CN101394815A - A fastening device - Google Patents
A fastening device Download PDFInfo
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- CN101394815A CN101394815A CNA2007800077139A CN200780007713A CN101394815A CN 101394815 A CN101394815 A CN 101394815A CN A2007800077139 A CNA2007800077139 A CN A2007800077139A CN 200780007713 A CN200780007713 A CN 200780007713A CN 101394815 A CN101394815 A CN 101394815A
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Abstract
A fastening device is provided to be associated with a first object, for the attachment of the object to a second object. The device comprises at least one fastening element having a base portion and at least one securing portion. The fastening element is originally produced with its securing portion having a first orientation relative to the base portion and with a possibility to bring the securing portion into a second orientation relative to the base portion, to allow the at least one securing portion to penetrate the second object being exposed thereto while staying in the second orientation, and being adapted to change the second orientation into the first orientation to provide the attachment.
Description
Technical field
The present invention relates to a kind of be used to make object be attached to each other together clamp device and method, particularly used medical clamp device and the method for anastomosis especially.
Background technology
The clamp device type that the present invention relates to generally includes such element, these elements are the most normal be suitable for penetrating treat by they attached one or more objects and in the process of penetrating the orientation of these elements can change.Introduce the embodiment of such various adapters below.
US 5,597, and 378 disclose the medical apparatus that is combined with the SIM alloying element.Use at present the medical apparatus of the element of making by marmem to bring out the martensitic alloy element and be improved by replacing applied stress.Applied stress brings out the temperature sensitivity that martensite has reduced device, thus make their install and/or dismounting easier.
US 5,207, and 695 disclose and are used to repair aneurysmal arterial graft (aortic graft), implanting device and restorative procedure.The system and method that arterial graft is provided and has been used to implant arterial graft.Arterial graft comprises having the columned graft material of being roughly of attachment component, this attachment component comprises a plurality of hook assemblies (post and hook assembly), these assemblies are implanted to penetrate arterial wall in aneurysmal above and below by dual duct system, thereby attached securely arterial graft, and get rid of aneurysm from blood circulation thus.
US 7,081, and 132 disclose the flexible barb that is used for the anchoring prosthese.Disclose a kind of medical prosthesis that has barb, wherein barb comprises the base portion that is made of the abutment that engages with protocorm (such as, pillar); Be suitable for being embedded into the anchorage part in the tissue, and the stress between base portion and anchorage part disperses part.In one embodiment, stress through part branch comprises having the solenoid that freely winds the line, and this solenoid does not link to each other with the pillar that is extended with barb.In another embodiment, be formed on a series of bending sections or curve part in the barb near the abutment that stress through part branch is included in pillar engages.Barb can be mechanically by attached and/or be welded on the prosthese, or form as one with it.Base portion is also extensible to have second barb part and stress to disperse part.
US 20050256531 discloses equipment and the method for implanting securing member in target body region (for example, hollow body cavity or cavity space).This equipment and method adopt the securing member attachment assembly that has actuator in the target body region.This actuator selectively is used for producing implantation power securing member is implanted to the tissue in the target body region.Securing member can be implanted with for example fixed fae body (for example, graft in the blood vessel).This system and equipment apply decomposing force near actuator place or its, thereby may form stable and reliably based on the tightening platform of conduit.
US 20060030921 discloses the method and apparatus that is used for fixing device, this fixture can be used for aneurysmal treatment, and this device comprises hub (hub) and also comprises arm or the spoke that a plurality of star-shaped patterns extend and engage with vessel arms from this hub on the one hand.Auxiliary device anchoring in the inner chamber that flows that this fixture can be used for device (for example, stent graft) and so on is put in expansion is in place and prevent from whereby to expand and put device and flowing and move in the inner chamber.Arm can be oriented to penetrate expand and put device and enter in the internal chamber wall that flows this fixing to realize thus.
US 6,358, and 258 disclose and are used for the apparatus and method of actuating station to side-to-side anastomosis.The device, method and the tool set that are used for an end of the first body pipe is sewn onto the lateral hole of the second body pipe are provided.This apparatus and method are used to simplify sewing process and therefore shorten operating time.In one embodiment, this device comprises such structure, and this structure is used for keeping an end of the first body pipe and this end is positioned near the hole of the second body pipe side.This structure of this device is generally the axle with the surface that is suitable for receiving the first body pipe.Be furnished with on this structure along the progressive many pins of mulitpath.Each bar pin path at first radially enters an end of the first body pipe and leaves this end forward, enters then in the hole of the second body pipe.Overturning then in the path, thereby during near the structure a end of the first body pipe is in hole in the second body pipe, makes pin and relevant stitching thread outwards through arriving described hole around the tissue.Described pin is preferably advanced along such path when advancing forward.In one embodiment, described device uses the J-shaped pipe, is used for guiding wherein pin along expected path.In another embodiment, use shape memory pin to form expected path with arc profile.
US 7,048, and 747 disclose and are used for the apparatus and method of actuating station to side-to-side anastomosis.The device, method and the tool set that are used for an end of the first body pipe is sewn onto the lateral hole of the second body pipe are provided.This apparatus and method are used to simplify sewing process and therefore shorten operating time.In one embodiment, this device comprises such structure, and this structure is used for keeping an end of the first body pipe and this end is positioned near the hole of the second body pipe side.This structure of this device is generally the axle with the surface that is suitable for receiving the first body pipe.Be furnished with on this structure along the progressive many pins of mulitpath.Each bar pin path at first radially enters an end of the first body pipe and leaves this end forward, enters then in the hole of the second body pipe.Overturning then in the path, thereby during near the structure a end of the first body pipe is in hole in the second body pipe, makes pin and relevant stitching thread outwards through arriving described hole around the tissue.Described pin is preferably advanced along such path when advancing forward.In one embodiment, described device uses the J-shaped pipe, is used for guiding wherein pin along expected path.In another embodiment, use shape memory pin to form expected path with arc profile.
US 6,645, and 227 disclose a kind of suture anchor, and it comprises and easily unloads the placing portion that is connected with attachment part of ground (frangably).Attachment part comprises outwards outstanding barb.In the process that suture anchor is inserted in the boring that forms on bone, barb is indentation on the part of bone and boring adjacency at least.In case suture anchor is set in the boring, just applies the power of recalling to suture anchor, thereby its attachment part is separated at the boring internal rotation and with placing portion.In optional embodiment, suture anchor can form does not have outwards outstanding barb.
US 6,363, and 938 disclose such equipment and method, are used for forming passage to strengthen syringeability wherein at organ or blood vessel.This equipment can comprise that bioactivator is with the vascularization near tissue growth the stimulation channels and the tissue.This equipment comprises and is applicable to the support of settling in percutaneous or the art that this support comprises the tube-like piece with a plurality of tips, barb, rib or other structures, is used for support is fixed on in-house desired locations place.
US 20050125020 discloses the method and apparatus that is used for carrying out anchoring in gastrointestinal tract.This invention relates to and is used for the anchoring piece that Wicresoft implants, and the size of this anchoring piece is decided to be and keeps being located reliably at least a portion gastrointestinal tract of animal.This anchoring piece comprises the radial spring that is formed by elongated elastic component, and it is configured as about central axis and circularizes the ripple pattern.This anchoring piece limits central lumen and outside radial force is provided, and can take place significantly crooked simultaneously about its periphery.This anchoring piece is dismountable on the whole, but also can comprise the securing member such as barb, so that it further is fixed on the surrounding tissue.In some embodiments, anchoring piece comprises the part that is fixed is connected to connector on the removable section.In addition, anchoring piece can be used for medical apparatus is fixed in the body, for example spring-backed quill is fixed to enteral.
US 20040068217 discloses the self-expanding outer connector that is used for utilizing hollow and formed the method and apparatus that coincide and be connected between second hole in first hole of graft pipe side wall and the soma pipe side wall.Tissue around first hole is introduced in the hollow connector and first parts of connected piece distal portion keep.Then, means of delivery by make connector distortion make the distal circumference that limits by first parts collapse and via second hole with first component feed in the inner chamber of soma's pipeline.When first parts being inserted in soma's pipeline, unload this instrument and connector is restored, so that first parts are with the wall portion of pushing these two pipelines around in described hole at the more proximal part of the connector of soma pipeline outside.
WO 2005/004727 discloses and has been used for the operation clamp device of sutures pin to the soma.This device comprises grasping member and the slender axles that extend from this grasping member.The one or more surgical fasteners of chamber housing.Ejecting mechanism is used for from the chamber that the holds one or more surgical fasteners surgical fasteners of being hit by a bullet out.This device also comprises the suture distribution system, and this system distributes sutures so that securing member is being caught suture from the axle At time of eject along described axle.This invention also provides surgical fasteners and the sutures that is used in this device.
WO 96/02211 discloses a kind of intracavity stent.Improved support provides the mechanical anchor of support to blood vessel or other body pipes.In a preferred embodiment, this support has barb (18), when support be in its not during deployed condition these barbs remain in the surface of support, and stretch out on the surface from support when support launches.These barbs (18) are suitable for engaging for example graft and/or blood vessel inner layer, with rack mechanical be attached on the blood vessel.Owing to not only depend on frictional force support is remained on the appropriate location, so support may apply less power to blood vessel, this means and can use and need power still less carry out unfolded thinner support.In addition, can reduce the radial force that after support launches, in tremulous pulse, always acts on, thereby the infringement that blood vessel is caused is littler.
The system and method that WO 90/015582 discloses arterial graft and has been used to implant this arterial graft.Arterial graft comprises having the columned graft material of being roughly of attachment component, this attachment component comprises a plurality of hook assemblies, these assemblies are implanted to penetrate arterial wall in aneurysmal above and below by dual duct system, thereby attached securely arterial graft, and get rid of aneurysm from blood circulation thus.
