JP2011528258A - 側枝付きの脈管管腔内器具 - Google Patents
側枝付きの脈管管腔内器具 Download PDFInfo
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- JP2011528258A JP2011528258A JP2011518731A JP2011518731A JP2011528258A JP 2011528258 A JP2011528258 A JP 2011528258A JP 2011518731 A JP2011518731 A JP 2011518731A JP 2011518731 A JP2011518731 A JP 2011518731A JP 2011528258 A JP2011528258 A JP 2011528258A
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- prosthetic
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- prosthesis
- trunk
- stent
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Abstract
Description
下行胸大動脈及び腹大動脈の動脈瘤を治療する際に使用するためのモジュール型人工器官が知られており、この人工器官においては、近位端に大動脈内に配置するための単一の管腔が規定されており、他端は腸骨動脈内へと伸長するために分岐されている。腸骨伸長人工器官モジュールは分岐の端部に結合することができる。このような人工器官の概略図がPCT出願第WO98/53761号に更に詳細に示されている。
人工器官モジュールは順次配備されるのが好ましい。側枝付きの人工器官750と分岐された人工器官720との間のモジュール間結合は生体内で形成される。最初に、分岐された人工器管720が配備され、次いで、側枝付きの人工器管750が配備される。例えば、WO98/53761号に記載されている分岐された大動脈人工器官720を腹大動脈内に配備することができる。分岐された人工器官720は逆Y字形状を有しており、この構造は本体部分723と短い方の脚部760と長い方の脚部732とを備えている。この人工器官の本体は織られたポリエステル織布によって作られている。人工器官720の近位端には自己拡張型ステント721が設けられており、該ステントは人工器官の端部を越えて伸長しており且つ遠位方向に伸長している逆棘部751を備えている。短い方の脚部760と長い方の脚部732とは、それらの遠位の終端から伸長している内側突出部を備えている。
分岐した脚部にかかる血流による力は、分岐点及び人工器官側枝の最終的な屈曲角部分にかかる荷重に依存する。人工器官から側枝伸長部を分離させる力は特に重要である。y方向への流れによる力は、これが十分に大きい場合には、側枝伸長部と人工器官側枝とを相互に保持する摩擦力よりも大きくなって分離を生じさせ得る。分離がかなり大きい場合には、III型のエンドリークが生じ、もはや動脈瘤を締め出すことはできないであろう。
上記の人工器官は人間ではない哺乳動物内で生体試験することができる。試験及び治療目的のための人工器官の移植に適した一つの動物は畜産牛である。試験目的で、生後6〜10週間の雄の子牛を使用した。
一つの螺旋状の血管側枝ステント移植片は、側枝が内腸骨動脈に対して適正な向きとなるように配備させる。側枝の遠位端上の4つのマーカーを内腸骨動脈のおよそ5mm上方に配置する。当該器具を収容しているシースが引き抜かれて側枝の脚部が露出されて外腸骨動脈内でシース内に拘束されたままの状態とする。対側脚部内でのワイヤーの場所が操縦可能なガイドワイヤーに置き換えられ、次いで、このガイドワイヤーが遠位動脈内へと進められ且つ対側大腿動脈から導入されたスネア器具によって係蹄にかけられて取り出される。これによって、対側鼠径から腸骨側枝の基端側を通り腸骨脚部内へ入り次いで遠位区分の外側部分(外腸骨動脈部分)に沿って同側の鼠径部に達するアクセスが得られる。
20 人工器官幹部、 21 連結部、 22 人工器官側枝、
25 側枝伸長部、 27 取り付け部、 40 人工器官、
42 人工器官幹部、 44 人工器官側枝、 46 吻合部、
47 継ぎ目、 48 襞、 50,52,53 ステント、
54 遠位の小孔、 55 側枝伸長部、 60 人工器官、
62 人工器官幹部、 64 人工器官側枝、 65 遠位小孔、
66 外側Z型ステント、 68 吻合部、
70 内側Z型ステント、 72 内側ステント、 74 遠位の先端、
75 長手軸線、 80 人工器官側枝、 84 近位端、
86 外周、 88 人工器官幹部、 89 外周、
