relative to each other in the direction of the longitudinal axis. The first surgical tool is movable in the catheter sheath in the direction of the longitudinal axis by the first drive means. The second surgical tool may be movable in the catheter sheath in the direction of the longitudinal axis by means of a second drive means or may be fixed in the catheter sheath.

In other words, the first surgical tool and the second surgical tool are arranged in the sheath of the catheter and are movable relative to each other in the direction of the longitudinal axis. Here, the first surgical tool is movably arranged in the catheter sheath. The first drive means is configured to move the first surgical tool in the catheter sheath in the direction of its longitudinal axis. The second surgical tool may be either movable or fixed in the catheter sheath. When the second surgical tool is movably arranged in the catheter sheath, a second drive means is configured to move the second surgical tool in the catheter sheath in the direction of its longitudinal axis. Thus, by providing a first drive means and a second drive means, the first surgical tool and the second surgical tool can be moved independently of each other. It is apparent that for driving the first surgical tool, the first drive means is connected to the first surgical tool. Therefore, in order to move the second surgical tool, the second drive means is connected to the second surgical tool.

The catheter of the present invention having two surgical tools, which can be moved controllably relative to each other, has the advantage that a distance between the two surgical tools can be set in a controllable manner. Further, the position of the first surgical tool relative to the catheter sheath can also be adjusted. Particularly when both surgical tools, i.e. the first and second surgical tools, can be moved, a more precise adjustment of the distance between the two surgical tools as well as the position of each of the surgical tools relative to the catheter sheath can be achieved. Depending on the initial relative distance between the two surgical instruments when both are in their proximal position and their ranges of motion in the longitudinal direction of the catheter sheath, the catheter can be used in various medical applications as well as in patients with different anatomical characteristics and /or a different clinical condition. Further advantages such as isolating a portion of the body lumen, improving the most important catheter characteristics such as propelability, traceability and crossability, stabilizing a body region or applying force to one or more body regions can be achieved by appropriate selection. of the first surgical instrument and the second surgical instrument. The catheter of the present invention can advantageously be used as an intravascular, gastrointestinal or urological catheter.

Preferably, the first surgical instrument is a proximal surgical instrument and the second surgical instrument is a distal surgical instrument. This means that the first surgical tool is preferably closer to a proximal sheath end than the second surgical tool is to the proximal sheath end. In other words, the second surgical tool is preferably closer to a distal sheath end than the first surgical tool is to the distal! sheath end.

It is noted that the catheter of the present invention may include more than two surgical tools, that is, additional surgical tools in addition to the first surgical tool and the second surgical tool. Also in this case, as in the case of a catheter having the first surgical tool and the second surgical tool, it is sufficient to achieve the aforementioned advantages for a catheter of the present invention if at least one of the surgical tools is longitudinally arranged with possibility of movement in the sheath of the catheter.

Preferably, the catheter further includes a third surgical tool secured to the catheter sheath. According to an advantageous embodiment of the present invention, the first surgical tool and the second surgical tool are movably arranged in the catheter sheath and the third surgical tool is fixed in the catheter sheath.

Preferably, the third surgical tool is arranged between the first surgical tool and the second surgical tool.

Any of the surgical tools of a catheter, namely the first surgical tool and/or the second surgical tool and/or the third surgical tool, may each be formed as an inflatable balloon, a cutting device, a stent, a stabilizing tool, a sensor pressure cuff or any other tool that may be used in a surgical procedure in which a catheter is used. The cutting device may specifically be a blade, e.g. an atherotomy blade, or a tubal scraping wire (scraping wire for uterine scraping). Within the scope of the present invention, any combination of the aforementioned tools is possible. However, it is preferred that at least one of the surgical instruments is an inflatable balloon.

Accordingly, it is preferable if the first surgical instrument movably arranged in the catheter sheath is an inflatable balloon. The catheter with the first surgical instrument being an inflatable balloon further has the advantage of adjusting the position of the balloon relative to the second surgical instrument and the catheter sheath as an advantage of improving the characteristics of a catheter. This is described in more detail below.

When the inflatable balloon is inflated within a body lumen, the balloon is anchored to the wall defining the lumen and thus cannot move relative to said wall. Therefore, application of a force to the first movable means translates into movement of the catheter sheath relative to the balloon. In particular, with the aid of the inflatable balloon, the catheter can gain greater propellability, as the required pushing force to move the catheter sheath forward can be applied close to its tip. The term "propulsion" means the degree to which force transmitted from a proximal sheath end of the catheter sheath is translated into movement of a peripheral sheath end (tip) of the catheter sheath, which is dependent on the transmission of the force along the body of the sheath catheter. In other words, the term "movability" means the ease of advancing the catheter into a lumen, e.g. a blood vessel, and is indicative of the amount of force experienced by the distal sheath end of the catheter sheath when a known force is applied to the proximal end of the catheter sheath. In terms of crossability, i.e. the ability to navigate the sheath tip through narrow restrictions in the vasculature, the proposed catheter can move through significant stenosis with greater force using the propulsive force exerted by the moving balloon when pushing the sheath tip . When a guidewire is further provided to the catheter, the catheter can provide maximum safety backup support to the guidewire and, in addition, the greatest possible thrust, crossability and trackability over the guidewire in narrow or blocked lumens and passages of the patient's body. More specifically, the catheter sheath can provide back-up support to the guidewire in attempting to navigate through anatomically difficult luminal regions of the human body, while - at the same time - being precisely repositionable, keeping the balloon inflated and anchored within the lumen. In particular, the tracking of the catheter sheath over the guidewire is high, as once again the propulsive force of the balloon moving near the tip of the catheter sheath is much greater. This is particularly advantageous in tortuous lumens, where passage of the catheter is impeded due to the multiplication of friction between the catheter sheath and lumen walls, as well as between the catheter sheath and the guidewire caused by the existing torque.

When in addition to the first surgical tool formed as an inflatable balloon, the second surgical tool is for example a cutting device such as an atherotomy blade attached to the catheter sheath, improving the characteristics of the catheter as described above results in the cutting device being able to cut with more force. The reason for this is that the application of a propulsive force to the balloon by the first movable means when the balloon is inflated and thus anchored to the walls of a body lumen translates into a forward movement of the catheter sheath with a high force and thus a movement towards the forward with high force and the cutting device.

If, according to another embodiment of the catheter, the first surgical tool is formed as a first inflatable balloon and the second surgical tool as a second inflatable balloon fixed or immovably arranged in the catheter sheath, improving the characteristics of the catheter as described above results in ability of the sheath catheter to be advanced through narrow passages of the patient's body in order to place the second inflatable balloon at the site of the stenosis. The second inflatable balloon can advantageously be placed within the stricture and then inflated to widen the narrowed passage.

According to an advantageous embodiment, the first surgical tool, the second surgical tool and the third surgical tool of the catheter are inflatable balloons. Here, it is preferable that the third surgical tool attached to the catheter sheath is arranged between the first surgical tool and the second surgical tool. The use of a catheter with such a configuration can provide results of paramount importance to the survival of a patient in the event of treatment of an abdominal aortic aneurysm.

When the third surgical tool is an inflatable balloon, the catheter sheath preferably includes an inflation fluid passing through the lumen communicating with the inflatable balloon via an inflatable fluid passing through an opening formed in a peripheral region of the catheter sheath. Thus, the third surgical tool may be equipped with inflation fluid through the inflatable fluid lumen. If the catheter consists of a plurality of inflatable balloons attached to the catheter shaft, the same inflatable fluid passageway can be used to deliver the inflatable fluid to some or all of the inflatable balloons. In this case, a plurality of expandable fluid openings are formed in the peripheral region of the catheter sheath, where the respective expandable fluid passage openings are in communication with the inflation fluid passage lumen. Alternatively, the catheter may include a (separate) inflation fluid passageway per inflatable balloon.

According to another embodiment of the present invention, the first surgical tool is formed as an inflatable balloon and the second surgical tool is secured to the catheter sheath and formed as a cutting device.

According to another embodiment of the present invention, the first surgical tool is formed as a stabilizing tool and the second surgical tool is a mobile surgical tool and is formed as an inflatable balloon.

Preferably, the first movable means comprises a first movable element.

Advantageously, the first movable element is flexible, connected to the first surgical tool and arranged in a first movable lumen receiving means defined by a catheter sheath wall. The first movable element is arranged within the first movable means receiving lumen such that the first movable element is at least partially supported circumferentially by the wall of the catheter sheath so that the first surgical tool is movable from the first movable element to a direction from a proximal sheath end to a distal sheath end of the catheter sheath.

When the first surgical tool is formed as a first inflatable balloon, the first movable element is preferably hollow and in fluid communication with the first inflatable balloon.

When the second surgical tool is a movable surgical tool that is movable in the catheter sheath in the direction of the longitudinal axis with the second movable means, the second movable means preferably includes a second movable element.

Advantageously, the second movable element is flexible, connected to the second surgical tool and arranged in a second movable lumen receiving means defined by a catheter sheath wall. The second movable element is arranged within the second movable means receiving lumen such that the second movable element is at least partially supported circumferentially by the wall of the catheter sheath such that the second surgical tool is movable from the second movable element to a direction from a proximal sheath end to a distal sheath end of the catheter sheath.

Being supported at least partially circumferentially by the wall of the catheter sheath, as described above, the first/second movable element is movable such that its movement causes movement of the first/second surgical tool. In other words, the first/second movable member is arranged to be supported laterally by the wall of the catheter sheath, so that the first/second movable member, although itself flexible, can push the first/second surgical tool. Should it not be for the peripheral support of the first/second movable element provided by the wall of the catheter sheath, the first/second movable element will bend, at least in part, when moving in the direction from the proximal end of the sheath to the distal sheath end of the catheter sheath, i.e. it will be pushed and thus unable to move the first/second surgical tool. In other words, the first/second movable element is/are advantageously constrained by the wall of the catheter sheath so that the first/second movable element acts as a stiffness imparting element when pushed so that the first/second movable element can transmit the its movement on the first/second surgical tool. Thus, the wall of the catheter sheath acts as a restraining and supporting element for the first/second movable element so that the first/second movable element is supported throughout its movement in the first/second movement means receiving a lumen so that it the movement to result in a corresponding movement of the first/second surgical tool. In particular, the wall of the catheter sheath provides the first/second movable element with the stiffness that the first/second movable element inherently lacks and therefore needs to be able to move the first/second surgical tool. However, the first/second movable element is capable of bending when the catheter, specifically the catheter sheath, is advanced through curved paths, e.g. tortuous blood vessels, of a patient's body.

The above-described arrangement of the first/second movable element for moving the first/second surgical tool has the advantage that the catheter can have a compact structure, as it is sufficient for the catheter sheath to include only one movable lumen receiving means per movable surgical tool. More specifically, the present invention enables the reduction of the maximum outer dimension, namely maximum diameter, of the catheter/catheter sheath compared to a catheter with a catheter sheath that requires two mobile receiving lumens per mobile surgical instrument. This in turn has the advantage that the catheter can be used in a wide variety of applications and in particular in applications where the blood vessels, lumens and cavities of small dimensions of a human or animal body need to be accessed. By requiring only one movable lumen receiving means per movable surgical instrument, a catheter with the same maximum end dimension, namely the same maximum final diameter, can be equipped with more surgical instruments than a catheter requiring two movable media receiving lumens per movable surgical instrument . Furthermore, the catheter provides great flexibility with respect to the spatial arrangement of the mobile medium receiving lumen(s) relative to any further lumen(s) that could be formed in the catheter sheath, such as a fluid transport lumen therethrough and/or receiving a guidewire.