WO 2003/099167 discloses the intracavitary unit with barb assembly.The intracavitary unit that is used for implanting body cavity has reduced device moving or moving after implanting by utilizing barb or barb assembly.First embodiment uses at least one barb assembly, and this barb assembly has first, the bending section on the implant of being attached to and is arranged to relative with first with respect to bending section and has surface-supported second portion.Second portion is suitable for radially inwardly stretching out when implant is in the radial compression structure and radially outward stretching out when implant is in its radial development structure.Second embodiment uses the barb with curved section, and this section radially curves inwardly in the proximal end.The 3rd embodiment adopts at least one barb assembly, and described barb assembly has the line of length greater than the compartment height (cell height) of implant, and wherein this line crosses the area of section that this implant extends and have basically identical.
Summary of the invention
The present invention relates to be used to make object based on penetrating of at least one object and relative to each other fastening apparatus and method, described object therefore can be by fabric or similarly natural or artificial material make (but must so), and described object all can be the layer form of the arbitrary shape that comprises curve or flat shape, described object also can be tissue, comprise such as biological tissue, for example blood vessel wall.
Term " fastening " under the application's the situation except its its ordinary meaning, also expression makes two or more objects relative to each other to be in contact with one another or discontiguous mode connects or fixing, perhaps the structure that expression connects or fixing two or more objects form with some objects that form by the layer form that links together.If be used in the medical applications, thisly fasteningly (for example can for example represent blood vessel with various versions, side to side-to-side anastomosis, end to end anastomosis, end to side-to-side anastomosis) coincideing of carrying out, perhaps represent anchoring such as securing bracket object, make vascular shunt, with artificial (tremulous pulse) valve connect in place, pick off is anchored in the human chamber or the like.
According to an aspect of the present invention, a kind of clamp device is provided, this device is associated with first object, be used for described object is attached to second object, this device comprises at least one tightening member with base portion and at least one standing part, described tightening member manufactures at first and makes its standing part have first orientation and can make described standing part be in second orientation with respect to described base portion with respect to described base portion, thereby make described at least one standing part when remaining in described second orientation, penetrate described second object to its exposure, and described tightening member is suitable for described second orientation is changed into described first orientation, and is described attached to realize.
But the tightening member of said apparatus can be included in the constraint portions between described base portion and the standing part, but described tightening member manufactures at first and makes its standing part have described first orientation and make described standing part be in described second orientation with respect to described base portion by retraining described constraint portions with respect to described base portion, thereby but when the constraint removed described constraint portions, make described standing part return its first orientation from its second orientation; Tightening member in the described device has the state of penetrating, but described constraint portions is constrained for described at least one standing part remained at this state of penetrating and constitutes it and penetrate the described second orientation in orientation, so that described at least one standing part can describedly penetrate described second object when penetrating the orientation remaining in, thereby and be suitable for the described state of penetrating changed into and remove described constraint and make described at least one standing part return the attached state of its described first orientation, this first orientation constitutes the attached orientation of described at least one standing part, and described first object is attached to described second object in this attached orientation.
Under the application's situation, term " but constraint portions " is meant the part of tightening member, thinking here that the state of this part manufactures at first in this element is in " not constrained state ", and this part can deform or mechanically be operated when directly or indirectly being applied with so-called " restraining forces "; Constraint portions is returned its original state when restraining forces is disengaged.
According to a further aspect in the invention, a kind of clamp device with a plurality of aforesaid tightening members and a plurality of confinement elements is provided, described confinement element can be for being installed in the form of the keeper on the clamp device, each keeper all is used for the constraint portions of at least one tightening member is remained on constrained state, but each described confinement element all is suitable for being applied in motivator discharging described constraint portions, and makes the standing part of described tightening member return its attached orientation whereby.
The orientation that it should be noted that the standing part of tightening member can not only be set up with respect to described base portion, can also with respect to object to be penetrated or on it certain a bit or surface and setting up.
Described confinement element can move between constrained and off-position with respect to its tightening member, but described confinement element imposes restriction power so that described at least one standing part is remained on the described orientation that penetrates to constraint portions directly or indirectly in described constrained, and in described off-position, but removal is to the described restraining forces of described constraint portions, thereby makes described at least one standing part be in described attached orientation.
Described clamp device also can comprise bearing part, and this bearing part has at least one bearing part that a more than described tightening member is installed.Described bearing part can be suitable for changing its state between collapsed state and deployed condition, when being in collapsed state, described tightening member is arranged apart from described second object to be penetrated relatively far, and when being in deployed condition, the described tightening member of at least a portion is near described second object and is caused and penetrates this object.When bearing part was in its collapsed state, described tightening member was along the direction orientation that is different from penetration direction, and this bearing part is suitable for making described tightening member to align with penetration direction before near arrival second object.
Described clamp device can be manufactured into and make its bearing part be in aforesaid collapsed state, described bearing part can for example apply compression stress thereon by sheath and be kept this state, and when removing compression stress, can a plurality of tightening members be alignd with penetration direction.Can utilize air bag respectively by expanding and shrinking and realize the expansion of bearing part and make it be in collapsed state.
Described bearing part can be configured for confinement element is applied the part of the actuation component of motivator, and this can be achieved by described bearing part being had be suitable for when described bearing part is expanded to predetermined extent the layout that each described confinement element is applied described motivator.Therefore, for example when penetrating object to predetermined extent, the further expansion of bearing part can make can remove described restraining forces, thereby makes the orientation of the standing part of described tightening member change into constant bearing from penetrating the orientation.
Optionally, each tightening member can have such layout, and this layout is suitable for when described at least one standing part has penetrated second object to predetermined extent described confinement element being applied described motivator.Therefore, for example when penetrating second object when it is contacted with described keeper, the further expansion of bearing part can make described keeper move with respect to tightening member, thereby removes described restraining forces.
In accordance with a further aspect of the present invention, provide a kind of method that is used for first object is attached to second object, this method comprises:
-at least one tightening member is set, described tightening member extends along penetration direction, stretch out or be connected on described first object from described first object, and has a standing part, this tightening member is suitable for changing its state between state of penetrating and attached state, under the state of penetrating, described standing part has the orientation that penetrates that is suitable for penetrating described second object, and under attached state, described standing part has and is transverse to the attached orientation that penetrates the orientation, the described attached orientation of wherein said standing part is the residing predetermined state of the initial manufacturing of described tightening member, can penetrate the orientation and can make described standing part turn back to described predetermined state from its second orientation when removing restraining forces by to the described tightening member power of imposing restriction described standing part being in;
-make described at least standing part penetrate described second object when penetrating the orientation being in; And
-remove described restraining forces, so that described tightening member is changed into described attached state with its state.
Advantageously, clamp device according to the present invention can be used for side offside, end offside or end-to-end mode tubular articles being attached to each other together.An embodiment of this purposes is that the stent graft side offside that is arranged in the blood vessel is attached on the blood vessel wall.In this application, clamp device can constitute the integral part of support, and this support is the part of stent graft, and this is configured to bearing part, and this bearing part has at least one bearing part, and described at least one tightening member is installed on this bearing part.Optionally, clamp device can form dividually with stent graft, in this case, described device also comprises bearing part, this bearing part has at least one bearing part that described at least one tightening member is installed, stent graft has at least one join domain, described bearing part can be inserted into stent graft inside so that described tightening member can penetrate described support at described join domain place and stretch out from described join domain.In this case, clamp device must be arranged in the stent graft.According to another aspect of the invention, provide and utilize support to make the apparatus and method of clamp device with respect to blood vessel location and centering with upper and lower, described upper and lower all can be independent of another and collapse and launch, and clamp device is attached to the bottom of support.Under the original state of support, all collapse by the compression stress (for example, passing through sheath) that is applied thereto in described upper and lower.Then, remove compression stress, thereby its periphery contact with on every side blood vessel wall, just can the bottom of support and attached thereon clamp device correctly be located also thus and can realize centering with respect to blood vessel from the top of support.
According to another aspect of the invention, be provided for making described clamp device with respect to stent graft or treat to arrange the apparatus and method of another tubular articles centering of this clamp device within it.
According to another aspect of the invention, the support that is suitable for being arranged in the blood vessel and has at least one join domain is provided, this support is suitable for playing the effect of clamp device and comprises that at least one is such as aforesaid tightening member afterwards in being disposed in blood vessel at least, described tightening member stretches out along penetration direction from described join domain and has a standing part, this standing part can penetrate its orientation with respect to described penetration direction of change between orientation and the attached orientation, when being in when penetrating the orientation, at least the penetrable blood vessel wall of described standing part, and when being in attached orientation, standing part is transverse to the penetration direction orientation and is suitable for pushing described blood vessel wall at least in part towards the described join domain of support.
Described support can have top about described all features of the bearing part of clamp device.Specifically, described support can change its state between collapsed state and deployed condition, when being in collapsed state, tightening member is arranged apart from blood vessel wall relatively far, and when being in deployed condition, at least a portion tightening member is near the blood vessel wall and the penetration rate of blood tube wall.When bearing part was in its collapsed state, described tightening member was along the direction orientation that is different from penetration direction, and wherein made before tightening member is near the blood vessel wall, and described bearing part is suitable for making tightening member to align with penetration direction.
The bearing part of support can have for the bearing part that described tightening member is installed, described bearing part is suitable for changing its shape and/or orientation with respect to the neighbouring part of bearing part, thereby the concrete layout that changes described tightening member between layout and the described attached orientation that penetrates at described tightening member, deposit at the described cloth that penetrates, the standing part of described tightening member has the described orientation that penetrates, and in described attached orientation, described standing part is transverse to described penetration direction orientation.This for example can realize to change its shape and/or orientation by making described bearing part carry out plastic deformation, for example, and when bearing part is in described deployed condition.Optionally, tightening member can move to change the orientation of described standing part with respect to described bearing part.
The bearing part of support can have a plurality of bearing parts and described tightening member can be installed on the described bearing part to fix with respect to it, this bearing part constitutes described first object maybe can be connected to described first object, the described bearing part plastically deformable of described bearing part is to change into their original state their end-state, under described original state, described tightening member is orientated to penetrate described second object along penetration direction, and under described end-state, described tightening member is transverse to described penetration direction orientation to push described second object at least in part towards described bearing part.