90 人工器官、 92,94 人工器官側枝、
93 人工器官の遠位端、 95 ステント、 96 ステント、
97 ステント、 98 吻合部、 110 人工器官、
112 対側人工器官側枝、 114 人工器官幹部、 116 分枝、
118 継ぎ目、 120 遠位小孔、
122 人工器官幹部の遠位端、 123 内側ステント、
124 人工器官幹部の近位端、 126 人工器官幹部ステント、
128 ステント、 130 近位小孔、
132 人工器官側枝の遠位端、 140 人工器官、
141 人工器官幹部、 142 放射線不透過性のマーカー、
143 外側ステント、 144 人工器官側枝、
145 人工器官幹部の遠位端、 146 継ぎ目、
160 内側ステント、 161 人工器官側枝、
162 外側ステント、 163 遠位のステント、 168 分岐、
170 人工器官幹部、 210 人工器官、
211 対側の人工器官、 212 人工器官、 213 人工器官側枝、
214 人工器官幹部、 215 金マーカー、 217 近位部分、
219 遠位部分、 220 遠位小孔、
222 遠位端、人口器官側枝の遠位小孔、
223 内側ステント、 224 人工器官幹部の近位端、
225 継ぎ目、 226 ステント、 227 分岐、
228 ステント、 229 遠位のステント、 230 近位小孔、
231 山部、 250 人工器官、 252 人工器官側枝、
253 第一の近位のステント、 254 人工器官幹部、
255 第二の近位のステント、 256 隙間、 259 吻合部、
300 人工器官、 301 襞、 302 人工器官幹部、
304 人工器官側枝、 306 ステント、
310 近位のステント、 314 ステント、 320 吻合部、
322 近位のステント、 330 遠位小孔、 350 人工器官、
352 人工器官側枝、 354 吻合部、
358 近位のステント、 400 人工器官、 402 大動脈、
403 人工器官モジュール、 404,405 腸骨動脈、
406 下腹動脈、 407 腸骨動脈肢、 408 人工器官側枝、
409 腸骨動脈伸長部、 410 下腹動脈側枝伸長部、
412 幹部、 413 中間人工器官モジュール、
414 人工器官側枝、 415 環状のステント、
416 遠位小孔、 417 縫合糸、 418 ステント、
419 閉ループ、 420 内側ステント、 422 外側ステント、
423 中間人工器官モジュールの遠位端、
437 Z型ステント、 440 ループ、 470 ステント、
471 近位の輪部分、 472 遠位の輪部分、
473 卵形のステント外周部分、
474 装置、 478,479 アーチ状の面、
480 穴、 481 装置のキャビティ、
483 基部、 484 アーチ状部分、
485 遠位のアーチ状部分、 486 柱、
519 吻合部、 520 大動脈モジュール、人工器官幹部、
521 SMA枝、 522 腹腔枝、 524,525 腎枝、
523 腹腔枝、 526 腹腔枝、 527 人工器官幹部、
528 内側螺旋状側枝、 529 遠位小孔、
530,531 バッフル、 532 隙間、 533 腹腔枝、
533 側枝管腔、 534 SMA枝、幹部管腔、
535 Z型ステント、 536 ポケット、 537 吻合部、
538,539 腎枝、 540 人工器官幹部、
541 吻合部、 542 尾部、 543 配備ワイヤー、
545 人工器官側枝、 546 遠位小孔、
547,567,569 側枝、 548 吻合部、
549 管腔内人工器官、 550 人工器官幹部、
551 左総頚動脈用人工器官側枝、 552 側枝、
553 左鎖骨下動脈用人工器官側枝、 555 遠位端、
556 上腸間膜動脈開窓、SMA用開窓、
557,559 放射線不透過性のマーカー、
558 腎臓開窓、 559 遠位の内側ステント、
579,581 襞、 560 近位の内側ステント、
561 外側ステント、 562 近位端、 564 吻合部、
565 小孔、 582 遠位のステント、
583 近位のステント、 600 ステント移植片、
602,612 放射線不透過性のマーカー、
604 補助開窓、 606 左腎用開窓、 608 ステント、
610 ステント、 614 人工器官側枝、 618 吻合部、
620 マーカー、 622 吻合部、 624 遠位端、
626 ステント移植片の近位端、 630 スカラップ、
632,634 領域、 636 右腎用開窓、
650 ステント移植片、 652 近位のステント、
654 外側Z型ステント、 656 遠位端、 658 近位端、
660 側枝、 662 SMA用開窓、
664 左腎用開窓、 666 近位部分、 668 遠位部分、
670 テーパー部、 672 右腎用開窓、
676 内側Z型ステント、 670 側枝−幹部吻合、 720 人工器官、
