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JPH04500328A - Splice for aorta. and implantable devices to treat aortic aneurysms. - Google Patents

Splice for aorta. and implantable devices to treat aortic aneurysms.

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Publication number
JPH04500328A
JPH04500328A JP2509878A JP50987890A JPH04500328A JP H04500328 A JPH04500328 A JP H04500328A JP 2509878 A JP2509878 A JP 2509878A JP 50987890 A JP50987890 A JP 50987890A JP H04500328 A JPH04500328 A JP H04500328A
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Prior art keywords
aortic
aorta
splice
balloon
splicing
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JP2509878A
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JPH07106213B2 (en
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トラウト ヒュー,エイチ.ザ サード
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Expired - Lifetime legal-status Critical Current

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    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02Prostheses implantable into the body
    • A61F2/04Hollow or tubular parts of organs, e.g. bladders, tracheae, bronchi or bile ducts
    • A61F2/06Blood vessels
    • A61F2/07Stent-grafts
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/82Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02Prostheses implantable into the body
    • A61F2/04Hollow or tubular parts of organs, e.g. bladders, tracheae, bronchi or bile ducts
    • A61F2/06Blood vessels
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/82Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/848Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents having means for fixation to the vessel wall, e.g. barbs
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/95Instruments specially adapted for placement or removal of stents or stent-grafts
    • A61F2/958Inflatable balloons for placing stents or stent-grafts
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61MDEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00Catheters; Hollow probes
    • A61M25/10Balloon catheters
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/82Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/86Stents in a form characterised by the wire-like elements; Stents in the form characterised by a net-like or mesh-like structure
    • A61F2/89Stents in a form characterised by the wire-like elements; Stents in the form characterised by a net-like or mesh-like structure the wire-like elements comprising two or more adjacent rings flexibly connected by separate members
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02Prostheses implantable into the body
    • A61F2/04Hollow or tubular parts of organs, e.g. bladders, tracheae, bronchi or bile ducts
    • A61F2/06Blood vessels
    • A61F2/07Stent-grafts
    • A61F2002/075Stent-grafts the stent being loosely attached to the graft material, e.g. by stitching
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2250/00Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2250/0058Additional features; Implant or prostheses properties not otherwise provided for
    • A61F2250/0096Markers and sensors for detecting a position or changes of a position of an implant, e.g. RF sensors, ultrasound markers
    • A61F2250/0098Markers and sensors for detecting a position or changes of a position of an implant, e.g. RF sensors, ultrasound markers radio-opaque, e.g. radio-opaque markers

Landscapes

  • Health & Medical Sciences (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • Veterinary Medicine (AREA)
  • Public Health (AREA)
  • General Health & Medical Sciences (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Cardiology (AREA)
  • Transplantation (AREA)
  • Vascular Medicine (AREA)
  • Pulmonology (AREA)
  • Gastroenterology & Hepatology (AREA)
  • Hematology (AREA)
  • Anesthesiology (AREA)
  • Biophysics (AREA)
  • Child & Adolescent Psychology (AREA)
  • Prostheses (AREA)
  • Media Introduction/Drainage Providing Device (AREA)
  • Graft Or Block Polymers (AREA)

Abstract

(57)【要約】本公報は電子出願前の出願データであるため要約のデータは記録されません。 (57) [Summary] This bulletin contains application data before electronic filing, so abstract data is not recorded.

Description

【発明の詳細な説明】 大動脈用継ぎ木、大動脈瘤を治療する埋込み装置及び方法 本発明は大動脈継ぎ木、大動脈瘤の治療に用いられる装置及び方法に関するもの である。動脈瘤は、病気または他の要因による血管の弱い部分における血管壁の 膨らみである。動脈瘤が治療されないと、動脈瘤が破裂し血液が流出することに なる。[Detailed description of the invention] Aortic splice, implantable device and method for treating aortic aneurysm TECHNICAL FIELD The present invention relates to an aortic splice, an apparatus and method used for the treatment of aortic aneurysms. It is. An aneurysm is a break in the wall of a blood vessel in a weakened area due to disease or other factors. It's a bulge. If the aneurysm is not treated, it can rupture and drain blood. Become.

