JP2005270395A - Insertion appliance of tubular organ treatment instrument - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide a carrier appliance of a tubular organ treatment instrument capable of easily and quickly inserting the carrier appliance in the blood vessel or the like and carrying the tubular organ treatment instrument retaining the tubular organ lumen in an opened state and precisely indwelling the tubular organ treatment instrument in the carrier appliance. <P>SOLUTION: This insertion appliance is provided with an outer tube 20 storing the tubular organ treatment instrument 10 in its distal end internal circumference, an inner tube 30 disposed inside the outer tube 20, a guide wire 40 inserted inside the inner tube, extracted from the distal end of the inner tube and the outer tube and inserted inside the tubular organ treatment instrument, a cap part 70 disposed in an extraction part from the tubular organ treatment instrument of the guide wire, and fixing means 50 and 60 detachably fixing the inner tube and the cap part to the guide wire. <P>COPYRIGHT: (C)2006,JPO&NCIPI

Description

  The present invention relates to an insertion device for a tubular organ treatment tool for inserting a treatment tool such as a stent into a tubular organ such as a blood vessel.

  In recent years, for the treatment of human tubular organs such as blood vessels, ureters, bile ducts, and trachea, a stent is inserted and placed through a catheter. For example, a treatment method is known in which a stent is placed in a stenosis of a blood vessel to be expanded, or a stent is placed in a place where an aneurysm is formed to prevent rupture of the aneurysm.

  As a stent insertion apparatus as described above, for example, in Patent Document 1 below, a catheter including an outer tube and an inner tube slidably inserted into the lumen of the outer tube, The shaft member and a tubular member provided around the outer periphery of the central shaft member. The distal end portion of the central shaft member has a gradient on the distal end side and an outer diameter equal to that of the outer tube. A distal tip provided with a concave portion to be a part of the stent housing portion is attached, and the tubular member is fixed to the rear side with a space from the rear end of the distal tip, and the rear tube and the central axis of the outer tube and the distal tip are fixed. A stent delivery catheter is disclosed in which a stent housing portion is formed between the members. Further, it is described that the central shaft member may be a tubular member having a lumen penetrating in the longitudinal direction.

  For example, when a stent is inserted into a stenosis of a blood vessel using the above-described stent insertion device, a guide wire is first inserted percutaneously into the blood vessel. For example, when indwelling in a thoracic aorta or the like of a blood vessel, a guide wire is inserted from the right femoral artery, and is pulled out of the body from the right upper arm artery of the arm through the aorta. In this state, the proximal end portion of the guide wire inserted from the right femoral artery and the distal end portion of the guide wire extracted from the right upper arm artery to the outside of the body are pulled away from each other and held so as not to loosen.

Next, the stent insertion device (stent delivery catheter) is inserted along the outer periphery of the guide wire held in this manner, and the tip thereof reaches a treatment site such as a stenosis. After that, the distal end of the inner tube inserted into the outer tube was placed in contact with the proximal end of the stent, and the position of the distal end of the stent slightly exceeded the stenosis while confirming the position with an X-ray monitor. Position it at a point. The stent is gradually exposed from the distal end of the outer tube by pulling the outer tube back to the proximal side while holding the inner tube, and the stent is expanded by its self-expanding force and pressed against the inner wall of the blood vessel. Fixed. As a result, the narrowed portion of the blood vessel is expanded and held by the stent.
JP-A-8-280815

  However, in the conventional stent insertion method as described above, for example, the proximal end portion of the guide wire inserted from the right femoral artery and the distal end portion of the guide wire extracted from the right upper arm artery to the outside of the body are pulled, and the state Therefore, since it is necessary to insert a stent insertion device such as a delivery catheter, there is a problem that the work needs to be performed by a plurality of operators, and the burden on the patient is large. If the guide wire is loose, the distal end of the delivery catheter or the like may be inserted into the wrong path at the branching portion of the blood vessel, and the inner wall of the blood vessel may be damaged.

  Accordingly, it is an object of the present invention to provide an insertion device for a tubular organ treatment tool that can more easily and quickly insert a tubular organ treatment tool such as a stent.