Furthermore, due to the flexible nature of the first movable element, and in particular the second movable element, when the second surgical tool is a movable surgical tool, the catheter may still bend as a whole. Thus, the first/second movable element does not alter the flexible nature of the catheter as a whole. It is noted that within the context of the present invention, a catheter is specifically understood to mean a device having a flexible sheath (catheter) for insertion into a body cavity, duct, conduit, blood vessel or passageway of a patient and configured to deliver or receiving fluids from a patient via the catheter sheath and/or inflating a passageway and/or placing a surgical instrument at a targeted site within the patient's body to cause a modification in the body cavity, duct, channel, vessel, or passageway.

Advantageously, the first/second surgical tool is connected to the first/second movable element at a distal portion and/or peripheral end of the first/second movable element.

Preferably, the flexibility of the first/second movable element is such that the flexibility of the catheter sheath and/or the catheter with the first/second movable element does not exceed 20%, preferably not more than 10%, preferably not more than 5%, different, specifically greater, than the flexibility of the catheter sheath and/or the catheter without the first/second movable element.

When the second surgical tool is formed as a second inflatable balloon, the second movable element is preferably hollow and in fluid communication with the second inflatable balloon.

Here, the first surgical tool may preferably be controlled by a first control means connected to the first movable element.

In particular, the first control means may advantageously comprise a first control housing which is longitudinally movable, in particular slidable, arranged in the sheath of the probe and connected to the first movable element. The first control housing is the component that a doctor manipulates using the probe to control the first surgical tool. The first movable element can be connected directly to the first control housing. Alternatively, the first control means may comprise a first control element by which the first movable element is connected to the first control housing and which is formed as a rigid control element. However, it is also possible that the first control means comprises the aforementioned first control element without the first control housing. In this case, the first control element is the component manipulated by a physician using the probe to control the first surgical tool.

Preferably, the first control housing is connected to the first movable element through a first proximal connection opening.

Accordingly, the second surgical tool may preferably be controlled by a second control means connected to the second movable element.

In particular, the second handling means may advantageously comprise a second control housing which is movable in the longitudinal direction, in particular slidable, arranged in the sheath of the probe and connected to the second movable element. The second control housing is the component that a physician manipulates using the probe to control the second surgical tool. The second movable element can be connected directly to the second control housing. Alternatively, the first control means may comprise a second control element with which the second movable element is connected to the second control housing and which is formed as a rigid control element. However, it is also possible that the second control means comprises the aforementioned second control element without the second control housing. In this case, the second control element is the component manipulated by a physician using the probe to control the second surgical tool.

In addition to the first movable element, the first movable means may preferably further comprise a first distal piston and a first proximal piston, which are arranged in the first movement means receiving lumen. A first space between the first distal piston and the first proximal piston is filled with an incompressible fluid. Here, the first movable element is further connected to the first remote piston. The first movable member is arranged within the first movable means receiving lumen such that the first movable member is at least partially supported circumferentially by the wall of the catheter sheath such that a movement of the first proximal plunger in a direction from the proximal sheath end of the catheter sheath toward the distal sheath end of the catheter sheath to cause movement of the first surgical tool. This means that the arrangement of the first movable element in the first movement means that the receiving lumen is such that a movement of the first proximal piston transferred to the first distal piston through the incompressible fluid can be transferred to the first surgical tool through the first movable element.

In addition to the second movable element, the second movable means may preferably further comprise a second distal plunger and a second proximal plunger, which are arranged in the second movable means receiving lumen. A second space between the second distal piston and the second proximal piston is filled with an incompressible fluid. Here, the second movable element is further connected to the second remote piston. The second movable member is arranged within the second movable means receiving lumen such that the second movable member is at least partially supported circumferentially by the wall of the catheter sheath such that a movement of the second proximal plunger in a direction from the proximal sheath end of the catheter sheath toward the distal sheath end of the catheter sheath to cause movement of the second surgical tool. This means that the arrangement of the second movable element within the second movable means receiving lumen is such that a movement of the second proximal piston transferred to the second distal piston via the incompressible fluid can be transferred to the second surgical tool via the second movable element.

The advantages presented above in view of the first/second flexible movement also apply to the implementation of the probe using an incompressible fluid between two pistons to transmit a movement is advantageous as a controlled transmission of the movement between the pistons can be achieved. In addition, a length of the first/second space filled with the incompressible fluid and a length of the first/second movable element in the direction of the longitudinal axis of the catheter sheath can be adapted to the application for which the catheter is intended. For example, the first/second space filled with the incompressible fluid can be chosen so that the first/second movable element has a shorter length if the probe is designed for use in high torque lumens. On the other hand, the length of the first/second flexible element can be chosen to be shorter if tortuous lumens are to be accessed with the catheter. Furthermore, the force transferred from the first/second proximal piston to the first/second distal piston is independent of the speed of movement of the first/second proximal piston. As an incompressible fluid, water or water solution may be used to fill the first/second space between the pistons.

It is noted that the movement of the first/second proximal plunger in one direction from the distal sheath end of the catheter sheath to the proximal sheath end of the catheter sheath affects a corresponding movement of the first/second surgical tool, since the movement of the first/second proximal plunger has as resulting in a build-up of negative pressure in the first/second space between the first/second proximal piston and the first/second distal piston, which in turn causes fluid and the first/second distal piston to move/pull in the same direction as first/second proximal piston; The movement of the first/second remote piston is then transferred to the first/second movable element, which in turn pulls the first/second surgical instrument connected thereto.

It is further noted that the terms "proximal plunger" and "distal plunger" with respect to the first and second proximal plungers and the first and second distal plungers, respectively, mean that the respective proximal plunger is closer to the proximal sheath end of the catheter sheath. than the corresponding distal plunger is at the proximal end of the sheath. In other words, the corresponding rotary piston is closer to the distal sheath end of the catheter sheath than the corresponding proximal piston is to the peripheral shaft end.

In addition to the first movable element being hollow, when the first surgical tool is formed as a first inflatable balloon, the first distal plunger and the first proximal plunger are also advantageously hollow. Additionally, in addition to the first movable element being in fluid communication with the first surgical tool, the first movable element is preferably also in fluid communication with a first conduit arranged between the first distal plunger and the first proximal plunger.

In addition to the second movable element being hollow, when the second surgical tool is formed as a second inflatable balloon, the second peripheral piston and the second proximal piston are also advantageously hollow. Additionally, in addition to the second movable element being in fluid communication with the second surgical tool, the second movable element is preferably also in fluid communication with a second conduit arranged between the second distal plunger and the first proximal plunger.

At this point it is noted that the term "at least in part" in the corresponding expressions "at least in part peripherally supported" presented above in relation to the first/second movable element refers to the term "peripherally". This means that the first/second movable element rests or rests at least on a part of its entire circumference at a given cross-section. In particular, the first/second movable element can rest on its entire circumference at a given cross-section. Furthermore, it is noted that the at least partially circumferential support provided by the catheter sheath wall defining the first/second movable lumen receiving means specifically means that the support is provided by an inner portion, preferably an inner surface, of the catheter sheath wall which is facing the first/second moving media receiving lumen.

Preferably, the first/second movable element is/are fully supported circumferentially by the wall of the catheter sheath. This means that the first/second mobile element rests around its entire circumference at a given cross-section.

Advantageously, the first/second movable element are longitudinally movable arranged in the receiving lumen of the first/second movable means. In particular, the first/second movable element is extractably arranged in the receiving lumen of the first/second movable means. This means that the first/second movable element can be moved out of the first/second movable means receiving lumen due to the at least partial peripheral support by a catheter shaft wall so that the first/second movable element can move the surgical tool.

The receiving lumen of the first/second movable means can preferably be configured so as to provide/provide in only a part of their length or throughout their length at least partial peripheral support to the first/second movable element.

The first/second moving element is advantageously flexible along its entire length. Additionally, the flexibility of the first/second element drive may vary along its length. This allows the first/second movable element to be adapted to a corresponding probe application.

In the embodiment of the catheter having the first proximal plunger and the first distal plunger as described above, the first surgical tool is preferably controlled by a first control means connected to the first proximal plunger.

The first control means preferably a first control element. According to one embodiment, the first control element is formed as a rigid control element connected to or integrally formed with the first proximal piston. According to an alternative embodiment, the first control element is configured as a flexible control element connected to the first proximal plunger and arranged such that the first control element is at least partially supported circumferentially by the catheter sheath wall such that the first proximal piston being movable toward the distal end of the catheter sheath from the first control element. In particular, the first control preferably further means that it comprises a first control housing which is movable in the longitudinal direction, in particular slidable, arranged in the sheath of the catheter and connected to the first control element. Preferably, the first control element is connected to the first control housing through a first proximal connection opening.

In the embodiment of the catheter having the second proximal plunger and the second distal plunger as described above, the second surgical tool is preferably controlled by a second control means connected to the second proximal plunger.

The second control means preferably a second control element. According to one embodiment of the invention, the second control element is formed as a rigid control element connected to or formed integrally with the second proximal piston. According to an alternative embodiment, the second control element is formed as a flexible control element connected to the second proximal plunger and arranged such that the second control element is at least partially supported circumferentially by the catheter sheath wall such that the second proximal plunger are movable toward the distal sheath end of the catheter sheath from the second control element. In particular, the second control means preferably further comprises a second control housing which is movable in the longitudinal direction, in particular slidable, arranged in the sheath of the probe and connected to the second control element. Preferably, the second control element is connected to the second control housing through a second proximal connection opening.

Preferably, a maximum cross-section or a maximum external dimension of the first movable element can be at least 80%, more preferably at least 85%, even more preferably at least 90%, even more preferably at least 95%, most preferably substantially 100 %, minimum cross-section or minimum internal dimension of the first moving medium receiving lumen, respectively.

Accordingly, a maximum cross-section or a maximum external dimension of the second movable element can be at least 80%, more preferably at least 85%, even more preferably at least 90%, even more preferably at least 95%, most preferably substantially 100% , maximum cross-sectional area or minimum internal dimension of the receiving lumen of the second moving medium.

It is preferred that at least the first/portion of the second flexible movable element is arranged to be movable or arranged/movable during the first/second movement means that receiving a clearance between a first end position and a second end position of the first/second flexible element has cross-sectional area over at least a part of its total length, i.e. only a part of its length or over its entire length, i.e. at least 80%, more preferably at least 85%, even more preferably at least 90%, even more preferably at least 95%, most preferably substantially 100%, of a cross-sectional area of the first/second movement means receiving lumen.

Preferably, the first/second flexible movable element has along its entire length a cross-sectional area that is at least 80%, more preferably at least 85%, even more preferably at least 90%, even more preferably at least 95%, at most substantially 100% preference of a cross-sectional area of the first/second movement means receiving the lumen.

