MXPA01000293A - Stent placement instrument and method of assembly - Google Patents

Abstract

An instrument (10) places a stent (11) axially and is reusable with different size stents (11). A loop on an arm (14) extends tangentially so at least one bore (15) aligns axially. A tab (16) extends from the arm (14) axially and from the loop in a plane. A ring on a limb (18) extends tangentially and has an axially aligned hole (19) in a plane. A bracket (20) extends from the tab (16) over and in front of the limb (18). A tube (21) extends for coaxial deposition axially, into the bore (15) and the hole (19) locating the ring forward of the loop. An end on the tube (21) opposite the bore (15) grips the stent (11). A sheath (23) coaxial to the tube (21) slides along the end and extends from the hole (19). A sheath (23) cavity (24) near the end is for the stent (11). A shaft (25) in the plane attaches to the bracket (20) parallel and axially conjugates with the limb (18) and arm (14) to prevent rotation.

Description

INSTRUMENT FOR PLACING ENDOPROTESIS AND ASSEMBLY METHOD FIELD OF THE INVENTION The present invention relates to an instrument that a surgeon uses to place and / or remove a stent within and along an axis aligned with a lumen of a patient; More particularly, the medical specialist can load the instrument with a stent and can be reused because it is easily assembled and disassembled for cleaning and sterilization.

BACKGROUND OF THE INVENTION Tubular prostheses for transluminal implantation in bodily conduits, for example urethra or ureters, for repair or dilatation are known. These prostheses, hereinafter referred to as stents, can generally be tubular elements. The endoprostheses expand on their own or can expand radially with a balloon within a lumen to open passage therethrough; in the present, all types of stents will be referred to as expansion stents. A typical self-expanding stent is described in the U.S. patent. No. 4,655,771; said endoprosthesis has a body tubular elastic, radial and axially flexible, of a predetermined diameter that is variable under the axial movement of the ends of the body in relation to each other. This endoprosthesis has a plurality of individual stiffening but flexible and elastic stiffening elements defining a self-expanding helix in the radial direction. The description that is made in the patent of E.U.A. No. 4,655,771 is a part of the present and is incorporated by reference. The placement of the stent in accordance with the patent of E.U.A. number 4,655,771 in a body vessel is achieved by a The device has a plunger for pushing the endoprosthesis or a clip to engage the endoprosthesis and push or pull it in place. The patent of E.U.A. No. 4,990,151 has an instrument for the implantation or removal of a stent. The instrument has a plurality of spring elements held in the interior that are released when removing a top tube. In this way, the elements are coupled to the interior of the urethra to expand the lumen, so that the spring elements can advance through the endoprosthesis and be coupled to the outside thereof, on which, the upper tube is placed to preserve the coupled elements. While this instrument is separated to be sterilized and returned to used, it is not adjustable for stents of different sizes, and was developed to be used for explanatory purposes. The patent of E.U.A. 4,768,507 has a mandrel to carry a spring propeller inside a tube and is released by removing the tube, so E $ ^ ¿& ^ ** ^ ** & & amp; * - * that the spring of the propeller can be wound and expanded. It is illustrated as a disposable instrument. The patent of E.U.A. No. 5,026,377 describes and claims in combination a self-expanding stent graft as in '771 and an instrument for deployment or retraction in a body conduit of the stent. The instrument has an elongated tubular outer sheath with proximal and distant ends, an elongated core in the sheath can move relative to it, so the core that is longer than the sheath includes a fastener at or near the end distant. The handle element is in the core for: i releasably attaching the self-expanding stent within the outer sheath, ii deploying the stent beyond the distal end of the outer sheath as it moves backward relative to the core and iii retracting the stent within said outer sheath by pulling the core backward relative to the outer sheath. European patent number EP 0 518 838 A1 has a transluminal implantation device for a stent implantation of substantially tubular radial expansion. The device has a central tube or bar surrounded by an outer tube that can be moved axially relative to said central tube or bar, the radial dimensions of the tubes or tube and bar form an annular space therebetween to hold the stent in a state of no expansion. The clamped stent can be moved axially from the outer tube relative to said central tube or rod at a distal end thereof. A biased groove forms a circumferential protrusion wherein the proximal end of the stent rests to the release with backward displacement of the outer tube. It has now been discovered that a reusable deployment instrument for implanting a variety of stent designs and configurations may be necessary to reduce health care expenses. The available disposable deployment devices have not resolved the need to sterilize and adjust the instrument. In addition it is not so easy to review those disposable tools that will be used more than once. The manufacturers of these disposable devices have managed to make such tools difficult or impossible to use again. This invention relates to an instrument that can be reused for the placement of a stent in a body conduit, as well as to the means for positioning and releasing the stent.