  In order to achieve the above object, according to a first aspect of the present invention, an outer tube that accommodates a tubular organ treatment instrument in an inner periphery of a distal end portion, an inner tube disposed inside the outer tube, and an inner tube are inserted. A guide wire that is inserted from the distal ends of the inner tube and the outer tube, and further inserted into the tubular organ treatment tool, and a cap that is disposed at the insertion portion of the guide wire from the tubular organ treatment tool And a fixing means for detachably fixing the inner tube and the cap portion to the guide wire, and the tubular organ treatment tool is disposed between the cap portion and the distal end portion of the inner tube In this state, the tubular organ treatment is configured to be accommodated in the inner periphery of the distal end portion of the outer tube. There is provided a insertion device.

  According to the above invention, the guide wire is inserted into the inner tube, inserted from the distal ends of the inner tube and the outer tube, further passed through the inside of the tubular organ treatment instrument, and then inserted through the inside of the cap portion. In this state, the tubular organ treatment tool is disposed between the distal end portion of the inner tube and the cap portion, and the inner tube and the cap portion are fixed to the guide wire by the fixing means. Then, while reducing the diameter of the tubular organ treatment instrument, the distal end portion of the outer tube is slid, and the tubular organ treatment instrument is accommodated in the inner periphery of the distal end portion of the outer tube. The guide wire is inserted into the tubular organ, passed through the treatment site of the tubular organ, and the tip of the guide wire is inserted from another location of the tubular organ.

And when the guide wire is further inserted while pulling the tip end portion of the guide wire, the cap portion and the inner tube fixed to the guide wire by the fixing means also move,
The tubular organ treatment tool sandwiched between the cap portion and the inner tube and the outer tube that accommodates the tubular organ treatment tool and is disposed on the outer periphery of the inner tube are also inserted into the tubular organ. Thus, since the cap portion, the inner tube, and the outer tube that hold the tubular organ treatment tool together with the guide wire are inserted, the insertion thereof is performed smoothly. Further, if the proximal end side of the guide wire is pulled, the cap portion, the inner tube, and the outer tube that hold the tubular organ treatment tool can be pulled back together with the guide wire, so that the insertion position can be easily corrected.

  Thus, when the tubular organ treatment tool is placed at the treatment site, the outer tube is slid toward the proximal end side with respect to the inner tube, and the tubular organ treatment tool is gradually exposed from the distal end portion of the outer tube. Open into the tubular organ. When the tubular organ treatment tool is, for example, a stent or the like, it is pressed against the inner wall of the tubular organ by its self-expanding force and fixedly disposed in the tubular organ. Next, when the guide wire is pulled to the proximal end side, the cap portion and the distal end portion of the guide wire pass through the inside of the tubular organ treatment tool and are pulled toward the proximal side, and can be extracted from the tubular organ.

  As described above, according to the present invention, the cap unit that holds the tubular organ treatment instrument together with the insertion of the guide wire by providing the fixing unit that detachably fixes the cap unit and the inner tube to the guide wire. The inner tube and the outer tube can be inserted, and the insertion operation of the tubular organ treatment instrument can be performed easily and quickly.

  In addition, by fixing the cap portion and the inner tube to the guide wire, when the tubular organ treatment device is placed in the tubular organ, the tubular organ treatment device is not displaced by the blood flow, and the tubular organ treatment device is not misaligned. Can be detained.

  According to a second aspect of the present invention, in the first aspect, the fixing means is a first fixing means for detachably fixing the inner tube to the guide wire, and the cap portion is detachably fixed to the guide wire. It is an object of the present invention to provide an insertion device for a tubular organ treatment instrument constituted by the second fixing means.

  According to the above invention, the inner tube is fixed to the guide wire by the first fixing means, and the cap portion is fixed to the guide wire by the second fixing means, so that it matches the length of the tubular organ treatment instrument. Thus, the cap part and the inner tube can be fixed to any part of the guide wire.

  According to a third aspect of the present invention, in the first or second aspect of the invention, the inner tube is entangled with a first insertion passage for inserting the guide wire and an outer periphery of a proximal end portion of the tubular organ treatment instrument. Thus, the present invention provides an insertion device for a tubular organ treatment tool having a second insertion passage for inserting an operation wire that allows the diameter of the proximal end portion of the tubular organ treatment tool to be reduced.