According to another aspect of the invention, be provided for making the method for clamp device with at least one aforesaid tightening member, this tightening member is associated with first object, be used for this object is attached to second object, described device comprises at least one tightening member, described tightening member has base portion and standing part, this standing part can be suitable for penetrating penetrating the orientation and being transverse to its orientation with respect to described base portion of change between this attached orientation that penetrates the orientation of described second object at described standing part, and described method comprises:
-make described tightening member with described standing part, this standing part is in the initial orientation that is similar to described attached orientation at least, and penetrates the orientation being applied in described initial orientation to be changed into when binding; With
-confinement element is placed on the tightening member it is applied described restraining forces, thereby make described standing part be in the described orientation that penetrates, described confinement element can move along the direction of described tightening member, to remove described restraining forces from described standing part, thereby make described standing part be in described attached orientation, the size of this confinement element on described direction is less than described tightening member.
Tightening member in the clamp device of Zhi Zaoing can be designed to as mentioned above, but makes its base portion and standing part for to sentence mechanical system separating component connected to one another in described constraint portions.Optionally, but the tightening member of some or all can be at least at the monomeric form of described constraint portions place elastically deformable.In this case, tightening member can comprise elastic material or shape-memory material or be made by this material.Back one material has the characteristic that undergoes phase transition under given conditions, therefore work as this material and (for example be in an one phase, produce described tightening member in the time of at high temperature), thereby make its cooling (for example be transformed to its second state then, at low temperatures), penetrate the orientation so that the standing part of tightening member is in it, and when needs are taked its attached orientation, recover its original state subsequently (for example, by temperature is risen).
The concrete state that wherein aforesaid tightening member can be manufactured at first is a case of bending, and this can realize by tightening member is applied bending force.Therefore, when tightening member is in it not during case of bending, described standing part is in it and penetrates the orientation, and when tightening member was in its case of bending, described standing part was in its attached orientation.In this case, clamp device also can comprise such parts, these parts be used for by provide by at least one keeper the opposing described bending force balancing force make tightening member remain in its not case of bending, and by make described at least one keeper with respect at least one tightening member move make tightening member under the bending force effect in described bending area bending.
In accordance with a further aspect of the present invention, a kind of be used to make first object and the attached clamp device of second object are provided, this device comprises bearing part, this bearing part has at least one bearing part and is mounted on the described bearing part with respect to its fixed at least one tightening member, this bearing part constitutes described first object and can be connected on described first object, described at least one bearing part elastically deformable of bearing part is to change into end-state from its original state, under original state, tightening member is orientated to penetrate described second object along penetration direction, under end-state, tightening member is transverse to described penetration direction orientation to push described second object at least in part towards described bearing part.
Description of drawings
For ease of understanding the present invention and understanding how to implement the present invention in practice, only embodiment is described below with reference to accompanying drawings in the mode of non-limiting example, among the figure:
Figure 1A and Figure 1B are the sketch maps of seeing from the top according to the clamp device of one embodiment of the present invention;
Fig. 1 C, Fig. 1 D and Fig. 2 are the identical view that is in the clamp device in the operation as shown in Figure 1A and Figure 1B respectively;
Fig. 3 A and Fig. 3 B be another embodiment according to the present invention clamp device before its operation and afterwards from above the sketch map seen;
Fig. 4 A to Fig. 4 C shows the different embodiments that can be used on according to the tightening member in the clamp device of the present invention;
Fig. 5 A and Fig. 5 B be according to the present invention again the clamp device of an embodiment before its operation and afterwards from above the sketch map seen;
Fig. 5 C be according to the clamp device of alternative embodiment of the present invention, with Fig. 5 category-B like sketch map;
Fig. 6 A to Fig. 8 B shows the embodiment that can be used on according to the different embodiments of tightening member in the clamp device of the present invention and constraint component thereof;
Fig. 9 A to Figure 11 shows tightening member about can be used on the embodiment according to the difference setting of the bearing part in the clamp device of the present invention;
Figure 12 shows the embodiment according to the mode of operation of the tightening member of different embodiments of the invention;
Figure 13 A to Figure 13 B shows the design implementation example that can be used on according to the different piece of the tightening member in the clamp device of the present invention;
Figure 14 A to Figure 15 shows the embodiment that can be used on according to the different cross section shape of the standing part of the tightening member in the clamp device of the present invention and corresponding keeper;
Figure 16 A to Figure 16 C shows according to the present invention tightening member and the operation thereof in the clamp device of an embodiment again;
Figure 17 A to Figure 18 C shows the embodiment that can be used on according to the different designs of the bearing part in the clamp device of the present invention;
Figure 19 A and Figure 19 B show other optional designs that can be used on according to the tightening member in the clamp device of the present invention;
Figure 20 A to Figure 21 B shows the embodiment that can be used for making according to the localized positioning element of clamp device of the present invention;
Figure 22 shows and the similar clamp device shown in Fig. 1 C, and this device is in the centering position in blood vessel;
Figure 23 A to Figure 23 C shows an embodiment of the air bag that can use with this bearing part shown in Figure 17 A to Figure 17 E;
Figure 24 A to Figure 26 F shows the different embodiment that clamp device of the present invention are set to endovascular process;
Figure 27 shows according to the present invention the layout of the tightening member in the clamp device of a part embodiment, that constitute support again; And
Figure 28 A to Figure 28 C shows the different attached type that utilization clamp device according to the present invention is attached to one another object.
The specific embodiment
Schematically show a simplified embodiment among Figure 1A and Figure 1B according to clamp device of the present invention.Clamp device 11 comprises bearing part 13 and attached thereon a plurality of tightening members 15.Shown in Figure 1B, but each tightening member 15 includes base portion 17, standing part 18 and the constraint portions between them 19, and each tightening member 15 is suitable for being in different conditions according to the different azimuth of its standing part 18, and these states are state that penetrates shown in Figure 1A and the attached state shown in Figure 1B.
Usually, clamp device 11 can constitute the part of first object, this first object is treated to be attached on this second object by the tightening member that penetrates second object, and perhaps this clamp device can be attached on one or more other objects one of them object by making tightening member penetrate all these objects.In the previous case, in Figure 1A and Figure 1B, the bearing part 13 of clamp device 11 can for example constitute the part of the object with rounded outer surface, and this object can be by being penetrated into tightening member to be inserted in this tubular articles in the tubular articles and attaching on its inner surface.Under latter event, clamp device 11 can for example be used for first tubular articles is fastened at its second tubular articles on every side, in this case, clamp device can be arranged in first object, and these two objects can owing to tightening member penetrate they wall and secured together.
The embodiment of use more specifically that is used for the clamp device 11 of the attached stent graft that is intended to arrange and attach to blood vessel is, utilizes tightening member 15 penetration rate of blood tube walls and fixing whereby this is attached.Clamp device can constitute the integral part of support, and in this case, bearing part 13 is the bearing part of support, i.e. the part of support, and tightening member 15 is installed in this part place and stretches out and the penetration rate of blood tube wall from this part.Clamp device also can separate manufacturing with support and can be suitable for being arranged in wherein.In this case, stent graft will have the join domain (not shown), and tightening member will penetrate graft and protruding from this zone in this zone.In the clamp device shown in Figure 1A and Figure 1B, can suppose that join domain is arranged near the outer surface of bearing part 13, and fastened element 15 penetrates with further penetration rate of blood tube wall.
In view of above-mentioned, and only for the ease of understanding better, in the further specifying of the clamp device that clamp device 11 and other is had bearing part, in due course, should be considered as the bearing part that each bearing part all constitutes the support that is integrally formed therewith, perhaps be considered as wherein being furnished with the join domain of the stent graft of each bearing part.
Fig. 1 C and Fig. 1 D show clamp device 11 and are attached to process on the blood vessel wall W.Shown in Fig. 1 C, penetrate in the process of wall W at tightening member 15, its standing part 18 roughly aligns with base portion 17 along the penetration direction shown in the arrow.Shown in Fig. 1 D, when penetrating when finishing, standing part 18 is in itself and the attached orientation of base portion 17 traversed bies, to face toward bearing part 13 extruded wall W.
Though it should be noted that in Figure 1A to Fig. 1 D, penetration direction is depicted as with respect to bearing part 13 roughly to become radially, might not be so.Therefore, optionally the same with the situation of for example holding offside or end to end anastomosis, penetration direction can be parallel to the longitudinal axis of bearing part, and perhaps penetration direction can be any other directions according to the geometry for the treatment of the fastening object of fastened device and layout.
Above-mentioned can the realization by making tightening member 15 with suitable material as described below, thereby under original state, make the standing part 18 of tightening member have or identical orientation approximate with its predetermined attached orientation, penetrate the orientation and retrain constraint portions 19 but standing part 18 is in, but and finally discharge constraint portions 19 so that standing part 18 is in attached orientation so that standing part remains in this orientation whole penetrating in the process (as below will describing in detail).It is strict with base portion 17 that standing part 18 might not be wanted when being in its attached orientation, but can form any obtuse angle or acute angle with it, and standing part might not be wanted to align with base portion 17 fully when being in it and penetrating the orientation, can tilt slightly with respect to it and make.
Tightening member can be made by elasticity or elastic material, shape-memory material or alloy (such as Nitinol) or any other suitable material, so that but strain can at first for example take place at its constraint portions place in tightening member 15, but remain in this deformation state a period of time by the constraint component that acts on this constraint portions then, return its initial deformation state by discharging described constraint component at last.The simplest embodiment of the above-mentioned distortion of tightening member 15 is but that it is in constraint portions 19 places bending.