In particular, when the receiving lumen of the first/second movable means and at least the first/part of the second flexible movable element which is or can be arranged/moveable in the receiving lumen of the first/second movable element between the first and second positions of the flexible first/second end movable element is formed as a circular cylinder, it is preferred that at least said first/second flexible movable element portion has at least a portion of its length, i.e. only a portion of its length or throughout its length, a diameter that is at least 80%, more preferably at least 85%, even more preferably at least 90%, even more preferably at least 95%, most preferably substantially 100%, preferably substantially 100%, of the diameter of the receiving lumen of the first/second moving medium.

Preferably, when the first/second movable means receiving lumen and the entire first/second flexible drive member are each formed as a circular cylinder, it is preferred that the first/second flexible movable member has a diameter that is at least 80% along its length; more preferably at least 85%, even more preferably at least 90%, even more preferably at least 95%, most preferably substantially 100%, of a diameter of the first/second movement means receiving lumen. Advantageously, an arrangement between the first/second flexible movable element and the first/second movable means receiving the lumen is a tolerance fit.

It is noted that when referring to the shape of a part or the whole of the first/second flexible movable element, the shape of a main body of the first/second flexible movable element extending in the direction of its longitudinal axis, without taking into account possible protrusions that can act as connecting parts of the flexible movable element to a further component of the catheter, i.e. when the first/second flexible movable element extends substantially along its longitudinal axis, is specifically understood within the scope of the present invention. Thus, the length of a part or the whole of the first/second flexible movable element specifically means a length of the part or the whole of the flexible movable element in the direction of its longitudinal axis, respectively.

It is further noted that the term "at least the first/second flexible movable member portion" specifically means the portion of the first/second flexible movable member, which is arranged within the lumen during its movement from the first end position to the second end position or vice versa.

By selecting the dimensional relationship of the first/second flexible movable member and the first/second movable lumen receiving means as shown, it can be ensured that the greater part of the force with which the first/second flexible movable member is pushed can be transferred to the first/ second surgical instrument and cause it to move, specifically push. The term "substantially" in relation to the terms "cross-section" and/or "diameter" specifically means that the first/second movable means receiving lumen and the first/second flexible movable element are produced within the technical tolerances thereof or the methods used to the construction of said elements.

Preferably, at least the first/second flexible movable member portion being movably arranged or arranged/movable during the first/second movement means receiving a clearance between the first and second end portions of the first/second flexible movable member has at least a portion of its length, i.e. only a portion of its length or its entire length, the same shape as the first/second movable means means receiving lumen. Preferably, the first/second flexible movable element has throughout its length the same shape as the first/second movable means receiving the lumen.

Preferably, the first/second flexible movable element is arranged in the first/second movement means receiving a lumen in such a way that the first/second flexible movable element part which is arranged to be movable or arranged/movable during the first/second movement means that the receiving lumen between the first and second positions of the first/second flexible movable element has at least a portion of its length, i.e. only in a portion of its length or throughout its length, a shape that is complementary to a shape of first/second movement means receiving a groove. For example, if both the first/second flexible movable member and the first/second movable lumen receiving means have an elliptical cross-section, the first/second flexible movable member is arranged in the first/second movable means receiving lumen in such a way that a major axis and a minor axis of the first/second flexible movable member to be aligned with a major axis and a minor axis of the first/second movable means receiving lumen, respectively.

According to an advantageous embodiment, at least the first/part of the second flexible movable element which is arranged to be movable or arranged/movable in the first/second movement means receiving a clearance between the first and the second extreme position of the first/second flexible movable element, namely of the entire first/second flexible moving element, is formed as a circular cylinder.

Preferably, the first/second movable lumen receiving means is formed as a circular cylinder. The first surgical tool can preferably be directly connected to the first movable element and placed directly in the catheter sheath. Alternatively, the first surgical tool may be mounted, in particular secured to, a first tool receiving housing which is longitudinally movable, in particular slidable, arranged in the sheath of the catheter and connected to the first movable element. The first tool receiving housing is arranged between the first flexible movable element and the first surgical tool. Additionally, the first surgical tool may also be directly connected to the first movable element.

The second surgical tool is preferably connected directly to the second movable element and is directly arranged in the sheath of the catheter. Alternatively, the second surgical tool may be mounted, in particular secured to, a second longitudinally movable, in particular slidable, tool receiving housing arranged in the sheath of the catheter and connected to the second movable element. The first tool receiving housing is arranged between the second flexible movable element and the second surgical tool. In addition, the second surgical tool may also be directly connected to the second movable element.

Advantageously, the first surgical tool is connected to the first movable means through a first distal connection opening formed in a peripheral region of the catheter sheath.

When the second surgical tool is movable in the catheter sheath in the direction of the longitudinal axis with the second movable means, the second surgical tool is advantageously connected to the second movable means through a second distal connection opening formed in a peripheral region of the catheter sheath.

Preferably, each movable surgical tool provided in the catheter is connected to the respective drive means through a respective distal connection opening formed in the peripheral region of the catheter sheath. In this case, the number of mobile surgical tools is equal to the number of mobile media and the number of peripheral connection openings.

Preferably, the catheter sheath further comprises at least one further lumen for receiving a guidewire and/or passing a substance, in particular liquid therethrough, e.g. for delivering fluid to a point of interest on the patient's body and/or removing body or other fluids from the patient's body. It is also possible that the at least one further lumen consists of at least one guidewire receiving lumen and at least one substance passing through the lumen as a separate lumen. The catheter together with a guidewire can be characterized as a catheter assembly.

The at least one further lumen advantageously extends the entire length of the catheter sheath. In other words, a proximal end and a distal end of the at least one additional lumen correspond to a proximal sheath end and a distal sheath end of the catheter sheath, respectively. Alternatively, at least one more lumen may extend a partial length of the catheter sheath.

According to an advantageous embodiment of the present invention, the catheter sheath comprises at least one body fluid passage opening. The at least one body fluid bypass opening is formed in a peripheral region of the catheter sheath and is in fluid communication with at least one more lumen. The at least one body fluid passage opening is arranged proximal to the first surgical tool, the first surgical tool being closer to the proximal end of the sheath of the catheter sheath than the second surgical tool (being at the proximal end of the sheath). In other words, the first surgical tool and the second surgical tool are compared with each other as a proximal surgical tool and a distal surgical tool, respectively. The first surgical tool and the second surgical tool are inflatable balloons. This configuration allows body fluids to enter the at least one more lumen and exit proximally from the at least one more lumen through the at least one body fluid bypass opening. In this way, body fluids flowing into the body lumen in which the catheter is placed can bypass the portion of the body lumen between the two inflatable balloons when they are inflated. The exact location of the at least one bodily fluid bypass in the catheter sheath can be selected according to the medical application for which the catheter is intended. Thus, a portion of the body fluids can exit the at least one more lumen at a desired location, while the remaining body fluids can exit the at least one more lumen through an opening formed in the distal end of the catheter sheath. In particular, the catheter sheath may include a plurality of body fluid bypass openings. The body fluid bypass openings may preferably be spaced from each other in the direction of the longitudinal axis and/or in the circumferential direction of the catheter sheath. Thus, a portion of the body fluids can be more evenly distributed proximal to the first balloon-shaped surgical tool. It is noted that bodily fluids may enter the at least one further lumen through an opening formed toward the distal sheath end of the catheter sheath and/or at least one opening, specifically a plurality of openings, formed in a peripheral region of the catheter sheath distal to the second surgical instrument formed as a balloon.

According to an advantageous embodiment of the present invention, the catheter sheath comprises at least one fluid supply opening formed in a peripheral region of the catheter sheath and in fluid communication with at least one further lumen. Thus, a fluid can be delivered in a targeted manner to a specific part of the patient's body through the at least one fluid providing opening.

In particular, the catheter sheath may include a plurality of openings that provide fluid. Thus, depending on the arrangement of fluid providing openings in the peripheral region of the catheter sheath, more targeted fluid delivery to various locations on the patient's body can be achieved. The fluid providing apertures may preferably be separated from each other in the direction of the longitudinal axis and/or in the circumferential direction of the catheter sheath.

Preferably, the at least one fluid delivery opening is arranged between the first surgical tool and the second surgical tool, when the first surgical tool and the second surgical tool are inflatable balloons. Thus, a fluid can be delivered to a part of the patient's body between the balloons which can be isolated when the balloons are inflated. In this way, the fluid can only be provided to the isolated part without mixing with body fluids. For example, the liquid may be a drug or a contrast agent.

The first/second movable element is preferably formed as a wire. The term "wire" may also include a wire or any other flexible rod-shaped element. However, the first/second movable member may be any bendable member such that the catheter may bend as a unit when advanced through hollow organ lumens and cavities of the patient's body.

The first/second flexibility control element is preferably formed as a wire. The term "wire" may also include a wire or any other flexible rod-shaped element. However, the first/second control element when flexible can be any bendable element such that the catheter can bend as a unit when advanced through hollow organ lumens and cavities of the patient's body.

The first/second movable element and/or the first/second control element can be made, for example, of metal, plastic or composite material.

Within the context of the present invention, the term "flexible" describing a component of the probe, namely the first/second movable element or the first/second control element when formed as a flexible first/second control element, advantageously means that the respective component bends by its weight. In other words, the term "flexible" means that the corresponding component cannot support/carry/carry its weight without bending when it is fixed at one end and the other end is free. It is noted, however, that bending does not mean that the corresponding component collapses under its own weight when it is fixed at one end and the other end is free. In other words, the flexible component can only partially support its own weight. Accordingly, within the context of the present invention, the term "rigid" describing a component, namely the first/second control element when formed as a rigid first/second control element, advantageously means that the first/second control element cannot bend by its weight. In other words, the term "rigid" means that the first/second control element can support/carry/carry its weight without bending when it is fixed at one end and the other end is free.

Within the context of the present invention, the term "movable means" may specifically be substituted by the term "drive means". By "drive means" is meant a means for transmitting the movement of a physician's hand, or a movement of the control means, if such a control means is present in the catheter, which is moved by the physician using the catheter in the corresponding surgical tool. In particular, in the context of the present invention, a means for transmitting motion can also be understood as a means for transmitting force for transmitting a force applied thereto, by the physician using the catheter, to the corresponding surgical tool.

It is noted that, within the context of the present invention, a first element being attached to a second element means that there is no relative movement between the first and second elements when they are connected.

It is also noted that each of the movable components of the catheter consists of a first end position (proximal end position) and a second end position (peripheral end position). In the first extreme position, a distal end of a respective component is in its closest position with respect to the distal sheath end of the catheter sheath, while in the second end, the distal end of a respective component is positioned in its closest position with respect to the rotary sheath end of the catheter sheath. A corresponding component is mobile between its respective first extreme position and its second extreme position. Specifically, the difference between the first extreme position and the second extreme position of the first/second surgical tool corresponds to the range of motion of the first/second surgical tool, in other words the maximum distance that the first/second surgical tool can cover during of his movement. Further, specifically, the first/second movable element is extended to its second end position and retracted to its first end position.