大動脈の動脈瘤は血管の動脈瘤で最も多いものであり生命の危険に関わるもので ある。大動脈は循環器系に血液を供給する主たる動脈である。大動脈は心臓の空 洞から上方に延び心臓の後ろ側に曲がり胸郭及び腹部を降下する。腹部の大動脈 は2つの側部血管を腎臓血管に送っている。腎臓血管の下方において、腹部大動 脈は第4腰椎のレベルまで続いている。大動脈は腸骨動脈に分かれている。腸骨 動脈は血液を下端部及び分陰部まで供給している。Aortic aneurysms are the most common type of vascular aneurysms and are life-threatening. be. The aorta is the main artery that supplies blood to the circulatory system. The aorta is the sky of the heart It extends upward from the sinuses, curves behind the heart, and descends through the thorax and abdomen. abdominal aorta supplies two lateral vessels to the renal vessels. Below the renal vessels, abdominal large movements The pulse continues to the level of the fourth lumbar vertebra. The aorta is divided into the iliac arteries. ilium Arteries supply blood to the lower extremities and genitalia.

大動脈瘤は腎臓動脈と腸骨動脈との間の腹部動脈に発生しやすい。腹部動脈のこ の部分は特に弱いもので動脈瘤になりやすい。この部分の直径4cmを越える大 動脈瘤は悪いものである。治療されないと動脈瘤は破裂し、急激な大出血を起こ す。Aortic aneurysms tend to occur in the abdominal arteries between the renal and iliac arteries. abdominal artery saw This area is particularly weak and prone to aneurysms. The diameter of this part exceeds 4 cm. Aneurysms are bad. If untreated, the aneurysm can rupture and cause rapid, heavy bleeding. vinegar.

腹部動脈の動脈瘤は特に死亡率の高いものである。従って現代の医学基準では腹 部動脈瘤の手術は緊急に行なっている。腹部外科手術自体は身体に大きなストレ スを与える手術である。大動脈瘤の死亡率は極めて高いものであるが、大動脈瘤 を治療する外科的処置に関する死亡率及び種化率t1高い。本発明は、動脈瘤の ある腹部面管壁を通して動脈瘤のある部分をバイパスまたは交換させることであ る。特に合成チューブのような人口装置がこの目的のために使われる。この継ぎ 木は動脈瘤を循環器系から排除し動脈瘤のある弱い部分の圧力とストレスを取除 くものである。Abdominal artery aneurysms have a particularly high mortality rate. Therefore, according to modern medical standards, abdominal Surgery for partial aneurysms is performed urgently. Abdominal surgery itself puts a lot of stress on the body. This is a surgery that gives you a lot of energy. Although the mortality rate of aortic aneurysm is extremely high, Mortality and speciation rates for surgical procedures to treat t1 are high. The present invention is a method for treating aneurysms. Bypassing or replacing the aneurysm through a ventral canal wall. Ru. In particular, prosthetic devices such as synthetic tubes are used for this purpose. This joint Trees remove aneurysms from the circulatory system and relieve pressure and stress on weak areas where aneurysms are located. It's a spider.

外科手段に動脈瘤の治療は主たるものである。さらに実質的な罹患率は手術を必 要とし長い回復期間が必要である。最後に手術は高い死亡率を伴う。しかしなが ら外科的手術は高い危険性にも係らず動脈瘤の場合は必要とされるか腹部外科の ストレスに患者か耐えられない場合もある。腹部外科手術に関する死亡率及び罹 患率を低減することか望まれている。Surgical methods are the main treatment for aneurysms. Furthermore, substantial morbidity requires surgery. A long recovery period is required. Finally, surgery is associated with a high mortality rate. But long Despite the high risks, surgical procedures are often required in cases of aneurysms, or abdominal surgery is not recommended. Sometimes patients cannot bear the stress. Mortality and morbidity related to abdominal surgery It is desired to reduce the incidence rate.

