CN102105185A

CN102105185A - Method and apparatus for vascular access

Info

Publication number: CN102105185A
Application number: CN2008801288521A
Authority: CN
Inventors: 大卫·张
Original assignee: Individual
Current assignee: Individual
Priority date: 2008-02-26
Filing date: 2008-08-05
Publication date: 2011-06-22
Also published as: WO2009108164A1; EP2257322A1

Abstract

The present invention relates to methods and apparatus that facilitate arterial and/or venous access using a securable/anchored structure such as a diaphragm on an outer/adventitial surface of a vessel, as well as to related structures and features. Further methods and apparatus may involve using a semi-permeable sheath with a filter segment to prevent potential embolization. Advantages of some implementations herein relating to eliminating the chamber of a vascular access device may be achieved by making the vessel itself the chamber and incorporating the device as part of the vessel, for example, without reliance of an indwelling catheter sheath to remotely gain access. Some innovations herein relate to facilitating access including methods and devices for automating the access process and preventing embolization.

Description

The method and apparatus that is used for vascular access

The cross reference of related application

The application number that the application requires on February 26th, 2007 to submit to is 60/903,608 U.S. Provisional Patent Application, the application number 60/920 that on March 27th, 2007 submitted to, the application number 60/920 that 153 U.S. Provisional Patent Application and on March 31st, 2007 submit to, the priority of 892 U.S. Provisional Patent Application, all these patent applications all by reference mode are all included this description in.

Background technology

The field:

The present invention relates to use the structure that to fix (securable)/grappling to promote the method and apparatus of tremulous pulse and/or venous channel, the barrier film on the structure example of described fixing/grappling such as the vascular outer surface/outer membrane face; And relate to dependency structure and feature.

The explanation of relevant information

Treatment medium vessels path at human numerous disease is most important.Vascular access is to such as hemodialysis and to the intervention of native blood vessel with to arrive operations such as final organ be necessary.Yet, at present, not easily, guarantee trouble-freely, the path that can repeat to enter tremulous pulse, vein and tract is carried out such as dialysing and medical care precess such as other blood vessel interventions and do not have significant complications.The path that enters tremulous pulse or venous circulation both can be diagnostic also can be curative, and angiorrbagia, obturation and thromboembolism can make these complicated operations.For example, in some process such as hemodialysis, the equal ports having of long-term access equipment (port) at present/conduit/graft, have very high crash rate and with the direct Continuous Contact of blood circulation, have to cause septicemia and dead risk.Therefore, have one reliably, repeatably highway device is got involved to help hemodialysis and other blood vessels, and do not have wound, obturation, thromboembolism or hemorrhage, these all be existing care appliances standard can not provide.

The restriction (as those equipment that use in dialysis particularly) that repeats vascular access equipment is that infected, thrombosis, the hemorrhage and risk that proximity structure caused traumatic injury are arranged.Provided the effort of path mainly to concentrate on transplantation or the inherent equipment that allows to exist the continuous conduit that is used for vascular access and have chamber in the past.These equipment comprise that the transplantation port that has storage (is central harbour, lifeports), and interim (quintons) or long-term conduit (hickman, ash split carheter).Any traditional access port or conduit include inherent intracavity foreign material, and described foreign material form obturation or form scar tissue by blood coagulation easily, and cause the life-threatening infection of possibility easily.A great factor that causes this class blood infection is the compartment (compartment) that has the antibacterial that wherein can grow, for example storage or pipeline.In addition, this compartment can be used as the thrombosis focus, no matter is at vascular (vessel) or in compartment (compartment).In addition, can be used as the potential position of areolar tissue from the conduit of skin surface projection.

Other longer vascular path modes such as arterial graft are relevant with high complication rate with fistula.Tremulous pulse fistula and graft that the aneurysm degeneration takes place easily need carry out expensive correction, get bolt or thrombolytic program, often therefore need to settle graft, support, overlay film frame or anastomotic stoma top capping fourth.The natural vascular anastomosis mouth interface place neointimal hyperplasia that is caused by the non-physiology hemodynamics at graft place can finally cause graft failure, and limits the quantity of each limbs (extremity) and every patient's attainable feasible graft.This is the shortcoming that the existing dialyzing access that uses in limbs is transplanted scheme.

Improve the needs of vascular access, expanded to and comprise the intervention of vascular itself and arrive the operation of final organ.This is vital in arterial circulation, but causes hemorrhage threat to life owing to hypertension in arterial circulation, and the blood flow that stops can to cause the infringement to final organ.Get involved for other blood vessels, owing to worry risk of bleeding may take place, vascular access is less preferred.Therefore, present selection to vascular access is to avoid position and health hemorrhage and that optimize blood vessel.For example, the standard vias site of present tremulous pulse operation is common femoral artery.Unfortunately, to the greatest extent let it be dissects conveniently, and it is the far-end of one of ill the most serious and the most zigzag tremulous pulse section in the health often.This will cause being difficult to giving aorta and ramose disease thereof with treatment, particularly the endovascular device of big caliber if desired.By contrast, subclavian artery be one more not ill, can be formed on the human engineering can and and the vascular greatly that is positioned at low infection risk district.Using an obstacle of this vascular easily is exactly hemorrhage probability, causes brachia plexus injury, hematoma or hemothorax.In addition, under the situation of lacking experience, attempt entering the pneumothorax that this vascular may cause carrying out the decompression of breast pipe

In addition, be in the similar scope such as the caliber of the tremulous pulse of common carotid artery and brachial artery and the caliber of subclavian artery.These vasculars are also less ill, can be made on human engineering can and and be in the low zone of infection risk.The anatomical that is easy to of all these tremulous pulsies makes the place they can be positioned over more near brain and heart---they are most important two tremulous pulse beds---.Yet, although they are more near brain and heart---hold two most important vascular bedes, these tremulous pulsies are owing to there is tangible hemorrhage risk seldom to become the site of direct path with the shortcoming relevant with current available devices.

In addition, in comparing through the thigh path, the path of visceral vessel, renal blood vessels and other organ blood vessels is favourable because they from a site downward inclination angle naturally, the tremulous pulse of both legs is led at described inclination angle.Present challenge is to enter vascular consistently and repeatedly and do not have that wound, obturation, thromboembolism form or hemorrhage.There is closed system at present, only allows disposable arterial passageway.The equipment that these percutaneous are used has about 5 percent mortality.This is owing to incorrect described equipment to be placed on the tremulous pulse to a great extent, and described inappropriate placement is owing to place ill intra-arterial to cause through the lumen passageway device.