BRIEF DESCRIPTION OF THE INVENTION An instrument that employs a surgeon to place a stent-aligned endoprosthesis within a lumen of a patient, preferably can be reused, since it can be disassembled for cleaning and can be reloaded with a new stent. Also, the instrument is adjustable for stents of different sizes. A ring ~ S * Mtoeb &? TSl.- '... -,:. "A < __ & a_i ^? i ^ B WS _? _ fcá-aa__B < fi_? ainákYes. - _.:_-__., for thumb that will manipulate a surgeon can have an open center in which the thumb of the surgeon can adjust when it is normal to the axis. An arm that extends tangentially from the thumb ring is preferably in a plane with respect to the axis. The arm may have an inner diameter in alignment with the shaft. A projection extends from the arm along the axis and from the thumb ring, so that the arm, the projection and the thumb ring remain substantially in a plane with each other and the axis. A finger ring that a surgeon will manipulate may be open in the center to receive the surgeon's finger. A limb extends tangentially from the finger ring and preferably is attached thereto. The extremity may include an axially aligned hole, so that the hole, the finger ring and the limb can be placed flat with the shaft. A front bracket extends from the projection on and in front of the limb. A tube for supporting the stent can be positioned to extend therefrom. The tube can be placed for coaxial deposition on the shaft, inside diameter and hole; the tube locates the finger ring forward of the thumb ring. The location of the tube is preferably for the ergonomic use of the surgeon in a sliding action of the finger ring relative to the tube when being guided along the axis. One end of the stent may be in the tube on the opposite side where the tube is adjusted to the inside diameter to hold the stent in the sheath for delivery. A sheath could slide along the end of the endoprosthesis in the tube, when the sheath extends from the hole along the axis and towards the end of the stent. More preferably, the sheath is placed coaxially by the tube. A cavity in the sheath beyond the end of the endoprosthesis in the tube may be included to accommodate the stent to be carried along the shaft boss from the end of the stent in the tube. A bar placed in the plane can be attached to the front bracket. In general, the bar can be parallel to the axis, so that it is combined with the limb and the arm to avoid a relative rotation movement between them with respect to the axis. Preferably, an axial control is adjusted on the arm so that the surgeon makes a selective movement relative to the bar. The axial control is preferably to adjust the axial position of the bar relative to the arm. In this way, axial control can be used to establish the axial position of the bar with respect to the arm to thereby adjust the instrument for stents of varying lengths. A fastener can be found in the front bracket to secure the relative axial positions of the end and the front bracket. The fastener can be used to selectively allow the surgeon to move the sheath relative to the tube to load and then exit the stent. A latch in the projection can be included to prevent complete release of the stent from the tube without the prior manual release of the latch, thereby allowing the finger ring to completely approach the thumb ring. At least one handle can be found between the stent and the end of the stent to couple the stent-reduced to a diameter to fit within the cavity before and during placement in and / or removal of a patient's lumen. More preferably, that handle is operatively mounted in the sheath near the end of the stent to accurately locate the stent within the lumen of a patient for delivery. The axial control, the fastener and the latch, in the preferred embodiment, are positioned in relation to the bar and the projection and the front bracket, respectively, so that the instrument can be disassembled for cleaning and sterilization or assembled and adjusted to a length of endoprosthesis in particular. The fastener could include a spring-loaded key in the front bracket, and the bolt may have a spring-loaded key in the projection. More preferably, each spring loaded key is positioned to cooperatively couple a receiving passage on top of the limb to limit axial movement of the finger ring relative to the thumb ring. The axial control could include a safe for the transverse movement that the surgeon will perform in relation to the arm. The bar may have adjustments for cooperative engagement with the latch to establish the predetermined adjustment locations to accommodate the stents of various lengths. A support could be adjusted coaxially on and in the sheath. Preferably, the support extends along the sheath from the front bracket, so that the axial movement of the sheath can be independent of the support. A projection may be on the support for delimiting the front bracket, and a tongue on the delimited projection elastically engages the front bracket to contain the axial movement of the projection away from the front bracket. The axial control may alternatively include a pinion positioned on the arm for the rotational movement that the surgeon will make relative to the frame in the bar to establish the locations of adjustment of the tube relative to the sheath to accommodate stents of various lengths. Preferably, an adapter delimits the arm and extends away from the patient and towards the surgeon. The adapter may have a shape that allows sliding engagement relative to the bar. An extension can be adjusted inside the arm and on the bar in parallel relation to the adapter. The extension could be to support the sliding engagement of the adapter with the arm along the bar when moving away from the end of the stent. Preferably, the fastener and latch prevent the limb from moving axially toward the surgeon, but could be released by hand to achieve said axial movement and automatically allow movement of the axial limb away from the surgeon. A method for assembling and disassembling an instrument that will employ a surgeon to place a stent in a patient's lumen has operating steps. Extend a tube to support the »T" _ _ ».» _ »« -aafe. »_, _ * ¿^ *. & .- & .á * »£ _.