Advantageously, the first/second movable element is partially arranged within the receiving lumen of the first/second movable means when the first/second movable element is in its first end position corresponding to the first end position of the first/second surgical tool. Preferably, when the first/second movable element is in its second end position corresponding to the second end position of the first/second surgical tool, the first/second movable element may be partially disposed within the first/second movable receiving lumen medium. However, when the first/second movable means includes/comprises the first/second proximal and peripheral pistons, it is also possible for the first/second movable element to be arranged completely outside the first/second movable means receiving lumen in its second final position. In other words, it can be said that the first/second movable element is preferably partially arranged inside the receiving lumen of the first/second movable means between its first end position and the second end position, i.e. between the first end position and the second end position of the first/second surgical instrument.

In the case of the first/second control means that the first/second control element is rigid as described above, the first/second control element may be, depending on the design of the probe, partially or fully arranged in the first/second movable lumen receiving means in his second final position. In this case, it is noted that the first/second control element is arranged in the portion of the first/second movement means receiving a lumen that is not arranged inside a patient's body when the catheter is inserted into the patient's body.

In the case of the first/second control means the first/second control housing and the first/second movable element connected to the first/second witness housing with the first/second control element, the first/second control element is advantageously arranged at least in partially, specifically fully, within a first/second mobile media receiving lumen at both the second end position and the first end position.

Note that the composition using a "/" (slash) between two probe features can be read as "and/or". For example, the expression "the first/second movable element" can be read as "the first and/or the second movable element", which is equivalent to the expression "the first movable element and/or the second movable element".

The present invention further relates to a method of using the described catheter in a surgical procedure. The method includes the step of providing a catheter previously described.

Next, a medical balloon and a catheter with such a medical balloon are disclosed:

11. A medical balloon that is inflatable and includes:

• a balloon proximal end,

• a distal balloon tip, and

• at least one channel extending from the proximal end of the balloon to the distal end of the balloon to allow fluid to flow therein in the inflated state of the medical balloon. I2. The medical balloon of claim 11, wherein at least one channel is formed as a recess in a peripheral region of the medical balloon.

13. The medical balloon of item 11, wherein at least one channel extends through an interior of the medical balloon.

14. The medical balloon of any one of items 11 to 13, wherein the channel is formed such that fluid can flow substantially in one direction or only in one direction through the channel.

15. The medical balloon of any of points 11 to 14, wherein a first channel cross-section of the at least one channel is greater than a second channel cross-section of the at least one channel, in particular when the first channel cross-section is arranged at a first channel end, in particular a proximal channel end, and the second channel cross-section is arranged in a second channel end, namely a peripheral channel end.

16. The medical balloon of item 15, wherein at least one channel is tapered between the cross section of the first channel and the cross section of the second channel.

17. The medical balloon of any one of items 14 to 16, wherein a one-way valve is arranged in the first channel cross-section or in the second channel cross-section.

18. The medical balloon of any one of items 11 to 17, wherein at least one channel consists of two or more channels.

19. The medical balloon of any one of items 11 to I8, further comprising a fitting region for fitting the medical balloon to a component of a catheter.

110. A medical balloon device, comprising at least two medical balloons according to any of items 11 to 19, in particular when the channels of the at least two medical balloons are interconnected and in fluid communication with each other by conduit.

111. Catheter, comprising a medical balloon according to items 11 to I9 or a medical balloon device of item 110.

112. The catheter of 111, further comprising a catheter shaft and/or tool receiving housing disposed in the catheter sheath and configured to receive the medical balloon, wherein the medical balloon is directly disposed in the catheter sheath or the instrument receiving tool.

The medical balloon of subject 11 has the advantage that it can be secured within a lumen or body cavity of a patient when inflated while still allowing fluid exchange between the region proximal to the lumen or cavity and the region distal to the lumen or the cavity. This is particularly advantageous when the medical balloon is intended to be used in an intravascular catheter, as this would allow at least partial blood flow into the blood vessel.

The various designs of the medical balloon channel of elements 12 or 13 allow the medical balloon to be used in various medical applications, taking into account the anatomical characteristics of the part of the patient's body in which the balloon will be placed. For example, a medical balloon according to item 12 or 13 can be used in a catheter, which is fixed by anchoring the balloon to the wall of the esophagus or a blood vessel of a patient. Here, the inflated balloon inflates into the esophagus or blood vessel, respectively, while allowing e.g. saliva or blood, respectively, to pass through the channel. On the other hand, a medical balloon according to point 13 may be preferred for example in a gastrointestinal catheter which must be prevented from being removed from the patient's body by inflating the balloon inside a patient's stomach. Another criterion for choosing between the medical balloon according to points 12 or 13 may be the flow characteristics of a liquid within the part of the patient's body in which the balloon is to be placed. For example, the channel of a medical balloon according to point 12 will be closer to the wall of a body lumen of the patient than the channel of a corresponding medical balloon according to point 13, when the balloon is placed within a body lumen. The fluid velocity near the wall is generally expected to be less than that in the middle of the body lumen. Thus, a catheter according to item 12 can be used when there is sufficient fluid flow in the body lumen, while a medical balloon according to item 13 can be used when weaker fluid flow occurs in the body lumen.

In the medical balloon of point 12, a first portion of the peripheral region of the medical balloon at a given cross-section has a larger dimension than a second portion of the peripheral region at the same cross-section. Especially when the medical balloon has two or more channels formed as recesses in its peripheral region, the medical balloon can be specifically considered to have a main region and two or more protruding regions protruding from the main region. Here, the protruding areas are the areas of the medical balloon intended to contact the wall of a body lumen or cavity of a patient when the balloon is in an inflated state within the body lumen or cavity. The number of protruding areas corresponds to the number of recesses.

The medical balloon of item 14 is particularly advantageous in cases where a body fluid in a first body region separated from a second body region by the balloon when inflated is desired or required to pass from the first body region to the second body region, while a body fluid present in the second body region should not be allowed to pass the first body region. For example, the first body region may include the esophagus and the second body region the stomach of a patient. Saliva must be allowed to pass from the esophagus into the stomach when the medical balloon is anchored to the esophageal wall, and gastric contents must not be able to enter the esophagus.

Selective flow of liquids in only one or substantially one direction can be achieved with the medical balloon of objects 15 to 17. In addition, the medical balloon of objects 15 or 16 may have the advantage that a liquid passing through the channel can exit through a smaller or larger cross-section than that through which the liquid entered.

Providing two or more channels in the medical balloon of object 18 has the advantage that a larger volume of fluid can pass through the channels.

The arrangement area for arranging the medical balloon on a component of a catheter in the medical balloon of element 19 can be extended in the direction of the longitudinal axis of a component of a catheter shaft, namely a catheter shaft or a tool receiving housing arranged in the catheter sheath and shaped to receive the balloon.

When a catheter must include at least two medical balloons, the use of the medical balloon device of 110 has the advantage that the passage of fluid from a first region of the body proximal to the first medical balloon to a second region of the body distal to the second medical balloon or from said second region to said first region becomes possible.

It is noted that the medical balloon of items 11 to 19 can be used as the first surgical tool and/or the second surgical tool and/or the third surgical tool in a catheter according to the present invention when any of these surgical tools is formed as an inflatable balloon. . It is also possible that the medical balloon of items 11 to 19 is an independently marketable product.

These and further details, advantages and features of the present invention will be described based on embodiments of the invention and by reference to the accompanying figures. Appears in:

figures 1 to 3 are simplified schematic views of a catheter with three surgical instruments according to the first embodiment of the present invention;

figure 4 a simplified schematic view of a part of the probe of the first embodiment,

figure 5 a simplified schematic view of a part of the catheter of the first embodiment,

figure 6 a simplified schematic view of a part of the catheter according to a second embodiment of the present invention;

figures 7 to 9 are simplified schematic views of the application of the probe of the first or second embodiment;

figure 10 a simplified schematic view of the catheter according to the third embodiment of the present invention together with the application of said catheter,

figure 11 a simplified schematic view of a catheter with two surgical instruments according to the fourth embodiment of the present invention;

Figure 12 is an enlarged schematic perspective view of a portion of the catheter of the fourth embodiment;

figure 13 a simplified schematic view of a catheter with two surgical instruments according to the fifth embodiment of the present invention;

figure 14 a simplified schematic perspective of a part of the catheter of the fifth embodiment;

figure 15 a simplified schematic view of the catheter implementation of the fourth or fifth embodiment;

figure 16 a simplified schematic view of a further implementation of the probe of the fourth or fifth embodiment;

figures 17 and 18 are simplified schematic views of a catheter with two surgical instruments according to the sixth embodiment of the present invention together with the application of said catheter;

figure 19 a simplified schematic view of a catheter with two surgical instruments according to the seventh embodiment of the present invention;

figure 20 a simplified schematic view of an inflatable balloon according to an example;

figure 21 a simplified schematic view of an inflatable balloon according to a further example, and

figure 22 a simplified schematic view of an inflatable balloon according to a further example.

Embodiments and uses of the present invention are detailed below with reference to the accompanying Figures 1 through 22. Identical or equivalent features and features acting in the same or equivalent manner are denoted by the same reference numerals. For the sake of brevity, a detailed description of the elements and components is not repeated in each instance of their occurrence. It is also noted that the figures are not necessarily to scale.

Figures 1 to 5 show a catheter 100 according to a first embodiment of the present invention.

As shown in figure 1, the catheter 100 consists of a catheter sheath 2, a first surgical tool 11, a second surgical tool 12 and a third surgical tool 13.

The catheter sheath 2 extends along a longitudinal axis 500 from a proximal sheath end 29 to a peripheral sheath end 28. In addition, the catheter sheath 2 consists of a main body 201 and an end 202 attached to the main body 201.

The first surgical tool 11 and the second surgical tool 12 are arranged in the sheath of the catheter 2, while the third surgical tool 13 is fixed in the sheath of the catheter 2 and is arranged between the first surgical tool 11 and the second surgical tool 12 in the direction of longitudinal axis 500. Specifically, the first surgical tool 11 and the second surgical tool 12 are movable in the sheath of the catheter 2 in the direction of the longitudinal axis 500. Thus, the first surgical tool 11, the second surgical tool 12 and the third surgical tool 13 are movable relative to each other in the direction of the longitudinal axis 500. The first surgical tool 11 is specifically a proximal surgical tool and the second surgical tool 12 a distal surgical tool.

As shown in Figures 3 and 4, for the movement of the first surgical tool 11 and the second surgical tool 12, the catheter 100 consists of a first movement means 31 and a second movement means 32, respectively.

Specifically, the first movement means that 31 is formed as a first movable element 310 and the second movement means that 32 is formed as a second movable element 320. Both the first movable element 310 and the second movable element 320 are flexible and preferably formed as wires.

The first movable element 310 is connected to the first surgical instrument 11 and is arranged in a first movable means receiving a lumen 21 defined by a catheter sheath wall 20. Accordingly, the second movable element 320 is connected to the second surgical instrument 12 and is arranged in a second movable means receiving a lumen 22 defined by the catheter sheath wall 20. The first and second movements mean receiving lumens 21, 22 is best shown in Figures 2 and 4.

