JP2013528472A - 動静脈(av)フィステルを作るためのシステムおよび方法 - Google Patents
動静脈(av)フィステルを作るためのシステムおよび方法 Download PDFInfo
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Abstract
【選択図】図1
Description
Claims (35)
- 動静脈(AV)フィステルを作るための装置であって、
前記装置は、
第1の管腔と第2の管腔を有する本体を含む第1の部材、
前記第2の管腔に配され、前記第2の管腔から遠位に移動するように、および、遠位に移動する間に組織を切り裂くように構成された穿刺部材を含む、第2の部材、
前記穿刺部材の遠位端から延び、隣接する第1および第2の血管を互いに向かって移動させるように、および、第1の血管と第2の血管の各々の対向する側部に細長く延びた連通開口を形成するように動作可能な第3の部材を含む、装置。 - 第3の部材は、前記穿刺部材の遠位端にヒンジ接続され、前記穿刺部材に対して第1の配向と第2の配向の間で旋回可能なトグル部材を含む、請求項1に記載の装置。
- 前記トグル部材は、その1つの端部に尖端を有する、請求項2に記載の装置。
- 前記細長く延びた連通開口を作る目的で、トグル部材に適用するためのRFエネルギー源をさらに含む、請求項2に記載の装置。
- 前記細長く延びた連通開口を作る目的で、トグル部材に適用するための抵抗性の熱エネルギーの源をさらに含む、請求項2に記載の装置。
- 第3の部材は、前記穿刺部材の遠位端から前記本体の第1の管腔の遠位端へ延伸可能な針を含む、請求項1に記載の装置。
- 前記針を近位方向に引っ込めるために前記第1の管腔に配される器具をさらに含む、請求項6に記載の装置。
- 隣接する第1および第2の血管の間にAVフィステルを作るための方法であって、
前記方法は、
前記第1の血管内に装置の本体を位置づける工程と、
前記第1の血管の壁と、隣接する第2の血管の壁とを貫いて前記本体から遠位状に第2のまたは穿刺部材を延伸させる工程であって、その結果、前記穿刺部材の遠位端が前記第2の血管内に配される工程と、
前記第1の血管および第2の血管の対向する壁に細長く延びた連通開口を穿設するために前記穿刺部材の遠位端に対して移動するように第3の部材を動作させる工程を含む、方法。 - 前記位置づける工程は皮膚を通して行なわれる、請求項8に記載の方法。
- 前記第3の部材は旋回可能なトグル部材を含み、動作させる工程は、前記穿刺部材の遠位端に対して前記トグル部材を旋回させる工程を含む、請求項8に記載の方法。
- 動作させる工程は、前記トグル部材が前記第2の血管を前記第1の血管の方に引っ張るように、前記トグル部材に、近位方向に向けられた張力を加える工程を含む、請求項10に記載の方法。
- 前記細長く延びた連通開口を生成するために、前記第1および第2の血管の前記対向する壁に沿って切断動作を引き起こすために、RFエネルギーによって前記トグル部材にエネルギーを与える工程をさらに含む、請求項11に記載の方法。
- 前記細長く延びた連通開口を生成するために、前記第1および第2の血管の前記対向する壁に沿って切断動作を引き起こすために、抵抗性の熱エネルギーによって前記トグル部材にエネルギーを与える工程をさらに含む、請求項11に記載の方法。
- 動静脈(AV)フィステルを作るためのシステムであって、
前記システムは、
中空内部及び出口ポートを有する血管アクセスシース、
前記シースの中空内部内に適合するように構成された側部アクセス針カテーテル、
前記側部アクセス針カテーテルを通して血管内に挿入されるように構成された針、
前記シースの前記内部内に適合するように構成されたトグル送達カテーテル、および、
前記トグル送達カテーテルを介して血管内に送達されるように構成されたトグル装置を含み、前記トグル装置は、シャフトと、前記シャフトの遠位端に旋回可能に取付けられたトグル部材を備える、システム。 - 前記側部アクセス針カテーテルは、第1の管腔および第2の管腔を含む、請求項14に記載のシステム。