With reference to Fig. 2, bearing part 13 can be suitable for shown in the solid line collapse or contraction state and dotted line shown in deployed condition between change its state.It should be noted, the tightening member 15 that illustrates might not extend along penetration direction shown in this Fig in collapsed state, and as below with more detailed description, can take measures with when described device still is in its collapsed state along penetration direction to the tightening member channeling conduct.This is particularly useful for medical applications, and in this occasion, clamp device must be first drawn in the inner chamber or chamber such as blood vessel, launch then so that tightening member 15 near chamber wall and penetrate chamber wall.Bearing part 13 can launch by any suitable mode, for example launches by the air bag (not shown) that is incorporated into is wherein expanded.Optionally, bearing part 13 can self-deploy, and in this case, this bearing part is suitable for remaining in collapsed state at first by the sheath (not shown) directly or indirectly, realizes launching by removing this sheath.Bearing part 13 might not be closure or round-shaped, but can have any spatial form according to object to be tightened.For example, Fig. 3 A and Fig. 3 B show the clamp device 31 that has for the bearing part 33 of elongated open structure, and wherein tightening member 15 is in it and penetrates state (Fig. 3 A) and attached state (Fig. 3 B).Bearing part 13 can by arbitrarily suitably material make, this material makes bearing part can finish aforesaid behavior.Described material can have high resiliency and can be and the identical kind of material phase XOR of making tightening member 15.
With reference to Fig. 4 A, Fig. 4 B and Fig. 5 A to Fig. 5 C, the embodiment of constraint component will be described below, penetrate in the process and shown in Fig. 1 C, each tightening member 15 utilizes constraint component that its standing part 18 is remained in and penetrates the orientation aforesaid.In all these embodiment, constraint component is the form of keeper 41 (Fig. 4 A and Fig. 4 B) or 51 (Fig. 5 A to Fig. 5 C), and this keeper is for movably being installed in sleeve or the sleeve pipe on the tightening member 15.The length L of keeper 41,51
H(only in Fig. 4 A, marking) but depend on the length L of constraint portions 19
RLength L with the base portion 17 of tightening member 15
B, L
R≤ L
H≤ L
BThe length L of keeper
HBut at least a portion of the constraint portions 19 that can cover tightening member 15 and make near base portion 17 at least a portion bearing part 13 keep exposing, thereby but make keeper can move to the required degree of release constraint portions 19 along tightening member 15 along direction towards bearing part 13.Tightening member 15 can also have the parts that prevent that keeper 41 edges from moving away from the direction of bearing part 13, separates with tightening member 15 to avoid it.Aforesaid this keeper can be suitable for keeping a more than tightening member, as shown in Fig. 4 C.
In the keeper 41 of Fig. 4 A, Fig. 4 B and Fig. 4 C, should move and to realize by following manner, that is: the flange 43 that is in its near-end 45 places and crosses out for the keeper setting from this near-end 45, in the process of penetrating by such as blood vessel wall or organize the quilt of (not shown) to penetrate object keeper is applied motivator F.Shown in Fig. 4 B, in case but keeper 41 moves to the degree that constraint portions 19 to the small part that makes tightening member 15 is exposed under the effect of motivator, but thereby discharging constraint portions 19 (recovering its initial not constrained state), standing part 18 is just correspondingly changed into attached orientation with its orientation.
In the keeper 51 shown in Fig. 5 A to Fig. 5 C, the 53 pairs of keepers of cable that utilize an end to be connected with this keeper apply motivator.The other end of cable 53 is suitable for actuating cable by making cable become tensioning state (Fig. 5 B and Fig. 5 C) from its relaxed state (Fig. 5 A), so that keeper moves with respect to tightening member 15.The tensioning of cable 53 can realize by any suitable manner, perhaps by the mode of remote control or for example the state by the bearing part 13 that is mounted thereon with tightening member change the layout that is associated and realize.This bearing part can be for as above described like that with reference to Fig. 2, and variation between the deployed condition (Fig. 5 B, Fig. 5 C) of collapsed state (Fig. 5 A) that therefore its state will cable be loose therein and wherein cable 53 tensionings.In the embodiment of Fig. 5 A and Fig. 5 B, the cable 53 of a tightening member 15 is connected with the keeper 51 of the tightening member of the opposite side that is in bearing part 13.Under the situation shown in Fig. 5 B, bearing part 13 for example enters its deployed condition by above-mentioned arbitrary mode, it has predetermined final size in this state, the cable 53 that also has a predetermined final lengths converges keeper 51 toward each other and therefore towards bearing part 13, thereby but they is moved at least towards bearing part fully leave the constraint portions 19 of corresponding tightening member 15 and therefore these parts are released until them.As a result, standing part 18 with its orientation from penetrating the orientation and change into attached orientation and tightening member 15 being changed into the attached state identical with its original state with its state from the state of penetrating.In the embodiment of Fig. 5 C, the keeper 51 of all tightening members 15 all with bearing part in an element be connected, such as center ring or ringed line 55.Optionally, in the embodiment of Fig. 5 C, all keepers 51 all can be connected by the single cable along the circumferential extension of bearing part 13 (not shown).Similar shown in final result under latter event and the final result under the situation of Fig. 5 C and Fig. 5 B, wherein tightening member 15 is because moving of keeper 51 and its state is changed into attached state.
Fig. 6 A and Fig. 6 B show the optional embodiment of constraint component, this constraint component is the form that is arranged separately in the keeper 61 of (but not covering constraint portions) on the standing part 18 of tightening member 15, can move along standing part when it is subjected to the time spent of doing of the motivator that object is applied thereto under penetrativity.In this embodiment, constraint component also comprises cable 63, one end of this cable is connected with keeper 61 and the other end is controlled as along a direction tensioning (Fig. 6 A), and this direction and standing part 18 wherein are for taking its attached orientation must motion direction (Fig. 6 B) opposite.But be positioned on the standing part 18 or must apply tensile force to cable on the constraint portions 19 time at keeper 61 at least.
It should be noted that keeper 41,51 and 61 need not be form of sleeve, also can make or not make keeper to enter any other forms of waiting to penetrate object for being suitable for the standing part 18 of tightening member 15.And, but but the length of keeper can be less than the length of constraint portions or covers constraint portions.For example, as shown in Figure 7A, keeper can be the form of retainer 71, and it has for example flange 43 similar flat surfaces of size and operation and keeper 41.Especially advantageously, retainer 71 can use with these two tightening members by the standing part 18 (the same as shown) of two tightening members, but these two tightening members are tending towards along opposite direction bending at their constraint portions 19 places.But therefore retainer 71 holds them in together between the top of these two tightening members and constraint portions.
In addition, above-mentioned keeper can have such design, shown in Fig. 7 B, tightening member 15 is held in its standing part 18 is tilted as expectation with respect to base portion.In one embodiment of back, this inclination can be along being tending towards moving with the side that realizes its attached orientation in the opposite direction with standing part 18 wherein.
In above-mentioned all embodiment, keeper is installed on the tightening member 15 tightly, thereby on this tightening member, remain in its initial position by frictional force, when under the effect that makes keeper in motivator when tightening member moves, this motivator must be greater than frictional force.But for realizing above-mentioned action, with reference to as described in Figure 14 A to Figure 14 C, keeper needn't contact with tightening member on its whole circumference or whole length as following.
In addition, for the ease of the interaction between keeper and the tightening member, their interactive surfaces can have specific fit shapes so that keeper has rotational component along moving of tightening member.Fig. 8 A and Fig. 8 B show the different embodiment of this layout.In Fig. 8 A, tightening member 81 has threaded portion 85 and keeper 83 has corresponding spiral part 87, and this spiral part is suitable for interacting with described threaded portion and making keeper carry out screw along tightening member 81 thus when being applied in motivator.In Fig. 8 B, tightening member 80 has skewed slot 84 and keeper 82 has corresponding projection 86, and this projection is suitable for being contained in the skewed slot 84 and keeper is moved with spiral or similar mode along tightening member 80 when being applied in motivator.
Tightening member can have initial space with respect to bearing part when being in it and penetrating state arranges, this is different from the space of tightening member when penetration direction is directed and arranges.In these cases, need take measures to make tightening member to be moved into penetration direction from its initial placement aligns.Some embodiment that tightening member is arranged with respect to the difference of bearing part have been shown among Fig. 9 A to Fig. 9 C, and bearing part is the form with Z-shaped support 91 of pillar S.The height of pillar S is parallel to the central axis of support.In Fig. 9 A, tightening member 93 is roughly along the circumferential orientation of support 91, and this is circumferentially perpendicular to the height of pillar S and represented by arrow in Fig. 9 A, and tightening member 95 is with respect to this peripheral, oblique.Fig. 9 B show tightening member 97 perpendicular to support circumferentially.Fig. 9 C shows along the tightening member 99 of a part of pillar orientation of support.Shown in Figure 10 A and Figure 10 B, tightening member 103 can have the layout that differs from one another when being in it and penetrating state.
Can comprise more than row's tightening member according to clamp device of the present invention, these tightening members along the height placement of clamp device at the diverse location place.Figure 11 shows clamp device 110, and it has the bearing part for Z-shaped support 111 forms, and the two row's tightening members 113 and 115 that are in attached state, and this two rows tightening member is installed in the upward end 117 and lower end 119 places of stent strut.The position of tightening member 113 and 115 on bearing part 111 is not limited to post tips, but can be in any suitable position along pillar.In addition, bearing part can have the pillar of differing heights, also can be fixed with tightening member on this pillar.
To illustrate below in having the clamp device of above-mentioned arbitrary constraint component, according to the various embodiments of tightening member of the present invention.
But tightening member can maybe can make these parts interconnect mechanically for the monomeric form that has base portion constraint portions and standing part as mentioned above.In these two kinds of schemes, but that the constraint portions 19 of tightening member all is suitable for is restrained as mentioned above, but and standing part 18 be suitable for changing its orientation with respect to base portion 17 because of the release of constraint portions 19.Figure 12 shows and is installed on the bearing part 121, is used for two kinds of tightening member 123a of fastening two objects 128 and 129 and the embodiment of 123b.Can comprise base portion 122 (shown in broken lines) for the tightening member 123a of monomer or kit form but constraint portions 124 and standing part 126.At the (not shown) in the state that penetrates of tightening member 123a, but base portion 122 constraint portions 124 and standing part 126 penetrate object 128 and 129.Then, but constraint portions 124 is released and standing part 126 penetrates the orientation from it and changes over attached orientation, and wherein object 128 and 129 is extruded against bearing part 121.Tightening member 123b has the additional base portion 122b that is connected with bearing part 121.This extention makes object 128 and 129 to be extruded against extention 122b rather than against bearing part 121.Therefore, saving under the situation of bearing part, tightening member 123b can be used as bearing part and a part of tightening member simultaneously.
