WO2018056940A2 - Nouveau système d'ablation mécanochimique par voie intraveineuse à utiliser pour le traitement de veines variqueuses - Google Patents

Nouveau système d'ablation mécanochimique par voie intraveineuse à utiliser pour le traitement de veines variqueuses Download PDF

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Publication number
WO2018056940A2
WO2018056940A2 PCT/TR2017/050316 TR2017050316W WO2018056940A2 WO 2018056940 A2 WO2018056940 A2 WO 2018056940A2 TR 2017050316 W TR2017050316 W TR 2017050316W WO 2018056940 A2 WO2018056940 A2 WO 2018056940A2
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WO
WIPO (PCT)
Prior art keywords
balloon
vein
sclerosant
hardener
agent
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PCT/TR2017/050316
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English (en)
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WO2018056940A3 (fr
Inventor
Alper ERKİN
Sinan AKDENİZ
Original Assignee
Erkin Alper
Akdeniz Sinan
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Application filed by Erkin Alper, Akdeniz Sinan filed Critical Erkin Alper
Publication of WO2018056940A2 publication Critical patent/WO2018056940A2/fr
Publication of WO2018056940A3 publication Critical patent/WO2018056940A3/fr

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
    • A61B17/12022—Occluding by internal devices, e.g. balloons or releasable wires
    • A61B17/12027—Type of occlusion
    • A61B17/1204—Type of occlusion temporary occlusion
    • A61B17/12045—Type of occlusion temporary occlusion double occlusion, e.g. during anastomosis
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00008—Vein tendon strippers
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
    • A61B17/12022—Occluding by internal devices, e.g. balloons or releasable wires
    • A61B17/12099—Occluding by internal devices, e.g. balloons or releasable wires characterised by the location of the occluder
    • A61B17/12109—Occluding by internal devices, e.g. balloons or releasable wires characterised by the location of the occluder in a blood vessel
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
    • A61B17/12022—Occluding by internal devices, e.g. balloons or releasable wires
    • A61B17/12131—Occluding by internal devices, e.g. balloons or releasable wires characterised by the type of occluding device
    • A61B17/12136—Balloons
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
    • A61B17/12022—Occluding by internal devices, e.g. balloons or releasable wires
    • A61B17/12131—Occluding by internal devices, e.g. balloons or releasable wires characterised by the type of occluding device
    • A61B17/12181—Occluding by internal devices, e.g. balloons or releasable wires characterised by the type of occluding device formed by fluidized, gelatinous or cellular remodelable materials, e.g. embolic liquids, foams or extracellular matrices
    • A61B17/12186—Occluding by internal devices, e.g. balloons or releasable wires characterised by the type of occluding device formed by fluidized, gelatinous or cellular remodelable materials, e.g. embolic liquids, foams or extracellular matrices liquid materials adapted to be injected
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/18—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves
    • A61B18/20—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser
    • A61B18/22—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser the beam being directed along or through a flexible conduit, e.g. an optical fibre; Couplings or hand-pieces therefor
    • A61B18/24—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser the beam being directed along or through a flexible conduit, e.g. an optical fibre; Couplings or hand-pieces therefor with a catheter
    • A61B18/245—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser the beam being directed along or through a flexible conduit, e.g. an optical fibre; Couplings or hand-pieces therefor with a catheter for removing obstructions in blood vessels or calculi
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00535—Surgical instruments, devices or methods, e.g. tourniquets pneumatically or hydraulically operated
    • A61B2017/00557—Surgical instruments, devices or methods, e.g. tourniquets pneumatically or hydraulically operated inflatable
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00053—Mechanical features of the instrument of device
    • A61B2018/00214—Expandable means emitting energy, e.g. by elements carried thereon
    • A61B2018/0022—Balloons
    • A61B2018/00238—Balloons porous
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00053—Mechanical features of the instrument of device
    • A61B2018/00214—Expandable means emitting energy, e.g. by elements carried thereon
    • A61B2018/0022—Balloons
    • A61B2018/0025—Multiple balloons
    • A61B2018/00261—Multiple balloons arranged in a line
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00315—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for treatment of particular body parts
    • A61B2018/00345—Vascular system
    • A61B2018/00404—Blood vessels other than those in or around the heart
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00315—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for treatment of particular body parts
    • A61B2018/00345—Vascular system
    • A61B2018/00404—Blood vessels other than those in or around the heart
    • A61B2018/0041—Removal of thrombosis
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00315—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for treatment of particular body parts
    • A61B2018/00345—Vascular system
    • A61B2018/00404—Blood vessels other than those in or around the heart
    • A61B2018/00422—Angioplasty
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00571—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for achieving a particular surgical effect
    • A61B2018/00577—Ablation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES 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
    • A61M25/00—Catheters; Hollow probes
    • A61M25/10—Balloon catheters
    • A61M25/1011—Multiple balloon catheters
    • A61M2025/1015—Multiple balloon catheters having two or more independently movable balloons where the distance between the balloons can be adjusted, e.g. two balloon catheters concentric to each other forming an adjustable multiple balloon catheter system
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES 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
    • A61M25/00—Catheters; Hollow probes
    • A61M25/10—Balloon catheters
    • A61M2025/1043—Balloon catheters with special features or adapted for special applications
    • A61M2025/105—Balloon catheters with special features or adapted for special applications having a balloon suitable for drug delivery, e.g. by using holes for delivery, drug coating or membranes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES 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
    • A61M25/00—Catheters; Hollow probes
    • A61M25/10—Balloon catheters
    • A61M2025/1043—Balloon catheters with special features or adapted for special applications
    • A61M2025/1052—Balloon catheters with special features or adapted for special applications for temporarily occluding a vessel for isolating a sector