Summary of the invention

Herein disclosed is the method and apparatus that comprises the novelty relevant and help intravasation with no chamber vascular access.

Description of drawings

Fig. 1 has shown exemplary septum more of the present invention, valve and anchor feature;

Fig. 2 has shown exemplary nozzle conduit feature and valves more of the present invention;

Fig. 3 has shown exemplary grommet more of the present invention and locking mechanism;

Fig. 4 has shown exemplary wire conduits more of the present invention (wire guide) type;

Fig. 5 has illustrated a kind of exemplary percutaneous method that is used for intravasation, and what relate to is placed in self-sealing septum on the blood vessel of the present invention; [last part is copied in the following written explanation]

Fig. 6 has shown exemplary blood vessel embolism protection sheath of the present invention;

The specific embodiment

The such method and apparatus that the present invention relates to, promptly they can help by fixing/anchoring structure for example blood vessel outer/barrier film on the outer membrane face enters tremulous pulse and/or vein, and relevant structure and feature.Further method and apparatus can use a semi-transparent sheath that has the filter section to prevent potential thromboembolism.The advantage of some embodiments that this paper is relevant with the chamber of eliminating vascular access device is to realize in the following way: make described blood vessel coelosis and described device is integrated into the part of described blood vessel, for example do not rely on intrinsic catheter sheath and realize long-range entering.The present invention relates to favourable entering, comprise being used for the method and apparatus that automatization enters process and prevents thromboembolism.

Intravasation is got involved (example comprises placing rack and support implant) and the treatment of terminal organ (example comprises cardiac valve and cell transplantation) and the method such as hemodialysis for blood vessel itself, all is necessary.A kind of safe and reliably repeatably access arrangement can help to enter from blood vessel pathological changes still less, more good position, that preferably go up trunk, this is that existing apparatus is owing to above-mentioned restriction is difficult to realize.This equipment can be used for repeatably entering vein and tremulous pulse reliably, to help certain methods, comprises method mentioned above, for example: hemodialysis, cardiovascular is got involved, blood drawing, monitoring of blood pressure, medicine injects.

Enforcement of the present invention comprises such method and apparatus, and promptly they can reduce hemorrhagely, and thrombosis is blocked and/or entered tremulous pulse and venous infects complication, is that existing apparatus is irrealizable as above-mentioned this mode; Thereby help entering preferred vascular site, for example still less the blood vessel of pathological changes or the easier position that on dissecting, enters the inaccessiable target organ of above listed existing apparatus.As transplanting or graft when entering the chamber, controlled entering keeps in described conduit fast that physiological flows, and its antithrombotic blood vessel endothelium lining is had minimum cicatrix and destruction at blood vessel itself.Therefore, as this paper explanation, compare with existing apparatus, thrombosis, obturation and thromboembolism be minimized.Autologous tissue and do not exist inherent conduit foreign body can also resist infection, these 2 existing apparatus discussed above are not all accomplished.Therefore, infect, scab, blood coagulation and inaccessible can minimizing in the mode that a kind of existing apparatus can not use.In addition, the present invention does not need the chamber to enter and/or influence most of normal outer wall of blood vessel, thereby makes complication minimum.

The structure/component of the self sealss (resealable) that the outer surface that exemplary apparatus (apparatus) can comprise a kind of and blood vessel is connected via a kind of device (means), as barrier film or papillae, described device such as stitching thread, penetrating parts or skeleton part, tissue adhesive, their conjugate and/or other suitable mechanism (mechanism).Exemplary barrier film can comprise rigid structure such as barrier film grid (diaphragm shutter), and adjustable structure is as iris formula barrier film; Perhaps semirigid plasticity membrane configuration.Membranous exemplary materials comprises metal, rubber, plastics, fluoroplastics, silicones and thoralon.Mamelon makes to have the structure at the skin surface palpation of being easy to the trocar intravasation.Described mamelon can be the extension of diaphragm material or thicken, and can comprise that perhaps barrier film is as an ingredient.Barrier film or mamelon also can have a lower surface, and it promotes tissue to combine with porous or textured biocompatible layer that equipment (device) is fixed on the container.The access device of no inner chamber can produce by a kind of equipment is placed on the suitably big access blood vessel, for example carotid artery, subclavian artery, femoral artery, axillary artery, brachial artery or jugular vein, axillary vein, subclavian vein or femoral vein.The self-sealing function of barrier film or mamelon has reduced the shortcoming of this present commercially available equipment of generation of angiorrbagia, and is consistent with the content of above being discussed.In addition, because barrier film or mamelon do not have inner chamber and duct free, so make the problem that has the germ contamination in the commercially available equipment now and enter blood flow reduce to minimum.

Now describe to help suitably to place and insert device and allow conveniently to place and repeat to insert and exemplary method and apparatus that can be not hemorrhage.The parts of this equipment can comprise 1) the grappling barrier film, 2) seal member, 3) mamelon guiding container, 4) sealed trocar and relief valve, and/or 5) the delivery sheath assembly of applied dermally.The various combination of above-mentioned parts can be used in the different application.

The barrier film embodiment

Barrier film can be deployed in the latent space between vagina vasorum and the blood vessel outer surface.Barrier film can have the solid shape as a mamelon part, perhaps can be folding in the percutaneous operation.Barrier film can have the framework such as Nitinol, wherein can comprise cross bar, to produce a suitable arc that does not have fifth wheel in blood vessel.Barrier film can comprise a kind of suitable solid-state biocompatible polymer (as silicones) or porous polymer (as politef).Sebific duct can be fixed on the barrier film bottom surface of rolling when sending in sheath.In case barrier film places on the blood vessel, the pipe that has side opening is used described tissue glue, and can remove when having pressure to put on neck, shoulder, arm or the groin.

Exemplary septum can comprise being called herein and inserts membranous barrier film.In general, insert the film that barrier film can comprise the resealable (or self sealss) with blood vessel contact surface, intubate, pin, conduits etc. can pass through this surface intravasation.Insert barrier film and can be molded into the shape that its shape meets its blood vessel that will use (for example carotid artery).What contact with blood vessel thus, is surperficial flexible.Insert barrier film and can comprise a support frame.This support frame can help to form crooked shape, and can help the access barrier film is anchored on the blood vessel.Insert barrier film and also can comprise a set thing, be fixed on the blood vessel will insert barrier film.The set thing can be one or more teeth, organizes adhesion etc.