Stents in a coaxial arrangement on the shaft, in the inner diameter and the orifice is a step of the preferred method. The method may have the step of locating the finger ring in the tube forward of the thumb ring for the ergonomic use of the surgeon in a sliding action of the finger ring relative to the tube when being guided along the axis. Sliding a sheath that extends from the hole and is placed coaxially by the tube can be a step. The step of the method to accommodate the endoprosthesis in a cavity within the sheath and along the shaft may be included. The step of conjugating a bar placed which is attached to the front bracket and in a position parallel to the axis and the limb and the arm can be followed to prevent relative rotational movement between them with respect to the axis. The method can include the movement of a tight axial control inside the arm, as well as the adjustment of the axial position of the bar relative to the arm to establish the axial position of the bar with respect to the arm, in order to change the instrument for endoprosthesis. of different lengths. Preferably, the method has the step of securing the relative axial positions of the limb and the front bracket with a bracket on the front bracket and selectively allowing the surgeon to move the tube relative to the pod to load and then exit the bracket. stent The method comprises the step of preventing the complete release of the stent from the tube without the prior manual release of a latch in the projection, and thereby allow the finger ring to completely approach the thumb ring.

The step of coupling the reduced stent with a handle to a diameter to fit within the cavity before and after the displacement and / or removal of a patient's lumen is part of the method. It is preferred the step of the method to disassemble by means of the fastener and the latch, the instrument for sterilization. The method may include the step of adjusting the bar to a particular stent length with axial control. The step of cooperatively coupling a receiving passage over the limb to limit axial movement of the finger ring relative to the thumb ring with a spring loaded key in the forward bracket and with a spring loaded key in the projection can be performed . The method step is preferred to move an axial control latch with transverse relationship to the arm and the bar to define the predetermined adjustment locations to accommodate stents of various lengths. The method is followed to extend a support placed coaxially on and in the sheath.

BRIEF DESCRIPTION OF THE DRAWINGS Figure 1 is a perspective view of an instrument that will be used by a surgeon to place and remove an expansion stent within and along an axis aligned with a lumen of a patient. Figure 2 is a side elevation view of the instrument of Figure 1, but the view describes the opposite side illustrated in Figure 1.

Figure 3 is a side view of the instrument illustrated in cross section and as would be seen along the line 3-3 in Figure 2. Figure 4 is a view in elevation and magnification with the end in cross section as shown in FIG. see along lines 4-4 of Figure 2. Figure 5 is a final elevation view in cross section taken along lines 5-5 of Figure 2. Figure 6 is a perspective view of an alternating frame and axial pinion control for use with the instrument of Figure 1. Figure 7 is a side view of the instrument containing the frame and axial pinion control shown in cross section as would be seen throughout the line 7-7 in figure 1.