  According to the above invention, the operation wire is entangled with the outer periphery of the proximal end portion of the tubular organ treatment instrument, and both end portions thereof are inserted from the proximal end portion side of the inner tube through the second insertion passage. When the operation wire is pulled, the proximal end portion of the tubular organ treatment tool is drawn and contracted, so that the tubular organ treatment tool can be easily pulled into the outer tube, for example. Further, by pulling the operation wire, the treatment tool can be pulled back into the outer tube even after the treatment tool is once opened in the tubular organ, so that the position can be easily corrected.

  According to a fourth aspect of the present invention, in any one of the first to third aspects, the tubular organ treatment tool is a stent formed by knitting and / or assembling a wire into a tubular shape, and at least one of the wires is An insertion device for a tubular organ treatment instrument comprising a superelastic alloy disposed on the outer periphery and a radiopaque material disposed in the center thereof is provided.

  According to the above invention, at least one of the wires forming the stent is composed of a superelastic alloy disposed on the outer periphery and a radiopaque material disposed in the center thereof. The flexibility and shape restoration property are high, and when placed in a tubular organ such as a blood vessel, the position can be visually recognized with an X-ray fluoroscopic camera, so that it can be placed accurately at a target treatment site.

  According to the tubular organ treatment instrument insertion device of the present invention, the fixing means for detachably fixing the cap portion and the inner tube to the guide wire is provided to hold the tubular organ treatment tool together with the insertion of the guide wire. The cap portion, the inner tube and the outer tube can be inserted, and the insertion operation of the tubular organ treatment tool can be performed easily and quickly. In addition, by fixing the cap portion and the inner tube to the guide wire, when the tubular organ treatment device is placed in the tubular organ, the tubular organ treatment device is not displaced by the blood flow, and the tubular organ treatment device is not misaligned. Can be detained.

  Hereinafter, an embodiment of an insertion device for a tubular organ treatment instrument according to the present invention will be described with reference to the drawings.

  In the present invention, as a tubular organ treatment device, for example, a stent, a stent graft, a blood passage obstruction device, and the like can be applied. As shown in FIG. 9, in this embodiment, a stent graft 10 is used to treat a vascular aneurysm. The stent graft 10 includes a stent 11 formed by knitting and / or assembling metal wire rods 12 and formed into a cylindrical shape, and a graft 13 formed of a cylindrical cover covered on the outer periphery of the stent 11. At the proximal end portion of the stent 11, a plurality of end portions in which the metal wire 12 is extended toward the proximal end and a loop 12 a is formed at the distal end thereof are arranged along the circumferential direction at predetermined intervals. In FIGS. 1, 4, and 5, the graft 13 is omitted for convenience.

  As a material of the wire 12 of the stent 11, a shape memory effect by heat treatment or a shape memory alloy imparted with superelasticity is preferably adopted, but stainless steel, Ta, Ti, Pt, Au, W, or the like is used depending on applications. May be. As the shape memory alloy, Ni—Ti, Cu—Al—Ni, Cu—Zn—Al, and the like are preferably used. Further, the surface of the shape memory alloy may be coated with Au, Pt or the like by means such as plating.

  Moreover, as the wire 12, what is shown by FIG. 10 is used more preferably. The wire 12 is composed of a superelastic alloy B disposed on the outer periphery and a radiopaque material A disposed on the center thereof. The superelastic alloy B and the radiopaque material A may be integrated or may be relatively movable separately. Since the wire 12 is made of a radiopaque material and a superelastic alloy, the flexibility of the bent portion of the tubular organ that can naturally bend and respond, and the position of the stent 11 are fluoroscopically seen. It also has visibility that can be visually recognized by a camera, and the stent 11 can be placed smoothly and accurately at the treatment site inside the target tubular organ. Note that at least one of the wires 12 constituting the stent 11 only needs to be composed of the superelastic alloy B and the radiopaque material A. Even in this case, the visibility by the X-ray fluoroscopic camera is sufficient. Can be secured.

  The X-ray opaque material A is made of a metal such as Au, Pt, or Pd, and the superelastic alloy B is preferably a Ni-Ti-based shape memory alloy. The relationship between the diameter X of the radiopaque material A in FIG. 10 and the diameter Y of the superelastic alloy B is such that the cross sectional area of the radiopaque material A is larger than the cross sectional area of the super elastic alloy B. Is preferably set to be in the range of 10 to 40%.

