JP2000511787A - 組織を加熱するための脈管カテーテル利用システム - Google Patents
組織を加熱するための脈管カテーテル利用システムInfo
- Publication number
- JP2000511787A JP2000511787A JP09531985A JP53198597A JP2000511787A JP 2000511787 A JP2000511787 A JP 2000511787A JP 09531985 A JP09531985 A JP 09531985A JP 53198597 A JP53198597 A JP 53198597A JP 2000511787 A JP2000511787 A JP 2000511787A
- Authority
- JP
- Japan
- Prior art keywords
- catheter
- vein
- venous
- electrode
- contraction
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Granted
Links
Classifications
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/14—Probes or electrodes therefor
- A61B18/1492—Probes or electrodes therefor having a flexible, catheter-like structure, e.g. for heart ablation
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- A61B17/22—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
- A61B2017/22051—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for with an inflatable part, e.g. balloon, for positioning, blocking, or immobilisation
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- A—HUMAN NECESSITIES
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- A61B2017/22097—Valve removal in veins
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- A—HUMAN NECESSITIES
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- A61B2018/00011—Cooling or heating of the probe or tissue immediately surrounding the probe with fluids
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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- A61B2018/00005—Cooling or heating of the probe or tissue immediately surrounding the probe
- A61B2018/00011—Cooling or heating of the probe or tissue immediately surrounding the probe with fluids
- A61B2018/00029—Cooling or heating of the probe or tissue immediately surrounding the probe with fluids open
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- A61B2018/00053—Mechanical features of the instrument of device
- A61B2018/00059—Material properties
- A61B2018/00071—Electrical conductivity
- A61B2018/00083—Electrical conductivity low, i.e. electrically insulating
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- A61B2018/00053—Mechanical features of the instrument of device
- A61B2018/00107—Coatings on the energy applicator
- A61B2018/00154—Coatings on the energy applicator containing and delivering drugs
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- A61B2018/00267—Expandable means emitting energy, e.g. by elements carried thereon having a basket shaped structure
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- A61B2018/00053—Mechanical features of the instrument of device
- A61B2018/00273—Anchoring means for temporary attachment of a device to tissue
- A61B2018/00279—Anchoring means for temporary attachment of a device to tissue deployable
- A61B2018/00285—Balloons
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- A61B2018/00315—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for treatment of particular body parts
- A61B2018/00345—Vascular system
- A61B2018/00404—Blood vessels other than those in or around the heart
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- A61B2018/00488—Esophagus
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- A61B2018/00773—Sensed parameters
- A61B2018/00791—Temperature
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- A—HUMAN NECESSITIES