DETAILED DESCRIPTION OF THE INVENTION An instrument 10 that a surgeon will use to place and remove from a lumen of a patient an endoprosthesis 11 aligned along an axis A-A is illustrated in FIGS. 1 and 3. The instrument 10 can be reused., since it can be disassembled for cleaning and can be reloaded with a new stent 11. No tools are required to disassemble instrument 10 for cleaning or repair. The instrument 10 is also adjustable for stents 11 of different sizes. A thumb ring 12, which will be used by a surgeon, has an open center 13 in which the surgeon's thumb can be adjusted when it is normal to the A-A axis. Preferably, an arm 14 extending tangentially from the thumb ring 12 is in plane with the axis A-A. The arm 14 has at least one inner diameter 15 in alignment with the axis A-A. A projection 16 extends from the arm 14 along the axis AA and from the thumb ring 12, so that the arm 14, the projection 16 and the thumb ring 12 remain substantially in plane with each other and the axis AA . The finger ring 17 that a surgeon will manipulate may be open in the center to receive the surgeon's finger. An end 18 extends tangentially from the finger ring 17 and is preferably attached to it in Figure 1. The end 18 may include an axially aligned hole 19, so that the hole 19 the finger ring 17 and the end 18 they can be placed flat with the AA axis. A front bracket 20 extends from the projection 16 through and in front of the limb 18. A tube 21 for supporting the stent 11 can be positioned to extend from the arm 14. The tube 21 can be placed for coaxial deposition on the AA axis, in the inner diameter 15 and the hole 19, the tube 21 places the finger ring 17 forward of the thumb ring 12. The location of the tube 21 is preferably for ergonomic use of the surgeon in a sliding action of the finger ring 17 with regard to to tube 21 when it is guided along the axis AA. One end of stent 22 may be in tube 21, see Figures 3 and 7, opposite where tube 21 fits inner diameter 15 to hold stent 11 when released. A pod 23 slides as . "to"_ . < aaAa ^^ íÍÍ_t., Ífei »« «afejg > ^ _fc «_8s ^ t, ..:., - .., - M? -. < The length of the end of the endoprosthesis 22 in the tube 21 when the sheath 23 extends from the hole 19 along the axis AA and towards the end of the endoprosthesis 22. The sheath 23 is preferably placed coaxially in the 21. a cavity 24 tube in the sheath 23 beyond the end of the stent 22 in the tube 21 is included to accommodate the stent 11 being carried along the axis canecillo cross section (figure 3 and 7) from the end of the stent 22 in the tube 21. a rod 25 positioned in plane joins the front bracket 20. in general, the bar 25 is parallel to the axis position so that the bar 25 is combined with the end 18 and the arm 14 to prevent the relative rotational movement between them with respect to the axis AA. An axial control 26 is adjusted within the arm 14 for the selective movement that the surgeon will make with respect to the bar 25. The axial control 26 is for adjusting the axial positions of the bar 25 relative to the arm 14. In this way, the Axial control 26 can be used to establish the axial positions of bar 25 with respect to arm 14 to thereby adjust instrument 10 for stents 11 of various lengths. A fastener 27 in the forward bracket 20 secures the relative axial positions of the end 18 and the front bracket 20. The fastener 27 can be used to selectively allow the surgeon to move the sheath 23 relative to the tube 21 for loading, and subsequently , output the stent 11, figures 1, 3 and 7. A latch 28 on the projection 16 is included to prevent the complete release of the stent 11 from the tube 21 without manual release ^ aak .., -_. & ^ ~ ^ A ^ M How St Sf &.? ^ - s ^ after the latch 28, thereby allowing the ring finger 17 approaches completely hoops thumb 12, see Figures 1, 2, 3, 5 and 7 At least one handle 29 in Figure 3 can be found between the stent 11 and the end of the stent 22 for coupling the stent 11 reduced to a diameter to fit within the cavity 24 before and during the displacement and / or removal of the lumen. of a patient. That handle 29 is operatively mounted in the sheath 23 near the end of the stent 22 to accurately locate the stent 11 within the lumen of a patient to release it. The axial control 26, the fastener 27 and the latch 28 in the preferred embodiment are positioned relative to the bar 25, and the projection 16 and the front bracket 26, respectively, so that the instrument 10 can be disassembled for cleaning and sterilization or assembled or adjusted for a particular stent length 11. The fastener 27 includes a spring loaded key 30 in Figure 4 in the projection 16 and the bolt 28 has a spring loaded key 30 in the front bracket 20 in Figure 5. each spring loaded key 30 'is positioned to cooperatively engage a receiving passage 30 or 30' above the end 18 to limit axial movement of the finger ring 17 relative to the ring 12. the thumb 26 includes axial control insurance 32 for the transverse movement that the surgeon will make with respect to the arm 14. The bar 25 may have adjustments 33 for cooperative coupling with the safety 32 to define the predetermined adjustment locations to accommodate stents 11 ^ "« Afta_., "" I _s _..