最近は、腹部外科手術の危険性をなくした大動脈瘤を手術する方法か発達してい る。これらの例として米国特許第4,562.596号(1986年1月7日発 行)「大動脈継ぎ木、腹部大動脈層の治療装置及び方法」及び米国特許第4,7 87.899号(1988年11月29日発行)[内部継ぎ水装置、システム及 び方法」が知られている。Recently, a method has been developed to operate on aortic aneurysms that eliminates the risks of abdominal surgery. Ru. Examples of these include U.S. Patent No. 4,562.596 (issued January 7, 1986). row) “Aortic splint, abdominal aortic layer treatment device and method” and U.S. Patent Nos. 4 and 7 No. 87.899 (issued November 29, 1988) [Internal water connection device, system and ``methods'' are known.

上記米国特許第4,562.596号は継ぎ木の安定性及び弾性に貢献する複数 の支柱を有する可撓性チューブ材を有する大動脈継ぎ木を開示している。これら の支柱は、動脈瘤の上の動脈の内部に固着されるかかり部をその上端に有する曲 がったフックを備えている。上記米国特許第4,562.596号の継ぎ木は当 該特許に開示された管状装置を用いて挿入される。No. 4,562,596 discloses multiple components that contribute to the stability and elasticity of the joint. An aortic splint having a flexible tubing having struts is disclosed. these The strut is a curved strut with a barb at its upper end that is fixed inside the artery above the aneurysm. It has a sharp hook. The joint of the above US Pat. No. 4,562.596 is It is inserted using the tubular device disclosed in that patent.

しかしながら上記米国特許は動脈の継ぎ木の基端だけを固着するものである。上 記特許は血管の下方へ向かう流れか継ぎ木の末端を保持し末端を機械的に止める 必要がない。この点について上記米国特許のコラム6.24〜27行を参照され たい。しかしながら腹部動脈の血圧は約130mmHgである。継ぎ木の血流方 向に係らず動脈瘤の末端における背圧は端部が機械的に取付けられないと生じて しまう。端部の取付けなしに上記特許の装置は血圧に関係する力とストレスから 動脈瘤のある弱められた血管壁を効果的に排除することはできない。However, the above US patent fixes only the proximal end of the arterial splint. Up The patent retains the downward flow of the blood vessel or the end of the splice and mechanically stops the end. There's no need. In this regard, see column 6, lines 24-27 of the above US patent. sea bream. However, the blood pressure in the abdominal artery is approximately 130 mmHg. Blood flow in joints Regardless of the orientation, back pressure at the distal end of the aneurysm will occur if the distal end is not mechanically attached. Put it away. Without end attachment, the patented device eliminates the forces and stresses associated with blood pressure. A weakened vessel wall with an aneurysm cannot be effectively eliminated.

上記米国特許第4,787,899号は継ぎ木の基端に取付けられた複数の針を 用いた継ぎ木システムを開示している。この特許の針はバルーンカテーテルによ り大動脈壁に押え付けられる。しかしながら米国特許第4゜562.596号の ように米国特許第4.787.899号は継ぎ木の端に取付けられた針を開示し ている。米国特許第4,787.899号には動脈瘤のレベルよりも低い末端大 動脈に継ぎ木を機械的に取付けることは示されていない。U.S. Pat. No. 4,787,899 uses a plurality of needles attached to the proximal end of the splice. Discloses the splicing system used. This patented needle is attached to a balloon catheter. and is pressed against the aortic wall. However, U.S. Patent No. 4°562.596 No. 4,787,899 discloses a needle attached to the end of the splice. ing. U.S. Pat. No. 4,787.899 discloses Mechanical attachment of the splint to the artery is not indicated.

