JP5977291B2 - Introduction aid with side holes - Google Patents

Description

  The present invention relates to an introduction assisting device that includes a tubular body that is inserted into a tubular organ of a human body, and through which the medical device can be introduced into the tubular organ.

  In an operation in a tubular organ of a human body such as a blood vessel, an introduction assisting instrument such as a sheath introducer as described in Patent Document 1 or a guiding catheter as described in Patent Document 2 is inserted into the tubular organ, and after placement, A therapeutic instrument such as a therapeutic catheter is introduced into the lesion site through the internal passage of the introduction assisting instrument.

  When introducing a treatment instrument to a lesion site through an introduction aid placed in a tubular organ, first insert a guide wire for the treatment instrument into the internal passage of the introduction aid placed in the tubular organ. After the distal end reaches the vicinity of the lesion site, the proximal end of the guide wire for the treatment instrument is inserted into the distal end of the treatment instrument such as a treatment catheter, and the treatment instrument is guided along the guide wire for the treatment instrument to the lesion site. invite. At this time, the guide wire for the therapeutic instrument or the therapeutic instrument is advanced by transmitting the pushing force applied to the therapeutic instrument guide wire or the therapeutic instrument from the base end side (the operation side at hand of the doctor) to the distal end. .

  When there is a lesion site in a side branch blood vessel that branches off from a blood vessel into which an introduction assisting device is inserted (hereinafter referred to as “introduction blood vessel”), for example, as described in Patent Document 2, between the distal end portion and the main body portion. In addition, using the introduction assisting device having a curved portion formed in advance so that the distal end of the introduction assisting device can be easily oriented toward the entrance of the target side branch blood vessel, the distal end of the introduction assisting device is moved to the side branch blood vessel. Then, a treatment instrument guide wire or a treatment instrument (hereinafter referred to as a guide wire or the like) is extended from the distal end of the introduction assisting instrument and inserted into the side branch vessel for treatment. Further, if there is a stenosis site in the side branch blood vessel, the guide wire or the like receives a reaction force when the tip of the guide wire or the like passes through the stenosis, and the received reaction force acts on the introduction assisting device. This makes it difficult to push the guide wire or the like into the stenosis when the distal end of the introduction assisting device is disengaged from the entrance of the side branch vessel. For example, as described in Patent Document 3, a part of the bending portion described above is used. A method is also used in which the inner wall of the introduced blood vessel is brought into contact with each other so as to receive a reaction force.

JP 2003-325671 A JP 2009-22432 A JP 2006-326226 A

  In the conventional introduction assisting device, a guide wire or the like is extended from the distal end. Therefore, when introducing a guide wire or the like into a side branch vessel branched from the introduction blood vessel, as described above, the distal end of the introduction assisting device is It must be placed at the entrance of the side branch vessel. Therefore, the introduction assisting devices as described in Patent Document 2 and Patent Document 3 are also provided with a curved portion at the distal end portion so that the distal end can be directed to the entrance of the side branch blood vessel. Etc. can be introduced.

  On the other hand, for example, when advancing the introduction assisting device from the puncture hole provided in the femoral artery to the descending aorta and the ascending aorta, the right renal artery, the left renal artery, the left subclavian artery, the left common carotid artery, the brachiocephalic artery, The right subclavian artery, the right common carotid artery, and the like branch at an acute angle from the descending aorta and the ascending aorta, which are introduction blood vessels, with respect to the direction of travel of the introduction assisting device. The introduction assisting devices as described in Patent Document 2 and Patent Document 3 are provided as described above by providing, between the distal end portion and the main body portion, a curved portion that is curved so that the distal end is directed toward the side branch vessel. It is possible to introduce a guide wire or the like into a side branch vessel. However, using the introduction assisting device as described in Patent Document 2 and Patent Document 3, the tip of the introduction assisting device is directed to the entrance of the side branch blood vessel that branches at an acute angle from the introduction blood vessel with respect to the traveling direction of the introduction assisting device. It has been difficult to place or insert into the inlet, and there is a risk of damaging the inlet of the side branch vessel with the tip of the introduction assisting device.

  Further, in order to prevent the distal end of the introduction assisting device from coming off from the entrance of the side branch blood vessel due to the reaction force acting on the guide wire or the like when passing through the constricted portion of the side branch blood vessel, it is described in Patent Document 3. As described above, even if a part of the curved portion provided at the tip of the introduction assisting device is brought into contact with the introduction blood vessel so that the reaction force can be received by the inner wall of the introduction blood vessel, Since the distance is long, the distance from the contact point to the distal end of the introduction assisting device may bend, and the distal end of the introduction assisting device may be disengaged from the entrance of the side branch vessel. As a result, a sufficient backup force (that is, support force) for the introduction assisting device to resist the reaction force cannot be provided to the guide wire or the like, and there arises a problem that it becomes difficult to insert the guide wire or the like into the narrowed portion.