__ n_ _. ". * > ..? ~ £ ** s * "Í0t us $ ÍÍft1i? * aßeßa3l¿ & *, s «a_eg¿_ _ A" j .-. «__- .ifev: __.: _. _ of different lengths. A support 34 fits coaxially over and into the sheath 23. The support 34 preferably extends along the sheath 23 from the front bracket 20 so that axial movement of the sheath 23 may be independent of the support 34. A projection 35 in Figures 1, 2, 3, 4, 5 and 7 may be in the support 34 for delimiting the front bracket 20 and a tongue 36 on the delimited projection 35 elastically engages the front bracket 20 to prevent axial movement of the projection 35 away from the front bracket 20. The axial control 26 may alternatively include a pinion 37 in Figures 6 and 7 which is located in the arm 14 for the rotational movement that the surgeon will make with respect to the frame 38 in the bar 25 'to establish the adjustment locations of the tube 21 relative to the sheath 23 to accommodate the stent 11 of various lengths. Preferably, an adapter 39 delimits the arm 14 and extends away from the patient and towards the surgeon. The adapter 39 may have a shape that allows sliding engagement relative to the bar 25 or 25 '. An extension 40 may be fitted within the arm 14 and on the bar 25 or 25 'in parallel relation to the adapter 39. The extension 40 supports the sliding engagement of the adapter 39 with the arm 14 along the bar 25 or 25' when going away from the end of the stent 22. The fastener 27 and the latch 28 support the limb 18 preventing axial movement towards the surgeon, but can be released with the hand for ¿¿¿& fett ^^^^^^^^^^^^^^^ reach this axial movement, and automatically allows the axial movement of the limb 18 away from the surgeon. A method for assembling and disassembling the instrument 10 that will employ a surgeon to place the stent 11 within a lumen of a patient has operating steps. Extending the tube to support the endoprosthesis 11 in a coaxial arrangement on the axis A-A, in the inner diameter 15 and the hole 19 is a step of the preferred method. The method may have the step of locating the finger ring 17 in the tube 21 towards the thumb ring 12 for the ergonomic use of the surgeon in a sliding action of the finger ring relative to the tube 11 when it is guided along the AA axis. Sliding the sheath 23 that extends from the hole 19 and which is placed coaxially in the tube 21 is a step. The method step for accommodating the stent 11 in the cavity 24 within the sheath 25 and along the axis A-A is included. The step of joining the bar 25 or 25 'placed in connection with the front bracket 20 and in a position parallel to the axis A-A with the end 18 and the arm 14 to prevent the relative rotational movement between them with respect to the axis A-A is followed. The method includes moving the axial control 26 fitted within the arm 14 to adjust the axial position of the bar 25 or 25 'relative to the arm 14 to establish the axial position of the bar 25 or 25' with respect to the arm 14, so as to changing the instrument 10 for endoprostheses 11 of various lengths. The method has the step of securing the relative axial positions of the limb 18 and the front bracket 20 with the fastener 27 in the projection 16, and selectively allowing the surgeon to move the tube 21 relative to the _. < a ___ sgA s_, a _, - _ & _. < The sheath 23 for loading, and subsequently, discharging the stent 11. In the method is the step of preventing the complete release of the stent 11 from the tube 21 without the manual release prior to the latch 28 in FIG. the front bracket 20, so as to allow the finger ring 17 to completely approach the thumb ring 12. The step of coupling with handle 29 the stent 11 reduced to a diameter to fit within the cavity 24 before and during placement and / or removal of a patient's lumen is part of the method. The step of the disassembly method is preferred by the fastener 27 and the latch 28, the instrument 10 for sterilization. The method includes the step of adjusting the bar 25 or 25 'to a length of particular stent 11 with the axial control 26. The step of cooperatively coupling the receiving step 31 on top of the limb 18 is performed to limit the axial movement of the ring for finger 17 in relation to the thumb ring 12 with spring-loaded key 30 in the front bracket 20 and with a spring-loaded key 30 'in the projection 16. The method of moving the lock 32 of the axial control 26 is performed. transversely relative to the arm 14 and the bar 25 to define the predefined adjustment locations or adjustment 33 to accommodate stents 11 of various lengths. The method of extending the support 34 adjusted coaxially over and in sheath 23 is followed. Those skilled in the art will not hesitate to appreciate that the endoprostheses 11 of various constructions, materials, diameters and lengths can be used with the instrument 10 and the method described.

