JP2008036418A - 体内の径路の補綴による修復 - Google Patents
体内の径路の補綴による修復 Download PDFInfo
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- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
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Abstract
【解決手段】管形移植片42は体内の径路に挿入するために直径に沿った軸で折りたたむことができる環状締め付けリング30を有する。締め付けリング30は、体内の径路の定位置につくと、外側に向かって弾力的に復元し、体内の径路の内表面によって継続的に、弾力的に偏向させられるようになっている。又、締め付けリング30を管形移植片42の互いに向かい合う端部に取り付けることもできる。体内の径路に位置する環状リング30を選択的に拡張および/または、いくつかの実施形態では、収縮させるアプリケータを使って、リング30とそれに接合した移植片42を、体内の径路に位置させることができる。保持部材を使って、環状リング30が体内の径路内の希望の位置につくまで、その環状リング30を圧縮した状態に保持することもできる。
【選択図】図4
Description
本発明は、体内の径路内に留置する装置に関し、特に、動脈瘤として知られる動脈拡張症の治療に使用する血管用ステントに関する。
同様に、現存の補綴の多くは、希望の位置から外れてしまい、弱った血管を保護するという機能を効果的に果たさないといったことが起きる可能性がある。
本発明の一つの特徴は、補綴を体内の径路に留置するための装置は、環状の弾性要素を含むということである。この要素の変形前の直径は、体内の径路の直径よりも大きい。
本発明のもう一つの特徴は、体内の径路に挿入する補綴は、環状の弾性ばね要素と管形移植片を含むということである。移植片は、要素に取り付けることができる。この要素の変形前の直径は、移植片の直径よりも大きい。
本発明の一つ以上の実施形態について、添付の図面と下記の説明に基づいてより詳しく述べる。本発明のその他の特徴、目的、および利点は、その説明、図面および請求の範囲からより明白となろう。
図1は、本発明の一つの実施形態による、締め付けリングの一般的な上面図である。
図2は、図1の実施形態が、理想化した体内の径路内に位置しているところを表した、縮小斜視図である。
図3は、体内の径路の中に挿入する前の締め付けリングの正面図である。
図4は、体内の径路の中に導入した後の締め付けリングの正面図である。
図5は、図4に示した実施形態の側面図である。
図6は、取付け装置に取り付けた補綴の正面図である。
図7は、図6の線7−7におおむね沿って切った断面図である。
図8は、図6に示した保持装置の拡大一部切り欠き図である。
図9は、図8の線9−9におおむね沿って切った断面図である。
図10は、図8の線10−10のおおむね沿って切った断面図である。
図11は、保持ループによって保持した補綴の拡大正面図である。
図12は、保持ループの一部の拡大正面図である。
図13は、補綴と挿入装置のもう一つの実施形態の正面図である。
図14は、図13に示す補綴の拡大図である。
図15は、図11に示した実施形態の、体内の径路に挿入する前の状態を示した拡大断面図である。
図16は、図13に示した実施形態の、体内の径路に挿入する前の状態を示した断面図である。
図17は、もう一つの実施形態の、大動脈分岐点の中の定位置に配置した状態を切り欠いて示した正面図である。
図18は、さらにもう一つの実施形態の、大動脈分岐点の中の定位置に配置した状態を切り欠いて示した正面図である。
図19は、図18に示したモジュールの拡大正面図である。
図20は、図19の線20−20におおむね沿って切った断面図である。
図21は、図19の線21−21におおむね沿って切った断面図である。
図22は、図14の実施例の変形例を表した正面図である。
図23は、もう一つの実施例の一部切り欠き正面図である。
図24は、心臓内に位置する補綴装置の状態を切り欠いて示した正面図である。
図面について説明する。複数の図面において、類似した部分に対しては類似した符号番号を使用している。環状弾性締め付けリング30は、図1、8、および10に示すように、複数の弾性ワイヤの素線32から形成することができる。リング30の一つの実施形態は、単一の長さのワイヤで中心軸‘‘C‘‘を有するマンドレル(図示していない)の回りを包み、糸34を使ってその素線を束にして固定することによって形成することができる。糸34は、外科用縫合材から形成することができる。もちろん、リング30は、他にも、単一素線のワイヤを使用する方法、多重素線ワイヤロープのように、螺旋状によりあわせたワイヤからなる複数の素線を使用する方法、あるいは、弾性の高い環状リングを形成する他の適した技術を含む、様々な技術を使って形成することができる。