In a variation scheme, insert the normally flexible slightly planar structure of barrier film, it has a upper surface and (contacting a blood vessel) lower surface.As mentioned above, planar structure can be crooked, with it sweep on target vessel of using (as tremulous pulse) is complementary.Its sweep can be slightly less than the sweep of blood vessel.Major part can be puncturing surface (puncture surface) on this plane.In some variation schemes, support frame extends the periphery near equipment, makes central authorities' puncture parts (puncturing surface) not contain barrier, perhaps can comprise crossbeam.Flexible and some suitable directed rigidity can realize by using the wire frame of being made by metal such as Nitinol strengthen barrier film.The access barrier film is compared with the surf zone of upper surface and lower surface can be thinner.For example, inserting barrier film, to can be about 2mm thick.Gradually point, change are justified or are fractureed to insert membranous edge.In some variation schemes, insert gradually point of membranous edge, so that it may help to separate (as following description at dilator) and help insertion around the tissue plane of blood vessel.

In operation, exemplary access barrier film can be fixed on the blood vessel, and can pass through pin, and (for example, by a trocar or by special-purpose access port) such as sleeve pipe, conduits pierces through, to insert in the blood vessel.When removing pin, sleeve pipe, conduit etc., insert barrier film and close or reseal, hemorrhage to prevent.Inserting barrier film can self seals.Inserting barrier film can be implanted, and make it to keep original position and can be used as pin, sleeve pipe, the insertion site of conduit etc. is reused.

In addition, insert barrier film and can be configured to tremulous pulse access barrier film.Therefore, a tremulous pulse access barrier film can be configured to and is used for tremulous pulse (as carotid artery).But inserting the barrier film percutaneous implants or implants by operation (for example, by cutting and organizing to expose tremulous pulse).For example, this equipment can be placed on the tunica adventitia of artery by a little otch.

Insert barrier film and can comprise the puncturing surface that (to small part) made by any suitable biocompatible polymer (as silicones).It is particularly useful to repeat encapsulant (as silicones, rubber etc.).Insert membranous puncturing surface usually as self-sealing valve.For being designed in the embodiment that ductule inserts, as 4 to 9 French, it can be when conduit is removed the polymer of elastic packing around acanthopore.For bigger access conduit, as 10 to 24 French, preparation ready-formed aperture otch or preformed slit in material are to allow controllably to penetrate tremulous pulse.Insert for the sheath of maximum, have the access trocar that sheath blade or screwdriver formula end are arranged and also can be used for the location and open barrier film, thereby produce controlled arterial wall cutting and do not damage barrier film.

For carotid artery or femoral artery, the set thing comprises tissue glue, can be the ring-type object of 6 to 9 mm dias (but not necessarily will around tremulous pulse), perhaps for penetrating arterial wall but do not intercept the embedded set thing of cavity.They can comprise that near-end known in the art embeds membranous pin tooth, maybe can be the objects with framework or ring structure.Sharp-pointed tooth far-end can embed the angle of arterial wall (and can only partly pass or pass completely through described wall) wall with 5 degree to 60 degree, thereby barrier film is fixed in tremulous pulse.This tooth also can stop vascular tissue to prolapse afterwards and enter cavity removing big sheath (＞10 French).In some variation schemes, inserting barrier film can be fixed on the blood vessel by the opposite tooth of angle or with respect to the parallel denticle of other grappling tooth with arc shooting.In Wicresoft used, tooth can be the band angle, thereby realized grappling with direction opposite when entering.This can make diaphragm edge be easy to motion, and this can be used as dissecting tool, and (for example all sheaths of seminal vesicle) produces the space around blood vessel to help.

Insert a membranous advantage and comprise that enhancing carries out the ability that Wicresoft insert to implant under minimum thrombosis risk, because do not need inner chamber to fix.In addition, the access barrier film can be and repeats to insert the target area that provides big, and may be widely used in bigger blood vessel of size range (as tremulous pulse) and sleeve pipe.

Intervention barrier film as herein described (access diaphragm) can be sent through delivery sheath or carrier pipe, particularly gets involved membranous dermal delivery.In some variation schemes, get involved the barrier film rollable or be compressed into a kind of delivery form and place sheath.Get involved pipe can by will get involved barrier film push away the sheath chamber and be pushed into be applied on the vascular vascular (for example separate distinguish in tremulous pulse week after, be summarized as follows).In some variation schemes, can use a push rod will get involved the barrier film bullet to vascular.Can settle holdfast (for example pointed tooth) so that it inserts vascular behind the location.

More generally, exemplary septum can have about 60 radians to about 180 degree, and about 90 to about 100% diameter of artery diameter.Flexible and some suitable directed rigidity can realize by using a rack of being made by metal, for example Nitinol to reinforce barrier film.Holdfast comprises that tissue glue, diameter can be about 3 to about 9mm axle collar parts (but need not be positioned at around the tremulous pulse) or penetrate arterial wall but the embedding holdfast of non-occludes lumen.They can comprise uses means known in the art that near-end is embedded in sharp-pointed pointed tooth in the barrier film, or can be a body material with framework or axle collar.Far away most advanced and sophisticated be embedded in the arterial wall so that barrier film is fixed to tremulous pulse, or for using the self-locking pointed tooth, have the angles of the highest about 90 degree with about 5 degree to the angles of about 60 degree.Described pointed tooth can also prevent that vascular tissue from (prolapsing to tube chamber after removing approximately＞10Fr) at big sheath.Use the dihedral pointed tooth of arc structure or the parallel base material of pointed tooth to realize fixing by the grappling pointed tooth.Pointed tooth can be angled so that realize grappling with the direction opposite with inlet.These pointed tooths make the barrier film leading edge be easy to move, and described barrier film leading edge can be served as dissecting tool with along the pipe sheath and apply pull-back force so that the pipe sheath is flush state owing to the embedding of pointed tooth on barrier film.Perhaps, described equipment can by penetrate the anchor body, organize viscose glue, circumference or arcuate zone or make and carry out the textured of cellular growth or merging or any combination of porous material is fixed to vascular.The polymeric material that exists in somatomedin, substrate element or the intervention pipe box for example polyester can be used for promoting to merge.Wear wall grappling holdfast and also can be used for big vascular.If not considering in several weeks to repeat gets involved, then the barrier film grappling can only comprise the merging material.This material can make the surface be filled in another surface of vascular and equipment to help being connected of stable placement of this device security and maintenance and vascular.