Tightening member can have a more than aforementioned each several part, these parts all not necessarily as described above embodiment equally be straight.Figure 13 A and Figure 13 B show the embodiment of various designs of the different piece of tightening member.Figure 13 A shows clamp device, and it comprises the tightening member 133 with two base portion 134a and 134b, but and shows constraint portions 135 and standing part 136.Base portion 134a is arranged essentially parallel to standing part 136, thereby makes it whereby towards base portion 134a extruding object to be penetrated when the attached orientation shown in standing part 136 is in.Standing part 136 has arrow shaped end 137 at the top, so that it penetrates object to be tightened.It should be noted that described in this application standing part can have any appropriate format that allows to be penetrated in the object, for example it can be the form of barb or hook.
But the constraint portions 135 shown in Figure 13 A has the round-shaped of opening, so that standing part 136 can be further parallel with base portion 134a when being in attached orientation, but and the less bending of constraint portions 135 generation radiuses.Figure 13 B shows tightening member 139, and it has two standing parts 138 that are sinusoidal shape, this shape can for any other cycle shapes or aperiodic shape, wherein the extension elongation L of standing part is less than its physical length.This standing part can be object to be tightened better tensioning is provided.
With reference to Figure 14 A to Figure 14 D, show some embodiment of the various cross sectional shapes of standing part and corresponding keeper, they can be used for above-mentioned arbitrary tightening member.These shapes since tightening member with wait to penetrate the minimizing of the total contact area between the object, be convenient to tightening member and penetrate into object to be penetrated and may be selected to be, and so come overcome friction by keeper is applied motivator.The different feasible cross sectional shape of standing part 141 has been shown among Figure 14 A, Figure 14 B and Figure 14 C, and this standing part has far-end and near-end (not shown) and the cross section that illustrates relates generally to their near-end, and their far-end can have sharp-pointed end 145.Figure 14 A to Figure 14 B also show (with dotted line) keeper 143 on being installed in corresponding standing part so that it remains in the cross sectional shape when penetrating the orientation.Standing part 141 can contact with its keeper 143 fully along the whole periphery in its cross section, as shown in Figure 14B, perhaps can only partly contact with standing part 141, shown in Figure 14 A, perhaps in selected contact point place contact, shown in Figure 14 C.Figure 14 D shows circular standing part 141 and keeper 143 thereof.Standing part and keeper 143 might not be always contact along their periphery.The cross section of standing part 141 can be less than the cross section of keeper 143.Under latter event and among the embodiment shown in every other, have specific gap between standing part 141 and keeper 143, available viscosity is enough to the material of the mutual rubbing action of generation between standing part and keeper and fills this gap.Interactional another embodiment between standing part and the keeper has been shown among Figure 15.Because the given shape of standing part 151 and keeper 153 mounted thereto has reduced the total contact area between them.
Can have according to tightening member of the present invention a pair of incessantly, but each is to including a constraint portions and a standing part.Figure 16 A to Figure 16 C shows tightening member 161, but but it has base portion 163 constraint portions 165a, standing part 167a, another constraint portions 165b and another standing part 167b.This tightening member also comprises two keeper 168a and 168b, but is used to make each constraint portions 165a and 165b to keep being tied.These parts can connect by line 166, so that they can carry out collaborative mutually motion.Particularly, keeper 168a is longer than keeper 168b, but and is designed and is mounted to line 166 and make that keeper 168a and moving downward of 168b can make constraint portions 165b at first be released in the process of penetrating.This can represent by following relation: but but between the upper limb of keeper 168a and the constraint portions 165a apart from △ a greater than between the upper limb of keeper 168b and the constraint portions 165b apart from △ b.In operation, at first, tightening member 161 is in it and penetrates state (Figure 16 A), in the process of penetrating, keeper 168a moves down then, thereby by cable 166 pulling keeper 168b, but constraint portions 165b is released, but and constraint portions 165a is not released.Therefore, have only standing part 167b to penetrate the orientation and become its attached orientation (Figure 16 B), penetrate the orientation and standing part 167a still is in it from it.When proceeding to penetrate, keeper 168a continues to move down, but up to keeper 168a constraint portions 165a is fully exposed, but constraint portions 165a is released.Therefore, standing part 167a penetrates the orientation from it and changes into its attached orientation, shown in Figure 16 C.
Figure 17 A to Figure 18 C represents that according to tightening member of the present invention its state changes along with the variation of at least a portion of the bearing part that connects these tightening members.
Figure 17 A and Figure 17 B show the part of the clamp device with bearing part 171, and this bearing part comprises a plurality of arcuations bearing part 175, and tightening member 173 is attaching to each bearing part with its summit 174 isolated location.The radius r of bearing part 175 is roughly less than the radius R of bearing part 171, and has connecting portion 175a and 175b, and the remainder of bearing part and bearing part converges at described connecting portion place.The bearing part be designed to when for example by air bag when the inboard of bearing part 171 is applied in radial force, the bearing part is crooked so that their form is changed into convex from spill.Therefore, tightening member 173 is changed into attached state (Figure 17 B) with its state from the state of penetrating (Figure 17 A).It should be noted that tightening member 173 does not change its form in this change process.When bearing part 175 is in the plastic region of making the used material in bearing part 171 and bearing part 175, can realize the above-mentioned variation of bearing part 175.This material can be rustless steel or other suitable materials arbitrarily.Shown in Figure 17 C, clamp device is the integral part of support, and stent strut constitutes bearing part 171 and have restriction pillar 176 near the bending point 177 of support, and this pillar is than bending point 177 firmer (for example, width is bigger than the pillar of support 171).Pillar 176 is used to limit the bending of the bending point 177 of bearing part 171.Therefore, when the air bag (not shown) expands in bearing part 171, cause bearing part 171 to be expanded to pillar 176 restrictions and further launch arbitrarily.In the process of penetrating, answer unfolded maximum gauge according to bearing part 171, pre-determine the design of pillar 176.Required for this reason expansion power is less than the required power of form (that is, making it in bending point 177 places bending) that changes the bearing part, thereby in the expansion process of bearing part, the bearing part does not deform.When power arrival makes the bearing part be out of shape required value, any further unfolded pillar 176 by restriction bearing part 171, power (that is, the additional expansion energy of air bag) is passed to bearing part 175 and makes its distortion, therefore makes tightening member 173 become attached state from its state of penetrating.
Figure 17 D and Figure 17 E show bearing part 171, its bearing part 175 with another structure and the tightening member 173 that under the state of penetrating (Figure 17 C) and attached state, is connected with this bearing part, and wherein the overlapping of tightening member 173 can promote attached.
Figure 18 A shows the embodiment of anastomosis clamp device 190, and this clamp device will be arranged in the stent graft 185, is used in the mode of side offside stent graft being attached to blood vessel wall W, and this attach procedure is shown in Figure 18 B and Figure 18 C.This clamp device comprises bearing part 181 that is roughly flap and the tightening member 183 that is connected with this bearing part under their initial (collapsing) state (Figure 18 A).Tightening member 183 is arranged in pairs with the decussation form, can cover the major part on this surface when being in its collapsed state in the mode on the lobe surface that is basically parallel to bearing part 181.Tightening member is installed in and makes its original state can change into the state of penetrating (Figure 18 B) on the bearing part 181, return then and its original state similarly attached (collapsing) state (Figure 18 C), wherein bearing part 181 is attached to stent graft 185 on the blood vessel wall W tightly.The expansion of bearing part 181 from collapsed state (Figure 18 A) to deployed condition (Figure 18 B), with and be withdrawn into collapsed state (Figure 18 C) can be by such as the expansion of air bag (not shown) with shrink and realize.
Figure 19 A and Figure 19 B show another embodiment according to clamp device 190 of the present invention, and this device is waited to be attached on the blood vessel wall W, and comprises: bearing part 191, and it can be stent graft; Tightening member 193, it attaches on the bearing part movably; And rotary part 195, it makes that tightening member 193 can be with respect to bearing part 191 rotations.The rotation of each tightening member 193 can be by being constrained to the desired orientation and the specific anglec of rotation such as the spring (not shown) that is fixed on the bearing part 191.Tightening member 193 has standing part 197 and base portion 199, and these two parts are all changed into attached orientation (as Figure 19 B shown in) with their orientation from penetrating orientation (shown in Figure 19 A) owing to the rotation of rotary part 195.Tightening member 193 can be in the state of penetrating by the expansion of air bag 198, prevents rotary part 195 rotations thereby air bag will push base portion 199.When airbag inflation, bearing part 191 launches, so tightening member 193 can transparent walls W.Air bag shrinks afterwards, thereby discharges rotary part, thereby makes tightening member 193 rotate to attached state.It should be noted that in these conversion processes, the form of tightening member 193 does not change.
In the purposes of treatment aspect the abdominal aortic aneurysm use of this clamp device is described with reference to clamp device according to the present invention below, may breaks if potential weakness is excessive in the arterial wall.In therapeutic process, stent graft is inserted into tremulous pulse (below be referred to as " blood vessel ") launches then to be fixed therein.Stent graft is intended to isolated by the aneurysmal mobile proper flow (via graft) of recovering blood subsequently.This prevents that conversely aneurysm from breaking.Therefore, above-mentioned arbitrary clamp device can be used for stent graft is fixed on the arterial wall, rather than or fixes the support except stent graft as is well known equally utilizes the radial force of effect thus.This is especially favourable in following situation, and wherein aneurysm is near important limbs or tremulous pulse, such as renal artery.In this case, there is not length to be enough to for arranging the commercially available healthy aorta wall that uses based on the fixed stent graft of radial force (not having " cervical region ").