  Accordingly, an object of the present invention is to solve the problems existing in the prior art and reduce the occurrence of damage to the entrance of the side branch tubular organ and to provide sufficient backup when inserting the medical device into the side branch tubular organ through the introduction assisting device. It is to be able to provide power.

In view of the above-described object, the present invention includes a tubular body that extends along a central axis and is inserted into an introduction tubular organ, and a side hole is provided in a peripheral wall of the tubular body, and the side hole is formed through the side hole of the tubular body. An introduction assist device with a side hole capable of introducing a medical device into a side branch tubular organ branched from an introduction tubular organ, wherein the tubular body includes a tip portion, a body portion, and the tip portion and the body portion. The medical instrument that is provided between and includes a first curved portion and a second curved portion that curves to the opposite side of the first curved portion with respect to the central axis, and extends from the measurement hole A backup providing unit for providing a backup force against the reaction force, and the side hole is provided in the first bending unit or the second bending unit, and the first bending unit And the second curved portion has the measuring hole located at the entrance of the side branch tubular organ Thus, when the tubular body is disposed in the introduction tubular organ, both the first bending portion and the second bending portion are formed so as to generate a contact portion that contacts the inner wall of the introduction tubular organ. And the measurement hole is positioned between the contact portion of the first bending portion and the contact portion of the second bending portion in the first bending portion or the second bending portion. An introduction assisting device with a side hole is provided.

  In the introduction aid with side holes, the medical device is introduced into the side branch tubular organ branched from the introduction tubular organ through the side hole of the tubular body inserted into the introduction tubular organ. It is not necessary to arrange it toward or in the entrance, and the occurrence of damage to the entrance of the side branch tubular organ due to the distal end of the tubular body of the side hole introduction assisting device can be suppressed. On the other hand, in order to introduce a medical device into the side branch tubular organ through the side hole, it is necessary to arrange the side hole of the tubular body in the inlet tubular organ at the entrance of the side branch tubular organ. Since the medical instrument inserted through the tubular body is bent in the vicinity of the side hole in the bending part and extends from the side hole, the reaction force acting on the tip of the medical instrument when passing through the stenosis part is It becomes easy to be transmitted to the peripheral wall of the curved portion near the hole. As a result, when the bending portion is deformed or moved to cause the positional deviation of the side hole, it becomes difficult to insert the medical instrument into the side branch tubular organ. However, in the introduction aid with a side hole, at least one of the one or a plurality of curved portions included in the backup providing portion can be brought into contact with the inner wall of the introduction tubular organ. The side hole is provided in one of the one or a plurality of curved portions supported in contact with the inner wall of the introduction tubular organ in this way, and the side hole is a portion of the contact portion with the inner wall of the introduction tubular organ. Since the reaction force acting on the medical device is transmitted to the peripheral wall of the tubular body in the vicinity of the side hole, the position of the side hole is not easily displaced and the reaction force is resisted when the medical device is inserted. Effectively providing a backup force to advance the medical device into the side branch tubular organ. In the present application, “place the side hole at the entrance of the side branch tubular organ” includes not only the position facing the entrance of the side branch tubular organ but also the placement of the side hole in the vicinity of the entrance.

The reaction force received when a medical device extending from the side hole arranged at the entrance of the side branch tubular organ passes through a stenosis or the like in the side branch tubular organ leaves the curved portion near the side hole away from the entrance of the side branch tubular organ. Acting on the back-up providing part in a direction transverse to the introduction tubular conduit. On the other hand, the first curved portion and a second curved section included in the backup provider than you are curved on opposite sides with respect to the central axis, in the state in which the side hole on the inlet side branch tubular organ, The curved portion opposite to the curved portion provided with the side hole can be brought into contact with the inner wall of the introducing tubular organ on the side facing the side branch tubular organ. Accordingly, the backup providing portion is supported by the inner wall of the introduction tubular organ on the side opposite to the inlet of the side branch tubular organ and acts on the backup supply portion in a direction transverse to the introduction tubular conduit so as to be separated from the inlet of the side branch tubular organ. It is possible to provide an effective backup force against the force, and to suppress the positional deviation of the side holes.

In the introduction aid with a side hole, the first bending portion is provided on the distal end side of the tubular body with respect to the second bending portion, and the side hole is provided on the first bending portion. It is preferable.

  Further, the introduction assisting device with a side hole may be a sheath introducer, a guiding catheter, or a stenosis penetration catheter.

  According to the introduction aid with a side hole of the present invention, it is not necessary to arrange the tip of the introduction aid with a side hole at the entrance of the side branch tubular organ when the medical device is introduced into the side branch tubular organ. The occurrence of damage to the entrance of the side branch tubular organ due to the tip of the auxiliary instrument can be reduced. In addition, since the side hole is provided in the backup providing unit including the curved portion supported in contact with the inner wall of the introduction tubular organ, the side hole is less likely to be displaced, and the medical device is backed up when the medical device is inserted. Power can be provided effectively.