米国特許第4,787,899号も大動脈を修繕する様々な手段を開示している 。これらは、バルーンカテーテルシステムを用いた様々な継ぎ水装置、ニチノル コイルの使用および外科的技術である。U.S. Pat. No. 4,787,899 also discloses various means of repairing the aorta. . These include various irrigation devices using balloon catheter systems, Nitinol The use of coils and surgical techniques.

従って近年ある技術は大動脈瘤を修繕する外科的手術を介したストレス、死亡率 及びその危険を減少させるように発展しているが現在まで開発された技術は循環 系の圧力やストレスから大動脈の影響された部分を排除したり大動脈を効果的に 治療することができない。従来の装置は信頼性のある、かつ迅速な動脈瘤バイパ スを提供することができない。Therefore, in recent years, techniques to repair aortic aneurysms reduce stress and mortality through surgical procedures. and technology developed to date to reduce the risk of Eliminate the affected part of the aorta from system pressure and stress, or effectively remove the aorta. cannot be treated. Conventional devices provide reliable and rapid aneurysm bypass cannot provide access.

従って本発明の目的は動脈瘤の腹部外科手術に関するよりも罹患率や死亡率をよ り低減させる大動脈瘤の治療方法を提供することである。Therefore, the purpose of the present invention is to reduce the morbidity and mortality associated with abdominal surgery for aneurysms. An object of the present invention is to provide a method for treating an aortic aneurysm that reduces the risk of aortic aneurysm.

本発明の他の目的は腹部外科手術に耐えられない患者の大動脈瘤を治療する手段 を提供することである。Another object of the invention is a means of treating aortic aneurysms in patients who cannot tolerate abdominal surgery. The goal is to provide the following.

本発明の他の目的は広範囲な外科手術による死亡率や罹患率を低減することであ る。Another object of the invention is to reduce mortality and morbidity associated with extensive surgical procedures. Ru.

本発明の他の目的は緊急手術として大動脈瘤から患者を迅速に守る手段を提供す ることである。Another object of the present invention is to provide a means to quickly protect patients from aortic aneurysms during emergency surgery. Is Rukoto.

本発明の他の目的は主たる外科手術をすることなく腹部動脈瘤を治療する手段を 提供することである。Another object of the invention is to provide a means of treating abdominal aneurysms without major surgery. It is to provide.

本発明の他の目的は腹部動脈瘤を外科的に手術する場合の死亡率や罹患率を低減 する腹部動脈瘤を治療する装置を提供することである。Another object of the present invention is to reduce mortality and morbidity when surgically operating abdominal aneurysms. An object of the present invention is to provide a device for treating abdominal aneurysms.

本発明の他の目的は動脈瘤の外科手術に関する治療における費用を低減する腹部 動脈瘤の手術方法及びシステムを提供することである。Another object of the present invention is to reduce the costs associated with surgical treatment of aneurysms. An object of the present invention is to provide a surgical method and system for aneurysm.

本発明の付加的な目的は、医療費、リハビリテーション、罹患率及び回復時間を 考慮して患者に対する費用を低減する腹部動脈瘤の手術方法及びシステムを提供 することである。Additional objects of the present invention are to reduce medical costs, rehabilitation, morbidity and recovery time. Provides a surgical method and system for abdominal aneurysm that takes into account costs for patients It is to be.