Definitions

  • This invention is a new intravenous mechanochemical ablation system to be used for chronic venous failure (variceal) treatment.
  • the first technique used for surgical treatment of varicose vein disease was a technique called stripping.
  • saphenous vein is found with surgical incisions at the point where it is connected to deep venous system and at the distal area.
  • a wire called the stripper is transmitted through the vein and connected to the vessel and the vessel is removed by pulling underneath the skin by means of that wire.
  • general anesthesia or spiral anesthesia must be used under any circumstance. Because it is a very painful method for the patient.
  • the most important problems related to this technique are heavy postoperative pain, under skin haemorrhage due to ruptured side branches of the vessel and long recovery period. There is also risk of emergence of nerve damage, which is an important health problem.
  • intravenous ablation systems have been developed. It is possible to divide intravenous ablations systems into two:
  • Thermal ablation systems One of the methods used is radiofrequency ablation method. In this system, thermal energy between 200 to 3000 kHz is applied on vessel wall endothelium (cell layer of the vessel in contact to blood, it has many functions) by means of a catheter (a hollow tube in different diameters and lengths) advanced inside the vessel. It causes contraction of collagen in vein wall (collagen is a protein structure that provide robustness to human body) and endovenous thermocoagulation.
  • Another method is the laser ablation method. In this method, changes related to high heat is aimed to have occurred in vein lumen by means of laser beams in 810 to 1470 nm wavelengths.
  • Deep vein thrombosis occlusion occurred as the result of clot formation in vena cava inside muscles
  • pulmonary embolus occlusion of pulmonary artery due to clot formation in vena cava inside muscles and its advancement upwards inside the vessel
  • Arterial (artery) wall damage phenomenon after thermal ablation is also available in literature.
  • Non-thermal methods Foam sclerotherapy (can be defined as pathologic hardening of vascular tissue (vessel hardening and deforming its structure (the vessel becomes dysfunctional) is the most frequently used method among Non- Thermal Non Tumescent (NTNT) methods.
  • NTNT Non- Thermal Non Tumescent
  • a foam form material obtained by mixing a sclerosant (hardener) drug with air is injected inside the vein in order to contact to inner surface of the vein and deform its venous structure.
  • ClariVein Another non-thermal method is ClariVein, which is a mechanochemical ablation system. It is not appropriate to make a comment on the success of the procedure since there are no sufficient randomized controlled studies on it.
  • presence of the use of liquid sclerosant (hardener) substance is a disadvantage in terms of contact with the vein wall.
  • variceal treatment the aim is to find the most efficient method with minimum complication (problems arising from the operation).
  • complication problems arising from the operation.
  • Increasing presence of non-thermal methods in clinical use will be important as to the increasing of post-operative comfort of the patients.
  • PCT/EP2007/063320 there is a patented invention (PCT/EP2007/063320) similar to the planned mechanochemical endovenous ablation catheter (a hollow tube in different diameters and lengths).
  • sclerosant (hardener) agent it was planned to increase contract of the sclerosant (hardener) agent by means of a balloon in order to ensure maximum contact between the foam sclerosant (hardener) agent and the vein wall.
  • intravenous volume could vary from 7-10 cm 3 to 90-120 cm 3 . This inhibits full dilution of sclerosant (hardener) agent with blood. It may be necessary to use the agent in high quantities in order to ensure contract.
  • foam sclerosant (hardener) agent may gravitate from wide perforating veins (veins connecting superficial veins to deep veins) to deep venous system (deep vein system) (with the effect of balloon dilatation system) and venous thrombosis (clotting inside the vein) and pulmonary embolus (embolism at pulmonary artery) risk may increase.
  • Purpose of the Invention is to eliminate problems revealed in prior art and to present an intravenous mechanochemical ablation system that will achieve the most successful results with minimum complication.
  • Figure 1 Application view of the new intravenous mechanochemical ablation system to be used in variceal treatment.
  • Figure 2 Pre-application view of the new intravenous mechanochemical ablation system to be used in variceal treatment.
  • Figure 3 Spinner- internal balloon detail view of the new intravenous mechanochemical ablation system to be used in variceal treatment.
  • Figure 4 View of the new intravenous mechanochemical ablation system to be used in variceal treatment, in which the advancer balloon closes vena cava valve.
  • This invention is related to endovenous ablation systems and is a dual balloon system that ensures ablation (closure of the vein) of the vein with contact of a sclerosant (hardener) agent that is advanced along the diseased vein (13) through a catheter (a hollow tube in different diameters and lengths) placed into the varicose vein (13) with Seldinger method.
  • a sclerosant hardener
  • Component of this invention are as follows; it is composed of a spinner balloon (1), an internal balloon (2), an advancer balloon (3), laser light (4), pores (5), advancer balloon air canal (6), internal balloon air canal (7), sclerosant (hardener) agent canal (8), advancer balloon inflation inlet (9), internal balloon inflation inlet (10) and sclerosant (hardener) agent inlet (11).
