US2799273A - Haemostatic catheter - Google Patents

Haemostatic catheter Download PDF

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Publication number
US2799273A
US2799273A US495845A US49584555A US2799273A US 2799273 A US2799273 A US 2799273A US 495845 A US495845 A US 495845A US 49584555 A US49584555 A US 49584555A US 2799273 A US2799273 A US 2799273A
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catheter
balloon
body portion
balloons
distal end
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Expired - Lifetime
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US495845A
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Vincent J Oddo
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Vincent J Oddo
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    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61MDEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00Catheters; Hollow probes
    • A61M25/10Balloon catheters
    • A61M25/1011Multiple balloon catheters

Description

v. J. oDDo HAEMOSTATIC CATHETER July 1e, 1957- 2 Sheets-Sheet l Filedllarch 22. 1955 Y INVYENTOR. vmm J, oooo July 16, 1957 v. J. oDDo HAEMOSTATIC CATHETER med umn 22.. 1955 y 2 Sheets-Sheet 2 v INVENToR.- VINCENT J. ODDO ATTORNEY United States Patent O lHAEMOSTATIC CATHETER y Vincent J. Oddo, Cranston, R. I. Application March 22, 1955, Serial No. 495,845 4 Claims. (Cl. 12S-325) My present invention Yrelates to a surgical apparatus and more particularly to a haemostatic catheter.

The principal object of the present invention is to provide a catheter which can be .used for stopping or checking bleeding in certain types of operations.

Another object of the present invention is to provide a catheter particularly adaptable to check bleeding after a prostatectomy 'has been performed.

A further object of the present invention is to provide a catheter which will apply pressure to the affected areas and check or stop bleeding immediately.

Another object of the present invention is to provide a `haemostatic catheter which is simple in construction and easy and economical to manufacture and assemble.

With the above and other objects and advantageous features in view, my invention consists of a novel arrange ment of parts, more fully disclosed in the detailed description following, in conjunction with the accompanying drawings, and more specifically delined in the appended claims.

In the drawings:

Fig. l is a hemisectional view of the male pelvic region.

Fig. 2 is an enlarged view of the bladder and urethra with the catheter of the present invention in place.

Fig. 3 is a side elevation of the catheter.

Fig. 4 is an enlarged view of the distal end with the balloons inated.

Fig. 5 is a longitudinal section catheter shown in Fig. 4.

In certain types of `operations there is a great -deal of post operative bleeding which -is difficult to check. More particularly, an .operation for the Vremoval of the prostate gland results in bleeding in the prostatic bed and the vesical neck. This is true regardless of the technique or method used in removing the gland. A conventional method of attempting to stop the bleeding is by inserting a balloon catheter, inflating the balloon in the bladder and pulling outwardly. This applies some pressure to the lower portion of the bladder and the upper portion of the vesical neck. But there is no pressure on the prostatic bed or the inferior portion of the vesical neck. Therefore the bleeding will usually continue for about one or two days or longer with the result that the patient becomes very weak.

The present invention is designed to provide a catheter which will apply a direct pressure to the affected areas thus immediately checking or stopping the bleeding. This isaccomplished by providing the catheter with two adjacent balloons designed to press against each other. By positioning one balloon in the bladder and the other in the prostatic bed, direct pressure can be brought to bear on the walls of the prostatic bed and on the vesical neck.

Referring more in ofthe portion of the detail to the drawings illustrating my invention, Figs. 3, 4, and 5 illustrate the construction of the catheter. While any type of material and construction may be used, I prefer that the catheter be made in an integral one piece construction of tlexible rubber.

2,799,273 Patented July 16, 1957 The catheter comprises a tubular body portion 10 having a central drainage channel 11 which is closed at the distal end 12. The body portion 10 vis provided with one or more openings 13 adjacent the distal end 12 and communicating with the channel 11. Integrally mounted on the body portion 10 and spaced from thel distal end but adjacent thereto is an inatable balloon portion 14. Mounted on the tubular body 10 and slightly spaced from the balloon 14 is al second balloon 15 to the same size, shape and capacity as the balloon 14.