Any material approved for medical use and resterilization is acceptable, but medical grade stainless steel is preferred for its rigidity and erosion resistance. Titanium, aluminum or reinforced polymers are also acceptable for the described and detailed components. The instrument 10 is designed to be used with commercial approaches for interluminal vision during stent placement and / or removal 11. While self-expanding stents 11 are preferred, there is no reason why expandable stents 11 of various types can not be taken out and placed. Similarly, stent grafts can be clamped, supported and deployed with the instrument 10 and by the method, since stent graft coatings will not interfere with their use. While alternatives and a particular preferred embodiment have been illustrated and described, the protection approach sought is in the following claims. i,

Claims (10)

NOVELTY OF THE INVENTION CLAIMS

1. An instrument 10 that will employ a surgeon to place within and remove from a lumen of a patient an endoprosthesis 11 aligned along an axis, the instrument 10 comprising: a thumb ring 12 which will be manipulated by the surgeon, the thumb ring 12 it has an open center 13 in which the surgeon's thumb adjusts when it is normal to the axis; an arm 14 extending tangentially from the thumb ring 12, the arm 14 in a plane with the shaft, the arm 14 has at least one inner diameter 15 in alignment with the shaft; a projection 16 extending from the arm 14 along the axis y from the thumb ring 12, so that the arm 14, the projection 16 and the thumb ring 12 remain substantially in plane with each other and the axis; a finger ring 17 that will be manipulated by the surgeon, the finger ring 17 is open in the middle to receive the surgeon's finger; an end 18 which extends tangentially from the finger ring 17 and is attached thereto, the end 18 has an axially aligned hole 19, so that the hole 19, the finger ring 17 and the end 18 can be placed flat with the axis; a front bracket 20 that extends from the projection 16 on and in front of the extremity 18; a tube 21 for supporting the endoprosthesis 11 located to extend therefrom, the tube 21 for coaxial deposition on the shaft, on the inner diameter 15 and the hole 19, the tube 21 for locating the finger ring 17 forward of the ring for thumb 12 for ergonomic use of the surgeon in a sliding action of the finger ring 17 relative to the tube 21 when guided by the shaft; the end of an endoprosthesis 11 in the opposite tube 21 where the tube 21 fits in the inner diameter 15, the end of the stent 11 holds the stent 11 in the sheath 23 for delivery; a sheath 23 for sliding along the stent end 22 in the tube 21, the sheath 23 extends from the hole 19 along the axis and towards the stent end 22, the sheath 23 arranged coaxially in the tube 21; a cavity 24 in the sheath 23 beyond the end of stent 22 in the tube 21, the cavity 24 for accommodating the stent 11 which is carried along the shaft boss from the stent end 22 in the tube 21; a bar 25 placed in the plane attached to the front bracket 20, the bar 25 generally parallel to the axis, the bar 25 is conjugated with the end 18 and the arm to prevent relative rotational movement between them with respect to the axis; an axial control 26 is adjusted within the arm 14 for the selective movement that the surgeon will make with respect to the bar 25, the axial control 26 for adjusting the axial position of the bar 25 relative to the arm 14 to establish the axial position of the bar 25 with respect to the arm 14 to thereby adjust the instrument 10 for stents 11 of various lengths; a fastener 27 in the front bracket 20 for securing the relative axial positions of the extremity 18 and the front bracket 20, the fastener 27 to selectively allow the surgeon to move the sheath 23 relative to the tube 21 to load and subsequently discard the stent 11, and a latch 28 on the projection 16 to prevent complete release of the stent 11 from the tube 21 without the prior manual release of the latch 28 thereby allowing the finger ring 17 to completely approach the thumb ring 12, so the axial control 26, the fastener 27 and the latch 28 are positioned relative to the bar 25 and the projection 16 and the front bracket 20, respectively, so the instrument 10 can be disassembled for cleaning and sterilization or assembled and adjusted to a length of a particular endoprosthesis 11.