Usually, in order to use, to need to carry out following phases and realize above-mentioned purpose according to clamp device of the present invention:
1. prepare to be used for inserting the clamp device of blood vessel; Because as mentioned above, clamp device can or separate manufacturing with the stent graft one, to it correspondingly being interpreted as the tightening member stent graft mounted thereto of clamp device in the further describing of the bearing part of clamp device, the perhaps join domain that penetrates of the tightening member that is arranged clamp device within it of stent graft;
2. clamp device is transported to endovascular appropriate location and makes its location, simultaneously or insert stent graft subsequently;
3. make clamp device be in the state of preparing to penetrate blood vessel;
4. penetrate process;
5. stent graft is attached on the blood vessel.
The above-mentioned stage 1 is the part of manufacture process normally, and the above-mentioned stage 2 to 5 carries out in patient's body and be called placement process together.
Preparation is used for inserting the clamp device of blood vessel
Clamp device should be inserted in the blood vessel under folding or collapsed state, thereby can become enough little of to be transferred the relative section by vascular system.In this state, bearing part is in its collapsed state, and tightening member is in it and penetrates state, but the orientation that its layout is different from for the part that is fixed is fixed as the expectation layout that should adopt along penetration direction institute.This embodiment that collapses and arrange has been described with reference to Fig. 9 A to Figure 10 B in the front.For tightening member being remained in these layouts, can use external jacket or other suitable parts.Except tightening member, when bearing part was the self-deployable type, same sheath also can make bearing part remain in its collapsed state.
Clamp device is transported to endovascular appropriate location and makes its location
According to method commonly known in the art, for example utilizing, lead and conduit are transported to the aneurysm place with clamp device.When folding clamp device has been transported to the aneurysm place, position.For clamp device being positioned at endovascular tram, utilize positioning element.
With reference to Figure 20 A to Figure 21 B, will some embodiment of this positioning element be described.Figure 20 A to Figure 20 C shows the positioning element 201 into strip locating support form, and it has top 206 and bottom 207, and this bottom constitutes the bearing part 205 of clamp device 203.Positioning element 201 can with clamp device 203 form one and can for or be not the part of stent graft, or optionally, clamp device can constitute directly or indirectly the self-contained unit that (by such as parts such as cables) is connected with positioning element, as among Figure 21 A and Figure 21 B further as described in.Positioning element 201 is transported to internal blood vessel with clamp device 203, and shown in Figure 20 A, and parts 201 and device 203 are for example covered by the sheath (not shown) and be in their collapsed state.For make clamp device in the blood vessel inboard with respect to its virtual center axis C centering (shown in Figure 20 B), remove sheaths from the top 206 of positioning element 201, therefore positioning element is expanded to diameter D
PM, shown in Figure 20 C, thereby launch to prevent clamp device 203 and especially its bearing part the bottom 207 that promotes still the positioning element that covered by sheath towards the center of blood vessel.The length L of positioning element 201
PMShould be enough big, so that clamp device 203 is positioned at accurate location, form special angle β with blood vessel wall W simultaneously.In addition, with reference to Figure 20 C, positioning element 201 is the diameter D that locates of 206 (deploying portion) at an upper portion thereof
PMShould be greater than the diameter D of bearing part 205
C, to guarantee clamp device 203 centering in blood vessel.
Figure 21 A and Figure 21 B show another embodiment of positioning element 211, it comprises in order to make its removable sheath that remains in folded state 212 (shown in broken lines among Figure 21 A), and be used at first carrying positioning element then (after the clamp device location) remove the lead 214 of this positioning element from blood vessel.Positioning element 211 is connected to clamp device 213 to pass through lead 214 the inboard centering of blood vessel.Positioning element 211 is the self-deployable structure, that is, be suitable for launching after removing sheath 212.When having removed sheath 212, the expansion of positioning element 211 can make its center that is positioned at blood vessel (Figure 21 B).As a result, clamp device 213 also is positioned in the center of blood vessel.Positioning element preferably has symmetrical structure, and being suitable under deployed condition, block blood flows.Positioning element can be made by vertical pillar, the set of its many elasticas making such as the material of Nitinol of can serving as reasons, and these elasticas are held togather at the upper end of positioning element 211 211a and lower end 211b place.Optionally, positioning element 211 can be made by the vertical and horizontal litzendraht wire.Positioning element 211 also can comprise over cap 216 (Figure 21 B), injury blood vessel wall W to avoid in expansion and when removing thromboembolism.Can increase the miscellaneous part on the outer surface that is distributed in over cap 216, such as net, filtration members or feature, to prevent embloy action freely.After the location of finishing clamp device 213, sheath 212 is returned and make positioning element 211 and over cap 216 folds back their folded state, then they are removed from blood vessel.
Make clamp device be in the state of preparing to penetrate blood vessel
In the time of in clamp device is positioned in blood vessel, requires tightening member to be in it and penetrate state and need being directed along penetration direction, promptly with respect to the virtual axis C of blood vessel by radial directed.As mentioned above, clamp device is transported to it at endovascular desired locations under folded state, wherein tightening member and be not parallel to penetration direction.As mentioned above, be inserted in the endovascular process,, make tightening member be in penetration direction by removing the oversheath that covers clamp device directly or indirectly at clamp device.Figure 22 shows the clamp device 221 that comprises stent graft bearing part 223, and tightening member 225 penetrates the center that is positioned in the blood vessel that wall W will be penetrated under the state and is orientated along penetration direction being in it.Tightening member is depicted as has keeper 227, and keeper can be for top according to arbitrary keeper of the present invention, the keeper shown in Fig. 4 A.
Penetrate process
In the process of penetrating, according to the kind of bearing part, by measures first mentioned make bearing part launch (for example, as shown in Figure 2), the tightening member penetration rate of blood tube wall that links to each other with bearing part.When bearing part when self-deploying type, penetrate voluntarily by it.But when bearing part is (for example bearing part 171 of Figure 17 A to Figure 17 E) during in the unfolded type of its plastic region, its expansion can realize by air bag.Figure 23 A to Figure 23 C shows an embodiment who is suitable for making the expansible air bag of described bearing part.Figure 23 A shows has a plurality of formation things 233 on it, these form thing and are suitable for being in contraction state (Figure 23 B) or swelling state (Figure 23 C).Form thing 233 and be suitable for promoting the bearing part 175 of the bearing part 171 shown in Figure 17 A to Figure 17 E, thereby make their form become convex from bow.Form thing 233 can by the same expansion system of air bag 231 or independently system expand.Above-mentioned air bag can be with respect to part or all symmetry in their axis.
Before the final stage of explanation active procedure, state once more that clamp device might not be for treating the integral part of fastened stent graft.When bearing part is not stent graft a part of, stent graft in blood vessel by after the suitable location, will comprise that the clamp device of bearing part and tightening member is inserted in the blood vessel.Figure 24 A to Figure 24 E shows above-mentioned first to fourth stage according to the active procedure of latter event.Figure 24 A shows the clamp device 241 that is under its folded state and is transported in the blood vessel that is positioned with stent graft 243 on lead 247.Figure 24 B shows the clamp device 241 that is transported in the blood vessel and is positioned in its appropriate location in the center of blood vessel.Then, remove the sheath (not shown), thereby make clamp device 241 prepare to penetrate (Figure 24 C and Figure 24 D).In the process of penetrating, shown in Figure 24 E, bearing part 243 launches and tightening member 245 at first penetrates stent graft penetration rate of blood tube wall W then.
In the process of penetrating, can use some Lock Parts so that tightening member 245 is locked to stent graft.
Stent graft is attached on the blood vessel
As illustrated among more described embodiment in the above, when tightening member comprises that but the constraint portions that is used to make them keeps affined constraint component, after discharging constraint component, carry out the attached of stent graft, so that the standing part of tightening member is in their attached orientation, such as, as Fig. 4 B, Fig. 4 C, Fig. 5 B, Fig. 5 C, Fig. 6 B and shown in Figure 25.The power effect that constraint component or the blood vessel wall that penetrates owing to fastened element are applied thereto is released, and is for example shown in Figure 25; Perhaps as described in reference Figure 17 A to Figure 19 C, because the variation of bearing part or be released by rotary part (in this case, needing optional feature, such as air bag), as mentioned before.
Figure 26 A to Figure 26 F summary shows aforesaid according to process of the present invention.Clamp device 216 is inserted into aorta A under its folded state, and positioning element 262 (Figure 26 A) is installed on it.Clamp device 261 and positioning element 262 remain in their folded state respectively by upper jacket 263a and lower jacket 263b.Remove upper jacket 263a, so that positioning element 262 is positioned at the desired locations place with clamp device 261 in aorta A.Shown in Figure 26 B, tightening member 264 and the rack bearing spare 265 that attaches to graft 266 still remain in folded state by lower jacket 263b.Then, partly remove lower jacket 263b so that tightening member 264 penetrate the orientation along penetration direction, remove lower jacket then fully, shown in Figure 26 C.Tightening member 264 has been in penetration direction, and bearing part 265 beginnings that self-deploy launch towards aortal wall W.After arriving aorta wall W, tightening member 264 begins to penetrate this wall (Figure 26 D).Because aorta wall W acts on the power on the keeper 267 that retrains tightening member 264, when the standing part 268 of tightening member 264 is in its attached orientation (Figure 26 E), but keeper discharges the constraint portions of tightening member 264, thereby realizes attached.Its attached state correctly be fixed and switched to the air bag (not shown) can to guarantee each tightening member 264 clamp device 261 inner expansions.Final result is as shown in Figure 26 F.
Seen in Figure 26 F, because above-mentioned clamp device has a plurality of tightening members, stent graft is being attached in the aortal process, form circular connecting line 260 by the standing part that is in its constant bearing, this connecting line constitutes a kind of stitching thread that a kind of seam and standing part constitute this seam.Generally speaking, length, these standing parts according to standing part in clamp device (are different from shown in Figure 26 F in the direction that its constant bearing extends, for example as shown in Figure 11 and Figure 17 E) and tightening member between mutual layout (for example shown in Figure 10 B), connecting line can have the structure of expectation, and for example can be for continuous more or less.Spacing between the adjacent stitching thread can be inhomogeneous and they can arrange (for example shown in Figure 27) in pairs, above wherein tightening member 271 and keeper 275 adopt with reference to Fig. 4 C and the described type of Fig. 7 A.
