JP4109422B2 - 大静脈フィルタ用回収装置 - Google Patents

大静脈フィルタ用回収装置 Download PDF

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JP4109422B2
JP4109422B2 JP2000573805A JP2000573805A JP4109422B2 JP 4109422 B2 JP4109422 B2 JP 4109422B2 JP 2000573805 A JP2000573805 A JP 2000573805A JP 2000573805 A JP2000573805 A JP 2000573805A JP 4109422 B2 JP4109422 B2 JP 4109422B2
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filter
shaft
wire
vena cava
loop
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JP2003503085A (ja
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スオン、ナーロン
ウェルドン、ジェイムズ
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Boston Scientific Limited
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/22—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
    • A61B17/221—Gripping devices in the form of loops or baskets for gripping calculi or similar types of obstructions
    • 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
    • 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
    • A61F2/01—Filters implantable into blood vessels
    • A61F2/0105—Open ended, i.e. legs gathered only at one side
    • 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
    • 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
    • A61F2/01—Filters implantable into blood vessels
    • A61F2/011—Instruments for their placement or removal
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/22—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
    • A61B17/22031—Gripping instruments, e.g. forceps, for removing or smashing calculi
    • A61B2017/22035—Gripping instruments, e.g. forceps, for removing or smashing calculi for retrieving or repositioning foreign objects
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/22—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
    • A61B17/221—Gripping devices in the form of loops or baskets for gripping calculi or similar types of obstructions
    • A61B2017/2215—Gripping devices in the form of loops or baskets for gripping calculi or similar types of obstructions having an open distal end
    • 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
    • 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
    • A61F2/01—Filters implantable into blood vessels
    • A61F2002/016—Filters implantable into blood vessels made from wire-like elements
    • 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
    • A61F2230/00—Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2230/0002—Two-dimensional shapes, e.g. cross-sections
    • A61F2230/0028—Shapes in the form of latin or greek characters
    • A61F2230/005—Rosette-shaped, e.g. star-shaped
    • 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
    • A61F2230/00—Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2230/0063—Three-dimensional shapes
    • A61F2230/0067—Three-dimensional shapes conical