Specifically, the first surgical tool 11 is fixed/loaded into a first tool receiving housing 61, which is connected to the first movable element 310. In other words, the first movable element 310 is connected to the first surgical tool 11 with the first receiving housing tool 61. The first tool housing 61 is movable in the longitudinal direction, specifically slidable, arranged in the sheath of the catheter 2. Thus, the tool housing 61 and the first surgical tool 11 can be moved as a unit by the first movable element 310 in the direction of the longitudinal axis 500 of the catheter sheath 2.

Accordingly, the second surgical tool 12 is fixed/loaded into a second tool receiving housing 62, which is connected to the second movable element 320. In other words, the second movable element 320 is connected to the second surgical tool 12 with the second housing tool holder 62. The second tool holder housing 62 is movable in the longitudinal direction, specifically slideable, arranged in the sheath of the catheter 2 and connected to the second movable element 320. Thus, the tool holder housing 62 and the second surgical tool 12 can be moved as a unit by the second movable element 320 in the direction of the longitudinal axis 500 of the catheter sheath 2.

It is, however, also possible for the first surgical tool 11 and/or the second surgical tool 12 to be formed so that the first surgical tool 11 and/or the second surgical tool 12 are directly formed in the sheath of the catheter 2. In this case , the first surgical tool 11 is directly connected to the first movable element 310 and/or the second surgical tool 12 is directly connected to the second movable element 320.

Referring now to Figure 4, the catheter sheath 2 includes a first distal connection opening 271 and a second peripheral connection opening 272. The first distal connection opening 271 and the second distal connection opening 272 are specifically formed as recesses in a peripheral region of the catheter sheath 2; through which the first movable element 310 and the second movable element 320 are connected to the first tool housing housing 61 and the second tool housing housing 62, respectively.

To control the movement of the first surgical tool 11 and the second surgical tool 12, the catheter 100 includes according to Figures 1 and 2 a first control means 71 and a second control means 72, respectively. In other words, the first surgical tool 11 is controlled by the first control means 71 , while the second surgical tool 12 is controlled by the second control means 72 .

Specifically, the first control means 71 is formed as a first control housing 710 and the second control means 72 as a second control housing 720. The first control housing 710 is specifically directly connected to the first movable element 310 and the second control housing 720 to the second movable element 320 .Both the first and second control housings 710, 720 are longitudinally movable, namely slides, arranged in the sheath of the probe 2.

Referring to Figure 4, the catheter sheath 2 includes a first proximal connection opening 261 and a second proximal connection opening 262. The first proximal connection opening 261 and the second proximal connection opening 262 are specifically formed as recesses in a peripheral region of the catheter sheath 2, through wherein the first movable element 310 and the second movable element 320 are connected to the first control housing 710 and the second control housing 720, respectively.

Due to the configuration described above, a movement of the first control housing 710 is transmitted from the first movable element 310 to the first surgical tool 11, while a movement of the second control housing 720 is transmitted from the second movable element 320 to the second surgical tool 12.

Specifically, movement of the first control housing 710 in one direction from the proximal sheath end 29 to the distal sheath end 28 causes movement of the first surgical tool 11 in the same direction. Accordingly, movement of the second control housing 720 in the direction from the proximal sheath end 29 to the distal sheath end 28 causes movement of the second surgical tool 12 in the same direction.

For this purpose, the first movable element 310 is arranged within the receiving lumen of the first movable means 21 in such a way that the first movable element 310 is supported at least partially circumferentially by the catheter sheath wall 20 so that the first surgical tool 11 is movable from the first movable member 310 in the direction from the proximal sheath end 29 to the peripheral sheath end 28 of the catheter sheath 2. Therefore, the second movable member 320 is arranged within the second movable means receiving lumen 22 in such a way that the second movable element 320 being supported at least partially circumferentially by the wall of the catheter sheath 20 such that the second surgical tool 12 is movable from the second movable element 320 in the direction from the proximal sheath end 29 to the peripheral sheath end 28 of the sheath catheter 2

Thus, the at least partial peripheral support of the first movable element 310 and the second movable element 320 by the wall of the catheter sheath 20 allows them, even if formed as flexible movable elements, to cause movement of the first surgical tool 11 and the second surgical tool 12, respectively.

As specifically shown in Fig. 5, the first movable medium receiving lumen 21 and the first movable member 310 have the same shape and each is specifically formed as a circular cylinder. To achieve the at least partial peripheral support of the first movable element 310, it is preferred that the first movable element 310 has a diameter (outer diameter) of at least 80%, more preferably at least 85%, more preferably at least 90%, more preferably at least 95%, most preferably at least 95%, preferably substantially 100%, of a diameter of the first moving medium receiving lumen 21. Note that Figure 5 shows only a portion of the catheter sheath wall 20 required for definition and graphical representation of the first mobile media to receive 21 lumens.

Preferably, the same configuration applies to both the second movable media receiving lumen 22 and the second movable member 320. That is, the second movement means receiving lumen 22 and the second movable member 320 have the same shape and each is specifically formed as a circular Cylinder. To achieve the at least partial peripheral support of the second movable element 320, it is preferred that the second flexible movable element 320 has a diameter (outer diameter) of at least 80%, more preferably at least 85%, more preferably at least 90%, even more preferably at least 95%, most preferably at least 95%, preferably substantially 100%, of a diameter of the receiving lumen of the second moving medium 22.

In this embodiment, all surgical instruments 11, 12, 13 are formed as inflatable balloons. In other words, the first surgical tool 11 is formed as a first inflatable balloon, the second surgical tool 12 as a second inflatable balloon, and the third surgical tool 13 as a third inflatable balloon.

For inflation of the first inflatable balloon, the first movable member 310 is hollow and in fluid communication with the first inflatable balloon. Thus, the inflation fluid can flow into the first movable element 310 (indicated by arrow 311 in Figure 5) and exit therefrom (indicated by arrow 312 in Figure 5) in order to be delivered to the first inflatable balloon. To this end, the first tool housing housing 61 and the first control housing 710 are equipped with a corresponding opening to allow the flow of the expanding liquid into and out of the first movable element 310.

Accordingly, for inflation of the second inflatable balloon, the second movable member 320 is hollow and in fluid communication with the second inflatable balloon. Thus, the inflation fluid can flow into and out of the second movable element 320 to reach the second inflatable balloon. To this end, the second tool housing housing 62 and the second control housing 720 are equipped with a corresponding opening to allow the flow of the expanding fluid into and out of the second movable element 320.

For inflation of the third inflatable balloon, the catheter sheath 2 includes an inflation fluid passing the lumen 23. The inflatable fluid passage lumen 23 communicates with the third inflatable balloon via an inflatable fluid passing the opening 230 formed in a peripheral region of catheter sheath 2. As shown in Figure 2, the inflatable fluid passage lumen 23 advantageously extends from the proximal end of sheath 29 at the location of the third inflatable balloon.

In addition, the catheter sheath 2 includes a further lumen 24. The further lumen 24 can be used to receive a guidewire 200 and/or to pass fluid, for example body fluids, therethrough. The further lumen 24 advantageously extends from the proximal sheath end 29 to the distal sheath end 28 of the catheter sheath 2.

In contrast to the further lumen 24 and the expanding lumen 23, which extend as described from the proximal sheath end 29 of the catheter sheath 2, it becomes apparent from figure 2 that a corresponding proximal end of the first movable means receiving lumen 21 and the lumen second movable media receptacle 22 is spaced from the proximal sheath end 29. Note that numeral 3 schematically represents a portion of the catheter 100 of Figure 2 extending from the distal sheath end 28 to an area of the catheter sheath 2 between the first circumferential opening connection 271 and the second proximal connection opening 262. This is why in Figure 3 all four lumens 21, 22, 23 and 24 are shown.

Figure 6 relates to a catheter 100 according to a second embodiment of the present invention.

The probe 100 according to the second embodiment differs from the probe 100 according to the first embodiment in the configuration of the first movement means 31 and the first controls mean 71 and that of the second movement means 32 and the second control means 72 for the movement and the control of the first surgical tool 11 and the second surgical tool 12, respectively. Preferably, the first movement means 31 and the second movement means 32, and the first control means 71 and the second control means 72 comprise the same components, respectively, so that Figure 6 refers to the components of said media as relates to both the first surgical tool 11 and the second surgical tool 12. It is noted that Figure 6 shows only a portion of the catheter sheath wall 20 required to define and graphically represent the first mobile media receiving lumen 21 or the second mobile media receiving lumen mobile media 22.

The first movement means 31 in the catheter 100 of the second embodiment consists in addition to the first movable element 310 of a first peripheral plunger 81 and a first proximal plunger 91. The first distal plunger 81 and the first proximal plunger 91 are arranged within the first movable receiving lumen medium 21. A first space 111 between the first distal piston 81 and the first proximal piston 91 is filled with an incompressible fluid.

Figure 6 shows that the first movable element 310 is connected to the first peripheral piston 81. Due to the at least partial peripheral support of the first movable element 310, as described above in relation to the catheter 100 of the first embodiment and the incompressible fluid in the first space 111 between the first distal plunger 81 and the first proximal plunger 91 , a movement of the first proximal plunger 91 in the direction from the proximal sheath end 29 to the distal sheath end 28 of the catheter sheath 2 causes the first surgical tool 11 to move in the same direction . A movement of the first proximal piston 91 in the opposite direction, in other words, the direction from the rotary sheath end 28 to the proximal sheath end 29 of the catheter sheath 2, causes due to the accumulation of negative pressure in the first space 111 the first distal piston 81 and thus also the first surgical tool 11 moving in the direction from the rotary sheath end 28 to the proximal sheath end 29. Here, the first surgical tool 11 is pulled by the first movable member 310 toward the proximal sheath end 29.

To control the movement of the first proximal piston 91 and thus the first surgical tool 11, the first control means 71 includes in addition to the first control housing 710 a first control element 711. The first control element 711 can be configured as a rigid control element connected or integrally formed with the first proximal piston 91.

Alternatively, the first control element 711 may be configured as a flexible control element connected to the first proximal piston 91. In this case, the first control element 711 is preferably arranged within the first moving medium receiving lumen 21 in such a way that the first element control 711 to be at least partially supported circumferentially by the wall of the catheter sheath 20 such that the first proximal plunger 91 is movable toward the distal sheath end 28 of the catheter sheath 2 by the first control element 711. Specifically, the first control element 711 may to be formed like the first mobile element 310.

In order to deliver the inflating fluid to the first surgical tool 11 which is an inflatable balloon (first inflatable balloon), in addition to the first movable element 310 which is hollow, the first peripheral piston 81, the first proximal piston 91 and the first control element 711 it is also hollow. In addition, a first conduit 121 is arranged between the first peripheral piston 81 and the first proximal piston 91 and establishes fluid communication between the first movable element 310 and the first control element 711 .

Accordingly, the second movement means 32 in the catheter 100 of the second embodiment includes in addition to the second movable element 320 a second peripheral piston 82 and a second proximal piston 92. The second distal piston 82 and the second proximal piston 92 are arranged in the lumen receiving a second moving medium 22. A second space 112 between the second distal piston 82 and the second proximal piston 92 is filled with an incompressible fluid.