発明の要約 添付図面及び請求の範囲に記載されたように本発明は大動脈の部分の吻合をする 大動脈継ぎ木に関するものであり、頭部端及び尾部端を有しかつ軸線を有する大 動脈継ぎ水装置と前記大動脈継ぎ水装置の前記頭部端及び尾部端に取付けられ前 記大動脈継ぎ水装置を前記大動脈に固定する複数の取付は装置を有しており、前 記取付は装置は、前記大動脈継ぎ水装置に取付けられ前記大動脈継ぎ水装置の前 記軸線にほぼ平行に指向したベース装置と前記ベース装置に取付けられ前記大動 脈継ぎ水装置からほぼ径方向外側に延びた支柱装置と、前記軸線に対しほぼ平行 に指向し前記支柱装置の末端に取付けられ前記大動脈を通過し前記継ぎ水装置を 前記大動脈に固定するフック装置を有していることを特徴とする大動脈継ぎ木を 提供する。Summary of the invention As described in the accompanying drawings and claims, the present invention provides an anastomosis of portions of the aorta. It relates to an aortic splice, which has a cranial end, a caudal end, and an axis. an arterial watering device and a front end attached to the head and caudal ends of the aortic watering device; A plurality of attachments for securing the aortic irrigation device to the aorta include a device and a The installation is such that the device is attached to the aortic irrigation device and in front of the aortic irrigation device. a base device oriented substantially parallel to the axis; and a large movable device attached to the base device. a strut device extending substantially radially outward from the vein water device and substantially parallel to said axis; attached to the distal end of the strut device and passing through the aorta to connect the water spout device. An aortic splint, characterized in that it has a hook device for fixing to the aorta. provide.

明細書に記載されているように、本発明の大動脈継ぎ木はバルーンカテーテル及 び大動脈継ぎ木を用いて大動脈瘤を循環から安全に除去する方法に用いられる。As described in the specification, the aortic splice of the present invention can be used with balloon catheters and It is used to safely remove an aortic aneurysm from the circulation using an aortic splint.

本発明によると前記動脈瘤に投影剤か満たされたカテーテルを、悪影響されてい ない血管組織に当接するように前記動脈瘤の直上の基端部まで挿入し、前記動脈 瘤の直上の基端部の大動脈の径を計測し、前記投影剤で満たされたバルーンカテ ーテルを除去し、影響されていない面前組織に当接する動脈瘤の直下の末端部に 悪影響された血管にカテーテルを再位置決めし、前記動脈瘤の直下の基端部の血 管の径を計測し、前記投影剤で満たされたバルーンカテーテルを除去し、電波映 像技術により前記基端部と前記末端部との間の距離を測定し、前記基端部及び末 端部における前記大動脈のサイズよりほぼ1〜4mm大きい第1及び第2の端部 を有する継ぎ木をダブルバルーンカテーテルにそって挿入し、頭部バルーンの末 端から前記頭部バルーンを膨らませ前記継ぎ木の頭部の末端部のフックを前記頭 部大動脈と整合させ、前記頭部バルーンが完全に膨らみ前記基端部のフックが前 記頭部の基端部における前記大動脈と整合するまで前記頭部バルーンの末端部か ら前記頭部バルーンを膨張させつづけ、尾部バルーンを膨らませながら前記頭部 バルーンの膨張を維持し、前記尾部バルーンの基端部から前記尾部バルーンを膨 らませ前記継ぎ木の尾部の前記基端位置のフックを前記尾部における大動脈と整 合させ、前記尾部バルーンか完全に膨らみ前記末端のフックが前記尾部大動脈の 前記末端の大動脈と係合するまで前記尾部バルーンの前記基端部から前記尾部バ ルーンを膨らませ続け、前記ダブルバルーンカテーテル装゛iを除去し、前記継 ぎ木に第1の膨張リングリテーナ−を挿入する方法か促供される。According to the present invention, a catheter filled with a projection agent is inserted into the aneurysm without being adversely affected. Insert the artery to the proximal end directly above the aneurysm so that it is in contact with the free vascular tissue. Measure the diameter of the aorta at the proximal end just above the aneurysm, and insert the balloon catheter filled with the projection agent. the distal end of the aneurysm abutting the unaffected anterior tissue. Reposition the catheter in the affected vessel and remove the proximal blood just below the aneurysm. Measure the diameter of the tube, remove the balloon catheter filled with the projection agent, and measuring the distance between the proximal end and the distal end by imaging technology; first and second ends approximately 1-4 mm larger than the size of the aorta at the ends; Insert the splint with the double balloon catheter along the end of the head balloon. Inflate the head balloon from the end and attach the hook at the end of the head of the joint to the head. Align the head balloon with the aorta until the head balloon is fully inflated and the proximal hook is in front. the distal end of the head balloon until aligned with the aorta at the proximal end of the marking head. Continue to inflate the head balloon, and continue to inflate the head balloon while inflating the tail balloon. maintain balloon inflation and inflate the tail balloon from the proximal end of the tail balloon. Align the hook at the proximal position of the tail of the splice with the aorta at the tail. the caudal balloon is fully inflated and the distal hook is in the caudal aorta. the tail balloon from the proximal end of the tail balloon until it engages the distal aorta; Continue to inflate the loop and remove the double balloon catheter device A method of inserting the first inflatable ring retainer into the tree is facilitated.