It is a top view which shows the whole block diagram of the introduction auxiliary instrument with a side hole of this invention. It is a diagram which shows other embodiment of the backup provision part of the introduction assistance apparatus with a side hole. It is explanatory drawing which shows the use condition of the introduction auxiliary instrument with a side hole in which the curved part of a backup provision part has S shape. It is explanatory drawing which shows the use condition of the introduction auxiliary instrument with a side hole in which the curved part of a backup provision part has a J shape. It is explanatory drawing which shows the use condition of the introduction auxiliary instrument with a side hole in which the curved part of a backup provision part has a spiral shape. It is sectional drawing which shows the deformation | transformation embodiment in which the curved part of the backup provision part has S shape, and the side hole was provided in the front end part side rather than two contact locations. It is sectional drawing which shows the use condition of the introduction auxiliary instrument with a side hole in which the curved part of the backup provision part has S shape and produced one contact location.

DESCRIPTION OF EMBODIMENTS Hereinafter, embodiments of an introduction assisting device with a side hole according to the present invention will be described with reference to the drawings.
Initially, with reference to FIG. 1, the whole structure of the introduction auxiliary instrument 11 with a side hole by this invention is demonstrated. The introduction assisting device 11 is inserted into a tubular organ such as a blood vessel (hereinafter referred to as an introduction tubular organ), and introduces a medical device 29 such as a guide wire or a treatment device into a side branch tubular organ branched from the introduction tubular organ. It is an instrument to make it easier. The introduction tubular organ is, for example, the ascending aorta or the descending aorta, and the side branch tubular organ is, for example, the brachiocephalic artery, right subclavian artery, right common carotid artery, left common carotid artery, left common carotid artery, left clavicle that branches from the ascending or descending aorta Inferior artery, left renal artery, right renal artery. However, these are examples, and the introduction tubular organ and the side branch tubular organ are not limited thereto.

  Hereinafter, the introduction assisting device 11 will be described using the sheath introducer as an example of the introduction assisting device 11. However, the introduction assisting device 11 is not limited to a sheath introducer as long as it is a device for assisting the introduction of the medical device 29 into a tubular organ such as a human body. It can also be used as a catheter.

  The introduction assisting instrument 11 includes a tubular body 13 that extends along the central axis, an instrument body 15, a connection tube 17 that extends from the instrument body 15, and a three-way switching valve 19. The tubular body 13 is a flexible tube such as a sheath tube formed from an appropriate synthetic resin material. The instrument body 15 is a substantially cylindrical member such as a sheath hub formed of an appropriate synthetic resin material, and is externally fixed to the proximal end portion of the tubular body 13. The connection tube 17 is a flexible tube formed of an appropriate synthetic resin material, and is connected to the instrument body 15 so as to communicate with the interior of the instrument body 15. A three-way switching valve 19 is connected to the free end of the connection tube 17 (the end opposite to the end connected to the instrument body 15), and any one of the three ports can be operated by operating the lever. The two can be communicated. Such a three-way switching valve is well-known and has nothing to do with the essential features of the present invention, so a detailed description of its structure is omitted.

  The tubular body 13 is provided with an internal passage through which a medical device 29 can be inserted, and a tip portion 21 located at a distal end portion, a main body portion 23 having a substantially linear shape, a tip portion 21 and a main body. The backup providing unit 25 is provided between the unit 23 and the unit 23. The backup providing unit 25 includes one or a plurality of curved portions 25a and 25b, and a side hole 27 that allows passage of the medical instrument 29 is provided on one peripheral wall of the single or plural curved portions 25a and 25b. ing. In the embodiment shown in FIG. 1, the side hole 21 is provided in the curved portion 25 a located on the side closest to the distal end portion 21. However, the side hole 27 may be provided in the bending part 25b other than the bending part 25a, and one side hole 27 may be provided in each of the bending parts 25a and 25b.

  The backup providing unit 25 introduces at least one of the curved portions 25a and 25b included in the backup providing unit 25 when the tubular body 13 is arranged in the introduction tubular organ so that the side hole 27 is located at the entrance of the side branch tubular organ. It is formed in a shape and a size so as to generate a contact portion that contacts the inner wall of the tubular organ. That is, the shape and size of the curved portions 25a and 25b of the backup providing unit 25 and the position where the side hole 27 is provided in the curved portion 25a or 25b are the shape and size of the introduced tubular organ into which the tubular body 13 is inserted and the introduced tubular organ. Depending on the position of the entrance of the side branch tubular organ at, various designs can be made.

  The side hole 27 fulfills the function of allowing the medical instrument 29 inserted into the tubular body 13 from the instrument body 15 to pass through and extending outside. The size and shape of the side hole 27 can be arbitrarily selected as long as the medical instrument 29 can be passed therethrough. For example, the side hole 27 has an elliptical shape in which the length in the short axis direction is larger than the outer diameter of the medical instrument 29. can do.