図4について説明する。補綴40は、左腎動脈50と右腎動脈52に隣接した腹部大動脈48内に位置させることができる。ループ38は、動脈50および52を超えて延在し、部位53は、動脈48および50へつながる開口部のすぐ遠位側に位置している。従って、図5に示すように、動脈48および50への開口部は、リング30の断面がおおむねC字型形状になっているため、環状リング30をそこに隣接して位置させても遮断されることはない。
図11について説明する。ボーデン管70は、補綴40の外側に沿って、ループ38に近接する点まで延在している。環状リング74は、ループ38の外周の回りの、その長さのほぼ中央部分に延在し、リング30に固定してある鳩目82に係合している、このように、ブロッキングワイヤ80を軸方向に引き出して、ループ型の端部78を解放することにより、ワイヤループ72を引き出して、リング30を解放して希望の位置で復元力によって開くようにすることができる。
図15について説明する。カテーテル68は、補綴40を取り囲んでおり、補綴40は、一対のチューブ66と、そこを通って延在するワイヤ64とを取り囲んでいる。必要な場合は、ガイドワイヤ104を設けて、まず、カテーテルを希望の箇所へ誘導し、必要な場合に追加の要素とともに同じ箇所に戻ることができるようにそのまま通路を維持しておくこともできる。ループ型のワイヤ72とブロッキングワイヤ80のついたボーデン管70も、カテーテルの内部の、カテーテルと補綴40との間に延在している。
移植片42は、関係する組織の量により、さまざまな長さのものを使用できる。移植片42は、図示しているよりもさらに拡張することができ、また、かなり短くすることもできる。例えば、心臓弁を交換するだけでよい場合は、移植片42を、機械の弁132とリング30を連結する短い可撓性のスリーブより少し長くするだけでよい。また、本発明について、限られた数の好ましい実施形態に関して説明してきたが、様々な変更や変形が可能であるということは、当業者によって理解できよう。例えば、ある場合では、この装置は、動脈瘤を治療するための血管ステントとして説明しているが、本発明は、あらゆる装置を内部の径路に固定するのに適用することができる。さらに、本発明のある実施形態では、上記のように、一つもしくはそれ以上の利点しかないものもあるが、代わりにここで特に述べていない他の利点を有するものもあるということは理解できよう。添付の請求の範囲は、その精神と範囲にもとることなく、そのような変形や変更を含むものである。
Claims (51)
- 変形前の直径が、体内の径路の直径よりも大きい環状の弾性要素を備えた、前記体内の径路に補綴を留置するための装置。
- 前記環状の弾性要素が、変形前は円形の断面を有することを特徴とする、請求項1に記載の装置。
- 前記要素に取り付けた管形の移植片を含むことを特徴とする、請求項1または2に記載の装置。
- 環状の弾性ばね要素と、前記要素に取り付けた可撓性の管形移植片を備えており、前記要素の変形前の直径は、前記移植片の直径よりも大きいことを特徴とする、体内の径路に挿入するための補綴装置。
- 前記移植片が織物で形成されていることを特徴とする、請求項3または4に記載の装置。
- 前記要素は、前記管形移植片の一端に接合されており、前記管形移植片は前記要素への接続部に近接した位置の第1の直径と、前記要素から離れた位置の第2の直径を有し、前記第1の直径は、前記第2の直径よりも大きいことを特徴とする、請求項3乃至5のいずれかに記載の装置。
- 前記要素は、織物製移植片の一端でのみ前記織物製移植片に接合されていることを特徴とする、請求項6に記載の装置。
- 一対の要素を含み、前記要素は、前記管形移植片と接合してあることを特徴とする、請求項3乃至6のいずれかの記載の装置。
- 移植片が、前記要素に接合した分岐型移植片であり、前記分岐型移植片は、前記要素に接合した第1の管形部と、前記第1の管形部に接合した一対の管形部とを含み、前記一対の管形部は、自由端を有し、環状の弾性を有する変形可能な要素が前記一対の管形部の自由端に接合されていることを特徴とする、請求項3乃至6のいずれかに記載の装置。
- 前記要素が、共通の芯の回りを複数の巻線で包み、前記巻線を共に接合させることによって形成してあることを特徴とする、請求項1乃至9のいずれかに記載の装置。
- 前記ワイヤが、超弾性位相のニッケル−チタン合金で形成されていることを特徴とする、請求項10に記載の装置。
- 前記要素が、前記要素の直径に沿った軸で折りたたまれ、C字型に変形した形状で体内の径路の中に位置することを特徴とする、請求項1に記載の装置。
- 前記環状要素が、変形前は円形の断面を有し、前記要素は、弾性金属で形成され、円周方向を向いた複数のワイヤの素線によって形成され、前記移植片は、互いに向き合う一対の自由端を有し、前記環状要素は、前記移植片の前記自由端のうちの一方に取り付けてあることを特徴とする、請求項3乃至12のいずれかに記載の装置。
- 前記移植片が互いに向き合う一対の自由端を有し、前記要素は前記自由端のうちの一方に接合してあり、前記要素に近接する前記移植片の領域の直径が前記要素から離れた移植片の部分の直径よりも大きいことを特徴とする、請求項3乃至5のいずれかに記載の装置。