700 導入器、 710 筒状のスリーブ、
711 可撓性の伸長部分、 712 穴、
715 薄壁の金属管、 716 結合装置、
719 自己拡張型ステント、 720 人工器官、
721 Z型ステント、 723 本体部分、
724 近位のワイヤー解放機構、 725 遠位のワイヤー解放機構、
729 側方チューブ、 730 シース、 732 長い脚部、
735 把持及び止血密封装置、 736 本体、
737 クランプねじ、 739 ピン用バイス、
741 プラスチック製のチューブ、 742 人工器官の遠位端、
746 ねじ込みキャップ、 750 人工器官、
751 逆棘部、 760 短い脚部、
780 外部操作部分、 782 遠位の取り付け部分、
784 近位の取付け部分、 800 送り込み先端、 802 ガイドワイヤー、
Claims (26)
- 貫通して延びている幹部管腔および幹部壁を有する人工器官幹部と、
貫通して伸長している第一の側枝管腔および側枝壁を有する、前記幹部壁から伸長している第一の人工器官側枝と、
貫通して伸長している第二の側枝管腔を有する、前記側枝壁から伸長している第二の人工器官側枝と、
を備えており、
前記第一の側枝管腔は、前記幹部壁を介して前記幹部管腔と流体連通し、
前記第二の側枝管腔は、前記側枝壁を介して前記第一の側枝管腔と流体連通する、人工器官。 - 前記第一および第二の人工器官側枝のうちの少なくとも1つが、前記人工器官幹部に沿って長手方向に且つ該人工器官幹部の周りに周方向に設けられている、請求項1に記載の人工器官。
- 前記第一の人工器官側枝と前記第二の人工器官側枝との両方が、前記人工器官幹部に沿って長手方向に且つ該人工器官幹部の周りに周方向に設けられている、請求項1に記載の人工器官。
- 前記第二の人工器官側枝が前記第一の人工器官側枝に沿って長手方向に且つ該第一の人工器官側枝の周りに周方向に設けられている、請求項1又は2に記載の人工器官。
- 前記第一および第二の人工器官側枝のうちの少なくとも1つは、その長さに沿ってテーパーが付けられている、請求項1乃至4のいずれかに記載の人工器官。
- 前記第一の人工器官側枝は、その長さに沿ってテーパーが付けられている、請求項1乃至5のいずれかに記載の人工器官。
- 前記第一の人工器官側枝が前記人工器官幹部の長手方向に沿って且つ該人工器官幹部の周りに周方向に設けられていること、
前記第二の人工器官側枝が前記人工器官幹部の長手方向に沿って且つ該人工器官幹部の周りに周方向に設けられていること、
前記第二の人工器官側枝が前記第一の人工器官側枝の長手方向に沿って且つ該第一の人工器官側枝の周りに周方向に設けられていること、及び
前記第一の人工器官側枝がその長さに沿ってテーパーが付けられていること、
のうちの2以上の特徴を更に備えている、請求項1に記載の人工器官。 - 前記第二の人工器官側枝が前記第一の人工器管側枝の壁に形成されている吻合部を介して該第一の人工器官側枝と流体連通しており、前記吻合部の直径が約10mmである、請求項1乃至7のいずれかに記載の人工器官。
- 前記第一の人工器官側枝が、前記人工器官幹部の壁に形成される吻合部を介して該人工器官幹部と流体連通しており、前記吻合部の直径が約16mmである、請求項1乃至8のいずれかに記載の人工器官。
- 前記第一および第二の人工器官側枝のうちの少なくとも1つが近位方向に伸長している、請求項1乃至9のいずれかに記載の人工器官。
- 前記第一および第二の人工器官側枝のうちの少なくとも1つが遠位方向に伸長している、請求項1乃至10のいずれかに記載の人工器官。
- 前記第一の人工器官側枝が患者の上腸間膜動脈内へ挿入できるようになされており、前記第二の人工器官側枝が患者の腹腔動脈内へ挿入できるようになされている、請求項1乃至11のいずれかに記載の人工器官。
- 貫通して伸長している幹部管腔、壁、及び該壁内の吻合部を有する人工器官幹部と、
前記吻合部に隣接して前記人工器官幹部に取り付けられたステントと、を備えており、
前記ステントは前記人工器官幹部に対して半径方向の支持を提供する管状のステント本体を有しており、前記ステント本体は第一のステントパターンと第二のステントパターンとの間で前記人工器官幹部の長手軸線を中心にエンドレスに互い違いになっており、
前記第一のステントパターンが、前記吻合部の外周全体に接触し且つこれを支持する外形形状を有するループを備える、人工器官。 - 前記第二のステントパターンがジグザグ形状を有する、請求項13に記載の人工器官。
- 前記ループが卵形形状を有する、請求項13に記載の人工器官。
- 貫通して伸長している幹部管腔を有する人工器官幹部と、
貫通して伸長している側枝管腔を有する人工器官側枝と、
第一の軸線を中心に配置されている第一の管状ステント部分と第二の軸線を中心に配置されている第二の管状ステント部分との間の外周でエンドレスに互い違いになっているステントパターンを有するステントと、を備えており、