  In the introduction assisting instrument 11, the side hole 27 as described above is provided in the tubular body 13, and therefore, the side hole 27 is arranged in advance at the inlet (including the vicinity thereof) of the side branch tubular organ, and is tubular from the instrument body 15. By extending the medical instrument 29 inserted into the body 13 to the outside through the side hole 27, the medical instrument 29 can be easily introduced into the side branch tubular organ. That is, when the medical device 29 is introduced into the side branch tubular organ, it is not necessary to bring the distal end of the tubular body 13 of the introduction assisting device 11 close to the inlet of the side branch tubular organ or to be inserted into the inlet of the side branch tubular organ. What is necessary is just to arrange | position the side hole 27 provided in the surrounding wall of the backup provision part 25 at the entrance of a side branch tubular organ. Therefore, if the introduction assisting device 11 is used, it is possible to suppress damage to the entrance of the side branch tubular organ due to the distal end of the tubular body 13. Further, in the conventional introduction assisting device, in order to make it easy to direct the distal end of the tubular body to the inlet of the side branch tubular organ branched from the introduction tubular organ, the tubular body is adjusted in accordance with the branching angle of the side branch tubular organ with respect to the introduction tubular organ. It is common to bend the front end of the. However, in particular, it is a technique to form a curved portion so that the distal end of the introduction assisting device can be directed to a side branch tubular organ where the introduction tubular conduit branches at an acute angle of 45 ° or more with respect to the insertion direction of the introduction assisting device. Both spatially and spatially of the introduced tubular organ. However, in the introduction assisting device 11, as described above, there is no need to direct the distal end of the tubular body 13 to the entrance of the side branch tubular organ.

  Further, in the introduction assisting device 11, when the medical device 29 inserted into the tubular body 13 is extended to the outside from the side hole 27, the medical device 29 is curved in the vicinity of the side hole 27 in the tubular body 13. It extends from the hole 27. For this reason, when a reaction force acts on the medical instrument 29 when passing through a stenosis or the like in the side branch tubular organ, the medical instrument 29 is extended from the distal end of the tubular body 13 arranged toward the entrance of the side branch tubular organ. The reaction force is easily transmitted to the peripheral wall near the side hole 27 of the backup providing portion 25 of the tubular body 13, and the reaction force separates the backup providing portion 25 near the side hole 27 from the entrance of the side branch tubular organ. It acts on the backup providing unit 25 in the direction in which the side holes 27 are displaced, and the side holes 27 are likely to be displaced. When the position shift of the side hole 27 occurs, the medical instrument 29 meanders in the introduction tubular organ, so that the force for pressing the applied medical instrument 29 is dispersed and efficiently transmitted to the distal end of the medical instrument 29. This makes it difficult to insert the medical device 29 into the side branch tubular organ against the reaction force. However, in the introduction assisting device 11, at least one of the curved portions 25a and 25b of the backup providing portion 25 provided with the side hole 27 can be brought into contact with the inner wall of the introduction tubular organ to generate a contact portion. It is like that. Therefore, the backup providing part 25 provided with the side hole 27 is supported by the inner wall of the introduction tubular organ, the medical instrument 25 receives a reaction force, and the reaction force is transmitted to the peripheral wall of the tubular body 13 near the side hole 27. Even in this case, the displacement of the side hole 27 with respect to the entrance of the side branch tubular organ can be suppressed against the reaction force. Further, since the backup providing unit 25 is supported by the inner wall of the introduction tubular organ, deformation of the backup providing unit 25 and positional displacement of the side hole 27 are suppressed, so that a backup force against the reaction force can be provided. The medical device 29 can be advanced within the side branch tubular organ.

  As described above, the introduction assisting instrument 11 is provided with the side hole 27, and the medical instrument 29 inserted into the tubular body 13 from the instrument body 15 can be extended to the outside from the side hole 27. Therefore, it is not necessary to extend the medical device 29 from the tip of the tubular body 13. Therefore, as shown in FIG. 1, the distal end portion 21 of the tubular body 13 of the introduction assisting device 11 is allowed to pass the guide wire for the introduction assisting device for guiding the introduction assisting device 11 in the introduction tubular organ. You may connect the front-end | tip member 31 provided with the through-hole (not shown) to do.

  If the diameter of the tip opening of the through hole of the tip member 31 is determined so as to allow the passage of the guide wire for the introduction assisting device to the minimum, intrusion of body fluid or the like into the tubular body 13 of the introduction assisting device 11 Can be suppressed. As a result, when the distal end portion 21 of the tubular body 13 of the introduction assisting device 11 is located in the introduction tubular organ and the side hole 27 is located outside the introduction tubular organ, the distal end of the tubular body 13 enters the tubular body 13. For example, there is an effect of preventing body fluid from entering and flowing back through the side hole 27 to the outside of the introduction tubular organ. Further, if the distal end member 31 is formed so that the outer peripheral surface has a tapered shape as it goes toward the distal end side, insertion of the introduced tubular organ through the puncture hole or the like and expansion of the puncture hole or the like can be performed. Has the effect of facilitating.