Description

【０００１】
（関連出願情報）
本願は１９９８年９月２４日に出願された米国特許仮出願第６０／１０１，６１６号の特典に権利主張するものである。
【０００２】
（発明の分野）
本発明は大静脈内フィルタの分野に関する。本発明は詳細には大静脈内フィルタの回収に関するものである。
大静脈内フィルタは一時的または恒久的に患者の体内に一般的に移植されるが、血液凝固のリスクをともなう。
【０００３】
（発明の概要）
本発明は一時的または恒久的に移植可能な大静脈内フィルタならびにこれを除去するための方法に関する。このフィルタは、静脈壁または他の臓器の内表面に係合してフィルタの位置的安定性を与える先鋭化された先端部を有するストラットを備える。本発明に基いた方法は、好ましくは、フィルタを更に安定化する工程、ストラットを圧縮する工程、及び、後のフィルタの除去のためにストラットの先鋭先端部を保護する工程を含む。
【０００４】
（発明の詳細な説明）
図中、複数の図にわたって類似の要素を類似の参照符号にて示してある。図１は、大静脈Ａの内部に配されたフィルタ１０を側面図にて示したものである。フィルタ１０はハブ１２を備え、ハブ１２から複数のストラット１４が延びる。各ストラットは好ましくは、矢印の方向に血管Ａ内を流れる血栓を捕捉するために全長に沿った屈曲部を有する。具体的には、フィルタ１０はメディテック社（Ｍｅｄｉ−Ｔｅｃｈ）（マサチューセッツ州ウォータータウン（ｗａｔｅｒｔｏｗｎ））により製造されるグリーンフィールド（Ｇｒｅｅｎｆｉｅｌｄ）（商標）フィルタなどの従来技術に基いたフィルタを使用することが可能である。フィルタ１０は、頚静脈のアクセス部位または当業者に知られる他の血管内経路を経由して血管Ａ内に留置することが可能である。
【０００５】
ここに開示されるフィルタは、大静脈や他の臓器内に恒久的もしくは一時的に留置することが可能である。ここに開示されるフィルタを除去するための器具ならびに方法は、フィルタの移植後数週間以内で内皮組織が増殖するよりも前に、除去を困難なものとするフィルタの部分上に使用される。
【０００６】
図１には更にスタビライザ２０が示されている。スタビライザ２０は基端と末端とを備えている。スタビライザ２０は大腿静脈のアクセス部位を介してフィルタ１０にまで進めることが可能である。スタビライザ２０は例えばステンレス鋼性のハイポチューブや方向転換可能カテーテルなどのほぼ剛性の生体適合性材料にて形成されることが好ましい。
【０００７】
図１においてフィルタ１０の近傍に除去装置３０が配置されている。除去装置３０はスタビライザ２０と同様、大腿静脈のアクセス部位を介してフィルタ１０にまで進めることが可能である。除去装置３０は好ましくは基端（図に示されていない）と末端とを有する長尺のシャフトを有する。シャフト３０は、好ましくはステンレス鋼製のハイポチューブなどのほぼ剛性の生体適合性材料にて形成される。シャフト３１の末端からはワイアループ３２が延出する。ワイアループ３２はニチノールなどのＮｉＴｉ合金にて好ましくは形成される。ループ３２を形成するワイアは好ましくはシャフト３１を通じて基端にまで延びているため、医師がループ３２をシャフト３１内に引き込むことが可能である。ループ３２を形成するワイアは好ましくはヒートセットされるかまたは機械的に付勢され、シャフト３１の末端から血管Ａ内にワイアが進められる際に、図１に示されるようにシャフト３１にほぼ直交する方向に折れ曲がる。
【０００８】
図２は図１のフィルタを示したものであり、ループ３２は除去装置３０が基端方向に引かれることによってフィルタ１０を取り囲んでいる。図３は、図１のフィルタを示したものであり、除去装置３０は図２に示されるよりもフィルタ１０及びスタビライザ２０に対して基端方向に更に引かれている。図３に示されるように除去装置３０を更に基端方向に引くことによってストラット１４はスタビライザ２０に向けて内側に圧縮され、鉤１６が血管Ａの壁から離れる。
【０００９】
図３には更に、除去シース４０が断面にて示されている。シース４０は例えばガイドカテーテルと同様、生体適合性材料にて形成することが可能である。シース４０は例えば大腿静脈のアクセス部位を介してフィルタ１０にまで進めることが可能である。図３に見られるように、ストラット１４が除去装置３０によって充分に内側に圧縮された時点でフィルタ１０をシース４０内に引き込んで患者から取り外すことが可能である。
【００１０】
図４は図１のフィルタを示したものである。図４では除去装置４８がフィルタ１０の上方に配されている。除去装置４８はスタビライザ５０及びカテーテル６０を備えている。カテーテル６０はガイドカテーテルと同様にして形成することが可能である。スタビライザ５０は好ましくは基端（図に示されていない）と末端とを有する管状シャフト５１を有する。この基端と末端との間には好ましくはシャフト５１の末端を越えて延びる末端を備えた複数の長尺部材５２が延びている。部材５２の末端は図に示されるように好ましくは屈曲されて鉤爪状部を形成する。部材５２の末端には非外傷性ボール５４を配することが可能である。除去装置４８は例えば頚静脈のアクセス部位を介して図に示される位置に配置することが可能である。
【００１１】
図５は、図４のフィルタを示したものであるが、スタビライザ５０の鉤爪状部がハブ１２と接触させられている。非外傷性ボール５４がハブ１２の一部に接触することによってフィルタ１０が保持されている様子が示されている。部材５２上にシャフト５１を進めることにより鉤爪状部のボール５４同士を互いに閉じ合わせて装置５０の鉤爪状部を閉じ、ハブ１２を把持することが可能である。フィルタ１０がスタビライザ５０によって把持された時点でカテーテル６０をストラット１４と接触するように進めることが可能である。
【００１２】
図６は、図４のフィルタを示したものであるが、カテーテル６０は図５に示されているよりも先に進められてストラット１４を圧縮しており、先端部１６が血管Ａの壁から引き離されている。例として頚静脈のアクセス部位からフィルタ１０の全体を覆うようにシース４０が進められている。シース４０は矢印にて示される方向にフィルタ１０が抜脱される際に、先端部１６から血管壁を保護する。
【００１３】
図７は、大静脈Ａ内に留置された図１のフィルタを示したものである。フィルタ１０の上方にはカテーテル６０の内部に置かれた除去装置３０が配置されている。装置３０及びカテーテル６０は好ましくは頚静脈のアクセス部位を介してこの位置にまで進められる。
【００１４】
図８では、装置３０のループ３２はハブ１２の一部を取り囲んでいる。あるいはハブ１２は、仮想線にて示されるフック３３を備えることも可能であり、これにループ３２が取り付けられる。ループ３２を形成するワイアはシャフト３１内に基端方向に引き込まれてループ３２がハブ１２の周囲に締め付けられる。カテーテル３６は末端方向に進められてストラット１４に接触している。
【００１５】
図９では、カテーテル６０は図８に示されているよりも装置３０及びフィルタ１０に対して更に先に進められている。このようにカテーテル６０を進めることにより、ストラット１４が内側に圧縮されて複数の先端部１６は血管Ａの壁から引き離される。ループ３０がストラット１４を内側に圧縮し、以って先端部１６を血管Ａから引き離すように構成された本発明の実施形態も想到されるものである。ループ３２が末端方向に進められてストラット１４を内側に圧縮し、以って先端部１６を血管Ａから引き離すような本発明に基く方法も想到されるものである。シース４０が図９に示されるようにフィルタ１０を覆って末端方向に進められ、フィルタ１０が除去される際に先端部１６から血管壁を保護する。
【００１６】
この文書に含まれる本発明の多くの特徴ならびに利点について上記の説明文に述べてきたが、本開示は多くの意味においてあくまで説明的のものであることは理解されよう。発明の範囲を逸脱することなく、特に形状、大きさ、及び工程の順序といった細部に変更を加えることが可能である。発明の範囲は、無論のこと、特許請求の範囲を記述する文言によって定義されるものである。
【図面の簡単な説明】
【図１】血管内に配された大静脈内フィルタ及び除去装置を示す図。
【図２】図１のフィルタ及び除去プロセスにおける後の配置にある除去装置を示す図。
【図３】図１のフィルタ及び除去プロセスにおいて図２に示された配置の次の配置にある除去装置を示す図。
【図４】図１の大静脈内フィルタ及び血管内に配された除去装置の別の一実施形態を示す図。
【図５】図４のフィルタ及び除去プロセスにおける後の配置にある除去装置を示す図。
【図６】図４のフィルタ及び除去プロセスにおいて図５に示された配置の次の配置にある除去装置を示す図。
【図７】図１の大静脈内フィルタ及び血管内に配された除去装置の更なる別の一実施形態を示す図。
【図８】図７のフィルタ及び除去プロセスにおける後の配置にある除去装置を示す図。
【図９】図１のフィルタ及び除去プロセスにおいて図８に示された配置の次の配置にある除去装置を示す図。