The second movable element 320 is connected to the second peripheral piston 82. Due to the at least partial peripheral support of the second movable element 320, as described above with respect to the catheter 100 of the second embodiment and the incompressible fluid in the second space 112 between the second distal piston 82 and the second proximal plunger 92, a movement of the second proximal plunger 92 in the direction from the proximal sheath end 29 to the distal sheath end 28 of the catheter sheath 2 causes the second surgical tool 11 to move in the same direction. A movement of the second proximal piston 92 in the opposite direction, in other words the direction from the distal sheath end 28 to the proximal sheath end 29 of the catheter sheath 2, causes due to the build-up of negative pressure in the second space 112 the second distal piston 82 and thus also the second surgical tool 12 moving in the direction from the rotary sheath end 28 to the proximal sheath end 29. Here, the second surgical tool 12 is pulled by the second movable member 320 toward the proximal sheath end 29.

To control the movement of the second proximal piston 92 and thus the second surgical tool 12, the second control means 72 includes in addition to the second control housing 720 a second control element 721. The second control element 721 can be configured as rigid a control element connected or integrally formed with the second proximal piston 92;

Alternatively, the second control element 721 may be configured as a flexible control element connected to the second proximal piston 92. In this case, the second control element 721 is preferably arranged within the second movable means receiving lumen 22 in such a way that the second element control 721 is at least partially supported circumferentially by the wall of the catheter sheath 20 such that the second proximal plunger 92 is moved toward the distal sheath end 28 of the catheter sheath 2 by the second control element 71. Specifically, the second control element 721 may to be formed like the second movable element 320.

In order to deliver the inflation fluid to the second surgical tool 12 which is an inflatable balloon (second inflatable balloon), in addition to the second movable member 320 being hollow, the second peripheral piston 82 and the second proximal piston 92 are also hollow. In addition, the second control element 721 is equipped with a corresponding opening so that fluid communication can be achieved between the second control element 721 and the second control element 720. In addition, a second conduit 112 is arranged between the second peripheral piston 82 and the of second proximal piston 92 and establishes fluid communication between second movable element 320 and second control element 721.

Although the first movement means 31 and the second movement means 32 of the probe 100 of the first embodiment or the second embodiment includes the same components, respectively, it is also possible that the first movement means 31 of a probe 100 according to the present invention is formed as first movement means 31 of the probe 100 of the first embodiment and the second movement means 32 as the second movement means 32 of the probe 100 of the second embodiment or vice versa. Same goes for the first controller means 71 and the second controller means 72.

Figures 7 to 9 show an advantageous embodiment in which the catheter 100 of the first or second embodiment of the present invention may be used.

In Figures 7 to 9, the catheter 100 is shown within a blood vessel 900, specifically the descending aorta, in different states. In Figure 7, the first inflatable balloon corresponding to the first surgical instrument 11 and the second inflatable balloon corresponding to the second surgical instrument 12 are placed in their closest position to the third inflatable balloon corresponding to the third surgical instrument 13. It is recalled that the first inflatable balloon and the second inflatable balloon are movably arranged in the catheter sheath 2 of the catheter 100, while the third inflatable balloon is fixed in the catheter sheath 2.

In the state of probe 100 shown in Figure 7, all inflated balloons are deflated.

In the state of the probe 100 shown in Figure 8, all the inflatable balloons are inflated, while the first inflatable balloon and the second inflatable balloon have moved away from the third inflatable balloon. The first inflatable balloon can be designated as the proximal balloon, the second inflatable balloon as the distal balloon, and the third inflatable balloon as the intermediate balloon.

In the state of the probe 100 shown in Figure 9, the first inflatable balloon and the second inflatable balloon are at their most distant position from the third inflatable balloon while still inflated.

By suitably combining a movement of the first and second inflatable balloons with each other and with the third inflatable balloon in an inflated or deflated state, the catheter 100 can be used as a blood pump, specifically an intra-aortic balloon pump.

For this purpose, the doctor first inserts the catheter 100 into the patient's body, for example through the femoral artery, and advances the catheter 100 until it reaches the ascending aorta. This is done with all the inflated balloons deflated (figure 7). At the beginning or just before the next diastolic phase of the heart, the doctor inflates all the inflatable balloons and starts moving the first and second, now inflated, balloons away from each other and away from the third, now inflated, balloon ( figures 8 and 9). Thus, the blood already present in the ascending aorta due to the previous systolic phase of the heart is pumped by the first inflated balloon to the patient's legs and by the second inflated balloon to the patient's heart and head. In other words, the first inflated balloon and the second inflated balloon act as pistons that push blood to the periphery of the patient's body. When the next systolic phase of the heart begins or shortly before it, the doctor deflates all the balloons and starts moving the first and second, now deflated, balloons towards the third, now deflated, balloon in order to prepare for the next diastolic heart phase. As all inflatable balloons deflate during the systolic phase of the heart, blood pumped from the heart can pass through catheter 100.

Due to the provision of two movable inflatable balloons, that is, the first and second inflatable balloons, to the catheter 100, the cardiac output can be greatly increased, and more parts of the human body can be supplied with blood at the same time. The movement of the first and second inflatable balloons is mechanically supported due to the fixed arrangement of the third inflatable balloon in the catheter sheath 2.

Figure 10 shows a catheter 100 according to a third embodiment of the present invention together with an advantageous embodiment of said catheter 100.

The catheter 100 according to the third embodiment differs from the catheter 100 according to the first or second embodiment in that the catheter 100 includes a plurality of body fluid bypass openings formed in a peripheral region of the catheter sheath 2 proximal to the first inflatable balloon corresponding to the first surgical instrument 11. The body fluid bypass openings are in fluid communication with further lumen 24.

Catheter 100 according to the third embodiment can be advantageously used to treat an abdominal aortic aneurysm.

An abdominal aortic aneurysm is a localized swelling of the abdominal aorta so that the diameter is usually greater than 3 cm or more than 50% larger than normal. An abdominal aortic aneurysm usually causes no symptoms, except during rupture. In 70% to 80% of patients with an abdominal aortic aneurysm, the vessel wall of the abdominal aortic aneurysm is covered by intraluminal thrombus, which generally does not block blood flow. It is generally accepted that the sooner a patient with a ruptured abdominal aortic aneurysm is operated on, the better the patient's chance of survival, as massive bleeding from a ruptured abdominal aortic aneurysm leads to massive internal bleeding and blood loss that usually results in death. of the patient. On the other hand, a surgical treatment of abdominal aortic aneurysm rupture carries a high morbidity and mortality rate, as such a procedure most often takes place only many hours after diagnosis, as not all medical centers are capable of performing such surgeries and therefore the patient must first be transferred to a specialist hospital. Thus, for the most successful outcome, early diagnosis and prompt treatment of ruptured abdominal aortic aneurysm is essential. Once an abdominal aortic aneurysm ruptures, death is inevitable unless the bleeding can be stopped and blood flow to the lower body can be restored immediately within the first few hours after diagnosis.

The catheter 100 according to the third embodiment has the great advantage that it can be used by any endovascular surgeon in any medical center with an angiography suite and immediately stabilizes the patient by stopping blood loss and restoring blood perfusion to lower extremities and internal organs.

Referring to Figure 10, blood vessel 900 there indicated the abdominal aorta of a patient. As further shown, an abdominal aortic aneurysm 903 is covered by an intravenous thrombus 902 and has a rupture 901 .

To treat the abdominal aortic aneurysm, the surgeon must insert the catheter 100 of the present embodiment into the abdominal aorta, place the first inflatable balloon 11 and the second inflatable balloon 12 at a distal end and a proximal end of the aneurysm 903, respectively, and inflate them so that the area of blood vessels 900 that includes the aneurysm 903 is isolated and blood loss through the rupture 901 is prevented. The third inflatable balloon arranged between the first and second inflatable balloons is also inflated in order to better stabilize the catheter 100 within aneurysm 903. However, it is also possible that catheter 100 does not consist of the third inflatable balloon.

Blood flowing in a region protruding toward the aneurysm 903 may enter the further lumen 24 (indicated by arrow 904 ) and exit the further lumen 24 in a vortex region in the aneurysm 903 through the plurality of openings body fluid bypass 280 (indicated by the plural of arrows 905). Thus, blood flow is not blocked or at least not completely blocked during the treatment of the abdominal aortic aneurysm 903. In particular, the body fluid bypass openings 280 can be placed in the catheter sheath 2 in such a way that blood can be directed to different parts of the patient's body.

Figures 11 and 12 refer to a catheter 100 according to a fourth embodiment of the present invention.

The catheter 100 according to the fourth embodiment differs from the catheter 100 according to the first or second embodiment in that the catheter 100 according to the fourth embodiment includes only the first surgical tool 11 and the second surgical tool 12 formed as inflatable balloons.

In other words, the third surgical tool 13 which is an inflatable balloon in the catheter 100 of the first or second embodiment is omitted here. Because of this, also the inflation fluid passing the opening 230 and the corresponding fluid inflation lumen 23 are stuck.

It is noted that first movement means 31, second movement means 32, first control means 71 and second control means 72 may be formed as those of the probe 100 of the first or second embodiment.

A further difference between the catheter 100 of the fourth embodiment and that of the first or second embodiment is that the catheter 100 of the fourth embodiment consists of two additional lumens 24.

The first further lumen 24 preferably communicates with a fluid providing opening 290 formed in a peripheral region of the catheter sheath 2 between the first surgical tool 11 and the second surgical tool 12. Thus, the first further lumen 24 is used as a fluid passing intangible. Therefore, the first further lumen 24 preferably extends from the proximal end of the sheath 29 to the location of the fluid providing opening 290. Through the fluid providing opening 290, a fluid can be delivered to a region of a body lumen that is isolated from the first and second inflatable balloons.

The second further lumen 24 can be used to receive a guide wire 200 as well as to pass fluid therethrough when the guide wire 200 is removed. In other words, the second further lumen 24 can be characterized as a receiving guide wire and a passage lumen fluid 24. Therefore, the second further lumen 24 preferably extends from a proximal sheath end 29 to the distal sheath end 28 of the catheter sheath 2. In particular, the second further lumen 24 may be used to pass bodily fluids therethrough.

Figures 13 and 14 refer to a catheter 100 according to the fifth embodiment of the present invention.

The catheter 100 according to the fifth embodiment differs from that of the first or second embodiment in that the catheter 100 according to the fifth embodiment consists of only one movable surgical tools formed as an inflatable balloon, that is, the first surgical tool 11.

Unlike the catheter 100 of the first or second embodiment, the second surgical tool 12 of the catheter 100 in the present embodiment is secured to the sheath of the catheter 2. The second surgical tool 12 is also here configured as an inflatable balloon. Specifically, the second surgical tool 12 of the catheter 100 of the present embodiment corresponds to the third surgical tool 13 of the catheter 100 according to the first or second embodiment.

The catheter 100 of the fourth or fifth embodiment can be used in an angiography procedure explained based on Fig. 15.