  In the embodiment shown in FIG. 1, the backup providing unit 25 includes two curved portions 25 a and 25 b, and the curved portion 25 a and the curved portion 25 b are opposite to each other with respect to the central axis of the tubular body 13. Curved sideways to form a generally S-shape. However, the curved portion of the backup providing unit 25 can have another curved shape as long as it can be brought into contact with the inner wall of the introduction tubular organ at at least one contact location. For example, like the backup providing unit 25 ′ shown in FIG. 2A, the backup providing unit 25 ′ is provided with one curved portion 25 a, and the curved portion 25 a is the proximal end of the tubular body 13. It may have a substantially J-shape extending toward the side, and a curved portion 25a provided in the backup providing unit 25 ″, such as the backup providing unit 25 ″ shown in FIG. 2B. May have a spiral shape extending spirally around the central axis. In the embodiment shown in FIG. 1, the side hole 27 is provided in the curved portion 25a on the side close to the distal end portion 21 among the two curved portions 25a and 25b provided in the backup providing unit 25. As shown in FIG. 2C, a side hole 27 may be provided in the curved portion 25 b far from the tip portion 21.

Next, referring to FIG. 3, the method of using the introduction assisting device 11, for example, when the medical device 29 is introduced into the right renal artery 35 among the right renal artery 35 and the left renal artery 37 that branches from the descending aorta 33. Will be explained.

First, like Seldinger technique, the descending aorta 33 (introducing a tubular organ) in the right kidney in the vicinity of the entrance of the arterial 35 causes the guide wire (shown for introducing aid into the descending aorta 33 to the leading edge reaches the using the puncture needle Insert). Next, the proximal end portion of the guide wire for the introduction assisting device is inserted into the tubular body 13 through the through hole of the tip member 31 connected to the distal end (distal end portion) of the introduction assisting device 11, thereby introducing the introduction assisting device. The tubular body 13 of the introduction assisting device 11 is inserted into the descending aorta 33 along the guide wire. When the introduction assisting device 11 is placed in the descending aorta 33 so that the side hole 27 of the tubular body 13 is positioned in the vicinity of the entrance of the right renal artery 35 branched from the descending aorta 33, the guide wire for the introduction assisting device from the introduction assisting device 11. Is removed. Since a backflow prevention valve and a three-way switching valve are provided at the proximal end of the instrument body 15 of the introduction assisting instrument 11 and the free end of the connection tube 17, it is inserted into the descending aorta 33 up to the side hole 27 of the tubular body 13. Even if the introduction assisting device 11 is left in the descending aorta 33 in this state, blood that has entered the lumen of the tubular body 13 from the side hole 27 can be prevented from flowing out of the body. In addition, if the diameter of the tip opening of the through hole of the tip member 31 is determined so as to have a minimum size that allows the guide wire for the introduction aid to pass, the introduction aid can be inserted when the introduction aid 11 is inserted. Even when the distal end portion 21 of the 11 tubular body 13 is located in the blood vessel while the side hole 27 is located outside the blood vessel, blood enters the tubular body 13 from the distal end portion 21 of the tubular body 13. , It is possible to suppress backflow out of the blood vessel through the side hole 27.

  Since the tubular body 13 is more flexible than the guide wire for the introduction aid, the guide wire for the introduction aid is used when the introduction aid 11 is inserted into the descending aorta 33 along the guide wire for the introduction aid. 11 is inserted into the tubular body 13, the curved portions 25a, 25b of the backup providing unit 25 are in a form close to a straight line. Therefore, the introduction assisting device 11 can be smoothly moved in the descending aorta 33. On the other hand, when the introduction assisting device 11 is placed in the descending aorta 33 so that the side hole 27 is arranged near the entrance of the right renal artery 35, the guide wire for the introduction assisting device is removed from the introduction assisting device 11, and backup is provided. The curved portions 25a and 25b of the portion 25 recover the curved shape, and the curved portion 25a is in a state where the side hole 27 of the backup providing portion 25 is positioned near the entrance of the right renal artery 35 as shown in FIG. , 25b can be brought into contact with the inner wall of the descending aorta 33. When the backup providing portion 25 of the tubular body 13 is arranged in the descending aorta 33 so that the side hole 27 of the backup providing portion 25 is located near the entrance of the right renal artery 35, the curved portions 25a, It is assumed that the backup providing unit 25 is formed so that both of 25b come into contact with the inner wall of the descending aorta 33.

  When both of the two curved portions 25a and 25b having a substantially S-shape are in contact with the inner wall of the descending aorta 33, the backup providing unit 25 presses the curved portions 25a and 25b against the opposite sides of the inner wall of the descending aorta 33. It becomes a state. Therefore, in a state where the side hole 27 of the tubular body 13 is located near the entrance of the right renal artery 35, the backup providing unit 25 is securely anchored in the descending aorta 33, whereby a force is applied to the backup providing unit 25 from the outside. Even if it acts, it becomes possible to suppress the position shift of the side hole 27 provided in the backup providing unit 25.