In addition, exemplary septum or joint complex can comprise the parts of a control cover needle penetration vascular degree of depth.For example, a teat or pin portion can be embedded in the barrier film, or be made into part barrier film framework, described diaphragm frame bridge joint is gone in the trocar wall.Perhaps, described teat is along the passage or the potential passage of joint or joint receiving port.The magnetic of radiopacity or echo free space labelling can be along the paracentesis area control with the interventions that promotes automatically or image guides.

In another illustrative methods, can suitable barrier film be placed pipeline external surface and be seamed to vascular by material or appended eyelet by little otch.Install appended stitching thread or metal wire via guide channel and also can pass vascular or in the vascular positioned inside, to help grappling immediately and sealed penetration along the circumference of recommending puncture site.

The seal member embodiment

Under situation according to the invention, seal member can be identical with the grappling barrier film or can be an absolute construction.In addition, membranous puncturing surface can be used as one from sphragis.For the embodiment that is intended to tubule (for example 4 to 9Fr) intervention, it can be a kind of at the polymer that is removing pipe back elastic packing keyhole periphery.For bigger intervention pipe (for example 10Fr to 24Fr), preexisting hole or seam are inserted in the material, penetrate with the traumatic of control appliance and tremulous pulse.Can be perpendicular to the vascular tangent plane or inserts at a certain angle in the potential hole of this preformation.Described seal member can be barrier film, and uses holdfast and tissue merging parts to be fixed in blood vessel wall.This can make mini-plant be applicable to the dermal delivery method.Perhaps, described lobe can be an independent shell, and it is right after the grappling barrier film and inserts, and makes this lobe to replace.

In other embodiments, the described screening film that can be used as vascular or membrane surface top from sphragis.For example, described screening lobe can be opened by the trocar drive mechanism, and can close at puncture site upper spring loaded type.In addition, described screening film also can have an opening that is surrounded with receiving port or recess, and described receiving port or recess can guide to trocar described opening.In this class exemplary,, then hide the aperture position that film can slide into guiding if blood vessel wall exposes or to be in preexisting hole supreme at membranous anchoring section.After recalling paracentesis trocar, described screening film can serve as the healing support, because it can slide above puncture site.Perhaps, described screening film can be opened by the top to the opposite direction shift joint of joint fixing base.These devices can be used for producing holdfast and need not to seal immediately tube wall.This particularly can be used for relying on fully the major diameter intervention device under the involutory not too reliable probably hemostatic seal trial situation of vascular.Serving as the membranous planar interior surfaces zone that hides film can be used for improving anchor body, wall or the enclosed area of flexibility to serve as plug of getting involved the door pipe by moving the puncture hole.So, can use minor diameter or major diameter sleeve pipe at unified pipeline location.

Plug receiving port guiding embodiment

Usage example receiving port guide structure/parts are to promote in the traumatic reliably intervention vascular of sleeve pipe.In an anticipation embodiment, can use a tubular structure to get involved site or valve trocar is guided to predetermined vascular.The nearly portion of guiding channel can be funnel-form trocar is drawn in the narrower region of passage.The passage far-end can be attached to sleeve pipe or barrier film.Perhaps, it can separate with barrier film or vascular, thereby drains all potential blood or floating thing and prevent passage.The rigidity of guidance and trocar may be selected to be can meet the vascular intervention position and directly guidance do not contact with vascular or barrier film.Described guidance also can be slit or groove, but not the pipe that cooperates with trocar.These guide structures all can be fixed to vascular grappling barrier film and form the teat of actual interface shape arbitrarily, and described teat can be applied to the surface of skin.This can realize by use memory metal, for example Nitinol in structure.The device that use has the induction element of complete exocoel seal makes the single-point wound on the inner tubal wall minimize, and described inner tubal wall is easy to healing and the vascular that can not weaken.

In other embodiments, this device can have one or more projections, the elasticity that described projection does not have the space chamber for being connected to blood vessel by a potential passage, and described potential passage is owing to having suitable polymers---for example rubber, polysiloxanes or plastics---is compressed.End away from blood vessel can be used as opening, and guide needle or blunt nosed trocar enter the potential passage that is positioned at entry site.Guiding and improve in the material of trocar sliding and have one or more slit to help described potential passage.An illustrative configuration is a T groove part crack passage, but it can make the trocar of varying dimensions adapt to the common base portion orientation of mentioning.In case take out pin or trocar, barrier film/projection sealing thorn hole path.

Perhaps, equipment and materials can be spongiform in inside, and can have the impermeability film along described potential passage.In another embodiment, described equipment can be seamless being installed together to seal two or more parts of described potential passage with one or more spring loadeds.Can use sterilization material such as silver along described passage and miscellaneous part.

Along the potential passage of trocar or the track of physical channel, displaceable supporter can be inserted in abutting connection with self-sealing gate valve structure far-end.Described barrier film can have the valve that is positioned at blood vessel acanthopore site, or can only cover and the fixing arc thing of the blood vessel of the either side in blood vessel acanthopore site.Described thrust piloting trocar is to this entry site.Because described trocar withstands above support, dislocation supporter far-end is opened gate valve with near blood vessel wall or barrier film.In case the taking-up trocar, spring loaded gate valve hemostasis formula ground (hemostatically) covers the acanthopore site.

Perhaps, away from barrier film and be slidingly connected to its independently protruding member and can be used for blood vessel wall or membranously do not cover and cover the position.Described position can obtain linearly or with the camber line slip by making described protruding member.Load on spring can be carried out in the position that does not have to cover.Along with taking out trocar, described projection is returned the position of covering.In the slide block embodiment, the projection of tape guide is by skin, and dislocation is in unlapped position.In this position, guider accurate piloting trocar intravasation wall or membranous acanthopore site.In case the taking-up trocar, the bottom surface of projection can be restored as the cell that platform allows to carry out with its cross-over connection acanthopore site.The locking part that also can use trocar to drive.In the rocker arm type embodiment, the projection guider has one or more supporting constructions that are fixed on the barrier film.Axostylus axostyle is connected on the projection guider of arc thing of the similar cogwheel of shape.At defective locations, the tooth of described cogwheel covers entry site.The projection guider so is set, so that trocar passes through adjacent to the position of the depression of the described cognate gear teeth.Trocar is inserted receptor, and the trocar that part is inserted guider can be used as the lever that cogwheel is displaced to aperture position.The also displaceable lever of described trocar lifts the locking part on the surperficial part of the fixation kit that is connected to described device, thereby makes described device move to aperture position.Directly enter described blood vessel by blood vessel wall, or enter described blood vessel indirectly by barrier film base portion as second valve.Can allow a plurality of trocars to enter simultaneously by producing a plurality of sealing areas the molded arc thing that meets the projection guider of described barrier film base portion.Take out trocar and make that entering the locking part that covers the position withdraws from.Another advantage of arc configuration is that the projection receptor also can comprise tissue such as the polyester of introducing element, or ingrown platform such as polyglycolic acid.Aspect the skin and the blood vessel degree of depth, enter the stability that is enhanced two or more grades, the darker part of described equipment is not still rotated between opening and closure state.The multiple combination of the apparatus and method of describing in full can be used for overcoming the defective of this paper explanation.