- 前記要素が前記移植体の二つの互いに向き合う自由端の一方に取り付けられており、前記移植片は、前記ばね要素に接合された端部の直径が、前記要素から離れた位置の直径よりも大きく、前記移植片は、前記要素に接合した前記端部から直径が小さい部分に向かって先細になっており、移植片の残りの部分は比較的一定の直径を有することを特徴とする、請求項3乃至5のいずれかに記載の装置。
- 前記移植片は管形であり、一対の互いに向かい合う自由端を有し、ばね要素が前記自由端のそれぞれに取り付けてあることを特徴とする、請求項3乃至5のいずれかに記載の装置。
- 前記移植片が一対の互いに向き合う端部を有し、ばね要素が前記移植片の前記端部のうちの一方にのみ取り付けてあることを特徴とする、請求項3乃至5のいずれかに記載の装置。
- 位置決めワイヤを受容するための装置を含むことを特徴とする、請求項1乃至17のいずれかに記載の装置。
- 前記装置が、前記ワイヤを取り外し可能に受容するための内部通路含むことを特徴とする、請求項18に記載の装置。
- 環状要素の直径が実質的に13mmであることを特徴とする、請求項1乃至19のいずれかに記載の装置。
- 一つの方向に延在する第1の対のループと、反対の方向に延在する第2の対のループを有する、折りたたんだ、弾性環状リングを備え、前記第1と第2の対のループは互いに接続してあり、さらに、前記リングに接合した管形移植片を備え、前記移植片は、前記第1の血管の長さに沿って延在するように配置してあり、前記第1の対のループは、第2の血管が前記第1の血管と交差する点を少なくとも部分的に超えて延在するように配置してあり、前記第2の対のループのうちの一方は、少なくとも部分的に前記補綴を超えて前記第1と第2の血管の間を連通させるような開口部を形成していることを特徴とする、罹病状態の第1の血管を修復するための血管用補綴。
- 前記第2の対のループが前記補綴を腹部大動脈内に位置させる時に腎動脈を遮断しないように配置されていることを特徴とする、請求項21に記載の補綴。
- 前記管形移植片の直径が、前記環状リングの変形前の直径より小さいことを特徴とする、請求項21または22に記載の補綴。
- 前記環状リングが実質的に共通の中心軸を有する、複数の弾性ワイヤの素線によって形成されていることを特徴とする、請求項21、22または23に記載の補綴。
- 前記リングの断面が、変形前は円形であることを特徴とする、請求項21乃至24のいずれかに記載の補綴。
- 前記管形移植片が一対の互いに向き合う自由端を有し、環状リングを前記自由端のそれぞれに接合してあることを特徴とする、請求項21乃至25のうちのいずれかに記載の補綴。
- 前記管形移植片が、一対の自由端を有し、環状リングが前記自由端のうちの一方にのみ接合されていることを特徴とする、請求項21乃至25のうちのいずれかに記載の補綴。
- 軸方向にガイドワイヤを受容するための装置を含み、前記装置は、前記ガイドワイヤを伸縮自在に、および取り外し可能に受容するように構成されていることを特徴とする、請求項21乃至27のいずれかに記載の補綴。
- 弾力で変形可能な環状リングと、一対の互いに向き合う自由端を有する管形 移植片と、前記環状リングに取り付けた前記自由端のうちの一つと、前記リングを遠隔位置から圧縮したり拡張したりすることができるような構成の装置とを備えた、体内の径路の内表面に補綴を固定するための装置。
- 前記装置が、前記補綴を通って軸方向に延在するガイドワイヤカテーテルを含み、前記ガイドワイヤカテーテルは、直径に沿った軸でC字型に折りたたんだ時に前記環状リングに取り外し可能に係合するように構成してあり、前記軸から外側に向かって延在するループのそれぞれがガイドワイヤカテーテルとリングおよびループとの間を連結しており、前記ループの相互の変形の度合いを調整することができることを特徴とする、請求項29に記載の装置。
- 前記接続部のそれぞれが遠隔位置から取り外し可能であること特徴とする、請求項31に記載の装置。
- 弾力的に変形可能な環状ばね要素と管形移植片を含む第1の補綴部分を備え、前記管形移植片は、一対の自由端を有しており、前記環状ばね要素は、前記自由端のうちの一方に接合してあり、さらに、前記第1の補綴部分と共通の軸方向に並んで、前記第1の補綴部分の内部に係合するように配置してある第2の補綴部分を備え、前記第2の補綴部分は、前記第1の補綴部分の前記管形移植片の内表面に係合するように構成してある、弾力的に変形可能な環状ばね要素を含んでおり、最終的な補綴の長さを調整できることを特徴とする、体内の径路に挿入するための補綴。
- 前記第2の補綴部分が、前記環状ばね要素に取り付けた管形移植片を含み、前記管形移植片は、一対の自由端を有し、前記自由端のうちの一方は、前記ばね要素に接合してあり、前記自由端のもう一方は、前記自由端を開放形状で保持するための装置に接合してあることを特徴とする、請求項32に記載の補綴。