  Next, a guide wire for a therapeutic instrument as a medical instrument 29 is inserted into the inside of the tubular body 13 of the introduction assisting instrument 11 through a backflow prevention valve (not shown) provided at the proximal end of the instrument body 15 of the introducing assisting instrument 11. It is inserted into the passage and extends from the side hole 27 toward the entrance of the right renal artery 35, and further pushed until the tip exceeds the lesion site. Even if there is a stenosis at the lesion site and a reaction force acts on the distal end portion of the guide wire for the therapeutic instrument when passing through the stenosis, the side hole of the backup providing unit 25 that is supported in contact with the inner wall of the descending aorta 33 is supported. Since the peripheral wall in the vicinity of 27 provides a backup force, the pushing force is efficiently transmitted to the distal end of the therapeutic instrument guide wire, which facilitates the passage of the narrowed portion of the therapeutic instrument guide wire.

  Next, the proximal end portion of the guide wire for the treatment instrument is inserted into the distal end of the treatment instrument as another medical instrument 29, and the introduction assist is made through the backflow prevention valve provided at the proximal end portion of the instrument body 15 of the introduction assisting instrument 11. The therapeutic instrument is inserted into the tubular body 13 of the instrument 11. Further, along the guide wire for the therapeutic instrument, the therapeutic instrument is pushed forward in the tubular body 13 of the introduction assisting instrument 11 and introduced into the right renal artery 35 through the side hole 27 to treat the lesion site. Even when the reaction force acts on the treatment instrument when passing through the stenosis of the lesion site, the side of the backup providing unit 25 supported by being in contact with the inner wall of the descending aorta 33 as in the case of the guide wire for the treatment instrument Since the peripheral wall in the vicinity of the hole 27 provides a backup force, the pushing force is efficiently transmitted to the distal end of the treatment instrument, and the passage of the constriction portion of the treatment instrument is facilitated.

  In the method of use shown in FIG. 3, the introduction assisting device 11 is in a state where the backup providing unit 25 presses the curved portions 25 a and 25 b against the opposite sides of the inner wall of the descending aorta 33, and the right renal artery In the state where the side hole 27 of the tubular body 13 is located near the entrance of 35, the backup providing unit 25 is securely anchored in the descending aorta 33. Therefore, even when a reaction force acts on a medical instrument 29 such as a guide wire for a therapeutic instrument or a therapeutic instrument when passing through a narrowed portion of a lesion site and is transmitted to the peripheral wall in the vicinity of the side hole 27 of the backup providing unit 25. Since the displacement of the side hole 27 can be suppressed, the pushing force applied to the medical instrument 29 can be efficiently transmitted to the distal end of the medical instrument 29. Further, since the backup providing unit 25 is moored in the descending aorta 33, the medical device 29 is effectively provided with a backup force against the reaction force, and the right renal artery 35 is allowed to pass through the stenosis and medical. The instrument 29 can be advanced.

  In addition, as shown in FIG. 3, if the side hole 27 is provided near the contact portion between the curved portion 25a and the inner wall of the descending aorta 33, the descending aorta 33 is pressed with the curved portion 25a being pressed. Therefore, even if the bending portion 25a is deformed by the reaction force acting on the medical instrument 29, the amount of movement is small and positional deviation is unlikely to occur. Further, as shown in FIG. 3, a side hole 27 is provided between a contact portion between the bending portion 25 a and the inner wall of the descending aorta 33 and a contact portion between the bending portion 25 and the inner wall of the descending aorta 33. In this case, the portion between the two abutting locations is supported with both end portions abutting against the inner wall of the descending aorta 33, for example, closer to the tip 21 than the abutting location of the curved portion 25a. Compared to the cantilevered portion, deformation is reduced against an external force, so that an effect of further suppressing the displacement of the side hole 27 provided in the portion can be achieved. As a result, the effect that the pushing force applied to the medical device 29 can be efficiently transmitted to the tip of the medical device 29 and the effect of providing the medical device 29 with a backup force against the reaction force can be further improved. it can.

  In the case of using the backup providing units 25 ′, 25 ″, 25 shown in FIGS. 2 (a) to 2 (c) instead of the backup providing unit 25 of the introduction assisting device 11 shown in FIG. Except for the method of arranging the backup providing parts 25, 25 ′, 25 ″ in the introduction tubular organ, the method is the same as the method of using the introduction assisting instrument 11 shown in FIG. Therefore, in the following, backup providing units 25 ′ and 25 ″ shown in FIGS. 2A and 2B, which are different in arrangement method from the backup providing unit 25 of the introduction assisting device 11 shown in FIG. A method of arranging the introduction assisting device 11 using the inside of the introduction tubular organ will be described.

  2A includes, for example, a brachial carotid artery 43, a right subclavian artery 45, and a right common carotid artery that branch from an aortic arch 41 extending between the descending aorta 33 and the ascending aorta 39. 47, suitable for introducing the medical device 29 into the left common carotid artery 49, the left subclavian artery 51, and the like. Here, taking the case where the medical instrument 29 is introduced into the left common carotid artery 49 as an example, the arrangement method of the back-up providing unit 25 ′ shown in FIG. 2A will be described.

