JP2021118893A - 体内通路を通る流体の流れを提供又は維持する方法及びシステム - Google Patents
体内通路を通る流体の流れを提供又は維持する方法及びシステム Download PDFInfo
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- JP2021118893A JP2021118893A JP2021075815A JP2021075815A JP2021118893A JP 2021118893 A JP2021118893 A JP 2021118893A JP 2021075815 A JP2021075815 A JP 2021075815A JP 2021075815 A JP2021075815 A JP 2021075815A JP 2021118893 A JP2021118893 A JP 2021118893A
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- catheter
- vein
- end portion
- blood vessel
- stent
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- A61F2250/0014—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof having different values of a given property or geometrical feature, e.g. mechanical property or material property, at different locations within the same prosthesis
- A61F2250/003—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof having different values of a given property or geometrical feature, e.g. mechanical property or material property, at different locations within the same prosthesis differing in adsorbability or resorbability, i.e. in adsorption or resorption time
- A61F2250/0031—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof having different values of a given property or geometrical feature, e.g. mechanical property or material property, at different locations within the same prosthesis differing in adsorbability or resorbability, i.e. in adsorption or resorption time made from both resorbable and non-resorbable prosthetic parts, e.g. adjacent parts
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2250/00—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
- A61F2250/0014—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof having different values of a given property or geometrical feature, e.g. mechanical property or material property, at different locations within the same prosthesis
- A61F2250/0039—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof having different values of a given property or geometrical feature, e.g. mechanical property or material property, at different locations within the same prosthesis differing in diameter
Abstract
Description
2013年3月8日に出願された米国特許出願第13/791185号、2013年11月8日に出願された米国仮特許出願第61/901753号、2008年1月3日に出願された米国特許出願第11/662128号、2013年12月27日に出願された米国特許出願第14/141913号、及び、2007年4月20に出願されて2013年5月14日に米国特許出願第8,439,963号として発行されたPCT/GB2007/001430号の国際段階として、2009年2月25日に出願された米国特許出願第12/297498号が、引用することによりその全体が本明細書の一部をなす。
本明細書に記載される方法及びシステムは、いくつかの実施形態に従って心臓血管手術において特定の有用性を示す。いくつかの態様が以下の非限定的な例によって更に示され、そこでは、システムは、冠動脈の閉塞後の心臓組織の逆行性灌流を可能にするように動脈と静脈との接続処置(PICVA)を行う臨床医によって用いられる。
米国合衆国における肢喪失者は200万人近くである。
肢喪失者のうち、主な原因は以下である:
血管疾患(54%)(糖尿病及び末梢動脈疾患(PAD))、
外傷(45%)、及び、
癌(2%未満)。
毎年、合衆国において約185000件の切断が行われている。
肢切断に伴う入院費は2007年において総計65億ドルを超えた。
切断後の生存率は多様な要因に基づき様々である。血管疾患(PAD及び糖尿病を含む)に起因する切断を受けた者は、30日での死亡率が9%〜15%と報告されており、長期生存率は1年が60%、3年が42%及び5年が35%〜45%である。
血行障害(dysvascular disease)で肢を喪失した者の半数近くが5年以内に死亡する。これは、結腸直腸癌、乳癌及び前立腺癌を患った者が被る5年死亡率よりも高い。
糖尿病を患った者のうち下肢切断を受けた者は、最大55%まで、2年〜3年以内にもう一本の脚の切断が必要となる。
結果:
包括的な検討のために総計56の試験が選択された。特定されたランダム化比較試験(RCT)はなかった。228人の患者を含む7つの患者群が選択基準と合致した。1年全体の肢温存は71%(95% CI:64%〜77%)であり、1年の二次開存率は46%(95% CI:39%〜53%)であった。大切断術を回避した患者の大部分は首尾よく創傷治癒し、休息痛が現れず、深刻な合併症がなかった。
結論:
限定された証拠に基づき、静脈の動脈化は、「手術不能な」慢性重症虚血肢を患った患者に大切断術を行う前の実行可能な代案とみなすことができる。
Claims (15)
- 血管の弁を無機能化する装置であって、
近位部分と、
遠位部分と、
前記近位部分と前記遠位部分との間の長手方向軸と、
を備え、
前記遠位部分は、
少なくとも1つのブレードを有し、前記少なくとも1つのブレードは、該少なくとも1つのブレードが前記長手方向軸に対して実質的に平行な後退位置と、該少なくとも1つのブレードが前記長手方向軸に対して実質的に平行でない拡張位置とを有し、遠位に面するとともに該装置が血管を遠位に前進する時に前記血管の弁を少なくとも部分的に切除するように構成された鋭利な面を有し、これによって該装置が前記血管の元の流れに逆行する方向であるが、瘻孔形成後の前記血管の流体の流れの方向に前進するときに該装置が前記弁を切除するのを促進する、装置。 - 前記血管と動脈との間の瘻孔からの前記血管の流体の元の流れに逆行する方向に前記血管を押し進むように構成され、逆行アクセスなしに前記血管内の前記弁を少なくとも部分的に切除する、請求項1に記載の装置。
- 前記少なくとも1つのブレードは複数のブレードを有する、請求項1又は2に記載の装置。
- 前記複数のブレードは2つから5つのブレードを有する、請求項3に記載の装置。
- 前記複数のブレードは3つのブレードを有する、請求項3又は4に記載の装置。
- 前記3つのブレードは周方向に約120度離間している、請求項5に記載の装置。
- 前記近位部分は、前記後退位置と前記拡張位置との間で前記少なくとも1つのブレードを操作するように構成されたハンドルを有する、請求項1から6のいずれかに記載の装置。
- 前記少なくとも1つのブレードは形状記憶材料を有し、前記ハンドルは、前記少なくとも1つのブレードが前記後退位置から前記拡張位置に自己拡張することを可能にするように構成されている、請求項7に記載の装置。
- 前記ハンドルは、前記少なくとも1つのブレードを長手方向に圧縮するとともに前記後退位置から前記拡張位置に径方向に拡張させるように構成されている、請求項7に記載の装置。
- キットであって、
請求項1から9のいずれかに記載の装置と、
血管拡張装置と、
を備える、キット。 - 前記血管拡張装置は、止血帯、バルーン及びLeMaitre装置のうちの少なくとも1つを有する、請求項10に記載のキット。
- 前記血管拡張装置によって拡張された弁を少なくとも1つ切除するように構成される、請求項10又は11に記載のキット。
- キットであって、
請求項1から9のいずれかに記載の装置と、
プロテーゼ送達システムと、
を備える、キット。 - キットであって、
請求項1から9のいずれかに記載の装置と、
発射カテーテルと、
を備える、キット。 - 標的カテーテルをさらに備える、請求項14に記載のキット。
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