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- A61B2018/00636—Sensing and controlling the application of energy
- A61B2018/00773—Sensed parameters
- A61B2018/00791—Temperature
- A61B2018/00797—Temperature measured by multiple temperature sensors
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- A61B2018/00636—Sensing and controlling the application of energy
- A61B2018/00773—Sensed parameters
- A61B2018/00791—Temperature
- A61B2018/00821—Temperature measured by a thermocouple
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B2018/00636—Sensing and controlling the application of energy
- A61B2018/00773—Sensed parameters
- A61B2018/00875—Resistance or impedance
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/1206—Generators therefor
- A61B2018/1246—Generators therefor characterised by the output polarity
- A61B2018/1253—Generators therefor characterised by the output polarity monopolar
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
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- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/1206—Generators therefor
- A61B2018/1246—Generators therefor characterised by the output polarity
- A61B2018/126—Generators therefor characterised by the output polarity bipolar
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/14—Probes or electrodes therefor
- A61B2018/1465—Deformable electrodes
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/14—Probes or electrodes therefor
- A61B2018/1497—Electrodes covering only part of the probe circumference
Landscapes
- Health & Medical Sciences (AREA)
- Life Sciences & Earth Sciences (AREA)
- Surgery (AREA)
- Engineering & Computer Science (AREA)
- Plasma & Fusion (AREA)
- Medical Informatics (AREA)
- Otolaryngology (AREA)
- Physics & Mathematics (AREA)
- Cardiology (AREA)
- Biomedical Technology (AREA)
- Heart & Thoracic Surgery (AREA)
- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
- Molecular Biology (AREA)
- Animal Behavior & Ethology (AREA)
- General Health & Medical Sciences (AREA)
- Public Health (AREA)
- Veterinary Medicine (AREA)
- Surgical Instruments (AREA)
Abstract
Description
Claims (1)
- 【特許請求の範囲】 1.エネルギを適用して静脈の収縮を引き起こす装置であって、作業端及び静脈 の内径よりも小さな外径を有するカテーテル(10)と、カテーテルの作業端に 設けられていて、静脈の収縮を引き起こすよう静脈治療部位を加熱することが できる加熱装置(12)と、静脈の収縮を制御して静脈が静脈機能を発揮できる よう開存性のままであるようにする制御手段(32)とから成ることを特徴とす る装置。 2.制御手段は、加熱装置をカテーテルの外方に移動させることができる弓反り 自在な部材(32)を含むことを特徴とする請求項1記載の装置。 3.弓反り自在な部材(32)は、弓反り自在な部材により定まる有効直径を越え る静脈の収縮を阻止するほど十分な構造強度を有し、有効直径は、カテーテル の外径よりも大きいことを特徴とする請求項2記載の装置。 4.弓反り自在な部材は導電性であり、弓反り自在な部材は更に、非被覆部分を 除き、導電性弓反り自在な部材の表面を被覆する絶縁性フィルム(35)を含み 、非被覆部分は、弓反り自在な部材をカテーテルから外方へ移動させたときに 静脈壁に接触し、加熱装置は、導電性弓反り自在な部材の非被覆部分を含むこ とを特徴とする請求項2記載の装置。 5.カテーテルは、可動の外側スリーブ(36)を有し、弓反り自在な部材は、カ テーテルの作業端に連結された第1の端部及び可動外側スリーブに連結された 第2の端部を有し、外側スリーブを操作することにより弓反り自在な部材の露 出部分を移動させて静脈に並置させることができるようになっていることを特 徴とする請求項4記載の装置。 6.弓反り自在な部材とカテーテルとの間に設けられたバルーン(40)を更に有 し、弓反り自在な部材は、加熱装置を移動させて静脈壁に並置させることがで き、バルーンは、選択された直径の状態に膨らむことができ、弓反り自在な部 材は、加熱装置により引き起こされる静脈の収縮によって、膨らんだバルーン に向かって押されることができ、膨らんだバルーンは、これによって定まる直 径を越える静脈のそれ以上の収縮を防止できることを特徴とする請求項1〜5 のうち何れか一に記載の装置。 7.伸長自在な部材とカテーテルとの間に設けられたバルーン(40)を更に有し 、バルーンは、膨らむと伸長自在な部材に係合してこれを半径方向外方に押す ことを特徴とする請求項1〜6のうち何れか一に記載の装置。 8.加熱装置は、制御手段の一部であることを特徴とする請求項1〜7のうち何 れか一に記載の装置。 9.加熱装置は、少なくとも一つの電極を含むことを特徴とする請求項1〜8の うち何れか一に記載の装置。 10.少なくとも一つの電極は、カテーテルの一部に沿って全方向的な加熱を可能 にするようカテーテルの作業端の周囲に沿って配列され、静脈は円周方向に収 縮し、軸方向の収縮は減少することを特徴とする請求項9記載の装置。 11.長手方向電極は各々、直ぐ隣の長手方向電極の極性とは逆の極性を有してい ることを特徴とする請求項10記載の装置。 12.