Figure 27 also shows the embodiment how clamp device forms as one with support, and positioning elements (with shown in Figure 20 A similar) are formed at its top 277, and bottom 273 constitutes the bearing part of clamp devices.
In said process, adopt the attached mode (Figure 28 A) of side side that stent graft is attached to blood vessel.But process of the present invention and device also can be used for other situations, comprise that wherein tubular articles is attached to each other with the layout shown in Figure 28 B (the end offside is attached) and Figure 28 C (end-to-end attached).Those skilled in the art are readily appreciated that in the case without departing from the scope of the present invention can carry out multiple change, distortion and improvement under the situation of carrying out necessary modification.
Claims (66)
1, a kind of clamp device, this device is associated with first object, be used for described object is attached to second object, this device comprises at least one tightening member with base portion and at least one standing part, described tightening member manufactures at first and makes its standing part have first orientation and can make described standing part be in second orientation with respect to described base portion with respect to described base portion, thereby make described at least one standing part when remaining in described second orientation, penetrate described second object to its exposure, and described tightening member is suitable for described second orientation is changed into described first orientation, and is described attached to realize.
2, clamp device according to claim 1, but wherein said at least one tightening member is included in the constraint portions between its described base portion and the described standing part, but described tightening member manufactures at first and makes its standing part have described first orientation and can make described standing part be in described second orientation with respect to described base portion by retraining described constraint portions with respect to described base portion, thereby but when the constraint removed described constraint portions, make described standing part return its first orientation from its second orientation; Described tightening member in the described device has the state of penetrating, but described constraint portions is constrained for described at least one standing part remained at this state of penetrating and constitutes it and penetrate the described second orientation in orientation, so that described at least one standing part can describedly penetrate described second object when penetrating the orientation remaining in, thereby and be suitable for the described state of penetrating changed into and remove described constraint and make described at least one standing part return the attached state of its described first orientation, this first orientation constitutes the attached orientation of described at least one standing part, and described first object is attached to described second object in this attached orientation.
3, clamp device according to claim 2, the medical clamp device of this device for being suitable for using with support.
4, clamp device according to claim 3, wherein said support comprises that stent graft and described device also comprise bearing part, this bearing part has at least one bearing part that described at least one tightening member is installed, this stent graft has at least one join domain, described bearing part can be inserted into described support inside so that described tightening member penetrate described stent graft at described join domain place and stretch out from described join domain.
5, clamp device according to claim 3, this device constitutes the integral part of described support, and described is configured to bearing part, and this bearing part has at least one bearing part that described at least one tightening member is installed.
6, clamp device according to claim 1, this device also comprises bearing part, this bearing part has at least one bearing part that a more than described tightening member is installed.
7, according to claim 4 or 5 described clamp devices, wherein said bearing part is suitable for changing its state between collapsed state and deployed condition, when being in collapsed state, described tightening member is arranged apart from described second object to be penetrated relatively far, and when being in deployed condition, the described tightening member of at least a portion is near described second object and penetrates this object.
8, clamp device according to claim 7, wherein when described bearing part is in its collapsed state, described tightening member is along the direction orientation that is different from penetration direction, and wherein this bearing part is suitable for making described tightening member to align with penetration direction before near described second object of arrival.
9, according to claim 7 or 8 described clamp devices, this device also comprises sheath, and this sheath is used at least indirectly described bearing part being applied compression stress so that it remains in described collapsed state, and this sheath is detachably to allow described bearing part to launch.
10, according to claim 7 or 8 described clamp devices, wherein said bearing part is suitable for launching and collapsing by corresponding expansion that can be inserted in air bag wherein or contraction.
11, according to each described clamp device in the claim 2 to 10, wherein this device comprises a plurality of tightening members and a plurality of confinement element, each described confinement element is used to make the constraint portions of at least one tightening member to remain constrained state, but each described confinement element is suitable for being applied in motivator discharging described constraint portions, and makes the standing part of described tightening member be in its attached orientation whereby.
12, the described clamp device of claim 11 when being subordinated in the claim 6 to 9 each, wherein said bearing part are configured for applying the part of the actuation component of described motivator.
13, clamp device according to claim 12, wherein said bearing part has such layout, and this layout is suitable for when described bearing part is unfolded to the predetermined extent that the length by described at least one standing part limits each described confinement element being applied described motivator.
14, clamp device according to claim 11, wherein each tightening member is equipped with such layout, and this layout is suitable for when described at least one standing part has penetrated second object to the predetermined extent that limited by the length of described standing part described confinement element being applied described motivator.
15, clamp device according to claim 14, wherein said degree is greater than the length of described standing part.
16, according to each described clamp device in the claim 11 to 15, wherein at least one described confinement element can move between constrained and off-position with respect to described tightening member, but described confinement element imposes restriction power so that described at least one standing part remains in the described orientation that penetrates to described constraint portions directly or indirectly in described constrained, and in described off-position, but remove described restraining forces from described constraint portions, thereby make described at least one standing part be in described attached orientation.
17, clamp device according to claim 16, but wherein said at least one standing part extends between the far-end of described tightening member and described constraint portions, and described when penetrating the orientation when being in, described standing part extend out to the degree that increases away from the described distal movement of described tightening member along with described confinement element from described confinement element.
18, according to each described clamp device in the claim 14 to 17, wherein said confinement element has the flange that is arranged in its proximal end and crosses out from described confinement element, described confinement element is suitable for moving when its flange is applied in power away from described standing part, and this power constitutes described motivator.
19, clamp device according to claim 18, wherein said flange arrangement crosses out in the proximal end of described confinement element and from described confinement element.
20, according to the described clamp device of aforementioned each claim, wherein said base portion and described standing part are separately parts, but they are sentenced mechanical system in described constraint portions and are connected to each other.
21, according to each described clamp device in the claim 2 to 19, but wherein said tightening member is at least at the monomer of described constraint portions place elastically deformable.
22, clamp device according to claim 21, wherein said tightening member comprises elastic material or shape-memory material.
23, according to claim 20,21 or 22 described clamp devices, wherein under the described original state of described tightening member, the standing part of this tightening member is arranged to become first angle with described base portion, penetrate under the state the described of described tightening member, described standing part is arranged to become to be different from described base portion second angle of first angle, therefore and compare the described standing part described base portion that aligns more when being in first angle.
24, according to the described clamp device of claim 23 that is subordinated to claim 21 or at 22 o'clock, wherein said tightening member is crooked under original state and attached state, and penetrates under the state to straight at it.
25, according to the described clamp device of aforementioned each claim, wherein said tightening member has a more than standing part, but and correspondingly has along the suitable continuous more than constraint portions of arranging of the length of this tightening member.
26, according to the described clamp device of aforementioned each claim, this device also comprises the Lock Part that is suitable for described tightening member is locked in described attached orientation.
27, a kind of clamp device, this device is associated with first object, be used for this object is attached to second object, this device comprises at least one tightening member, described at least one tightening member has base portion, but at least one standing part and the constraint portions between this base portion and described at least one standing part, described tightening member has the state of penetrating, but penetrating under the state described constraint portions at this is constrained for and described at least one standing part is remained in respect to described base portion penetrate the orientation, thereby described at least one standing part can describedly be penetrated described second object when penetrating the orientation and keep the described orientation that penetrates simultaneously being in, and described tightening member is suitable for the described state of penetrating is changed into attached state, thereby but described constraint portions is released and described at least one standing part is in be different from the attached orientation that penetrates the orientation under this attached state, the attached state of wherein said tightening member is similar to the original state that described tightening member was had at least before but described constraint portions is tied, and but wherein said device also comprises at least one confinement element that is installed at least one described constraint portions, be used to make described constraint portions to keep constrained state, but described confinement element is suitable for being applied in motivator discharging described constraint portions, and makes the standing part of described tightening member be in its attached orientation whereby.
28, clamp device according to claim 27, wherein said tightening member is provided with such layout, and this layout is suitable for having penetrated second object at described at least one standing part and described confinement element is applied described motivator to the corresponding predetermined extent of length of described standing part the time.
29, clamp device according to claim 28, wherein said degree is greater than the length of described standing part.
30, according to claim 27,28 or 29 described clamp devices, wherein said confinement element can move between constrained and off-position with respect to described tightening member, but described confinement element imposes restriction power so that described at least one standing part remains in the described orientation that penetrates to described constraint portions directly or indirectly in described constrained, and in described off-position, but remove described restraining forces from described constraint portions, thereby make described at least one standing part be in described attached orientation.
31, tightening member according to claim 30, but wherein said at least one standing part extends between the far-end of described tightening member and described constraint portions, and described when penetrating the orientation when being in, described standing part extend out to the degree that increases away from the described distal movement of described tightening member along with described confinement element from described confinement element.
32, according to each described tightening member in the claim 27 to 31, the near-end at least of wherein said confinement element crosses out from the remainder of this confinement element.
33, a kind of clamp device, this device are used for first object is attached to second object, and this device comprises: bearing part, and this bearing part has at least one bearing part; And at least one tightening member, described tightening member is installed on the described bearing part to fix with respect to this bearing part, this bearing part constitutes described first object maybe can be connected to described first object, described at least one bearing part plastically deformable of this bearing part is to change into end-state with its original state, under described original state, described tightening member is orientated to penetrate described second object along penetration direction, and under described end-state, described tightening member is transverse to described penetration direction orientation, to push described second object at least in part towards described bearing part.
34, a kind of support, this support is suitable for being arranged in the blood vessel and has at least one join domain, this support is suitable for playing the effect of clamp device and comprising at least one tightening member after being arranged in the blood vessel at least, this tightening member stretches out along penetration direction from described join domain and has a standing part, this standing part can penetrate its orientation with respect to described penetration direction of change between orientation and the attached orientation, when being in when penetrating the orientation, at least the penetrable blood vessel wall of described standing part, and when being in attached orientation, described standing part is transverse to described penetration direction orientation and is suitable for pushing described blood vessel wall at least in part towards the described join domain of described support.