A lplurality of inating ducts are imbedded or formed in the walls of vthe tubular portion 10, the duct 16 communicating with the balloon 14 and the duct 17 communicating with the balloon 15. The rear end of the catheter is trifurcated as shown in Fig. 3. A funnel portion 18 communicating with the drainage channel 11 and the funnel portions 19' and 20 communicating with the inflating ducts '16 and 17.

It is preferable that the balloons 14 and 15 be shaped as illustrated in a general torus shape having bulging ends so that the adjacent walls of the balloons will press against each other in inated position as shown in Figs. 4 and 5. With this construction it is of course possible to inate one balloon more than vthe other as the circumstances may require and either air or water may be used.

The particular application of the above construction ICC as a haemostatic catheter is illustrated in Figs. l and 2.

Referring to Fig. l, the general area of the lower male pelvic region comprises a bladder 21, a urethra 22, and a vesical neck 23 which provides the muscular control between bladder and the urethra. The prostate gland-24 is of generally conical shape and surrounds the urethra just below the vesical neck 23. It is generally enclosed in a bed or -sheath 25 comprising the peri-prostatic tissues. vIn front of this area are the suspensory ligament 26, a symphysis 27 and Campers fascia 28. To the rear is the rectum 29 .and the seminal vesicle 30. Below the prostate area are various glands and ducts, the scrotal septum 31, and the yperineurn 32.

There are several methods of removing the prostate gland 24. One method is to cut through the front wall of the abdomen and through the wall of the bladder 21. The surgeon then inserts his finger through the vesical neck 23 and peels the prostate gland 24 away from the tissues 25 Vand removes it. Another method is to make an incision from underneath through the perineum 32 and remove the prostate gland 24 from that direction. In both cases the portion of the urethra which is sur rounded by the prostate gland is also torn out. There is thus bleeding at the vesical neck 23 and in the entire surface of the tissues 25. At this point, referring to Fig. 2, the catheter is inserted through the urethra 22 so that the distal end 12 extends into the bladder 2i. The balloon 14 is now inated through the duct 16 and the catheter pulled downwardly so that the balloon 14 rests on the vesical neck 23. The second balloon 15 is now inflated through the duct 17 so that it will completely fill the cavity formed by the tissues 25 from which the prostate gland 24 was removed. Pressure on the catheter is now released and the catheter is now locked in place and will not fall in or out. Ultimately these tissues and muscles will shrink and organize to form a new urethral passageway. However, at this time the area is enlarged and pliable and will take the shape of the balloon 15 as it is inflated. With both balloons inated the vesical neck 23 will be pressed from above and below between the two balloons stopping the bleeding in this area. The balloon 15 will also press outwardly and downwardly against the walls of the tissues 25 checking the bleeding from these tissues. ln the meanwhile, the bladder drains through the openings 13 and the drainage channel 11 in the usual manner.

In removing the prostrate gland many veins and arteries are torn and ruptured and there is great danger of bleeding and shock following a prostrate operation. The catheter of the present invention is designed to check and prevent these complications. The bleeding is checked almost immediately and the healing is more rapid.

The catheter of the present invention may also be used in other types of operations. For example, in certain lung operations the chest cavity is pierced and drained. A conventional catheter with one balloon is inserted. However, such catheters must be taped so that they will not fall into the chest cavity. The catheter ofthe present invention can be positioned so that one balloon will inilate inside the cavity and the second one outside the chest. The catheter will then be immovably positioned and will not move either in or out. Furthermore, the pressure between the two balloons will prevent any extraneous leakage and all drainage will be through the catheter.

While the catheter of the present invention is equipped with two balloons, it can also be used in the same manner as any other conventional catheter by inating only one of the balloons. A choice is thus afforded as to how far the doctor wishes the distal end to extend into the drainage area.

The catheter may be constructed in any desired manner and the shape and size of the various parts may be readily altered without departing from the invention as deiined in the appended claims.

I claim:

l. A surgical accessory comprising an elongated tubular body portion having a central longitudinal drainage channel closed at the distal end, a drainage opening in said body portion adjacent the distal end and communieating with said drainage channel, an iniiatable balloon on said body portion adjacent the drainage opening, a second inflatable balloon on said body portion in close proximity to said first balloon, said balloons pressing against each other in inflated position, said body portion having separate inflation channels each communicating with one of said balloons, and separate conduits at the proximal end of said body portion for said drainage channel and said ination channels.