  Further, as the graft 13, a thermoplastic resin processed into a cylindrical shape by a molding method such as extrusion molding or blow molding, a knitted fabric formed into a cylindrical shape using fibers of a thermoplastic resin, and a thermoplastic resin cylindrically shaped A non-woven fabric, a flexible resin sheet, a porous sheet or the like formed into a cylindrical shape can be used.

  As shown in FIG. 1, the tubular organ treatment instrument insertion device 100 includes an outer tube 20 for housing the stent graft 10 and an inner tube 30 inserted into the outer tube 20. At the proximal end of the outer tube 20, a holding portion 21 having an enlarged diameter is provided. The outer tube 20 is slidable in both directions of the distal end side and the proximal end side with respect to the axial direction of the inner tube 30.

  As the material of the outer tube 20, for example, a biocompatible synthetic resin selected from polyamide, polyethylene, fluororesin, polyimide, and the like is preferably used. The outer diameter of the outer tube 20 is appropriately selected depending on the application location, and is usually preferably 1 to 10 mm. The wall thickness is appropriately selected depending on the material used and the application location, and is preferably 0.1 to 1 mm.

  The inner tube 30 has a first insertion passage 31a and a second insertion passage 31b that penetrate along the axial direction, and an operation portion 32 having an enlarged diameter is formed at the proximal end. A guide wire 40 is inserted through the first insertion passage 31a, and a wire 80 is inserted through the second insertion passage 31b. A wire 80 is inserted and passed through the loop 12 a at the proximal end of the stent graft 10.

  The operation portion 32 of the inner tube 30 is provided with a receiving portion 32 a that abuts the end surface 21 a of the holding portion 21 of the outer tube 20 and restricts the pulling back operation of the outer tube 20. Further, a wire introduction tube portion 32b is formed on the side wall of the operation portion 32 so that the wire 80 can be inserted into the second insertion passage 31b.

  During the operation, the holding portion 21 of the outer tube 20 is gripped by one finger, and the operation portion 32 of the inner tube 30 is gripped and operated by the other finger. In addition, a temporary fixing tool may be provided in the holding portion 21 of the outer tube 20 so that the outer tube 20 and the inner tube 30 can be temporarily fixed. By doing so, there is no possibility of accidentally sliding the outer tube 20 and placing the stent graft 10 in insertion into the tubular organ.

  For example, a temporary fixing tool having a shape shown in FIG. 11 is used. That is, as shown to Fig.11 (a), the base end part of the outer tube 20 is provided with the slit 20b along an axial direction, a base end part is divided | segmented into the some surrounding wall 20c, and a base end part A male screw 20a is formed on the outer periphery. On the other hand, as shown in FIG. 11 (b), the holding portion 21 is formed with a female screw 21b on the inner periphery thereof and a tapered portion 21c that gradually decreases in diameter at the back thereof.

  In addition, the outer tube 20 can be slid with respect to the inner tube 30 by loosely screwing the holding portion 21 to the base end portion of the outer tube 20 at all times. On the other hand, when inserting into the tubular organ, by rotating the holding portion 21, the tapered portion 21c of the holding portion 21 contacts the divided peripheral wall 20c of the base end portion of the outer tube 20, and the peripheral wall 20c. And the outer tube 20 and the inner tube 30 are fixed.

  As shown in FIG. 2, a flange portion 33 is provided at the proximal end of the operation portion 32 of the inner tube 30, and an end surface of the flange portion 33 is connected to the guide wire 40 inserted into the first insertion passage 31a. A first fixing means 50 is provided for detachably fixing the inner tube 30.

  The first fixing means 50 has a chuck 51 that is screwed into a screw hole 33 a formed at the center of the end surface of the flange portion 33 of the inner tube 30. The screw hole 33a communicates with the first insertion passage 31a through the reduced diameter step portion 33b. The chuck 51 includes a flange portion 52, a cylindrical screw portion 53 that protrudes from one surface of the flange portion 52, and has a male screw formed on the outer periphery, and a tapered portion that is formed at the tip of the cylindrical screw portion 53. 53a, a slit 53b that divides the distal end portion of the cylindrical screw portion 53 in the axial direction, and an insertion passage 51a of the guide wire 40 formed at the center of the flange portion 52 and the cylindrical screw portion 53. The tapered portion 53a is divided into four by the slit 53b.