図面の簡単な説明 本発明の特徴は以下の添付図面により良く理解される。Brief description of the drawing The features of the invention will be better understood from the accompanying drawings, in which: FIG.

第1図は継ぎ木(7組込才れるダブルバルーンカテーテルシステムを用いた本発 明の大動脈継ぎ木の冠状縫合の拡大図である。Figure 1 shows the present invention using a double-balloon catheter system with 7 built-in joints. An enlarged view of the coronal suture of the bright aortic splice.

第2図は本発明の好適実施例の取付は装置の拡大図である。FIG. 2 is an enlarged view of the installation of a preferred embodiment of the present invention.

第3図は血管の径を測定するため動脈瘤の上の血管の頭部に挿入されたバルーン カテーテルの冠状図である。Figure 3 shows a balloon inserted into the head of the blood vessel above the aneurysm to measure the diameter of the blood vessel. FIG. 2 is a coronal view of the catheter.

第4図は血管の径を測定するために動脈瘤の腹部大動脈の尾部に挿入された投影 剤が満たされたバルーンカテーテルの冠状図である。Figure 4 shows a projection inserted into the tail of the abdominal aorta of an aneurysm to measure the diameter of the blood vessel. FIG. 3 is a coronal view of a drug-filled balloon catheter.

第5図は腹部大動脈に挿入され大動脈継ぎ木の頭部及び尾部がそれぞれ動脈瘤の 上部及び下部の頭部及び尾部と整合する本発明の継ぎ木とダブルバルーンカテー テルシステムの冠状図である。Figure 5 shows the head and tail of the aortic splice inserted into the abdominal aorta and the aneurysm, respectively. The splice and double balloon catheter of the present invention are aligned with the upper and lower heads and tails. FIG. 2 is a coronal view of the tell system.

第6図は頭部バルーンが膨張するときの取付は装置の血管壁への挿入を示す挿入 された継ぎ木及びダブルバルーンカテーテルシステムと動脈瘤上の頭部腹部大動 脈の冠状図である。Figure 6 shows the insertion of the device into the blood vessel wall when the head balloon is inflated. Head-abdominal mass movement over aneurysm with splint and double balloon catheter system FIG. 2 is a coronal view of the veins.

第7図は取付は装置が動脈壁を貫通したときの頭部バルーンの膨張中の状態を示 す第6図の継ぎ木と頭部バルーンの冠状図である。Figure 7 shows the installation during inflation of the head balloon when the device has penetrated the artery wall. Fig. 6 is a coronal view of the joint and head balloon of Fig. 6;

第8図は尾部バルーンが膨張したときの動脈壁を取付は装置が貫通することを示 す継ぎ木とダブルバルーンカテーテルシステムと動脈瘤の下部の尾部腹部動脈の 冠状図である。Figure 8 shows that the attached device penetrates the artery wall when the tail balloon is inflated. of the caudal abdominal artery at the bottom of the aneurysm with a splint and double balloon catheter system Coronal view.