2. A surgical accessory comprising an integral onepiece exible rubber tubular body portion having a central longitudinal drainage channel closed at the distal end, a plurality of drainage openings in said body portion adjacent the distal end and communicating with said drainage channel, an inatable balloon on said body portion adjacent the drainage openings, a second iniiatable balloon on said body portion in close proximity to said iirst balloon, said balloons pressing against each other in inflated position, said balloons being of the same shape and size, said body portion having separate ination channels each communicating with one of said balloons, and separate conduits at the proximal end of said body portion for said drainage channel and said inflation channels.

3. A surgical accessory comprising an elongated tubular body portion having a central longitudinal drainage channel closed at the distal end, a drainage opening in said body portion adjacent the distal end and communieating with said drainage channel, an inatable balloon on said body portion adjacent the drainage opening, a second infiatable balloon on said body portion in close proximity to said iirst balloon, said balloons pressing against each other in inated position, said balloons both being of a generally torus shape, said body portion having separate ination channels each communicating with one ofv said balloons, and separate conduits at the proximal end of said body portion for said drainage channel and said iniiation channels.

4. A surgical accessory comprising an integral onepiece exible rubber tubular body portion having a central longitudinal drainage channel closed at the distal end, a plurality of drainage openings in said body portion adjacent the distal end and communicating with said drainage channel, an inflatable balloon on said body portion adjacent the drainage openings, a second inflatable balloon on said body portion in close proximity to said rst balloon, said balloons pressing against each other in inated position, said balloons both being of a generally torus shape, said balloons being of the same shape and size, said body portion having separate inlation channels each communicating with one of said balloons, and separate conduits at the proximal end of said body portion for said drainage channel and said inlation channels.

Referencesy Cited in the file of this patent UNITED STATES PATENTS 2,210,744 Winder Aug. 6, 1940 2,493,326 Trinder Ian. 3, 1950 2,642,874 Keeling Jan.r 23, 1953 2,693,191 Raiche Nov. 2, 1954