長手方向電極の有効対が得られるよう偶数個の長手方向電極がカテーテル上 に配置されていることを特徴とする請求項10記載の装置。 13.電極の有効対が得られるよう偶数個の電極がカテーテル上に円周方向に配置 され、各電極は、直ぐ隣の電極の極性とは逆の極性を有していることを特徴と する請求項10記載のカテーテル。 14.電極の有効対が得られるよう偶数個の電極がカテーテル上に円周方向に配置 され、第1の電極は、第1の極性を有し、第1の電極の隣に位置する第2の電 極は、第1の極性とは逆の第2の極性を有し、第1の電極の隣の第3の電極は 、第1の電極の極性と同一の極性を有し、エネルギを指向的に適用する電極の 有効対が得られるよう偶数個の電極がカテーテル上に配置されていることを特 徴とする請求項10記載のカテーテル。 15.制御手段は、加熱装置を静脈の静脈治療部位に並置させる位置決め装置(40 )を含むことを特徴とする請求項1〜14のうち何れか一に記載の装置。 16.カテーテルは、カテーテルの一方の側部の作業端に設けられた非対称形のバ ルーンを更に有し、加熱装置は、非対称形バルーンを有する側部とは反対側の 側部に位置していることを特徴とする請求項1〜15のうち何れか一に記載の 装置。 17.カテーテルは、内腔(27)及びカテーテルの作業端のところを除いてカテー テルを包囲している剛直なジャケット(25)を更に有し、カテーテルは更に、 カテーテルの内腔を通って作業端に向かって押されるとカテーテルの作業端を 偏向させて静脈と並置させる剛直な曲げ部を備えた偏向ワイヤ(29)を有する ことを特徴とする請求項1〜16のうち何れか一に記載の装置。 18.内腔(27)は、偏向ワイヤが内腔から出ないよう作業端のところで封止され ていることを特徴とする請求項17記載の装置。 19.制御手段は、カテーテルの作業端のところに設けられた膨らませ可能なバル ーン(40)を含み、バルーンは、膨らむと静脈を閉塞するように構成されてい ることを特徴とする請求項1〜18のうち何れか一に記載の装置。 20.カテーテルの作業端に設けられたセンサを更に有し、制御手段は、治療部位 の状態を表すセンサからの信号を受け取るマイクロプロセッサを含み、マイク ロプロセッサは、センサからの信号に応答して静脈組織中における加熱効果の 広がりを制御するよう加熱装置を制御することを特徴とする請求項1〜19の うち何れか一に記載の装置。 21.制御手段は、静脈組織中における加熱効果の広がりを制御するために加熱装 置用の周波数を選択できるマイクロプロセッサを更に含むことを特徴とする請 求項1〜20のうち何れか一に記載の装置。 22.カテーテルは、流体を静脈内へ注入する内腔を更に有することを特徴とする 請求項1〜21のうち何れか一に記載の装置。 23.カテーテルは、ガイドワイヤ用内腔を更に有し、ガイドワイヤ用内腔は、ガ イドワイヤと電極との電気結合を防止するよう絶縁されていることを特徴とす る請求項1〜22のうち何れか一に記載の装置。 24.伸長自在な部材は、導電性膨張剤で膨らむことができるバルーンを更に有し 、バルーンは、カテーテルの作業端に形成され、少なくとも一つの電極により 、膨張剤は、膨張剤と並置関係にある静脈壁に熱伝導により熱を伝えて静脈の 収縮を引き起こすよう加熱された状態になることを特徴とする請求項1〜23 のうち何れか一に記載の装置。 25.エネルギを適用して静脈の収縮を引き起こす方法であって、作業端及び作業 端に設けられた加熱手段を有するカテーテルを静脈内の治療部位に導入する段 階と、加熱手段を静脈中の治療部位に位置決めする段階と、加熱手段からのエ ネルギを適用して治療部位を加熱して静脈の収縮を引き起こす段階と、静脈の 十分な収縮後、加熱手段からのエネルギの適用を停止して静脈が静脈機能を発 揮できるよう開存性のままであるようにする段階とから成ることを特徴とする 方法。 26.治療部位への加熱手段の位置決め段階は、静脈弁の完全閉鎖機能を回復させ るために加熱手段を静脈弁に隣接して治療部位のところに配置する段階を含む ことを特徴とする請求項25記載の方法。 27.治療部位への加熱手段の位置決め段階は、静脈の円周方向の収縮を達成する と共に軸方向の短縮を最小限に抑えるよう加熱手段を配置する段階を更に含む ことを特徴とする請求項25記載の方法。 28.治療部位への加熱手段の位置決め段階は、加熱手段を移動させて治療部位の ところで静脈壁に並置させる段階を更に含むことを特徴とする請求項25記載 の方法。 29.治療部位への加熱手段の位置決め段階は、カテーテルの有効直径を増大させ て加熱手段を静脈壁に並置させる段階を更に含み、エネルギ適用段階は、静脈 機能を回復させる静脈直径が達成されるまで静脈壁が収縮しているときに静脈 壁との並置関係を維持するような制御された方法でカテーテルの有効直径を減 少させる段階を更に含むことを特徴とする請求項25記載の方法。 30.静脈の収縮を加熱手段により定められる直径に制限する段階を更に有するこ とを特徴とする請求項25記載の方法。 31.弓反り自在な部材を用いて加熱手段をカテーテルから半径方向外方へ移動さ せて加熱手段を静脈に並置させる段階を更に有することを特徴とする請求項 30記載の方法。 32.エネルギ適用段階は、加熱手段からのエネルギを制御して静脈の治療部位の ところの加熱深さを制御する段階を更に有することを特徴とする請求項31記 載の方法。 33.静脈の収縮度を判定する段階を更に有することを特徴とする請求項25記載 の方法。 34.透視検査を用いて静脈の収縮度を判定する段階を更に有することを特徴とす る請求項25記載の方法。 35.超音波を用いて静脈の収縮度を判定する段階を更に有することを特徴とする 請求項25記載の方法。
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US08/610,911 US6036687A (en) | 1996-03-05 | 1996-03-05 | Method and apparatus for treating venous insufficiency |
US08/610,911 | 1996-03-05 | ||
US08/720,209 | 1996-09-26 | ||
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EP (1) | EP0921765B1 (ja) |
JP (1) | JP4060887B2 (ja) |
AU (1) | AU733465B2 (ja) |
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Also Published As
Publication number | Publication date |
---|---|
US20060069417A1 (en) | 2006-03-30 |
US6033398A (en) | 2000-03-07 |
JP4060887B2 (ja) | 2008-03-12 |
CA2248260A1 (en) | 1997-09-12 |
EP0921765B1 (en) | 2007-05-02 |
AU733465B2 (en) | 2001-05-17 |
US6981972B1 (en) | 2006-01-03 |
US7976536B2 (en) | 2011-07-12 |
WO1997032532A1 (en) | 1997-09-12 |
AU2073497A (en) | 1997-09-22 |
EP0921765A1 (en) | 1999-06-16 |
CA2248260C (en) | 2010-11-16 |
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