2. The instrument 10 according to claim 1, further characterized in that at least one handle 29 s e is between the stent 11 and the stent end 22 for coupling the stent 11 reduced to a diameter to fit within the cavity 24 before and during the placement and / or removal of a patient's lumen., that handle 29 is operatively mounted near the end of the stent 22 to axially locate the stent 11 within the lumen of a patient for release.

3. The instrument 10 according to claim 1, further characterized in that the fastener 27 includes a key loaded with spring 30 in the front bracket 20 and the bolt 28 has a key loaded with spring 30 in the projection 16, each key loaded with spring 30 is positioned to operatively couple a receiving step 31 above the limb 18 to limit the axial movement of the finger ring 17 relative to the thumb ring 12.

4. The instrument 10 according to claim 1, further characterized in that the axial control 26 includes a latch 32 for movement The surgeon will do the cross-section relative to the arm 14 and the bar 25 has adjustments 33 to cooperatively engage with the latch 32 to define the predetermined adjustment locations to accommodate the stents 11 of various lengths and that a support 34 fits coaxially on and in the sheath 23, the support 34 extends along the sheath 23 from the front bracket 20, so that the axial movement of the sheath 23 can be independent of the support 34 and a projection 35 is on the support 34 to delimit the front bracket 20 and a tongue 36 on the delimited projection 35 elastically engage the front bracket 20 to retract axial movement of the projection 35 away of the front bracket 20.

5. The instrument 10 according to claim 1, further characterized in that the axial control 26 includes a pinion 37 that is located in the arm 14 for a rotary movement that the surgeon will make with respect to the frame 38 in bar 25 to establish the adjustment locations of tube 21 relative to sheath 23 to accommodate stents 11 of various lengths.

6. The instrument 10 according to claim 1, further characterized in that the fastener 27 and the latch 28 prevent axial movement towards the surgeon, but can be released with the hand for It is possible to achieve said axial movement and automatically allow the axial end 18 to move away from the surgeon.