  • a advancer balloon (3) at the end of the system. Function of this advancer balloon (3) is to inflate and to fix the vein (13) after contacting with vein walls.
  • Catheter a hollow tube in different diameters and lengths
  • Veins (13), diameters of which are expanded due to varicosity may have a meandering route. Or there may bay severe expansion in veins called perforating veins (veins connecting superficial veins to deep veins), which ensure connection of vein with expanded diameter (saphenous vein) with side veins or deep venous system.
  • perforating veins veins connecting superficial veins to deep veins
  • This advancer balloon (3) which is a component of this invention, is inflated just before the meandering section or at the level of side branch with expanded diameter and catheter (a hollow tube in different diameters and lengths) section moving inside the balloon is advanced so that the problematic section is passed comfortably.
  • This balloon will also be inflated at the connection point of the vena cava (12) of the vein that will be subject to saphenofemoral junction during application with the spinner balloon (1) and function for closing that connection point. Therefore penetration of the sclerosant (hardener) agent into vena cava (12) system during application can be prevented.
  • sclerosant (hardener) agent Structure of the sclerosant (hardener) agent that will ensure vein (13) ablation by contacting to the venous wall, has also been changed as part of the invention.
  • sclerosant (hardener) agent in liquid or foam form losses its effect by mixing with blood inevitably or it may be necessary to increase sclerosant (hardener) agent quantity to levels beyond medical limits for ensuring an effective contract. Therefore a gel form of sclerosant (hardener) agent has been developed. Transformation into gel form will have two benefits.
  • sclerosant (hardener) agent causes venous sclerosis by leading to histopathologic (cellular and tissue) changes and denaturation (transformation of secondary, tertiary and quaternary structures available in natural structure of proteins or nucleic acids into primary structures by degradation with some physical (high temperature, radiation) and chemical (strong acid or base, organic solvents (alcohol, chloroform etc.), dense inorganic salt solution) external factors) in vein (13) layers when it contacts to vein (13) surface and therefore vein obliteration (vein ablation) is ensured.
  • this balloon which can be called the spinner balloon (1) lays along the vein to be intervened and inflates in a way that it fully contacts to vein walls.
  • This internal balloon (2) is located inside the spinner balloon (1) and when the internal balloon (2) is inflated, it is ensured that sclerosant (hardener) agent in gel form to be delivered by means of sclerosant agent canals (8) between the spinner balloon (1) and this balloon (2) exist from the pores (5) on the spinner balloon (1) and contacts to the vein (13) surface.
  • sclerosant (hardener) agent in gel form to be delivered by means of sclerosant agent canals (8) between the spinner balloon (1) and this balloon (2) exist from the pores (5) on the spinner balloon (1) and contacts to the vein (13) surface.
  • spinner balloon (1) Another function of the spinner balloon (1) is that it functions as a endothelial stripper balloon thanks to full contact with the vein (13) wall and performs endothelial (cell layer of the vessel in contact to blood, it has many functions) stripping operation. This operation is performed with circular moves after the spinner balloon (1) is inflated. Studies conducted showed that, endothelial (cell layer of the vessel in contact to blood, it has many functions) stripping facilitated contact of sclerosant (hardener) agent to vein layers and increased procedural success.
  • sclerosant hardener
  • advancer balloon air canal (6) and internal balloon air canal (7) that will ensure inflation of two spinner balloon (1) and internal balloon (2).
  • advancer balloon air canal (6) and internal balloon air canal (7) that will inflate advance balloon (3) and internal balloon (2) inside the spinner balloon (1).
  • These advancer balloon (2) and advancer balloon (3) can be inflated with liquid as well as with gas such as helium that will not cause air embolism (blockage of the vessel by a foreign substance carried with blood) if internal balloon (2) and advancer balloon (3) explode.
  • sclerosant canal (8) which will deliver sclerosant (hardener) agent to the area between the spinner balloon (1) and the internal balloon (2) inside the spinner balloon (1).
  • Another feature of the system is that there are advancer balloon inflation inlet (9) and internal balloon inflation inlet (10) for each canal through which the liquid or helium will enter the system for inflating the balloon at the end of advancer balloon (3) and internal balloon (2) inflating advancer balloon air canal (6) and internal balloon air canal (7) and an sclerosant agent inlet (11) located at the end of the sclerosant agent canal (8) that will administer sclerosant (hardener) agent into the system.
  • advancer balloon inflation inlet (9) and internal balloon inflation inlet (10) for each canal through which the liquid or helium will enter the system for inflating the balloon at the end of advancer balloon (3) and internal balloon (2) inflating advancer balloon air canal (6) and internal balloon air canal (7) and an sclerosant agent inlet (11) located at the end of the sclerosant agent canal (8) that will administer sclerosant (hardener) agent into the system.