  The substantially J-shaped curved portion 25 a of the backup providing portion 25 ′ of the tubular body 13 is disposed in the aortic arch 41 so that the side hole 27 of the backup providing portion 25 ′ is located near the entrance of the left common carotid artery 49. An abutment point 53 that sometimes curves to the aortic arch 41 and abuts the inner wall of the aortic arch 41 (including the descending aorta 33 and the ascending aorta 39 adjacent thereto) at the distal and proximal sides of the side hole 27. , 55 are formed in advance in a shape and dimensions. The introduction assisting device 11 using the backup providing portion 25 ′ shown in FIG. 2 (a) along the guidewire (not shown) for the introduction assisting device inserted in advance until reaching the aortic arch 41. The tubular body 13 is inserted into the aortic arch 41 so that the side hole 27 provided in the backup providing portion 25 ′ is positioned near the entrance of the left common carotid artery 49. Next, when the guide wire for the introduction assisting device is removed from the introduction assisting device 11, the side hole 27 of the backup providing unit 25 ′ is located near the entrance of the left common carotid artery 49 as shown in FIG. The curved portion 25 a can be brought into contact with the inner wall of the aortic arch 41 at the contact points 53 and 55 located on the distal side and the proximal side of the left common carotid artery 49 on the same side as the entrance of the left common carotid artery 49. it can.

  In a state where the side hole 27 is located in the aortic arch 41 in the vicinity of the entrance of the left common carotid artery 49, the contact points 53 and 55 located on the distal side and the proximal side of the entrance of the left common carotid artery 49 are substantially J-shaped. When the curved portion 25a is brought into contact with the inner wall of the aortic arch 41, as shown in FIG. 4, the backup providing portion 25 ′ presses the curved portion 25a against the inner wall of the aortic arch 41 on the left common carotid artery 49 side. It becomes a state. Thereby, the front and rear side portions of the side hole 27 of the curved portion 25a of the backup providing portion 25 'are pressed against and supported by the inner wall of the aortic arch 41 on the left common carotid artery 49 side. Therefore, even when the reaction force acts on the medical device 29 when passing through the narrowed portion of the lesion site and is transmitted to the peripheral wall near the side hole 27 of the backup providing unit 25 in a direction away from the entrance of the left common carotid artery 49. In addition to suppressing the displacement of the side hole 27, it is possible to provide a backup force against the reaction force.

  The backup providing unit 25 ″ shown in FIG. 2B is suitable for use when introducing the medical instrument 29 into the right renal artery 35 and the left renal artery 37 that branch from the descending aorta 33, for example. Here, taking the case where the medical instrument 29 is introduced into the right renal artery 35 as an example, an arrangement method of the backup providing unit 25 ″ shown in FIG. 2B will be described.

  When the spiral-shaped curved portion 25a of the backup providing portion 25 ″ of the tubular body 13 is disposed in the descending aorta 33 such that the side hole 27 of the backup providing portion 25 ″ is located near the entrance of the right renal artery 35. The spiral-shaped curved portion 25a is formed in advance so as to generate a contact portion that contacts the inner wall of the descending aorta 33 over 360 ° or more around the central axis of the descending aorta 33. A backup providing unit shown in FIG. 2 (b) along a guide wire (not shown) for an introduction assisting instrument inserted in advance until reaching the position of the descending aorta 33 beyond the entrance of the right renal artery 35. The tubular body 13 of the introduction assisting device 11 using 25 ″ is inserted into the descending aorta 33 so that the side hole 27 provided in the backup providing portion 25 ″ is positioned near the entrance of the right renal artery 35. . Next, when the guide wire for the introduction assisting device is removed from the introduction assisting device 11, the side hole 27 of the backup providing unit 25 ″ is positioned near the entrance of the right renal artery 35 as shown in FIG. The curved portion 25 a can be brought into contact with the inner wall of the descending aorta 33 near the entrance of the right renal artery 35 over 360 ° or more around the central axis of the descending aorta 33.

  In addition, since the backup providing unit 25 ″ shown in FIG. 2 (b) brings almost the entire curved portion 25a into contact with the descending aorta 33 (introducing tubular organ), it faces the inner wall of the descending aorta 33 ( That is, if the side hole 27 is provided in the radially outward direction of the spiral curved portion 25a, the side hole 27 may be closed by the inner wall of the descending aorta 33. Therefore, the side hole 27 is shown in FIG. As shown, it is preferably provided on the peripheral wall portion of the curved portion 25 a facing the central axis direction of the descending aorta 33.