The trocar embodiment

Described trocar or to enter pin can be one or more objects.In the embodiment in front, there is the blood entry site of a main sharp edges and a depression.Perhaps, can use the cut edge.An example of many bodies embodiment has the trocar and cannula of inner removable sharp trocar.

Described pin or the trocar of entering can have and allow the line can the big conduit of dislocation or the tube chamber of sheath.The outlet of this tube chamber can place an end or a side that enters instrument.Described pin, trocar or sheath can have the surperficial parts of one or more and access arrangement coupling, prevent to be advanced further, thereby prevent carelessness damage to tunica intima.This locking is abolishable, allows the carelessness disengaging that fixedly enters sleeve pipe and prevent conduit in insertion, monitoring or therapeutic process.This latch member can be positioned on the tip or handle of trocar.For example, can slit or the ditch that mate with the barrier film base portion be set at the tip of trocar, the restriction trocar inserts the degree of depth of blood vessel.Slit is shaped,, prevents blood vessel injury or break away from from blood vessel so that distortion or other move trocar is locked in the fixed position.

Perhaps, projection or depression/trough of belt parts can be arranged on the axle of trocar, with mamelon on desk-top container coupling.Projection can be the form with ring of different surfaces feature, forms a key that mates with the container lock.An example components is vertical slit, groove or the projection of a series of different interval or thickness.Slit, groove or the projection of another kind of parts for revolving.Along with the ring admission passage of trocar, ring moves a lever that makes the switch valve operation or make the release of mamelon position.The end of ring adjacent area stops on milk, prevents that trocar from moving into blood vessel or move out from blood vessel, its be positioned at locking mechanism in line remove on the direction except.

The trocar scheme can suitably be designed for different access functions, and is made of a variety of materials.For the venotomy function, the exemplary metal trocar of 27 to 24 gauges is enough.Trocar can comprise one with pin or be connected to the surface elements that membranous container is complementary, to prevent the rear wall puncture.For being used to monitor arterial pressure, the metal of 23 to 18 gauges or polymer trocar are suitable.Most advanced and sophisticated groove or slit can prevent the rear wall damage.For hemodialysis, the exemplary trocar with 17 to 12 gauges of sealed channel parts still can insert, and prevents rear wall damage and hemorrhage simultaneously.Inner sharp metal trocar can be complementary with the indwelling cover needle guard of metal or polymer.Vertical thorn on the trocar can be used for making a trocar with multiple diameter and a gathering sill on the mamillary complex to be complementary.Undue traction inserted body when the positive of trocar near-end and negative safety regulating valve can prevent to spur Dialysis tubing accidentally in the dialysis procedure of a few hours.Exemplary cardiovascular and cerebrovascular vessel insert the sealed polymer sheath that body sheath (5 to 25 French) can comprise sharp metal tip trocar and trough of belt, and wherein the latter has the near-end haemostatic valve.Vein in the exemplary chemotherapy inserts conduit also can have described locking member, to prevent exosmosing accidentally of corrosive medicine.Should be understood that and to be used in combination described any equipment and method.

Trocar filters sheath

Also described herein and had filter semi-transparent sheath (for example catheter sheath) partly to prevent to form thromboembolism.

Described another kind of method and apparatus, making has the probability minimum that produces thromboembolism on the inlet point.The design sheath is so that the part of described sheath wall can play the function of filter.Can prepare described wall so that it has by the porous area made from material: polymer fiber or the metal or the polymer of laser drill are wherein arranged.Perhaps, can use filter between the outer inwall of the sheath that embeds described most advanced and sophisticated contact blood, open to downside from interlock (occluding) element.An ancora is placed on the sheath in the filter part downstream of telling with filter as described in preventing mobile in the blood vessel external space as the sacculus that does not block.Occlusion balloon can also be placed on the sheath of described filter part upstream to prevent that thromboembolism from moving downward.

Delivery sheath assembly embodiment

Be applied dermally, use a delivery sheath to introduce access arrangement.Described sheath can be introduced by localization by ultrasonic or artificial palpation.Line-oriented device can be inserted blood vessel with to its location or placed on it until finding transmitted pulsation.In one embodiment, described line-oriented device is a pin that thrusts blood vessel, and refluxing by observable blood confirms to place suitably.The line that will have exemplary diameter 0.014 or 0.035 places blood vessel.Has taper but the dilator 4 at the saturating property of non-thorn tip can have the track 5 that is used for line and passes along tunica adventitia.

This track has a breach line, so that the sheath of dilator can continue to slide along the blood vessel outer surface away from silk thread insertion site.Dilator can be removed, and the access device that inserts or the guide edge of access device can be used as dilator.Delivery sheath can be retracted, so that equipment is opened with the method that draws near, perhaps the relative breach line on the main wall of sheath can promote equipment to open with the direction that draws near, because two sheaths of peeling off are removed.In addition, the mold of peeling off can be processed into the form with contact point, and it makes sends space enlargement and help membranous approaching expansion, and stops the anchor portion of equipment to activate in suitable location with before fixing.

In another embodiment, conduit (wire guide) is a kind of pin of specialization, described pin has a side opening with the single line tunica adventitia of artery plane (the adventitialplane) of leading, and has one can prevent the inside progressive protruding member of pin on needle handle.The?side?port?can?serve?both?functions?or?an?added?needle?feature?such?as?a?step?off?in?needle?sh

In another embodiment, described conduit is placed in the blood vessel outer surface without the piercing blood vessel inner chamber.Described conduit also can be that shaped form helps guide the space of described line along vagina vasorum and blood vessel outer surface.In case line is good by cloth, just produce the space of deployment instrument with dilator.Alternatively, do not use line and allow the dilator---as a polymeric bar (polymer rod)---of non-piercing through (non-piercing) of a taper pass along blood vessel surface.When described dilator was depressed the upper wall formation concave configuration (as the grove of dilator) of blood vessel, plane that just can be correct with ultrasound wave just can be manifested by ultrasound wave.(The correc tplane can be visualized on ultrasound as the dilator depresses the upper wall of the vessel into a concave configuration that acts as a grove for the dilator.) also can use the cumulative serial dilator of diameter or form the space of vagina vasorum and blood vessel outer surface along the balloon of pipeline expansion.