Claims (7)

  1. 血管から血栓フィルタを除去するための装置であって、
    基端、末端、及び内部を通じて延びる管腔を有するシースと、
    シースの前記管腔内に置かれるシャフトであって、基端、末端、及び内部を通じて延びる管腔を有するシャフトと、
    第１の端部及び第２の端部を有するワイアであって、シャフトの前記管腔の内部に部分的に置かれるワイアとを備え、
    該ワイアの一部は前記シャフトの前記末端を越えて延びてループを形成し、
    該ワイアの一部は前記シャフトの前記基端を越えて延び、
    ワイアの前記第１の端部はシャフトの前記末端近傍に固定され、ワイアの前記第２の端部はシャフトの前記基端を越えて延び、
    血流の方向に移動してフィルタに接近し、血流とは反対方向にフィルタを除去する装置。
  2. ワイアが形成する前記ループは血栓フィルタに係合するように構成されている請求項１に記載の装置。
  3. ワイアが形成する前記ループは前記血栓フィルタの一部を取り囲むように構成された請求項１に記載の装置。
  4. ワイアの前記第１の端部及び第２の端部はシャフトの前記基端を越えて延びる請求項１に記載の装置。
  5. 前記ワイアはニチノールにて形成される請求項１に記載の装置。
  6. ワイアが形成する前記ループは前記シャフトにほぼ直交する請求項１に記載の装置。
  7. 前記シャフトはシースよりも長い請求項１に記載の装置。
JP2000573805A 1998-09-24 1999-09-24 大静脈フィルタ用回収装置 Expired - Fee Related JP4109422B2 (ja)

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US10161698P 1998-09-24 1998-09-24
US60/101616 1998-09-24
US09/404,116 US6342062B1 (en) 1998-09-24 1999-09-23 Retrieval devices for vena cava filter
US09/404116 1999-09-23
PCT/US1999/022197 WO2000016846A1 (en) 1998-09-24 1999-09-24 Retrieval devices for vena cava filter

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US6342062B1 (en) 2002-01-29
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US20040172042A1 (en) 2004-09-02
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US7041117B2 (en) 2006-05-09
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WO2000016846A1 (en) 2000-03-30

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