  When the cylindrical screw portion 53 of the chuck 51 is screwed into the screw hole 33a of the inner tube 30 and screwed in, the divided taper portion 53a comes into contact with the reduced diameter step portion 33b and is reduced in diameter. Since the inner periphery 53 c of the divided tapered portion 53 a is pressed against the guide wire 40, the inner tube 30 can be fixed to the guide wire 40.

  The material of the inner tube 30 is preferably the same material as that of the outer tube 20, for example, a biocompatible synthetic resin selected from polyamide, polyethylene, fluororesin, polyimide and the like.

  As the guide wire 40, various known ones can be used. For example, a core wire made of a superelastic alloy or stainless steel or the like is coated with a synthetic resin film, or a coil is attached to the outer periphery of the core wire, and the outer periphery of the coil is further covered with a synthetic resin film.

  The guide wire 40 is inserted into the first insertion passage 31 a of the inner tube 30, protrudes from the distal end surface of the inner tube 30, passes through the inside of the stent graft 10, and is further inserted into the cap portion 70. Yes.

  The cap portion 70 includes a truncated cone-shaped main body portion 71 having a tip portion that has a tapered diameter, and a tightening nut 61 that is screwed to the main body portion 71 to form the second fixing means 60. . The main body 71 has a male screw portion 72 projecting from the base end surface and an insertion hole 73 penetrating in the axial direction. The guide wire 40 is inserted through the insertion hole 73. A tapered portion 74 is provided at the distal end of the male screw portion 72, and a plurality of slits 75 are provided along the axial direction. The distal end portion is divided into a plurality of portions.

  Further, the tightening nut 61 has a female screw portion 63 screwed into the male screw portion 72 on the inner periphery, and a hole 64 having a reduced diameter is provided on one end face 62 thereof. Therefore, when the female screw portion 63 of the tightening nut 61 is screwed onto the male screw portion 72 of the main body portion 71 and tightened, the tapered portion 74 of the male screw portion 72 is pressed into the hole 64 of the tightening nut 61, and the slit 75 is closed, the inner diameter of the male threaded portion 72 is reduced, and is fixed to the guide wire 40.

  The wire 80 is inserted into the loop 12a formed at the proximal end portion of the stent graft 10, and extends to the outside through the second insertion passage 31b of the inner tube 30 and the wire introduction tube portion 32b provided in the operation portion 32. Has been. When both ends of the wire 80 are pulled, the proximal end of the stent graft 10 is reduced in diameter, and when the wire 80 is loosened, the proximal end can be expanded by self-expanding force. Furthermore, if only one end of the wire 80 is pulled, the wire 80 can be pulled out of the loop 12a. The wire 80 is a wire, such as a string, a thread, or a wire, and as a material, a thermoplastic resin, a metal wire material, natural fibers such as cotton or silk can be preferably used. Even when the proximal end portion of the stent graft 10 is not provided with the loop 12a, the wire 80 is inserted so as to be entangled with the mesh along the periphery of the proximal end portion of the stent 11, and thus the same effect as described above. Can be performed.

  Next, a method for inserting the stent graft 10 into the vascular aneurysm using the tubular organ treatment instrument insertion device 100 according to the above embodiment will be described.

  First, the guide wire 40 is inserted into the inner tube 30 and the outer tube 20 through the first insertion passage 31 a of the inner tube 30. Further, the distal end portion of the guide wire 40 inserted from the distal end portion of the inner tube 30 is passed through the inside of the stent graft 10 and further inserted through the tightening nut 61 of the cap portion 70 and the insertion hole 73 of the main body portion 71.

  Then, after the inner tube 30, the outer tube 20, and the cap portion 70 are disposed at appropriate positions of the guide wire 40, the stent graft 10 is positioned so as to be sandwiched between the cap portion 70 and the distal end portion of the inner tube 30. In this state, as shown in FIG. 3, the tightening nut 61 of the cap unit 70 is tightened to fix the cap unit 70 to the guide wire 40. Further, as shown in FIG. 2, the inner tube 30 is fixed to the guide wire 40 by tightening the chuck 51 of the inner tube 30.