7. A method for assembling and disassembling an instrument 10 that will be used by a surgeon to place a stent 11 inside the lumen of a patient, the instrument 10 has an axis and a thumb ring 12 an arm 14 in a plane with the axis and it extends tangentially from the thumb ring 12, an inner diameter 15 in the arm 14 aligned with the axis, a projection 16 extending from the arm 14 along the axis and from the thumb ring 12, a finger ring 17 which will be manipulated by the surgeon, a limb 18 having an axially aligned hole 19 and the limb 18 extending tangentially from the finger ring 17, a front bracket 20 extending from the projection 16 through and in front of the limb 18, the method It comprises the following steps: extending a tube 21 to support the endoprosthesis 11 in a coaxial arrangement along the axis, in the inner diameter 15 and the hole 19; locating the finger ring 17 in the tube 21 forward of the thumb ring 12 for ergonomic use of the surgeon in a sliding action of the finger ring 17 relative to the tube 21 when guided by the shaft; sliding a sheath 23 extending from the hole 19 and placed coaxially in the tube 21; accommodating the endoprosthesis 11 in a cavity 24 within the stent end 22 of the sheath 23 and along the axis; conjugate a bar 25 placed in conjunction with the front bracket 20 and in a position parallel to the axis with the end 18 and the arm 14 to prevent the relative rotational movement between them with respect to the axis; • . _ & ._ fiJt? ^^^^^^ and ^ i ^^^ - move an axial control 26 fitted within the arm 14 and adjust the axial position of the bar 25 relative to the arm 14 to establish the axial position of the bar 25 with respect to the arm 14, in order to change the instrument 10 for endoprosthesis 11 of various lengths; securing the relative axial positions of the limb 18 and the front bracket 20 with a fastener 27 in the front bracket 20 and selectively allowing the surgeon to move the tube 21 relative to the sheath 23 to load and subsequently output the stent 11; and preventing complete release of the endoprosthesis 11 from the tube 21 without the prior manual release of a latch 28 in the projection 16 and thereby allow the finger ring 17 to completely approach the thumb ring 12. 8.- The method of according to claim 7, further characterized in that the step of coupling with a handle 29 the endoprosthesis 11 reduced to a diameter to fit within the cavity 24 before and during the placement and / or removal of the lumen of a patient and with the step of disassembling by the fastener 27 and the latch 28 the instrument 10 for sterilization. 9. The method according to claim 7, further characterized in that the step of adjusting the bar 25 to a length of particular endoprosthesis 11 with the axial control 26 and with the step of cooperatively coupling a receiving step 31 on top of the extremity 18 to limit the axial movement of the finger ring 17 relative to the ring for i. lpMni? W'ia_a ^ i m il? t i _? ^ _ ^ JA_ sife thumb 12 with a keyway 30 in spring-loaded front bracket 20 and a spring loaded projection 30 in the keyway 16. 10.- The method according to claim 7, further characterized by the step of moving a latch 32 of the axial control 26 transversely relative to the arm 14 and the bar 25 to define the predetermined adjustment locations for accommodating stents 11 of various lengths and with the step of extending a support 34 adjusted coaxially on and in the sheath 23. SUMMARY OF THE INVENTION An instrument places an endograft axially and can be re-used with stents of different sizes; a ring on an arm extends tangentially so that at least one inner diameter is axially aligned; a projection extends from the arm axially and from the rim in a plane; a ring on a projection extends tangentially and has an orifice axially aligned in a plane; a bracket extends from the projection on and in front of the limb; a tube extends for coaxial deposition axially in the inner diameter of the hole that locates the ring forward of the ring; one end in the tube opposite the inner diameter holds the stent; a sheath coaxial to the tube slides along the end and extends from the hole; a sheath cavity near the end is for the stent; a bar in the plane joins the parallel bracket and is axially conjugated with the limb and the arm prevents rotation; an axial control in the arm for the selective movement in relation to the bar adjusts the position of the bar to the arm; a bra in the bracket secures the extremity axially to load and release the stent; a latch in the projection prevents the release of the endoprosthesis from the tube, thus allowing the ring to completely approach the ring; at least one handle is between the stent and its end engages the stent in the cavity; the bra and latch have spring-loaded keys for coupling a . "* _- > • '_ _ ^ &. ^ Ge ^ step at the tip to limit movement of the ring to the ring;? A method for assembling the instrument has steps to extend the tube to support the stent, placing the ring in the tube forward of the ring, sliding the sheath and arranging the endoprosthesis in the cavity inside the end, conjugate the bar with the limb and the arm and move the axial control to adjust the bar are steps, the method has the steps to ensure the axial positions of the limb and the bracket with the holder and selectively allow the sheath relative to the tube to be loaded and then output to the stent, the steps are used to prevent the stent is released to the manual release of the latch, allow the ring to approach the ring, attach the endoprosthesis with the handle and disarm by means of the fastener and the latch, follow the steps to adjust the bar, couple the reception step to Check the axial movement, move an axial control lock and extend the bracket adjusted coaxially on and in the sleeve. 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