前記第一の管状ステント部分は前記人工器官幹部の少なくとも一部分に取り付けられてこれを支持しており、前記第二の管状ステント部分は前記人工器官側枝の少なくとも一部分に取り付けられてこれを支持している、人工器官。 - 前記ステントパターンがジグザグ形状を有する、請求項16に記載の人工器官。
- 前記第一の管状ステント部分が前記第二の管状ステント部分と異なる直径を有する、請求項16に記載の人工器官。
- 前記第一の管状ステントの軸線が前記第二の管状ステントの軸線と同一線上にある、請求項16に記載の人工器官。
- 前記人工器官側枝は、少なくとも一部が前記人工器官幹部管腔の内側に配置される、請求項16に記載の人工器官。
- 前記人工器官側枝は、少なくとも一部が前記人工器官幹部管腔の外側に配置される、請求項16に記載の人工器官。
- 前記ステントが8の字形状を有する、請求項16に記載の人工器官。
- 前記第一の管状ステント部分の少なくとも一部分が、前記人工器官幹部の内面上に配置されている、請求項16に記載の人工器官。
- 前記第一の管状ステント部分の少なくとも一部分が、前記人工器官側枝の外面上に配置されている、請求項23に記載の人工器官。
- 前記第二の管状ステント部分の少なくとも一部分が、前記人工器官側枝の外面上に配置されている、請求項16に記載の人工器官。
- 前記ステントパターンがジグザグ形状を有していること、
前記第一の管状ステント部分が前記第二の管状ステント部分と異なる直径を有していること、
前記第一の管状ステント部分の軸線が前記第二の管状ステント部分の軸線と同一線上にあること、
前記人工器官側枝が前記人工器官幹部管腔の内側に少なくとも一部が配置されていること、
前記人工器官側枝が前記人工器官幹部管腔の外側に少なくとも一部が配置されていること、
前記ステントが8の字形状を有していること、
前記第一の管状ステント部分の少なくとも一部分が、前記人工器官幹部の内面上に配置されていること、
前記第一の管状ステント部分の少なくとも一部分が、前記人工器官側枝の外面上に配置されていること、及び
前記第二の管状ステント部分の少なくとも一部分が、前記人工器官側枝の外面上に配置されていること、のうちのいずれか2以上の特徴を更に備えている、請求項16に記載の人工器官。
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EP (1) | EP2331013B1 (ja) |
JP (1) | JP5490794B2 (ja) |
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JP2020517409A (ja) * | 2017-04-24 | 2020-06-18 | エンドーロジックス インコーポレイテッド | 主グラフトのチャネルに分岐デバイスを配置可能にする血管内システム、デバイス、及び方法 |
US11331179B2 (en) | 2017-04-24 | 2022-05-17 | Endologix Llc | Endovascular systems, devices, and methods allowing for branch device placement in channel of main graft |
JP7332582B2 (ja) | 2017-04-24 | 2023-08-23 | エンドーロジックス リミテッド ライアビリティ カンパニー | 主グラフトのチャネルに分岐デバイスを配置可能にする血管内システム、デバイス、及び方法 |
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AU2009271595B2 (en) | 2013-10-10 |
WO2010008570A1 (en) | 2010-01-21 |
JP5490794B2 (ja) | 2014-05-14 |
EP2331013A1 (en) | 2011-06-15 |
US9125733B2 (en) | 2015-09-08 |
US9943400B2 (en) | 2018-04-17 |
US20180243076A1 (en) | 2018-08-30 |
EP2331013B1 (en) | 2014-11-26 |
US10631972B2 (en) | 2020-04-28 |
US20150374487A1 (en) | 2015-12-31 |
US20090043377A1 (en) | 2009-02-12 |
AU2009271595A1 (en) | 2010-01-21 |
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