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Cited By (40)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US2854982A (en) * 1958-01-22 1958-10-07 Vito V Pagano Nasopharyngeal tube
US3039468A (en) * 1959-01-07 1962-06-19 Joseph L Price Trocar and method of treating bloat
US3046988A (en) * 1958-12-01 1962-07-31 Davol Rubber Co Esophageal nasogastric tube
US3055371A (en) * 1958-12-23 1962-09-25 Kulick George Device for regulation and control of esophago-gastric balloons
US3292627A (en) * 1963-03-25 1966-12-20 Pharmaseal Lab Catheter
DE3204828A1 (en) * 1982-02-11 1983-09-15 Yale B Cook Catheter drainage and protection device for drainage of fluid through the male urethra
EP0260107A2 (en) * 1986-09-10 1988-03-16 G. David Jang Tandem independently inflatable/deflatable multiple diameter balloon angioplasty catheter systems.
US4744366A (en) * 1986-09-10 1988-05-17 Jang G David Concentric independently inflatable/deflatable multiple diameter balloon angioplasty catheter systems and method of use
US4878901A (en) * 1986-10-10 1989-11-07 Sachse Hans Ernst Condom catheter, a urethral catheter for the prevention of ascending infections
EP0341988A1 (en) * 1988-05-10 1989-11-15 American Medical Systems, Inc. Prostate balloon dilator
US4958634A (en) * 1987-05-06 1990-09-25 Jang G David Limacon geometry balloon angioplasty catheter systems and method of making same
US5002558A (en) * 1989-08-23 1991-03-26 The Beth Israel Hospital Association Adjustable urethral catheter and method for treating obstructive prostatism
EP0421031A1 (en) * 1989-10-03 1991-04-10 American Medical Systems, Inc. Prostate balloon dilator
US5007898A (en) * 1988-06-02 1991-04-16 Advanced Surgical Intervention, Inc. Balloon dilatation catheter
FR2659239A1 (en) * 1990-03-12 1991-09-13 Lefebvre Jean Marie Percutaneous vascular obturator
US5071406A (en) * 1987-05-06 1991-12-10 Jang G David Limacon geometry balloon angioplasty catheter systems
WO1992018194A1 (en) * 1991-04-11 1992-10-29 Roth Robert A Prostatic urethra dilatation catheter system and method
US5188596A (en) * 1990-09-27 1993-02-23 Mentor Corporation Transparent prostate dilation balloon and scope
US5312430A (en) * 1986-12-09 1994-05-17 Rosenbluth Robert F Balloon dilation catheter
US5318530A (en) * 1991-12-06 1994-06-07 Bissel Medical Products, Inc. Gastrointestinal tube with inflatable bolus
US5496271A (en) * 1990-09-14 1996-03-05 American Medical Systems, Inc. Combined hyperthermia and dilation catheter
US5527336A (en) * 1986-12-09 1996-06-18 Boston Scientific Corporation Flow obstruction treatment method
US5566221A (en) * 1994-07-12 1996-10-15 Photoelectron Corporation Apparatus for applying a predetermined x-radiation flux to an interior surface of a body cavity
US5588965A (en) * 1995-03-07 1996-12-31 American Medical Systems, Inc. Device for slowly dilating the prostatic urethra
US5621780A (en) * 1990-09-05 1997-04-15 Photoelectron Corporation X-ray apparatus for applying a predetermined flux to an interior surface of a body cavity
US5713861A (en) * 1994-10-17 1998-02-03 Vanarthos; William Trauma urethral catheter and method of using same
US5797877A (en) * 1993-10-01 1998-08-25 Boston Scientific Corporation Medical device balloons containing thermoplastic elastomers
US6132824A (en) * 1989-09-25 2000-10-17 Schneider (Usa) Inc. Multilayer catheter balloon
US6136258A (en) * 1991-04-26 2000-10-24 Boston Scientific Corporation Method of forming a co-extruded balloon for medical purposes
US6223085B1 (en) 1997-05-06 2001-04-24 Urologix, Inc. Device and method for preventing restenosis
US6299598B1 (en) * 1997-02-04 2001-10-09 Cook Urological, Incorporated Drainage catheter
DE10036164A1 (en) * 2000-07-25 2002-02-14 Ralf Basting Double balloon catheter in particular to be used for stopping hemorrhage during operation of prostate gland
US20040181273A1 (en) * 2003-03-10 2004-09-16 Evan Brasington Dilator with expandable member
US6896842B1 (en) 1993-10-01 2005-05-24 Boston Scientific Corporation Medical device balloons containing thermoplastic elastomers
US20060129136A1 (en) * 2004-12-09 2006-06-15 Meacham George B K Catheter
US20060212022A1 (en) * 2005-03-21 2006-09-21 Boston Scientific Scimed,Inc. Tissue approximation device
WO2011008880A3 (en) * 2009-07-14 2011-07-07 Apaxis Medical, Inc. Surgical coring system comprising a balloon catheter
US9295457B2 (en) 2010-05-06 2016-03-29 Universitätsmedizin Der Johannes Gutenberg Universität Mainz Balloon catheter system for sealing puncture points in body cavities, hollow organs or in percutaneous systems in mammals
US20160339266A1 (en) * 2010-09-23 2016-11-24 Best Medical International, Inc. Multi-balloon catheter for medical applications
US9839543B2 (en) 2013-03-14 2017-12-12 Cook Medical Technologies Llc Multi-stage balloon catheter

Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US2210744A (en) * 1939-01-17 1940-08-06 American Anode Inc Catheter
US2493326A (en) * 1949-03-01 1950-01-03 John H Trinder Tampon for control of intractable nasal hemorrhages
US2642874A (en) * 1951-06-04 1953-06-23 Wilmer B Keeling Instrument for treating prostate glands
US2693191A (en) * 1951-07-16 1954-11-02 Davol Rubber Co Incontinence urinal balloon plug

Patent Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US2210744A (en) * 1939-01-17 1940-08-06 American Anode Inc Catheter
US2493326A (en) * 1949-03-01 1950-01-03 John H Trinder Tampon for control of intractable nasal hemorrhages
US2642874A (en) * 1951-06-04 1953-06-23 Wilmer B Keeling Instrument for treating prostate glands
US2693191A (en) * 1951-07-16 1954-11-02 Davol Rubber Co Incontinence urinal balloon plug