What (therein) described therein is the method for vascular access, described method be included in a blood vessel (as on the clavicle or subclavian artery) go up and place a self-styled diaphragm or mammiform projection.The supraclavicular part of blood vessel divides and shifts (displacement) downwards by shoulder and just can enter easily, by described blood vessel self beat or ultrasound wave comes it is positioned.Clavicle and external jugular vein (when its clavicle of flowing through) during big individual sign comprises.Venous duct can be inserted external jugular vein or subclavian vein and help launch the tremulous pulse delivery sheath.In an embodiment of described method, a kind of exemplary pin advances the vein parallel with clavicle to avoid puncturing lung 22-18 bar wire gauge (guage).In another embodiment, the pin that ultrasonic guide is arranged or do not have a ultrasonic guide is pushed into wide-angle, but described angle is not more than the arterial level of being determined by palpation or imaging analysis.(In another, the needle with or without ultrasound guide is advanced as asteeper angle but not more than the level of the artery as determined by palpation or imaging study.) single line is passed described pin, and be used to along blunt dissector of tunica adventitia of artery soft tissue plane guiding.Described dissector can be a delivery sheath, passes described delivery sheath and can insert and launch lane device (access device).Alternatively, the open operation of execution blood vessel exposes and diaphragm or nipple is invested blood vessel.

Alternative method and apparatus is described to reduce moving of thromboembolism that possible inlet upstream forms.The part that a kind of sheath is designed to the sheath wall can be used as filter.Described wall can be configured to have make with the polymer fiber or distinguish with the porous infiltration that the metal or the polymer of laser drill are made.Alternatively, the outer wall at available recessed sheath tip and the filter of inwall, blood flows out from a side opening in the downstream of a closure elements.Callable anchor---for example a balloon that does not seal or projection---is placed on the sheath in downstream of filter part and prevents that filter from being pursued into outer blood vessel space.Also a sealing balloon can be placed on the sheath of filter upstream partly, any thromboembolism is turned to from the motion of unimpeded downstream.

A kind of method (Described also is a ethod for introducmtion of therapeutic devices) of introducing therapy equipment by the subclavian artery inlet (through safe subclavian artery access) of safety is also described, described device for example, stent (stents), Stent grafts (stentgrafts), valve (valves), stopper (occlusion devices), atherectomy device (athrectomy devices), thrombus dissolving device (thrombolytic devices), blood clot retrieval device (clot retrieval devices), angiopoiesis device (angioplasty devices) and sleeve pipe (cannulas).A kind of new method of hemodialysis of the present invention of using has been used a tremulous pulse that inlet device (access device) is housed, for example, be used for the left subclavian vein and the another kind of the venous cannulation of blood vessel dialysis, for example, be used for the right subclavian vein of arterial cannulation.Return sleeve pipe can place any other suitable blood vessel, for example, and jugular vein, subclavian vein or femoral artery.The missing device of big inlet makes the risk minimization of apoplexy (zing risk of stroke) simultaneously, thereby can be convenient to hemodialysis owing to need not with pump and allowing antidotal blood to return blood circulation.

This paper has also described a kind of dilator, and described dilator is used to prepare a kind of body vessel (body vessel), as tremulous pulse, is used at seminal vesicle week space (perivesicular space) implantable medical device.A kind of dilator can comprise a blunt separator (for example, a blunt trocar), and a guide rail (guiderail) can comprise that a side exit partly is used for the sidepiece separation of conduit from guide rail.

Fig. 1 a and 1b have shown the variant of described a kind of dilator.Thereby described dilator can be formed space (for example, all spaces of tremulous pulse) by side shifting outside blood vessel around blood vessel, graft can be inserted subsequently in described space, shown in Fig. 1 b.

Fig. 1 a and 1b represent an above-mentioned dilator not of the same race.Dilator may be that side shifting forms a circumvascular zone (as tremulous pulse week zone) outside blood vessel, wherein inserts an implant subsequently, shown in Fig. 1 b.Guide wire 2 may be to be fixed in the blood vessel (or near) and may be along with the mobile original place that rests on of dilator, so that lead does not suppress the activity of blunt dissector when leaving the side of guide rail.Therefore, guide rail may comprise a recess or an opening longitudinally, or guide rail may comprise sideslip or independently opening so that lead can break away from.Fig. 1 a '

Passivity sleeve area at some different dilators has a curved surface so that it may advance along the outer surface of conduit.To such an extent as to the telescopic edge of passivity is enough bluntly can not pass blood vessel (as tremulous pulse), but enough sharply come separating blood vessel organized layer on every side.

Accompanying drawing

According to some typical embodiment, may there be different lock sheath devices here, shown in the embodiment method among Fig. 1, some may be radial distributions (93) or distribute with parallel rectangular (94) formula.Some have barb (95).Some may look like stitching thread (96) and distribute.Some may embedded polymer in things or as the part of support (97).Some may distribute along the diversion channel in the barrier film (98), are arranged in inside and outside blood vessel wall and the barrier film.Some may be limited to overlapping of blood vessel inlet point (99) on every side or with inlet point, comprise as mirror image U configuration or a purse string.

According to some typical embodiment, may there be different barrier film entry sites here with part wall thickness, angle, slit and helical.The entry site complex also has the thrust that embeds membranous thrust or be connected with the support that links closely with the collar or mate.

According to some typical embodiment, may there be a shut off valve (110) here with spring (112).The pole (120) of being fixed on the cover pipe duct (130) replaces with telescopic passage (140), open shut off valve.

Randomly, (Fig. 2 b) sleeve pipe can participate in the surface character (121) on the valve, makes the position of its fragrance of a flower opening.

