JP4790672B2 - 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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- JP4790672B2 JP4790672B2 JP2007186160A JP2007186160A JP4790672B2 JP 4790672 B2 JP4790672 B2 JP 4790672B2 JP 2007186160 A JP2007186160 A JP 2007186160A JP 2007186160 A JP2007186160 A JP 2007186160A JP 4790672 B2 JP4790672 B2 JP 4790672B2
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- catheter
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- JSIGUUUNVYUWQT-UHFFFAOYSA-O C[NH2+]C1CCC1 Chemical compound C[NH2+]C1CCC1 JSIGUUUNVYUWQT-UHFFFAOYSA-O 0.000 description 1
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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。
が、一方向に延在する第1の対の湾曲部と、反対方向に延在する第2の対の湾曲部とを有
する環状の弾性要素を含むという点である。第1と第2の対の湾曲部は、互いに連結し
てある。管形移植片は、環状の弾性要素に接合してある。移植片は、第1の血管の全長にわたって延在するように配置し、第1の対の湾曲部は、第2の血管が第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る。第2の対の湾曲部のうちの一方は開口部を形成しており、少なくとも部分的に補綴を超えて第1と第2の血管の間を連通させる。
変形前の環状の弾性要素の断面積より小さい第1の形状に環状の弾性要素を折りたたむ工程を含む点である。環状の弾性要素は、体内の径路の希望の箇所に位置させ、第1の形状より直径が大きく、かつ、変形前の環状の弾性要素の直径よりも小さい第2の形状に弾力的に変形させる。
で、これは、弁と連結可能な第1の端部と、第2の端部を有する可撓性の管形移植片である。変形可能な環状の弾性要素を第2の端部に連結し、前記管形移植片を上行大動脈の一部の内側表面に接合するように配置する。
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、環状の弾性要素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環状の弾性要素の正面図である。
図4は、体内の径路の中に導入した後の環状の弾性要素の正面図である。
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。環状の弾性要素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。環状の弾性要素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、環状の弾性要素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。
持装置56は、少なくとも二箇所の正反対の位置で環状の弾性要素30に固定することができるため、装置56は、補綴40の軸におおむね平行に延在する。装置56は、一端に通路58を有し、さらに装置56を環状の弾性要素30に固定するための取付け金具60を有していてもよい。あるいは、通路58をワイヤ固定取付け金具(図示していない)と置き換えてもよい。場合によっては、装置56の一端にかえし62を設けてもよい。しかし、多くの場合、かえし62は必要ない。
一度環状の弾性要素30を管の壁に向けて拡張してしまったら、位置を直す際には環状の弾性要素の抵抗力に反して行なわなければならない。従って、補綴40がカテーテル68を離れた後も、補綴40が正確な位置につくまで環状の弾性要素30を保持したほうが都合がよい。そのため、図11および12に示す例では、ボーデン管70が伸縮自在にワイヤの先端にループが形成したワイヤループ72を保持している。ワイヤループ72は、管70を通って軸方向に延在し、環状リング74を形成し、ボーデン管72の近位の自由端の穴76を通る。この点で、ワイヤループ72のループ型の端部78は、ブロッキングワイヤ80を受容し、前記ループ型の端部78が穴の外側に延在している。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、湾曲部38に近接する点まで延在している。環状リング74は、湾曲部38の外周の回りの、その長さのほぼ中央部分に延在し、環状の弾性要素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、環状の弾性要素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。
一つもしくはそれ以上のモジュールを追加して補うことができる。第2の補綴106は、管形移植片42による抵抗力に反して外側方向に拡張する環状の弾性要素30を使って第1の補綴40に入れ子式に係合している。第2の補綴106は、上側環状の弾性要素30’と、下側環状の弾性要素30’’とを有する。移植片42に係合するのは上側環状の弾性要素30’で、一方、下側環状の弾性要素30’’は、遠位の頚部54bに係合する。第2の補綴106が入れ子式に第1の補綴40の中に拡張する量は調整可能で、長さの異なる血管に対し、広い範囲にわたる配置に対応できる。
ら下側頚部54bを超えて腸骨または骨盤動脈108および110の中に延在する、図18に示すような分岐ステント120を作ることもできる。この場合も、補綴40は、上記のように、頚部54aと係合する。先に説明した補綴106の代わりとして、次に特殊形状の補綴112を使用することができる。図19に示した補綴112は、その上端に環状の弾性要素30を有し、その下端には、一対のリング114を有している。リング114は、単に開口した形状の補綴112の下端を保持するだけなので、圧縮する必要はない。