Cited By (59)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US2854982A (en) * 1958-01-22 1958-10-07 Vito V Pagano Nasopharyngeal tube
US3046988A (en) * 1958-12-01 1962-07-31 Davol Rubber Co Esophageal nasogastric tube
US3055371A (en) * 1958-12-23 1962-09-25 Kulick George Device for regulation and control of esophago-gastric balloons
US3039468A (en) * 1959-01-07 1962-06-19 Joseph L Price Trocar and method of treating bloat
US3292627A (en) * 1963-03-25 1966-12-20 Pharmaseal Lab Catheter
DE3204828A1 (en) * 1982-02-11 1983-09-15 Yale B Cook Catheter drainage and protection device for drainage of fluid through the male urethra
US4744366A (en) * 1986-09-10 1988-05-17 Jang G David Concentric independently inflatable/deflatable multiple diameter balloon angioplasty catheter systems and method of use
EP0260107A2 (en) * 1986-09-10 1988-03-16 G. David Jang Tandem independently inflatable/deflatable multiple diameter balloon angioplasty catheter systems.
US4763654A (en) * 1986-09-10 1988-08-16 Jang G David Tandem independently inflatable/deflatable multiple diameter balloon angioplasty catheter systems and method of use
EP0260107A3 (en) * 1986-09-10 1988-11-23 G. David Jang Tandem independently inflatable/deflatable multiple diameter balloon angioplasty catheter systems and method of use
US4878901A (en) * 1986-10-10 1989-11-07 Sachse Hans Ernst Condom catheter, a urethral catheter for the prevention of ascending infections
US5836951A (en) * 1986-12-09 1998-11-17 Boston Scientific Corporation Balloon dilation catheter
US5312430A (en) * 1986-12-09 1994-05-17 Rosenbluth Robert F Balloon dilation catheter
US5752971A (en) * 1986-12-09 1998-05-19 Boston Scientific Technology, Inc. Method of treating a flow obstruction
US5527336A (en) * 1986-12-09 1996-06-18 Boston Scientific Corporation Flow obstruction treatment method
US4958634A (en) * 1987-05-06 1990-09-25 Jang G David Limacon geometry balloon angioplasty catheter systems and method of making same
US5304132A (en) * 1987-05-06 1994-04-19 Jang G David Limacon geometry balloon angioplasty catheter systems and method of making same
US5071406A (en) * 1987-05-06 1991-12-10 Jang G David Limacon geometry balloon angioplasty catheter systems
EP0341988A1 (en) * 1988-05-10 1989-11-15 American Medical Systems, Inc. Prostate balloon dilator
US4932958A (en) * 1988-05-10 1990-06-12 American Medical Systems, Inc. Prostate balloon dilator
US5007898A (en) * 1988-06-02 1991-04-16 Advanced Surgical Intervention, Inc. Balloon dilatation catheter
US5002558A (en) * 1989-08-23 1991-03-26 The Beth Israel Hospital Association Adjustable urethral catheter and method for treating obstructive prostatism
US6132824A (en) * 1989-09-25 2000-10-17 Schneider (Usa) Inc. Multilayer catheter balloon
EP0421031A1 (en) * 1989-10-03 1991-04-10 American Medical Systems, Inc. Prostate balloon dilator
FR2659239A1 (en) * 1990-03-12 1991-09-13 Lefebvre Jean Marie Percutaneous vascular obturator
US5621780A (en) * 1990-09-05 1997-04-15 Photoelectron Corporation X-ray apparatus for applying a predetermined flux to an interior surface of a body cavity
US5496271A (en) * 1990-09-14 1996-03-05 American Medical Systems, Inc. Combined hyperthermia and dilation catheter
US5188596A (en) * 1990-09-27 1993-02-23 Mentor Corporation Transparent prostate dilation balloon and scope
WO1992018194A1 (en) * 1991-04-11 1992-10-29 Roth Robert A Prostatic urethra dilatation catheter system and method
US5209725A (en) * 1991-04-11 1993-05-11 Roth Robert A Prostatic urethra dilatation catheter system and method