According to exemplary embodiments, may exist (Fig. 2) nozzle sample projection (150) to enter skin surface here in blood vessel surface to allow the location.Nozzle sample projection may be to be slidingly connected on blood vessel by the track (78) on the fixing barrier film.Barrier film may be to be fixed along complete arc (76) or in any side (77) of blood vessel wall point of puncture by tissue bond or other modes.An interchangeable valve pocket (79) can be connected nozzle sample projection, and mates with membranous standing part.Nozzle sample projection complex can slide between hidden inlet point position (160) and the inlet point position of opening (180).This may be a nozzle sample projection guide groove (190) with replaceable funnel (192).This may be one has tissue bond element (330), is locked in the substrate in the barrier film and the nozzle sample projection of guide groove (340).

Here exist one can go up the nozzle sample jut that slides at arc (200).Standing part (201) is fixed on the blood vessel.Slidably arc (205) connects and passes through the side support of standing part by an axostylus axostyle (202).This bar is the connection lever (204) of lock feature (206) in the startup.Sleeve pipe (210) is used to control nozzle sample projection and turns to open inlet point position.

Just there is different sleeve pipe features (Fig. 3) in this.Some have one (220) or a plurality of slit.Some have a lasso feature, and this lasso can be used as key and is used for slit (223) or thrust (224).Sleeve pipe also can start the lock sheath by lever mechanism.(230) the lock sheath can have a spring (232) and a lever displacement surface (233).Some sleeve pipes have a relief valve (310) that has the Dialysis tubing collar (315).

Here exist (Fig. 4) metallic channel to use with the percutaneous of the access to plant that helps to be positioned at blood vessel outer surface and vagina vasorum.Common needle-like metallic channel is a pipe (10) with needle-like stomidium (12).Other metallic channel has one the 0.5 step off (20) to 1cm, at the shaft diameter from open (22) flush of top and the side with step off.Other metallic channel has a solid-end or burr (24) and a side that points to the opening of guide wire (14) in the tunica adventitia of artery plane.Other metallic channel points to a line with curve shaft part (30) part and stomidium (32).

Fig. 5 illustrates a kind of percutaneous method that blood vessel enters that typically is used for, it comprise with sealing voluntarily or the barrier film that reseals place on the blood vessel.According to one or more representative embodiment, for example, the described barrier film of sealing voluntarily can be placed blood vessel for example on the clavicle or infraclavicular subclavian artery.According to some representative embodiment, there is a kind of for example method (Fig. 5) that repeats to enter through micromicro of subclavian artery of blood vessel that is used for.Seal wire (14) passes and blood vessel adjacent blood vessel sheath (40).Dilator (50) is followed the space that described seal wire enlarges the blood vessel top.Described dilator cutting vessel forms and helps the groove (60) of described space along vessel axis.Described dilator delivery sheath (52) comprises path barrier film (70), and described barrier film has blunt expansion end (51) or is inserted into after removing expansion trocar (50).When retracting described sleeve or removing when tearing sheath described barrier film and open.If place in the blood vessel described seal wire rather than outer membrane plane, described sheath sleeve can have coaxial track (54) with die parting line (55) or cannelure (56).This makes described sleeve to advance above described seal wire entry site in blood vessel.Described barrier film can have tissue and mix lining (72) and described device is fixed on and on the blood vessel wall angle rake teeth (90) arranged.In case in place, just launch one or more locking rake teeths (92) with stopper push rod (80).In another embodiment, tear the access to plant that sheath (300) can help to have latch feature (301) and open (Fig. 5 b).

Appended drawings:

Fig. 1 a and b show the cross section of tremulous pulse, show the tissue plane that is formed by dilator 1 discussed above.Seal wire 2 at first can be inserted in the blood vessel with the location, perhaps can will push away until the pulse of perceiving conduction under the described dilator.Described dilator can have the track (guide rail) 3 of described seal wire and pass through along the adventitia of blood vessel.Described track has die parting line (side exit part) thereby described dilator can continue to slide into along the adventitia tip insertion site of described seal wire.

Fig. 2 shows and insert the tremulous pulse that 9-24 France introduces sheath 4 in the dilator passage.Described sheath can be by ultrasound wave or hand push and is introduced.Barrier film 5 can have and has door bolt 6 structure so that the suitable arc of vascularization and the many materials of no mistake in treatment.Sebific duct 7 is fixed in the membranous downside of rolling and sending in described sheath.In case after described barrier film placed along blood vessel, the sebific duct with side hole just applied tissue glue, and when being exerted pressure, cervical region or groin be removed.

Fig. 3 a show tremulous pulse and similarly barrier film with introducing sheath that rod and/or push rod are connected in have the structure of rake teeth.3b is the viewgraph of cross-section that shows the compressed septum in the described sheath.3c shows that described path is membranous to be opened and launch.Rake teeth 8 is embedded in angle in the barrier film away from direction of insertion (for example, if to descend most the mode of infection to carry out) or insertion equidirectional.Strong 9 are connected in described barrier film by some guide rods 11 constructs.After described barrier film is delivered in the space adjacent with blood vessel fully, when on cervical region or groin, exerting pressure, spurs described rod, thereby described barrier film is fixed on the blood vessel with the direction identical with described rake teeth.Described rod is used to detect the safety of described connection.If satisfied, just unidirectional self-lock grappling subtie 12 is embedded in (Fig. 3 d) in the tremulous pulse by propeller 13.Described bar and sheath are removed (Fig. 3 e).Enter for vein, balloon can be inserted in the vein to be used as anvil so that described anchoring element fixedly secures.

Fig. 4 a shows another embodiment, has showed the radial rake teeth that has as the coil element of holdfast.4b shows the introducer that has the barrier film that cuts slit in advance and have the controlled path of big sheath.

Fig. 5 shows the tremulous pulse that is applied in diaphragm closure means and has obturating element and have the sheath of filtration fraction at near-end at far-end.

Claims

1. implantable automatic closing membrane, it is adaptive and cover one section blood vessel and have machinery or the surface composition of chemical fixation device by cambered surface with blood vessel, and described holder is fastened on the outer surface of described blood vessel on the described film.

2. the device of claim 1, wherein punching machine has pre-manufactured hole, slit or an a plurality of described hole of partially or completely passing its degree of depth or seam so that the entering of sting device.

3. the device of claim 1, described device provides with form folding in shell.

4. the device of claim 1, described device has a mechanism that is made of shape-memory material, and described mechanism has the pointed tooths of 5 to 90 degree of penetrable blood vessel wall.

5. the device of claim 1, described device have described film are fixed to collar element or sutures on the blood vessel.

6. the device of claim 1, described device are included in the described perforated film or adjacent with the described perforated film tubular structure of passing tissue glue that send.