- 前記装置が、前記第2の補綴部分の前記自由端の中に一対の独立した径路を形成する、一対の比較的剛性の要素を含むことを特徴とする、請求項32または33に記載の補綴。
- 前記第2の補綴部分の前記自由端上に前記比較的剛性の要素を入れ子式に係合する第3および第4の補綴を含み、前記第3および第4の補綴部分は、それぞれ、一対の環状の、弾力性を有する変形可能なばね要素と、管形移植片を含み、前記ばね要素は、前記管形移植片の自由端に取り付けてあり、前記ばね要素の少なくとも一方が前記第2の補綴部分の内部に係合するように構成してあることを特徴とする、請求項34に記載の補綴。
- 前記第2の補綴部分が、一本の径路を形成する一端と、前記一本の径路と連通する一対の分岐した径路を形成する反対側の端部とを有する移植片を含むことを特徴とする、請求項32乃至35のいずれかに記載の補綴。
- 弾性環状リングを前記変形前のリングの断面積より小さい断面積を有する第1の形状に折りたたむ工程と、前記リングを体内の径路の希望の箇所に位置させる工程と、前記リングを、前記第1の形状より大きく、さらに前記変形前のリングの断面積より小さい断面積を有する第2の形状に弾力的に変形させる工程とを含む、補綴装置を体内の径路に固定する方法。
- 前記リングを、前記リングを前記体内の径路内に挿入する前に変形させる工程と、前記リングを体内の径路の中の希望の箇所に位置させる工程と、前記リングを拡張させ、その体内の径路に係合する工程とを含む、請求項37に記載の方法。
- 遠隔アクチュエータをつかって体内の径路の中に位置する前記リングを選択的に圧縮したり解放したりする工程を含む、請求項37または38に記載の方法。
- 前記補綴装置を管形カテーテルの内部に挿入することによって、体内の径路の希望の位置に前記補綴装置を挿入する工程と、カテーテルを体内の径路の中の希望の箇所に位置させる工程と、前記補綴装置を前記カテーテルの内部から取り出す工程とを含む、請求項37乃至39のうちのいずれかに記載の方法。
- 環状リングをその直径に沿った軸で断面の小さい形状に折りたたむ工程と、前記軸から離れる方向に延在する一対のループを形成する工程と、前記ループが前記交差する血管を少なくとも部分的に超えて延在するように、前記リングを、前記交差する血管を遮断して、前記直径に沿った軸を交差する血管に近接させて前記血管内に配置する工程を含むことを特徴とする、罹病血管を修復する方法。
- 前記環状リングが、患者の体内の定位置についた時に、前記罹病血管によって弾力的に偏向させられることを特徴とする、請求項41に記載の方法。
- 前記ばねをその直径に沿った軸で折りたたむことによって、環状弾性ばねを変形させる工程と、前記ばねを体内の径路に位置させ、前記ばねを前記体内の径路に対して弾力的に拡張させる工程と、前記ばねが前記体内の径路に対して外側方向に連続的に押し出すようにする工程とを含む、体内の径路の中に補綴装置を固定する方法。
- 前記補綴装置が、前記ばねに接合した管形移植片を含み、前記方法は、さらに、前記管形移植片の内部に第2の補綴装置を入れ子式に挿入し、環状弾性ばね部材を外側方向に拡張させ、前記移植片の内表面に係合させる工程を含むことを特徴とする、請求項43に記載の方法。
- 第2の補綴装置を前記第1の補綴装置の中に入れ子式に挿入することによって、前記補綴装置の長さを調整する工程を含むことを特徴とする、請求項43に記載の方法。
- 一対のステントを、第2の補綴装置の中に入れ子式に挿入し、腸骨動脈から腹部大動脈への径路を形成する工程を含むことを特徴とする、請求項44または45に記載の方法。
- 補綴心臓弁と、前記弁に接続可能な第1の端部と第2の端部を有する可撓性の管形スリーブと、前記第2の端部に接続し、前記装置を上行大動脈の一部の内表面に接合するようにした弾性環状リングとを備えた補綴装置。
- 少なくとも二つの環状弾性ばね要素と、前記要素のそれぞれに取り付けた可撓性の管形移植片と、前記要素に長手方向に接続した剛性部材とを備え、前記部材は、前記移植片より可撓性が低いことを特徴とする、体内の径路に挿入するための補綴。
- 前記部材が、前記要素を接続するワイヤであることを特徴とする、請求項48に記載の補綴。
- 一対の管形補綴を共に体内の径路に挿入する工程と、前記補綴の一方の位置を前記補綴のもう一方の中で入れ子式に調整する工程とを含む、体内の径路の中に補綴を挿入する方法。
- 前記補綴を前記径路に共に挿入する前にそれぞれに設けられた環状弾性ばね要素を折りたたみ、前記要素を前記通路の中に固定し、同時に互いに固定する工程を含むことを特徴とする、請求項50に記載の方法。
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JP2007186160A Expired - Lifetime JP4790672B2 (ja) | 1996-06-20 | 2007-07-17 | 体内の径路の補綴による修復 |
JP2010260645A Expired - Lifetime JP5350352B2 (ja) | 1996-06-20 | 2010-11-22 | 体内の径路の補綴による修復 |