In the state where the side hole 27 is located in the descending aorta 33 in the vicinity of the entrance of the right renal artery 35, the spiral curved portion 25a is brought into contact with the inner wall of the descending aorta 33 in the vicinity of the entrance of the right renal artery 35. The portion 25 ″ is in a state where the bending portion 25a is pressed against the inner wall of the descending aorta 33. Thereby, the entire bending portion 25a including the portion where the side hole 27 of the bending portion 25a of the backup providing portion 25 ″ is provided. Is supported by being pressed against the inner wall of the descending aorta 33 around the entrance of the right renal artery 35. Therefore, even if an external force is applied to the bending portion 25a, the movement or deformation of the bending portion 25a is suppressed, and the displacement of the side hole 27 can be suppressed. Further, the curved portion 25a is in contact with the inner wall of the descending aorta 33 for 360 ° or more around the central axis of the descending aorta 33, and is also in contact with and supported by the inner wall of the descending aorta 33 facing the entrance of the right renal artery 35. Therefore, the reaction force acts on the medical device 29 when passing through the narrowed portion of the lesion site, and is transmitted to the peripheral wall in the vicinity of the side hole 27 of the backup providing portion 25 ″ in the direction away from the entrance of the right renal artery 35. However, it is possible to provide a backup force against the reaction force.

  The backup providing unit 25 shown in FIG. 2 (c) is located on the side of the curved portion 25a that is closer to the tip 21 of the two curved portions 25a and 25b in the backup providing unit 25 shown in FIG. The backup providing unit shown in FIG. 1 except that the hole 27 is provided, whereas the side hole 27 is provided in a curved portion 25b other than the curved portion 25a on the side closer to the distal end portion 21. As in the case of the backup providing unit 25 shown in FIG. 1, the side hole 27 may be arranged near the inlet of the side branch tubular conduit, and the backup providing unit shown in FIG. Since the effect is the same as that of No. 25, the description is omitted here.

  As mentioned above, although the introduction auxiliary instrument 11 with a side hole by this invention was demonstrated with reference to illustrated embodiment, this invention is not limited to illustrated embodiment. For example, in the embodiment shown in FIG. 1, the side hole 27 is provided between the portions where the two curved portions 25 a and 25 b having a substantially S-shape form contact portions. For example, as shown in FIG. 6, one of the two curved portions 25 a and 25 b having a substantially S shape is provided on either side of the curved portion 25 a or 25 b. The side hole 27 may be provided at a position closer to the distal end portion 21 than the contact portion in the curved portion 25a. In this case, the portion in which the side hole 27 is provided is in a cantilever support state, and the side hole 27 is likely to be displaced as compared with the embodiment shown in FIG. By forming it with a material, it is possible to suppress displacement. Further, in the embodiment shown in FIG. 1, both of the two curved portions 25a and 25b having a substantially S-shape are arranged so as to generate a contact portion with the inner wall of the introduction tubular organ. As shown in FIG. 7, only the curved portion 25b provided with the side hole 27 and the curved portion 25a curved to the opposite side with respect to the central axis of the tubular body 13 are brought into contact with the introducing tubular organ, The curved portion 25b provided with 27 may not be in contact with the inner wall of the introduction tubular conduit. Even in this case, even if a force acts in a direction in which the bending portion 25b in the vicinity of the side hole 27 is separated from the entrance of the side branch tubular organ due to the reaction force acting on the medical instrument 29, the bending portion 25a becomes the entrance of the side branch tubular organ. The side wall 27 is in contact with the inner wall of the introduction tubular organ on the opposite side, so that the movement of the side hole 27 can be suppressed against the reaction force and a backup force can be provided. Further, the tip member 31 is not an essential configuration, and the tip member 31 may not be connected to the tip portion 21 of the tubular body 13 as shown in FIG.

DESCRIPTION OF SYMBOLS 11 Introduction assistance instrument 13 Tubular body 21 Tip part 23 Main body part 25 Backup provision part 25a, 25b Bending part 27 Side hole 29 Medical instrument 53, 55 Contact location

Claims (3)

A side branch tubular organ comprising a tubular body extending along the central axis and inserted into the introduction tubular organ, the side wall of the tubular body being provided with a side hole, and branching from the introduction tubular organ through the side hole of the tubular body An introduction auxiliary device with a side hole capable of introducing a medical device into the inside,
The tubular body is provided between a distal end portion, a main body portion, and the distal end portion and the main body portion, and is opposite to the first curved portion with respect to the first curved portion and the central axis. And a back-up providing part for providing a back- up force for resisting a reaction force against the medical instrument extending from the measurement hole , the side hole being the first bend . Provided in the first curved portion or the second curved portion, and the first curved portion and the second curved portion are arranged in the introduction tubular organ such that the measurement hole is located at an inlet of the side branch tubular organ. When the tubular body is disposed on the first tubular portion, both the first curved portion and the second curved portion are formed so as to generate a contact portion that contacts the inner wall of the introduction tubular organ. In the first bending portion or the second bending portion, the contact portion of the first bending portion and the 2 sides perforated introduction aid, characterized in that are provided so as to be positioned between the contact portion of the bending portion. The said 1st curved part is provided in the said front end side of the said tubular body rather than the said 2nd curved part, The said side hole is provided in the said 1st curved part. Introduction aid with side holes. The introduction support device with a side hole according to claim 1 or 2 , wherein the introduction support device with a side hole is a sheath introducer, a guiding catheter, or a catheter for penetrating a stenosis.

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