US6482348B1 (en) 1991-04-26 2002-11-19 Boston Scientific Corporation Method of forming a co-extruded balloon for medical purposes
US6136258A (en) * 1991-04-26 2000-10-24 Boston Scientific Corporation Method of forming a co-extruded balloon for medical purposes
US7585289B2 (en) 1991-04-26 2009-09-08 Boston Scientific Scimed, Inc. Co-extruded medical balloon
US5318530A (en) * 1991-12-06 1994-06-07 Bissel Medical Products, Inc. Gastrointestinal tube with inflatable bolus
US5797877A (en) * 1993-10-01 1998-08-25 Boston Scientific Corporation Medical device balloons containing thermoplastic elastomers
US6086556A (en) * 1993-10-01 2000-07-11 Boston Scientific Corporation Medical device balloons containing thermoplastic elastomers
US6896842B1 (en) 1993-10-01 2005-05-24 Boston Scientific Corporation Medical device balloons containing thermoplastic elastomers
US7781038B2 (en) 1993-10-01 2010-08-24 Boston Scientific Scimed, Inc. Medical device balloons containing thermoplastic elastomers
US5566221A (en) * 1994-07-12 1996-10-15 Photoelectron Corporation Apparatus for applying a predetermined x-radiation flux to an interior surface of a body cavity
US5713861A (en) * 1994-10-17 1998-02-03 Vanarthos; William Trauma urethral catheter and method of using same
US5588965A (en) * 1995-03-07 1996-12-31 American Medical Systems, Inc. Device for slowly dilating the prostatic urethra
US6299598B1 (en) * 1997-02-04 2001-10-09 Cook Urological, Incorporated Drainage catheter
US6223085B1 (en) 1997-05-06 2001-04-24 Urologix, Inc. Device and method for preventing restenosis
DE10036164A1 (en) * 2000-07-25 2002-02-14 Ralf Basting Double balloon catheter in particular to be used for stopping hemorrhage during operation of prostate gland
DE10036164B4 (en) * 2000-07-25 2004-07-08 Basting, Ralf, Dr.-med. Double balloon catheter
US20100121345A1 (en) * 2003-03-10 2010-05-13 Boston Scientific Scimed, Inc. Dilator with expandable member
US8491620B2 (en) 2003-03-10 2013-07-23 Boston Scientific Scimed, Inc. Dilator with expandable member
US7655021B2 (en) 2003-03-10 2010-02-02 Boston Scientific Scimed, Inc. Dilator with expandable member
US20040181273A1 (en) * 2003-03-10 2004-09-16 Evan Brasington Dilator with expandable member
US20060129136A1 (en) * 2004-12-09 2006-06-15 Meacham George B K Catheter
US7708715B2 (en) * 2005-03-21 2010-05-04 Boston Scientific Scimed, Inc. Tissue approximation device
US20060212022A1 (en) * 2005-03-21 2006-09-21 Boston Scientific Scimed,Inc. Tissue approximation device
US20110172690A1 (en) * 2009-07-14 2011-07-14 Cohn William E Balloon Catheter for Use with a Surgical Coring System
WO2011008880A3 (en) * 2009-07-14 2011-07-07 Apaxis Medical, Inc. Surgical coring system comprising a balloon catheter
US9295457B2 (en) 2010-05-06 2016-03-29 Universitätsmedizin Der Johannes Gutenberg Universität Mainz Balloon catheter system for sealing puncture points in body cavities, hollow organs or in percutaneous systems in mammals
DE102010019795B4 (en) * 2010-05-06 2016-10-27 Universitätsmedizin Der Johannes Gutenberg-Universität Mainz Balloon catheter system for sealing puncture sites in body cavities, hollow organs or percutaneous systems in mammals
US10406381B2 (en) * 2010-09-23 2019-09-10 Best Medical International, Inc. Multi-balloon catheter for medical applications
US20160339266A1 (en) * 2010-09-23 2016-11-24 Best Medical International, Inc. Multi-balloon catheter for medical applications
US9839543B2 (en) 2013-03-14 2017-12-12 Cook Medical Technologies Llc Multi-stage balloon catheter

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