- 2つの隣接した血管の間に細長く延びた連通開口を作る目的のために、前記トグル部材へ適用するためのエネルギー源をさらに含む、請求項15に記載のシステム。
- 2つの隣接した血管の間の細長く延びた連通開口を作る目的で前記トグル送達カテーテル内にヒーターをさらに含み、および、前記ヒーターにエネルギーを与えるためのエネルギー源をさらに含む、請求項15に記載のシステム。
- 前記ヒーターは、前記トグル送達カテーテルから取り除かれるように、構造上、前記トグル送達カテーテルから分離されるヒーター挿入物を含む、請求項17に記載のシステム。
- ヒーター挿入物は、前記トグル部材が近位位置へ引込められる場合に、前記トグル部材と係合するのに適した表面を備えている、請求項18に記載のシステム。
- ヒーター挿入物は抵抗性の材料を含む、請求項18に記載のシステム。
- ヒーター挿入物は溶接切断領域を含む、請求項18に記載のシステム。
- ヒーター挿入物はガイドワイヤースロットを含む、請求項18に記載のシステム。
- 2つの隣接した血管の間に細長く延びた連通開口を作る目的で、前記トグル部材に適用するためのエネルギー源をさらに含む、請求項17に記載のシステム。
- 前記トグル部材は、前記シャフトを使用して、延伸された遠位位置と、引っ込められた近位位置の間で動作される、請求項21に記載のシステム。
- 前記エネルギーはRFエネルギーを含む、請求項23に記載のシステム。
- 前記エネルギーは抵抗性の熱を含む、請求項23に記載のシステム。
- 第1および第2の血管の間にAVフィステルを作る方法であって、
前記方法は、
第1の血管内に第1のガイドワイヤーを挿入する工程、
前記第1のガイドワイヤー上に前記第1の血管内の中空血管アクセスシースを位置づける工程、
前記シース内に針を挿入する工程、
第1の血管の側壁と隣接した第2の血管の側壁を貫通する針を使用し、針の遠位端が第2の血管に入るように針を進める工程、
前記針を介して第1の血管から第2のガイドワイヤーを挿入する工程、
処置位置から、第1のガイドワイヤーおよび針を引き抜く工程、
第2のガイドワイヤーにわたってシースにトグル送達カテーテルを挿入する工程、
シャフトと、前記シャフトの遠位端に旋回可能に取付けられたトグル部材を含むトグル装置を、第2のガイドワイヤーにわたって進める工程であって、その結果、トグル部材が第2の血管内に配される工程、
トグル部材を、第2の血管の壁に接触させるように近位に移動させる工程、および、
2つの血管のうちの1つの壁を通って開口を作る工程を含む、方法。 - 開口を作る工程は、前記壁に開口力をかけるためにエネルギーを与えられた部材を使用する工程を含む、請求項27に記載の方法。
- 開口を作る工程は、両方の血管の壁を貫いて開口を作成する工程を含み、第1および第2の血管の各々の壁の開口は、共に、前記AVフィステルを作成するために前記血管の間に連通開口を作成する、請求項28に記載の方法。
- 前記開口を定義する組織の縁を溶接する工程をさらに含む、請求項29に記載の方法。
- 前記エネルギーを与えられた部材は前記トグル部材を含む、請求項29に記載の方法。
- 前記トグル部材を移動させる工程は、前記トグル部材の長さが第2の血管の壁に接するようにトグル部材を旋回させる工程を含む、請求項27に記載の方法。
- 前記エネルギーを与えられた部材は、前記トグル送達カテーテルに配されたヒーターを備える、請求項29に記載の方法。
- 前記ヒーターは、前記トグル送達カテーテルから除去可能なヒーター挿入物を含む、請求項33に記載の方法。
- 前記開口を作る工程は、前記トグル部材および前記トグル部材に配されたヒーターにエネルギーを与え、開口が形成される組織の対向する側部にエネルギーを与えられたトグル部材およびエネルギーを与えられたヒーターを適用する工程を含む、請求項29に記載の方法。
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