35, support according to claim 34, wherein said support have pillar and are installed at least one row's tightening member on the described pillar along described join domain, and described zone is configured for the bearing part of described tightening member.
36, support according to claim 35, this support also comprises pillar and the graft that is carried by described pillar, be suitable for holding clamp device in this graft, this clamp device comprises bearing part and a plurality of tightening member, and described tightening member is suitable for that the described join domain place at described support penetrates described graft before penetrating described blood vessel wall.
37, according to claim 35 or 36 described supports, wherein said bearing part is suitable for changing its state between collapsed state and deployed condition, when being in collapsed state, described tightening member is arranged apart from blood vessel wall relatively far, and when being in deployed condition, the described tightening member of at least a portion is near the of described wall and is caused and penetrates this wall.
38, according to the described support of claim 37, wherein when described bearing part is in its collapsed state, described tightening member is along the direction orientation that is different from penetration direction, and wherein make before described tightening member arrives near the described wall, this bearing part is suitable for making described tightening member to align with penetration direction.
Claim 37 or 38 described supports when 39, basis is subordinated to claim 34, this support also comprises sheath, this sheath is used for described support is applied compression stress so that it remains in described collapsed state, and described sheath is detachably to allow described support to launch.
40, according to claim 36 or 37 described supports, this support is suitable for launching and collapsing.
41, the described support of claim 39 when being subordinated to claim 36, wherein said bearing part are suitable for by can inserting airbag inflation and the contraction in it, and are suitable for correspondingly making described support to launch at its described join domain place whereby and collapse.
42, according to each described support in the claim 35 to 41, wherein said bearing part has for the bearing part that described tightening member is installed, described bearing part is suitable for changing its shape and/or orientation with respect to the neighbouring part of described bearing part, thereby the concrete layout that changes described tightening member between layout and the described attached orientation that penetrates at described tightening member, deposit at the described cloth that penetrates, the standing part of described tightening member has the described orientation that penetrates, and in described attached orientation, described standing part is transverse to described penetration direction orientation.
43, according to the described support of claim 42, wherein said bearing part is suitable for carrying out plastic deformation to change its shape and/or orientation.
The described support of claim 43 when 44, basis is subordinated to claim 35, wherein said bearing part is suitable for carrying out described plastic deformation when described bearing part is in described deployed condition.
45, according to claim 42,43 or 44 described supports, wherein said bearing part by with the different material manufacture of material of the remainder of described bearing part.
46, according to each described support in the claim 42 to 45, wherein said bearing part had the geometry different with the adjacent domain of described bearing part before changing its shape and/or orientation.
47, according to each described support in the claim 35 to 46, wherein said at least one tightening member can move to change the orientation of described standing part with respect to described bearing part.
48, according to each described support in the claim 35 to 47, wherein said bearing part has a plurality of bearing parts and described tightening member is installed on the described bearing part to fix with respect to described bearing part, this bearing part constitutes described first object maybe can be connected to described first object, the described bearing part plastically deformable of described bearing part is to change into its end-state with its original state, under described original state, described tightening member is orientated to penetrate described second object along penetration direction, and under described end-state, described tightening member is transverse to described penetration direction orientation to push described second object at least in part towards described bearing part.
49, a kind of method that is used to make clamp device, this clamp device is associated with first object, be used for this object is attached to second object, this device comprises at least one tightening member, described tightening member has base portion and standing part, this standing part can be suitable for penetrating penetrating the orientation and be transverse between the described attached orientation that penetrates the orientation and changing its orientation with respect to described base portion of described second object at described standing part, and described method comprises:
-make described tightening member with described standing part, this standing part is in the initial orientation that is similar to described attached orientation at least, and penetrates the orientation being applied in described initial orientation to be changed into when binding; With
-confinement element is placed on the described tightening member it is applied described restraining forces, thereby make described standing part be in the described orientation that penetrates, described confinement element can move along the direction of described tightening member, to remove described restraining forces from described standing part, thereby make described standing part be in described attached orientation, the size of this confinement element on described direction is less than described tightening member.
50, a kind of method that is used for first object is attached to second object, this method comprises
-at least one tightening member is set, described tightening member extends along penetration direction, stretch out or be connected on described first object from described first object, and has a standing part, this tightening member is suitable for changing its state between state of penetrating and attached state, under the state of penetrating, described standing part has the orientation that penetrates that is suitable for penetrating described second object, and under attached state, described standing part has and is transverse to the attached orientation that penetrates the orientation, the described attached orientation of wherein said standing part is the residing predetermined state of the initial manufacturing of described tightening member, can penetrate the orientation and can make described standing part turn back to described predetermined state from its second orientation when removing restraining forces by to the described tightening member power of imposing restriction described standing part being in;
-make described at least standing part penetrate described second object when penetrating the orientation being in; And
-remove described restraining forces, so that described tightening member is changed into described attached state with its state.
51, according to the described method of claim 50, this method comprises a plurality of tightening members is set, the standing part of these tightening members when being in described attached orientation alignment to form suture on described second object or in described second object.
52, according to the described method of claim 51, wherein said tightening member is flexible, this method comprises that also the state with described tightening member is in the described not case of bending that penetrates the orientation from described standing part and changes into case of bending, in described case of bending, described element is crooked and described standing part is in described attached orientation at described bending area place.
53, according to the described method of claim 52, this method also is included in described tightening member is in before the described not case of bending, makes described tightening member be in predetermined case of bending by bending force.
54, according to each described method in the claim 50 to 53, this method also comprise by provide by at least one keeper the opposing described bending force balancing force make described at least one tightening member remain in described not case of bending, and by make described at least one keeper with respect to described at least one tightening member move make described tightening member under the bending force effect in described bending area bending.
55, according to each described method in the claim 50 to 54, this method also comprises by Lock Part makes described at least one tightening member remain in described attached orientation.
56, according to each described method in the claim 50 to 55, this method also comprises is installed on the common carrier part a plurality of tightening members.
57, according to the described method of claim 56, wherein said first object and second object are tubular articles, and described first object is arranged by described second object.
58, according to the described method of claim 57, wherein said bearing part is the part of described first object.
59, according to the described method of claim 57, wherein said clamp device is arranged in described first object, and realizes that by making described tightening member penetrate described first object before penetrating described second object the described of described tightening member stretches out.
60, according to claim 58 or 59 described methods, wherein said bearing part is in collapsed state at first, and be in its described tightening member that penetrates state along the direction orientation that is different from penetration direction, this method also comprises makes a plurality of tightening members align with penetration direction basically simultaneously.
61, according to the described method of claim 60, wherein said bearing part can be collapsed and launch, and realized aliging of described tightening member and penetration direction before this bearing part is in its deployed condition, described expansion makes described tightening member penetrate described second object.
62, according to the described method of claim 61, the collapsed state of wherein said bearing part obtains by utilizing sheath that described bearing part is applied compression stress.
63, according to the described method of claim 62, the expansion of wherein said bearing part and collapse by utilizing air bag corresponding expansion and shrink and realize.
64, according to the described method of claim 63, wherein when penetrating second object to predetermined extent, the further expansion of described bearing part can make removes described restraining forces, thereby constant bearing is changed into from penetrating the orientation in the orientation of the standing part of described tightening member.
The described method of claim 63 when 65, basis is subordinated to claim 54, wherein when penetrating second object when it is contacted with described keeper, the further expansion of described bearing part can make described keeper move with respect to described tightening member, thereby removes described restraining forces.
66, according to each described method in the claim 57 to 65, this method also comprises positioning element, and this positioning element is used in second object described clamp device being disposed to desired locations.
67, according to each described method in the claim 57 to 65, this method also comprises makes the axis centering of described clamp device with respect to described second object.
Applications Claiming Priority (3)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| US77836706P | 2006-03-03 | 2006-03-03 | |
| US60/778,367 | 2006-03-03 | ||
| US60/858,359 | 2006-11-13 |
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| Publication Number | Publication Date |
|---|---|
| CN101394815A true CN101394815A (en) | 2009-03-25 |
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Family Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| CNA2007800077139A Pending CN101394815A (en) | 2006-03-03 | 2007-03-05 | A fastening device |
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| Country | Link |
|---|---|
| JP (1) | JP2009528113A (en) |
| CN (1) | CN101394815A (en) |
Cited By (1)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN112118811A (en) * | 2018-06-13 | 2020-12-22 | 恩多隆医疗有限公司 | Graft fixation systems, applicators, and methods |
Family Cites Families (5)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| US5893856A (en) * | 1996-06-12 | 1999-04-13 | Mitek Surgical Products, Inc. | Apparatus and method for binding a first layer of material to a second layer of material |
| US6629987B1 (en) * | 1999-07-30 | 2003-10-07 | C. R. Bard, Inc. | Catheter positioning systems |
| GB2359024A (en) * | 2000-02-09 | 2001-08-15 | Anson Medical Ltd | Fixator for arteries |
| US6447524B1 (en) * | 2000-10-19 | 2002-09-10 | Ethicon Endo-Surgery, Inc. | Fastener for hernia mesh fixation |
| JP4593093B2 (en) * | 2003-02-17 | 2010-12-08 | 若井産業株式会社 | Pin for mounting on soft board |
-
2007
- 2007-03-05 CN CNA2007800077139A patent/CN101394815A/en active Pending
- 2007-03-05 JP JP2008556874A patent/JP2009528113A/en active Pending
Cited By (3)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN112118811A (en) * | 2018-06-13 | 2020-12-22 | 恩多隆医疗有限公司 | Graft fixation systems, applicators, and methods |
| CN112118811B (en) * | 2018-06-13 | 2024-05-14 | 恩多隆医疗有限公司 | Implant fixation systems, applicators, and methods |
| US12097136B2 (en) | 2018-06-13 | 2024-09-24 | Endoron Medical Ltd. | Graft securing system, applicator and method |
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| JP2009528113A (en) | 2009-08-06 |
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