During an angiography procedure, a contrast agent is delivered into the blood vessel 900 through the first further lumen 24 and the fluid providing opening 290 (indicated by arrows 907). In order to prevent the contrast agent from being washed away by the blood flow in the blood vessel 900 and thereby achieve that the contrast agent is targeted to the area of interest, for example the smaller blood vessels 906 that communicate with the blood vessel 900, the first inflatable balloon and the second inflatable balloon inflate. This has the effect of isolating the region of interest from the rest of the blood vessel 900. In this way, the maximum possible concentration of the contrast agent in the isolated region of interest can be achieved.

At the same time, the blood flow in the blood vessel 900 is not blocked, as the blood can flow through the second further lumen 24.

It is noted that the second further lumen 24 may be omitted from the catheter 100 according to the fourth or fifth embodiment, since an angiography procedure does not take long and therefore it is not critical to maintain blood flow in the blood vessel 900 during the procedure .

The catheter 100 of the fourth or fifth embodiment can also be used in a thrombolytic process explained based on Figure 16.

A region of the blood vessel 900 in which an intravenous thrombus 902 has formed can be isolated by inflating the first inflatable balloon and the second inflatable balloon.

Thus, a thrombolytic fluid can be delivered directly to the endosomal clot 902 through the fluid providing opening 290 communicating with the first further lumen 24 without being washed away by the blood flow into the blood vessel 900. In this way, the maximum possible concentration of thrombolytic fluid in the isolated region of interest. An additional advantage of isolating the region of the blood vessel 900 in which the endosomal thrombus 902 forms is that the smaller pieces into which the thrombus 902 breaks up after the initial effect of the thrombolytic fluid can remain between the initially inflated balloons. Thus, they can be further reduced in size so that they do not pose a threat to the patient when they return to normal blood circulation.

To simultaneously deliver thrombolytic fluid to multiple areas of the intravenous clot 902, a plurality of fluid delivery ports 290 may be provided in the peripheral region of the catheter sheath 2, as shown in Figure 16.

In addition, blood flow in the blood vessel 900 is not obstructed as blood can flow through the second further lumen 24. In addition, body fluid bypass openings 280 can be provided in the peripheral region of the catheter sheath 2 proximal to the first inflatable balloon for to achieve a more targeted delivery of blood to the blood vessel 900;

Figures 17 and 18 show a catheter 100 according to a sixth embodiment of the present invention along with a preferred embodiment of the catheter 100.

A first difference between the catheter 100 according to the sixth embodiment and that of the fourth embodiment is that the first surgical tool 11 in the catheter 100 according to the sixth embodiment is not an inflatable balloon but a stabilizing tool. The first surgical instrument 11 is a proximal surgical instrument.

A second difference is that the catheter 100 according to the sixth embodiment includes only one further lumen 24 which preferably extends from the proximal sheath end 29 to the distal sheath end 28. In particular, the further lumen 24 corresponds to the second further lumen 24 of the catheter 100 of the fourth implementation. Additionally, the fluid providing opening 290 and the corresponding further lumen 24 provided in the catheter 100 of the fourth embodiment are omitted in the catheter 100 of the present embodiment.

As can be seen from Figures 17 and 18, the catheter 100 of the present embodiment can be used in a gastrostomy, which is a surgical procedure used to provide a route for feeding tubes if needed for four weeks or more, and/or for venting the stomach for air or drainage.

More specifically, said pathway for feeding tubes may be provided by the catheter 100 of the present embodiment and specifically by the above further lumen 24.

For this purpose, the surgeon first inserts the catheter 100 through the abdomen 908 and the stomach 909, until the inflatable balloon corresponding to the second surgical tool 12 (remote surgical tool) is placed inside the stomach 909. During this step , the inflatable balloon is in a deflated state.

Next, the balloon is inflated and the first control housing 710 and the second control housing 720 which control the movement of the stabilizing tool and the balloon, respectively, are operated so that the abdomen 908 and the stomach 909 are pressed tightly against each other.

By holding the first control housing 710 and the second control housing 720 stationary and moving the catheter sheath 2 forward, that is, toward the inner lumen of the stomach 909, the catheter sheath 2, specifically the distal sheath end 28, can be placed in the area of interest within the stomach 901. At the same time, the abdomen 908 and the stomach 909 can maintain their position relative to each other.

In particular, food can be provided through the further lumen 24 into the stomach.

Figure 19 shows a catheter 100 according to a seventh embodiment of the present invention.

The catheter 100 according to the seventh embodiment differs from the catheter 100 according to the fourth embodiment in that the second surgical tool 12 of the catheter 100 of the seventh embodiment is not an inflatable balloon but a cutting device. Specifically, the cutting device is formed as an atherotomy blade used to cut an atheroma in a blood vessel.

For this purpose, the doctor inserts the catheter 100 into the blood vessel, while the inflatable balloon corresponding to the first surgical tool 11 is in a deflated state.

When the catheter sheath 2 has reached the atheroma, the doctor inflates the inflatable balloon, thus anchoring it to the blood vessel wall. Next, the catheter sheath 2 is pushed towards the atheroma. The force, with which the catheter sheath 2 is pushed, is transferred near the end 202 of the catheter sheath 2 and therefore also to the atherotomy blade fixed to the catheter sheath 2 near the end 202.

Thus, the atheroma can be easily cut off from the blood vessel.

Figure 20 shows an inflatable balloon (medical balloon) 1000 directly arranged on a catheter shaft 2. That is, the inflatable balloon 1000 is not attached to a tool housing housing which is longitudinally movably arranged in the catheter sheath 2, but is arranged to be movable in the longitudinal direction in the sheath of the catheter 2. The inflatable balloon 1000 advantageously has a shape that completely surrounds the shaft of the catheter 2. Specifically, the inflatable balloon is barrel-shaped. However, the inflatable balloon 1000 may also take other forms, e.g. to be formed as a donut or hollow cylinder.

The first inflatable balloon corresponding to the first surgical tool 11 and/or the second inflatable balloon corresponding to the second surgical tool 12 of the previously described embodiments can also be arranged directly on the catheter shaft 2 in a movable manner such as the balloon 1000 of Figure 20. In this case, the first movable element 310 and/or the second movable element 320 are directly connected to the first inflatable balloon and/or the second inflatable balloon through the first peripheral connection opening 271 and/or the second remote connection opening 272, respectively.

Figure 21 shows another example of an inflatable balloon (medical balloon) 1000.

The inflatable balloon 1000 consists of two channels 1003 extending from a proximal balloon end 1001 to a peripheral balloon end 1002 to allow a flow of fluid therethrough in its inflated state.

In particular, the channels 1003 are formed as recesses in a peripheral region of the balloon 1000.

Channels 1003 are formed such that fluid can flow substantially in one direction or only in one direction through each channel 1003.

To this end, a first channel cross-section (cross-sectional area) at the first channel end 1006 of each channel 1003 is larger than a second channel cross-section (cross-sectional area) at the second channel end 1007 of the corresponding channel 1003. As shown in Figure 21, the first channel end 1006 corresponds to a proximal channel end and the second channel end 1007 corresponds to a peripheral channel end.

Thus, each channel 1003 has a tapered shape between the cross section of the first channel and the cross section of the second channel, in other words between the proximal end of the channel and the end of the distal channel.

The inflatable balloon 1000 further includes a settling region 1005 for settling the medical balloon component of the catheter. The accessory may be a tool housing housing arranged on a probe shaft of the probe or on the probe sheath itself.

Figure 22 shows another example of an inflatable balloon (medical balloon) 1000.

The difference between the balloon 1000 of Figure 22 and Figure 21 is that the channels 1003 of the balloon 1000 of the present example are not formed as recesses in the peripheral region of the balloon 1000, but extend through the interior of the balloon 1000.

One of the channels 1003 has a taper formed between the first channel cross-section and the second channel cross-section, in other words between the proximal channel end and the distal channel end. Thus, fluid may flow, depending on the ratio of the first cross-section to the second cross-section, substantially or only in the direction from the proximal end of the channel to the distal end of the channel 1003 .

The other channel 1003 is cylindrical in shape but is equipped with a one-way valve 1008 at the distal end of its channel. The check valve can be formed for example as a vane. Thus, fluid can only flow in the direction from the proximal end of the channel to the distal end of the channel 1003.

It is noted that the first inflatable balloon corresponding to the first surgical tool 11 and/or the second inflatable balloon corresponding to the second surgical tool 12 and/or the third inflatable balloon corresponding to the third surgical tool 13 of the previously described embodiments may be shaped as a balloon 1000 of forms 21 and 22.

The illustrated and described features and further properties of embodiments of the invention may be arbitrarily isolated and recombined without departing from the essence of the present invention.

In addition to the above description of the present invention, reference is expressly made to the graphical representation of Figures 1 through 22 for additional disclosure.

List of reference symbols

2 catheter sheath

20 catheter sheath wall

21 receiving channel of the first drive means 22 receiving channel of the second driving means 23 passage channel of inflation fluid 24 additional channel

28 distal sheath end

29 proximal end of sheath

31 first means of movement

32 second means of movement

61 first tool housing housing 62 second tool housing housing 71 first control means

72 second means of control

81 first remote piston

82 second remote piston

91 first proximal piston

92 second proximal piston

100 catheter

111 first place

112 second space

121 first conductor

122 second pipeline

200 guide wire

201 main body

202 nose

230 inflation fluid passage opening 261 first proximal connection opening

262 second proximal connection opening

271 first remote connection opening 272 second remote connection opening 280 body fluid passage opening 290 fluid supply opening

310 first movable element

311 arrow

312 arrow

320 second movable element

500 longitudinal axis

710 first control housing

711 first control

720 second control housing 721 second control element

900 blood vessel

901 burglary

902 intraluminal thrombus

903 abdominal aortic aneurysm 904 arrow

905 arrow

906 blood vessel

907 arrow

908 abdomen

909 stomach

1000 inflatable balloon

1001 balloon proximal tip

1002 distal end of balloon 1003 channel

1004 interior space

1005 settlement area

1006 first channel edge

1007 second channel end

1008 one way valve

Claims (15)