  Next, as shown in FIG. 4, the wire 80 is inserted through the loop 12 a of the stent 11, and both ends of the wire 80 are passed through the second insertion passage 31 b of the inner tube 30 and taken out from the wire introduction tube portion 32 b. When the both ends of the wire 80 are pulled, the proximal end of the stent 11 is reduced in diameter like a drawstring bag. In this state, the outer tube 20 is slid with respect to the inner tube 30, and FIG. As shown, the stent graft 10 is housed in the inner periphery of the distal end portion of the outer tube 20. At this time, the distal end surface of the outer tube 20 comes into contact with the end surface 62 of the cap portion 70. Further, as shown in FIG. 5B, a male screw portion 65 having a guide wire insertion hole formed on the proximal end side of the tightening nut 61 is provided, and a female screw portion formed at the distal end portion of the outer tube 20 is provided there. You may screw together.

  In the state where the stent graft 10 is accommodated as shown in FIG. 5, when the temporary fixing tool described above is provided on the outer tube 20, the temporary fixing tool is tightened and the outer tube 20 is temporarily attached to the inner tube 30. It may be fixed.

  Next, as shown in FIG. 6, the distal end portion of the guide wire 40 is percutaneously inserted from the right femoral artery D. Then, the arm part is extracted from the right upper arm artery E to the outside of the body through the aorta. In this state, the guide wire 40 pulled out from the right upper arm artery E is pulled further in the direction of the arrow, so that the cap portion 70, the outer tube 20 and the inner tube 30 are connected to the guide wire 40 as shown in FIG. Together, the right femoral artery D is percutaneously inserted into the artery, and the portion in which the stent graft 10 is accommodated reaches the inside of the aneurysm C.

  At this time, the position of the portion in which the stent graft 10 is accommodated can be finely adjusted by pulling the guide wire 40 to the right upper arm artery E side or the right femoral artery D side. It can be placed accurately.

  And, when the indwelling position of the stent graft 10 is determined, if it is temporarily fixed by the temporary fixing tool, after releasing the temporary fixing, the outer tube 20 is slid to the base side with respect to the inner tube 30, The stent graft 10 is gradually exposed from the distal end portion of the outer tube 20. Then, as shown in FIG. 8, the exposed portion of the stent graft 10 is expanded in diameter by the self-expanding force, and is pressed against and fixed to the inner wall of the blood vessel. At this time, since the inner tube 30 is fixed to a predetermined portion of the guide wire 40, the inner tube 30 is not flowed by the blood flow, and the stent graft 10 can be accurately placed without misalignment.

  Further, when the placement position of the stent graft 10 is shifted, the proximal end portion of the stent graft 10 is contracted by pulling both ends of the wire 80 inserted into the loop 12 a provided at the proximal end portion of the stent graft 10. By making the diameter and sliding the outer tube 20 in the distal direction again in this state, the stent graft 10 can be recovered in the outer tube 20 and the operation can be performed again.

  And when there is no problem in the position where the stent graft 10 is taken care of, the wire 80 can be pulled out by pulling only one end of the wire 80 inserted through the loop 12a.

  When the stent graft 10 is thus placed at a predetermined location, the cap portion 70 is retracted through the inside of the stent graft 10 by pulling the guide wire 40 to the right femoral artery D side, and the cap portion 70, the outer tube 20 and the inner tube 30 are moved. It can be extracted from the blood vessel together with the guide wire 40. As a result, as shown in FIG. 9, the stent graft 10 is placed in a state of covering the inner periphery of the vascular aneurysm C, preventing the rupture of the aneurysm C and preventing the risk due to the aneurysm. be able to.

  A first fixed portion is obtained by extending a reduced diameter pipe portion having a hole communicating with the first insertion passage 31a from the tip portion of the inner tube 30 and integrally providing a cap portion 70 at the tip thereof. The cap part 70 can be fixed to the guide wire 40 only by fixing the means 50 to the guide wire 40.

  The present invention can easily and quickly insert a tubular organ treatment device such as a stent, a stent graft, or a blood passage obstruction device inserted into a tubular organ such as a blood vessel into the tubular organ, and accurately at a target treatment site. It can be used as an insertion device for a tubular organ treatment tool that can be placed.