JP2011108535A Expired - Lifetime JP5419924B2 (ja) | 1996-06-20 | 2011-05-13 | 体内の径路の補綴による修復 |
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JP50252298A Expired - Lifetime JP4014226B2 (ja) | 1996-06-20 | 1997-06-19 | 体内の径路の補綴による修復 |
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JP2010260645A Expired - Lifetime JP5350352B2 (ja) | 1996-06-20 | 2010-11-22 | 体内の径路の補綴による修復 |
JP2011108535A Expired - Lifetime JP5419924B2 (ja) | 1996-06-20 | 2011-05-13 | 体内の径路の補綴による修復 |
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US (7) | US8088155B1 (ja) |
EP (2) | EP1595513A3 (ja) |
JP (4) | JP4014226B2 (ja) |
CN (2) | CN1568905B (ja) |
AR (1) | AR007441A1 (ja) |
AT (1) | ATE288233T1 (ja) |
AU (1) | AU3182897A (ja) |
BR (1) | BR9709867A (ja) |
CA (1) | CA2258732C (ja) |
DE (1) | DE69732411T2 (ja) |
WO (1) | WO1997048350A1 (ja) |
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1997
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- 1997-06-19 JP JP50252298A patent/JP4014226B2/ja not_active Expired - Lifetime
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- 1997-06-19 WO PCT/GB1997/001663 patent/WO1997048350A1/en active IP Right Grant
- 1997-06-19 AU AU31828/97A patent/AU3182897A/en not_active Abandoned
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1999
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2002
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2004
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2005
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2006
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2007
- 2007-07-17 JP JP2007186160A patent/JP4790672B2/ja not_active Expired - Lifetime
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2010
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2011
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JPH04503318A (ja) * | 1989-02-13 | 1992-06-18 | バクスター インターナショナル インコーポレーテッド | 選択的に可撓性の弁輪形成リング |
US5123917A (en) * | 1990-04-27 | 1992-06-23 | Lee Peter Y | Expandable intraluminal vascular graft |
JPH05212121A (ja) * | 1991-02-05 | 1993-08-24 | Kanji Inoue | 弾性復元機能を有する折り曲げ自在な人体の器官に挿入する器具及び人体の器官に挿入する器具の折り曲げ装置 |
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