Claims 1. A probe (100), comprising: . a probe sheath (2) extending along a longitudinal axis (500); . a first surgical instrument (11); . a second surgical tool (12), and . a first movable means (31); . wherein the first surgical tool (11) and the second surgical tool (12) are movable relative to each other in the direction of the longitudinal axis (500), wherein the first surgical tool (11) is movable in the catheter sheath (2) in the direction of the longitudinal axis (500) by the first movable means (31), and wherein the second surgical tool (12) is movable in the catheter sheath (2) in the direction of the longitudinal axis (500) by a second movable means (32) or wherein the second surgical tool (12) is fixed to the catheter sheath (2) ). The catheter (100) of claim 1, wherein the catheter (100) further comprises a third surgical tool (13) secured to the sheath of the catheter (2). The catheter (100) according to claim 2, wherein the third surgical tool (13) is arranged between the first surgical tool (11) and the second surgical tool (12). The catheter (100) according to any of the preceding claims, wherein a corresponding surgical tool (11, 12, 13) is formed as an inflatable balloon or a cutting device or a stabilizing tool. The catheter (100) of any one of claims 2 to 4, wherein the third surgical tool (13) is formed as an inflatable balloon and the catheter sheath (2) comprises an inflation fluid passage lumen (23) communicating with the inflatable balloon. through an inflation fluid passage opening (230) formed in a peripheral region of the catheter sheath (2). The catheter (100) of any one of the preceding claims, wherein: the first movable means (31) comprises a first movable element (310), wherein the first movable element (310) is flexible, connected to the first surgical tool (11) and arranged in a first movable means receiving lumen (21) defined by a catheter sheath wall (20), wherein the first movable element (310 ) is arranged within the receiving lumen of the first movable means (21) in such a way that the first movable element (310) is at least partially supported circumferentially by the catheter sheath wall (20), so that the first surgical tool (11) can moving from the first movable member (310) in a direction from a proximal sheath end (29) of the catheter sheath (2) to a distal sheath end (28) of the catheter sheath (2); specifically wherein the first surgical tool (11) is formed as a first inflatable balloon and the first movable element (310) is hollow and in fluid communication with the first inflatable balloon, and the where: the second surgical tool (12) is movable in the catheter sheath (2) in the direction of the longitudinal axis (500) by the second movable means (32), and the second movable means (32) comprises a second movable element (320); wherein the second movable element (320) is flexible, connected to the second surgical tool (12) and disposed within a second movable means receiving lumen (22) defined by a catheter sheath wall (20), wherein the second movable element (320 ) is arranged within the second movable means receiving lumen (22) in such a way that the second movable element (320) is at least partially supported circumferentially by the catheter sheath wall (20), so that the second surgical tool (12) can to be moved by the second movable member (320) in a direction from a proximal sheath end (29) of the catheter sheath (2) to a distal sheath end (28) of the catheter sheath (2); specifically wherein the second surgical tool (12) is formed as a second inflatable balloon and the second movable element (320) is hollow and in fluid communication with the second inflatable balloon. 7. The catheter (100) of claim 6, wherein the first surgical tool (11) can be controlled by a first control means (71) connected to the first movable element (310), wherein in particular the first control means (71 ) comprises a first control housing (710) which can be moved in the longitudinal direction, namely by sliding, arranged in the catheter sheath (2) and connected to the first movable element (310), where the first movable element (310) is connected directly with the first control housing (710) or where the first control means (71) comprises a first control element (711) through which the first movable element (310) is connected to the first control housing (710) and which is formed as a rigid control, and the wherein the second surgical tool (12) can be controlled by a second control means (72) which is connected to the second movable element (320), wherein in particular the second control means (72) includes a second control housing (720) which can to be movable in the longitudinal direction, namely slidably arranged in the probe sheath (2) and connected to the second movable element (320), wherein the second movable element (320) is connected directly to the second control housing (720) or wherein the second control means comprises a second control element (721) with which the second movable element (320) is connected to the second control housing (720) and which is formed as a rigid control element. 8. The catheter (100) of claim 6, where: the first movable means (31) further comprises a first distal piston (81) and a first proximal piston (91); wherein the first distal piston (81) and the first proximal piston (91) are arranged within the first moving medium receiving lumen (21) and a first space (111) between the first distal piston (81) and the first proximal piston (91) ) is filled with an incompressible fluid, and wherein the first movable element (310) is further connected to the first remote piston (81), wherein the first movable element (310) is arranged within the receiving lumen of the first movable means (21) such that such that the first movable member (310) is at least partially supported circumferentially by the catheter sheath wall (20), so that a movement of the first proximal plunger (91) in a direction from the proximal sheath end (29) of the catheter sheath ( 2) toward the distal sheath end (28) of the catheter sheath (2) to cause a movement of the first surgical tool (11); in particular wherein the first distal piston (81) and the first proximal piston (91) are hollow and wherein the first movable element (310) is further in fluid communication with a first conduit (121) disposed between the first distal piston (81 ) and the first proximal piston (91), and the where: the second movable means (32) further includes a second distal piston (82) and a second proximal piston (92); wherein the second distal piston (82) and the second proximal piston (92) are disposed within the second movable media receiving lumen (22) and a second space (112) between the second distal piston (82) and the second proximal piston (92) ) is filled with an incompressible fluid, wherein the second movable member (320) is further connected to the second remote piston (82), wherein the second movable member (320) is arranged within the second movable means receiving lumen (22) such that the second movable member (320) being at least partially supported circumferentially by the catheter sheath wall (20) such that movement of the second proximal plunger (92) in the direction from the proximal sheath end (29) of the catheter sheath (2) to the distal sheath end (28) of the catheter sheath (2) to cause a movement of the second surgical tool (12); in particular wherein the second distal piston (82) and the second proximal piston (92) are hollow and wherein the second movable element (320) is further in fluid communication with a second conduit disposed between the second distal piston (82) and the of second proximal piston (92). 9. The catheter (100) of claim 8, Where: the first surgical tool (11) can be controlled via a first control means (71) connected to the first proximal piston (91); wherein the first control means (71) comprises a first control element (711) which is formed as a rigid control element connected or integrally formed with the first proximal piston (91) or which is formed as a flexible control element connected to the first proximal piston (91) and arranged such that the first control element (711) is at least partially supported circumferentially by the catheter sheath wall (20) so that the first proximal plunger (91) is movable toward the distal sheath end ( 28) of the catheter sheath (2) through the first control element (711), in particular where the first control means (71) further comprises a first control housing (710), which can be moved in the longitudinal direction, in particular slidable, arranged in the sheath of the catheter (2) and connected to the first control element ( 711), and the where: the second surgical tool (12) may be controlled by a second control means (72) connected to the second proximal plunger (92); wherein the second control means (72) comprises a second control element (721) formed as a rigid control element connected to or integrally formed with the second proximal piston (92) or formed as a flexible control element connected to the second proximal plunger (92) and arranged such that the second control element (721) is at least partially supported circumferentially by the catheter sheath wall (20) so that the second proximal plunger (92) is movable toward the distal sheath end (28) of the probe sheath (2) from the second control element (721), in particular where the second control means (72) further comprises a second control housing (720) which can be moved in the longitudinal direction, in particular slideable, arranged in the probe sheath (2) and connected to the second control element (721) . 10. The catheter (100) of any one of claims 6 to 9, where: at least the portion of the first flexible movable element which is movably arranged within the receiving lumen of the first movable means (21) between a first end position and a second end position of the first flexible movable element (310) has a cross-sectional surface on at least one part of of the total length which is at least 80%, more preferably at least 85%, even more preferably at least 90%, even more preferably at least 95%, most preferably essentially 100%, of a cross-sectional surface of the reception lumen of the first moving medium ( 21), and the at least the portion of the first flexible movable element which can move arranged within the receiving lumen of the first movable means (21) between a first end position and a second end position of the first flexible movable element (310) has for at least a part of its total length the same shape as the receiving lumen of the first moving medium (21), specifically where at least said first flexible movable element portion and the first movable means receiving lumen (21) are formed as circular cylinders, in particular where at least said portion of the first flexible movable element has over at least a portion of its total length a diameter that is at least 80%, more preferably at least 85%, even more preferably at least 90%, even more preferably at least 95% , preferably substantially 100%, of a diameter of the receiving lumen of the first moving medium (21), and the the first flexible movable element (310) is arranged within the first movable means receiving lumen (21) in such a way that the portion of the first flexible movable element which is movably arranged within the first movable means receiving lumen (21) between a first end position and a second extreme position of the flexible movable element (310) has for at least a part of its total length a shape that is complementary to a shape of the receiving lumen of the first movable means (21); and the where: at least the second flexible movable element portion that is movably arranged within the second movable means receiving lumen (22) between a first end position and a second end position of the second flexible movable element (320) has a cross-sectional area over at least a portion of of the total length which is at least 80%, more preferably at least 85%, even more preferably at least 90%, even more preferably at least 95%, most preferably essentially 100%, of a cross-sectional surface of the reception lumen of the second mobile medium (22 ), and the at least the portion of the second flexible movable element which is movably arranged within the receiving lumen of the second movable means (22) between a first end position and a second end position of the second flexible movable element (320) has over at least a portion of its total length the same shape as the receiving lumen of the second moving medium (22), specifically where at least said second flexible movable element portion and the second movable means receiving lumen (22) are formed as circular cylinders, in particular where at least said part of second flexible movable element has on at least one part of its total length a diameter which is at least 80%, more preferably at least 85%, more preferably at least 90%, even more preferably at least 95% , preferably substantially 100%, of a diameter of the receiving lumen of the second moving medium (22), and the the second flexible movable member (320) is arranged within the second movable means receiving lumen (22) in such a way that the portion of the second flexible movable member which is movably arranged within the second movable means receiving lumen (22) between a first end position and of a second extreme position of the flexible movable element (320) to have a shape complementary to a shape of the receiving lumen of the second movable means (22) over at least a part of its total length. The catheter (100) of any one of claims 6 to 10, wherein the first surgical tool (11) is connected directly to the first movable element (310) and is directly arranged in the catheter sheath (2) or wherein the first surgical tool (11) is arranged on, namely fixed to a first tool receiving housing (61), which can be moved in the longitudinal direction, namely slidable, arranged in the probe sheath (2) and connected to the first movable element (310 ), and the wherein the second surgical tool (12) is connected directly to the second movable element (320) and is directly arranged in the catheter sheath (2) or where the second surgical tool (12) is arranged, in particular fixed in, a second tool housing (62), which can be moved in the longitudinal direction, specifically slidably, arranged in the catheter sheath (2) and connected to the second movable element (320). The catheter of any one of the preceding claims, wherein the first surgical tool (11) is connected to the first movable means (31) through a first distal connection opening (271) formed in a peripheral region of the catheter sheath (2); and the wherein the second surgical tool (12) is movable in the catheter sheath (2) in the direction of the longitudinal axis (500) by the second movable means (32), wherein the second surgical tool (12) is connected to the second movable means (32) through a second distal connection opening (272) formed in a peripheral region of the catheter sheath (2). The catheter (100) according to any one of claims 6 to 12, wherein the first movable element (310) is formed as a wire and/or wherein the second movable element (320) is formed as a wire. The catheter (100) of any of the preceding claims, wherein the catheter sheath (2) comprises at least one additional lumen (24) for receiving a guide wire and/or passing a substance, in particular a fluid, therethrough. The catheter (100) of claim 14, wherein the catheter sheath (2) includes at least one body fluid passage opening (280) formed in a peripheral region of the catheter sheath (2) and in fluid communication with the at least one additional lumen (24), wherein the at least one body fluid passage opening (280) is disposed proximal to the first surgical instrument (11), wherein the first surgical instrument (11) is a proximal surgical instrument and the second surgical instrument (12) is a remote surgical instrument, and wherein the first surgical instrument (11) and the second surgical instrument (12) are formed as inflatable balloons; and the wherein the catheter sheath (2) includes at least one fluid supply opening (290) formed in a peripheral region of the catheter sheath (2) and in fluid communication with the at least one additional lumen (24), specifically wherein the at least one opening fluid supply (290) is arranged between the first surgical tool (11) and the second surgical tool (12), wherein the first surgical tool (11) and the second surgical tool (12) are shaped as inflatable balloons.