Abstract

L'invention concerne un système qui comprend un ballonnet de progression (3) dont la fonction est de fixer une veine (13) après avoir été gonflé et mis en contact avec les parois de la veine (13), un cathéter (un tube creux de diamètres et longueurs différents) qui se déplace vers l'avant et vers l'arrière à l'intérieur du ballonnet de progression (3), un ballonnet rotatif (1) qui assure le contact de l'agent sclérosant (durcisseur) avec la paroi de la veine et un ballonnet interne (2) qui gonfle à l'intérieur du ballonnet rotatif (1) le contenant et force l'agent sclérosant (durcisseur) contenu dans le ballonnet rotatif (1) à sortir des pores (5) sur le ballonnet rotatif (1), à utiliser pour le traitement de problèmes veineux (varicosités). La présente invention constitue un nouveau système d'ablation mécanochimique par voie intraveineuse qui garantit l'obtention de résultats cliniques de manière plus efficace et plus confortable avec moins de complications (problèmes causés par l'opération).
PCT/TR2017/050316 2016-07-13 2017-07-12 Nouveau système d'ablation mécanochimique par voie intraveineuse à utiliser pour le traitement de veines variqueuses WO2018056940A2 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
TR2016/09694A TR201609694A2 (tr) 2016-07-13 2016-07-13 Vari̇s tedavi̇si̇nde kullanilacak yeni̇ bi̇r damar i̇çi̇ mekanoki̇myasal ablasyon si̇stemi̇
TR2016/09694 2016-07-13

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WO2018056940A2 true WO2018056940A2 (fr) 2018-03-29
WO2018056940A3 WO2018056940A3 (fr) 2018-07-12

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Cited By (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN111887787A (zh) * 2020-08-25 2020-11-06 合肥中纳医学仪器有限公司 一种治疗食管静脉曲张的治疗仪及其使用方法
RU2756968C1 (ru) * 2021-03-09 2021-10-07 Юрий Германович Андреев Устройство механохимической стволовой склерооблитерации вен
RU207870U1 (ru) * 2021-06-11 2021-11-22 Юрий Германович Андреев Устройство механохимической стволовой склерооблитерации вен

Family Cites Families (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JPH0670984A (ja) * 1992-08-28 1994-03-15 Olympus Optical Co Ltd 生体拡張具
WO2014022867A1 (fr) * 2012-08-03 2014-02-06 Alumend, Llc Cathéters à ballons multiples endovasculaires à diffuseur optique pour le traitement de sténoses vasculaires
US8992817B2 (en) * 2012-12-10 2015-03-31 Abbott Cardiovascular Systems, Inc. Process of making a medical balloon

Cited By (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN111887787A (zh) * 2020-08-25 2020-11-06 合肥中纳医学仪器有限公司 一种治疗食管静脉曲张的治疗仪及其使用方法
RU2756968C1 (ru) * 2021-03-09 2021-10-07 Юрий Германович Андреев Устройство механохимической стволовой склерооблитерации вен
RU207870U1 (ru) * 2021-06-11 2021-11-22 Юрий Германович Андреев Устройство механохимической стволовой склерооблитерации вен

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TR201609694A2 (tr) 2017-01-23

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