It is a perspective view showing the whole insertion device of a tubular organ treatment instrument by one embodiment of the present invention. The fixing means of the guide wire and inner tube of the insertion apparatus of the tubular organ treatment tool is shown, (a) is a perspective view, (b) is a sectional view. The tip part of the insertion device of the tubular organ treatment tool is shown, (a) is a perspective view, (b) is a perspective view showing a fixing means between the guide wire and the cap part, and (c) is a sectional view of the fixing means. is there. It is a perspective view which shows the state which mounted | worn with the tubular organ treatment tool at the front-end | tip part of the insertion apparatus of the tubular organ treatment tool. The tubular organ treatment tool is attached to the distal end portion of the tubular organ treatment tool insertion device and accommodated in the outer tube, (a) is a perspective view, and (b) is a male screw portion at the proximal end of the tightening nut. It is a perspective view at the time of forming. It is explanatory drawing which shows the state which inserted the guide wire in the blood vessel using the insertion apparatus of the tubular organ treatment tool. It is explanatory drawing which shows the state which made the accommodating part of the tubular organ treatment tool reach the inner side of the vascular aneurysm using the insertion apparatus of the tubular organ treatment tool. It is explanatory drawing which shows the state which opened the tubular organ treatment tool inside the aneurysm of the blood vessel using the insertion apparatus of the tubular organ treatment tool. It is explanatory drawing which shows the state which pulled out the insertion apparatus of the tubular organ treatment tool from the inside of a blood vessel, and indwelled the tubular organ treatment tool. It is explanatory drawing which shows an example of the metal wire used for a tubular organ treatment tool. The temporary fixing tool which temporarily fixes the outer tube and inner tube of the insertion apparatus of the said tubular organ treatment tool is shown, (a) is a perspective view, (b) is sectional drawing.

Explanation of symbols

DESCRIPTION OF SYMBOLS 10 Stent graft 11 Stent 12a Loop 12 Wire 13 Graft 20 Outer tube 20a Male screw 20b Slit 20c Peripheral wall 21 Holding part 21a End surface 21b Male screw 21c Tapered part 30 Inner tube 31a First insertion path 31b Second insertion path 32 Operation part 32b Wire introduction Pipe portion 33 Flange portion 33a Screw hole 33b Reduced diameter step portion 40 Guide wire 50 First fixing means 51 Chuck 51a Insertion passage 53 Cylindrical screw portion 53a Taper portion 53b Slit 53c Inner circumference 60 Second fixing means 61 Tightening nut 62 End face 63 Female thread part 64 Hole part 65 Male thread part 70 Cap part 71 Main body part 72 Male thread part 73 Insertion hole 74 Taper part 75 Slit 80 Wire 100 Tubular organ treatment device insertion device C Aneurysm D Right femoral artery E Right upper arm artery

Claims (4)

  An outer tube that accommodates the tubular organ treatment instrument in the inner periphery of the distal end portion, an inner tube that is disposed inside the outer tube, and is inserted through the inner tube and inserted from the distal end portions of the inner tube and the outer tube. A guide wire that is inserted into the tubular organ treatment tool, a cap portion that is disposed at an insertion portion of the guide wire from the tubular organ treatment tool, and the inner tube and the cap portion are connected to the guide wire. Fixing means for detachably fixing to the tube, and the tubular organ treatment instrument can be accommodated in the inner periphery of the distal end portion of the outer tube in a state of being disposed between the cap portion and the distal end portion of the inner tube. It is comprised as follows. The insertion apparatus of the tubular organ treatment tool characterized by the above-mentioned.   The said fixing means is comprised by the 1st fixing means which fixes the said inner tube to the said guide wire so that attachment or detachment is possible, and the 2nd fixing means which fixes the said cap part to the said guide wire so that attachment or detachment is possible. An insertion device for the tubular organ treatment instrument described above.   The inner tube is entangled with the first insertion passage for inserting the guide wire and the outer periphery of the proximal end portion of the tubular organ treatment instrument so as to reduce the diameter of the proximal end portion of the tubular organ treatment instrument. The insertion device for a tubular organ treatment instrument according to claim 1 or 2, further comprising a second insertion passage for allowing the wire to pass therethrough.   The tubular organ treatment device is composed of a stent formed into a tubular shape by knitting and / or assembling a wire, and at least one of the wires is a superelastic alloy disposed on the outer periphery and an X disposed at the center thereof. The insertion device for a tubular organ treatment tool according to any one of claims 1 to 3, wherein the insertion device is made of a radiopaque material.

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