7. the device of claim 1, described device has porous or the veined surface that can introduce tissue.

8. the device of claim 1, described device has the label that can make the pinpoint radiopaque label of sting device, echo label, calorifics label or magnetic uniqueness.

9. method and apparatus of being made up of the expansion member with independent coaxial metal screw mandrel of placing, described metal screw mandrel can be by being used to instruct the low-shearing force of the layout of stitching devices on the blood vessel outer surface to divide.

10. method that is used for obtaining in hemodialysis repeated vascular access, described method is used a kind of implantable automatic locking device that is anchored on the blood vessel outer surface.

11. a sting device, described sting device is used for the noinvasive intervention by one and forms with flat mouthful of conical pipe of described automatic locking device coupling.

12. the device of being used for the treatment of a property blood vessel process, described device is made up of anchor in a shell and the retractable pipe, described shell is made of a filtration fraction of the shell body in upstream shield element around it and described shield element downstream, and anchor is positioned at the downstream of described filtration fraction in the described retractable pipe.

13. the device of claim 12, described device have an air bag shield element.

14. the device of claim 12, described device have the bounced back base or the unshielding air bag that are positioned at the downstream of described shield portions.

15. a method, described method use is a kind of can be with the localized guidance system that has the mechanical arm sting device of appropriate sensor and piercing element is pointed to blood vessel of access to plant.

16. a hematodinamics tremulous pulse monitoring method, described method have been used a kind of automatic closed access device in no chamber that is anchored on the blood vessel.

17. one kind is anchored on the method that the access device of blood vessel under the clavicle is introduced relatively large therapy equipment by a kind of.

18. a puncture intubate, described intubate comprises pipe or bar in the tip, and described pipe or bar are across outside tack or tip trocar, and described trocar has can be inserted into spatial side opening in the blood vessel.

19. the device of claim 18, described device has one or more protuberances, the complementary elements coupling on described protuberance and the automatic sealing blood vessels access device.

20. the device of claim 18, described device have can with the bounced back tinsel element of described automatic sealing blood vessels access device engagement.

21. an implantable automatic closing membrane, the lower surface of described closing membrane and blood vessel cambered surface are adaptive and cover one section blood vessel, and described closing membrane has the blood vessel outer surface is fixed on machinery or chemical fastener on the film.

22. implantable automatic closing membrane, the lower surface of described closing membrane and blood vessel cambered surface are adaptive and cover one section blood vessel, described closing membrane has the blood vessel outer surface is fixed on machinery or chemical fastener on the film, and described closing membrane provides with the folding form in shell.

23. the device of claim 2, described device have a mechanism that is made of shape-memory material, described mechanism has the pointed tooth of 4 to 60 degree of penetrable blood vessel wall.

24. the device of claim 2, described device comprise the collar element that described film can be fixed on the blood vessel.

25. the device of claim 2, described device comprise a removable tubular structure of inner surface that is positioned at described film, described tubular structure has can send the side opening of passing tissue glue.

26. the device of claim 2, described device comprise an assembly balloon catheter that is inserted in the blood vessel, described balloon catheter is used as the anvil when using film temporarily.

27. a dilator, described dilator have the independent coaxial metal screw mandrel of placing, described metal screw mandrel can divide with low-shearing force.

28. a shell, described shell partly is made of upstream air bag shield element around it and the downstream filter on its body.

Can bounce back and block the filtration fraction in a funnel and a shell body downstream 29. a shell, described shell have one.

30. the device of claim 8, described device have the bounced back base or the unshielding air bag that are positioned at the downstream of described shield portions.

31. an automatic locking device that is used for repeated vascular access, described device comprises: tube wall, anchoring device, automatic closing membrane or interface; A hard outside of supporting described film or interface; Pass housing apparatus with one with sending of connecing of symphysis.

32. the device of claim 31, the automatic closing membrane of wherein said grappling is by elastic closure, load on spring mechanism, shutdown mechanism or the sealing of valve mechanism.

33. the device of claim 32, the automatic closing membrane of wherein said grappling is made by being selected from following elastomer: silicone rubber, Thoralon and other are used for the material of elastic closure.

34. the device of claim 32, the automatic closing membrane of wherein said grappling is made by the multiple material that can be used for load on spring mechanism.

35. the device of claim 32, the automatic closing membrane of wherein said grappling is made by the material that can be used for shutdown mechanism.

36. the device of claim 32, the automatic closing membrane of wherein said grappling is made by any material that can be used for shutdown mechanism.

37. the device of claim 31, the automatic closing membrane of wherein said grappling effectively is attached to blood vessel by being selected from following sealer: the porous coating that pointed tooth, coaxial component, sutures, tissue adhesive, texture apply and be applied to film.

38. the device of claim 31, wherein said hard outside is fixed on the film by nail or by closure in the film.

39. the device of claim 38, wherein said hard outside is made by the material that is selected from metal, plastics and rubber.

40. the device of claim 31, wherein said send pass housing apparatus by be selected from be shown in shell to material.

41. the device of claim 31, do wherein said sending passed housing apparatus by [engineering? ] be connected to the automatic closing membrane of described grappling.

42. the device of claim 31 further comprises a tack pig tail catheter.

43. the device of claim 31, wherein said sending passed housing apparatus and further comprised the upstream element that blocks around the described shell; Filtration fraction on the shell body in a described shield element downstream; With a retractable pipe anchor that is positioned at the filtration fraction downstream.

44. the device of claim 43 further comprises an air bag shield element.

45. the device of claim 44, is wherein said air bag by [engineering? ] be fixed on described giving and pass on the housing apparatus.

46. the device of claim 44, wherein said bag material are [engineering? ].

47. the device of claim 31, wherein said sending passed housing apparatus and further comprised and can promote the at utmost co-operating member of intravasation of medical apparatus and instruments.

48. the device of claim 47, wherein said medical apparatus and instruments are trocar, conduit, syringe needle or other apparatuses.

49. the device of claim 47, wherein said co-operating member are piezometer or action bars.

50. one kind is sent the method that claim 31 is used for the automatic locking device of described repeated vascular access of passing, and is selected from following differentiation label by use: the label of radiopaque label, echo label, calorifics label or magnetic uniqueness.

51. one kind is sent the method that claim 31 is used for the automatic locking device of described repeated vascular access of passing, by use a kind of can be with the localized mechanical arm sting device of access to plant with pick off.

52. a method, described method use the automatic locking device of repeated vascular access to carry out the hemodynamics monitoring.