綴112と係合するように、左右対称に挿入する。特に、上側環状の弾性要素30’’は、リング114を通って入り、管形移植片42に対して外側方向に拡張する径路116の内部を通る。同時に、それぞれの補綴120のもう一端122は、腸骨動脈108または110で頚部54bと係合する。補綴120のうちの一方は、前に取り付けた補綴の位置決めに使用したものと同じガイドワイヤを使って挿入することができる。しかし、もう一方の補綴120は、そのガイドワイヤとは別に位置決めしなければならない。このため、環状の弾性要素30’’と114に耐X線材料を使用して、リング114の位置決めがしやすいように、また、予め設置したガイドワイヤなしで挿入しなければならない補綴120が、それらのリング114の中を通りやすいようにすることができる。
こともできる。大動脈の一部を外科手術により取り除いた後に環状の弾性要素30を上行大動脈‘‘D‘‘の残りの部分に取り付けることができる。環状の弾性要素30は、先に述べたように、大動脈‘‘D‘‘の内側表面に固定される。環状の弾性要素は、管形の、可撓
性スリーブまたは移植片42に接合され、管形移植片42は機械の心臓弁に接合しやすくするための縫合リング130に接合してある。弁と移植片の詳細は、当業者の知るところであり、本出願の中で明示的に引用している米国特許第5,123,919号で説明している。管形移植片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。管形移植片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、管形移植片42を、機械の弁132と環状の弾性要素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 (6)
- 管形移植片と、
前記管形移植片の一端に取付けられた環状の弾性要素と、
前記環状の弾性要素(30)に設けられ、かつひも通し穴を有するアイレットと、を備えたカテーテル内に収縮状態で収容される補綴装置であって、
前記管形移植片と、前記カテーテル内を挿通して設けられるガイドワイヤカテーテル(86)および第1ブロッキングワイヤとが、前記カテーテルと並行して前記カテーテル内に伸延された状態で、かつ、一端が前記ガイドワイヤカテーテル(86)に取付けられ他端が前記第1ブロッキングワイヤの挿通−抜去が可能となるようにループ端部(94)とされ、中間部が前記アイレットのひも通し穴に挿通された連結線材(90)により、前記ガイドワイヤカテーテル(86)と前記第1ブロッキングワイヤとを連結した状態から、前記第1ブロッキングワイヤを牽引し前記ループ端部(94)から抜去することにより、前記ガイドワイヤカテーテル(86)および前記第1ブロッキングワイヤとの連結を解除して前記管形移植片を体腔内所定位置に設置される補綴装置。 - 前記管形移植片は、前記環状の弾性要素に接合した分岐型移植片であって、
前記分岐型移植片の一端が前記環状の弾性要素に接合され、他端の少なくとも2つの分岐
部が自由端であることを特徴とする、請求項1に記載の補綴装置。 - 前記管形移植片は、前記環状の弾性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、前記環状の弾性要素に接合した第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1または2項に記載の補綴装置。 - 前記環状の弾性要素は、前記環状の弾性要素の直径に沿った軸で折り曲げるように形成
され、C字型に変形した形状で体内の径路の中に留置されることを特徴とする、請求項1
〜3のいずれか1項に記載の補綴装置。 - 請求項1〜4のいずれか1項に記載の補綴装置(40)をカテーテル内から放出し、体
腔内所定位置に設置する補綴装置を固定するための装置であって、
前記補綴装置を収縮状態で収容するカテーテル(68)と、
前記補綴装置内を挿通するガイドワイヤカテーテル(86)と、
近位端が前記カテーテル(68)から引き出され、遠位端が前記補綴装置の近傍に配置
され、前記カテーテル内を挿通して設けられ、かつ外部から操作する第1ブロッキングワイヤと、
前記ガイドワイヤカテーテル(86)に一端が取り付けられ他端が前記第1ブロッキングワイヤの挿通−抜去が可能となるようにループ端部(94)とされ、中間部が前記アイレットのひも通し穴に挿通され、当該ループ端部(94)に前記第1ブロッキングワイヤが挿通されている連結線材(90)と、を有し、
前記ガイドワイヤカテーテル(86)、前記第1ブロッキングワイヤ、および前記管形移植片が、前記カテーテル(68)と並行して前記カテーテル(68)内に伸延された状態で、かつ、前記連結線材(90)により前記ガイドワイヤカテーテル(86)と前記第1ブロッキングワイヤとを連結した状態から、前記第1ブロッキングワイヤを牽引し前記ループ端部(94)から抜去することにより、前記ガイドワイヤカテーテル(86)及び前記第1ブロッキングワイヤとの連結を解除して請求項1〜4のいずれか1項に記載の補綴装置を固定および離脱する装置。 - 近位端が前記カテーテル(68)から引き出され、遠位端が前記補綴装置の近傍に配置された、前記カテーテル(68)内を挿通して設けられた第2ブロッキングワイヤ(100)を、さらに有する、請求項5に記載の補綴装置を固定および離脱する装置であって、
前記第2ブロッキングワイヤ(100)と、
先端に前記ループ端部(94)を有し、前記ガイドワイヤカテーテル(86)に開設された開口部(102)から前記ループ端部(94)が引き出されるよう前記ガイドワイヤカテーテル(86)内に挿通され、かつ前記前記環状の弾性要素(30)に掛けられるよう延在した操作ワイヤ(103)と、が
前記ループ端部(94)を前記第2ブロッキングワイヤ(100)が挿入することで一時的に固定されてなる組立体を形成し、
前記第1ブロッキングワイヤ(96)および前記第2ブロッキングワイヤ(100)を牽引することにより、前記第2ブロッキングワイヤ(100)を前記ループ端部(94)から脱却させる、請求項5に記載の装置。
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- 1997-06-19 DE DE69732411T patent/DE69732411T2/de not_active Expired - Lifetime
- 1997-06-19 CN CN2004100560033A patent/CN1568905B/zh not_active Expired - Fee Related
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- 1997-06-19 CN CNB971968365A patent/CN1166346C/zh not_active Expired - Fee Related
- 1997-06-19 JP JP50252298A patent/JP4014226B2/ja not_active Expired - Lifetime
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