第9図は取付は装置が動脈壁を通過したときの尾部バルーンの膨張中の状態を示 す第8図の継ぎ木と頭部バルーンの冠状図である。Figure 9 shows the installation during inflation of the tail balloon as the device passes through the artery wall. Fig. 8 is a coronal view of the joint and head balloon of Fig. 8;

第10図は頭部及び尾部の取付は装置が動脈壁に取付けられダブルバルーンカテ ーテルシステムが除去されて動脈層を除いた後の本発明の大動脈継ぎ木の冠状図 である。Figure 10 shows the head and tail attachments where the device is attached to the artery wall and a double balloon catheter. Coronal view of the aortic splice of the present invention after the arterial system has been removed and the arterial layer has been removed. It is.

第11図は本発明のりチーナーリングの上面図である。FIG. 11 is a top view of the glue tiner ring of the present invention.

第12図は本発明のりチーナーリングの変更例を示す斜視図である。FIG. 12 is a perspective view showing a modified example of the glue tiner ring of the present invention.

第13図はバルーンカテーテルと頭部リテーナ−リングの取付けを示す本発明の 大動脈継ぎ木の頭部を示す冠状図である。FIG. 13 shows the attachment of the balloon catheter and head retainer ring of the present invention. FIG. 3 is a coronal view showing the head of the aortic splint.

第14図はバルーンカテーテルと尾部リテーナ−リングの取付けを示す本発明の 大動脈継ぎ木の尾部の冠状図である。FIG. 14 shows the installation of the balloon catheter and tail retainer ring of the present invention. Coronal view of the caudal part of the aortic splint.

第15図は大動脈瘤を除去する大動脈に埋め込まれた継ぎ木を示す本発明の大動 脈継ぎ木の冠状図である。Figure 15 shows the aortic graft of the present invention for removing an aortic aneurysm. It is a coronal view of a vein joint tree.

本発明の継ぎ木及び大動脈継ぎ木を取付ける装置及び方法は以下の図面により詳 述されるが本発明はこの実施例に限定されるものでなく添付の請求の範囲に基い て多くの変更か可能である。The splice of the present invention and the apparatus and method for attaching the aortic splice are shown in more detail in the following drawings. However, the present invention is not limited to this embodiment, but is based on the scope of the appended claims. Many changes are possible.

実施例 第1図は腹部大動脈瘤12を治療する大動脈継ぎ木手段10を示している。第3 図に示されるように、大動脈瘤12は腎動脈15と腸骨動脈16との間の腹部大 動脈11に位置している。Example FIG. 1 shows an aortic grafting means 10 for treating an abdominal aortic aneurysm 12. Third As shown in the figure, the aortic aneurysm 12 is located between the renal artery 15 and the iliac artery 16. Located in artery 11.

本発明の大動脈継ぎ木lOも添付請求の範囲において他の位置をとれることは当 業者にとって自明である。例えば継ぎ木は身体の他の部分または他の管に位置す る動脈のような流体を連通させる管にも用いることができる。It is of course that the aortic splice lO of the invention can also take other positions within the scope of the appended claims. It is self-evident for businesses. For example, splices may be located in other parts of the body or in other tubes. It can also be used for fluid communication tubes such as arteries.

実施例に示されるように、本発明の大動脈継ぎ水装置10は頭部19、尾部20 端及び本体21を有する大動脈継ぎ木18を育している。本発明の大動脈継ぎ木 18は、好ましくはテフロン(ポリテトラフルオロエチレン)等の可撓性、弾性 材料や他の同様に可撓性、弾性を存する材料からなる。天然または人口のポリマ ー材等の材料(ポリエステル繊維、ダクロン、マイラー、レーヨン、セルロース アセテート、セルロースブチネート)も使用できる。大動脈継ぎ木18を構成す る材質は生化学的に不活性であり大動脈継ぎ木が埋められる組織と相性がよくな ければならないことが重要である。この種の材料としては多くのものが知られて いる。As shown in the embodiment, the aortic irrigation device 10 of the present invention includes a head portion 19 and a tail portion 20. An aortic splint 18 is grown having an end and a body 21. Aortic joint of the present invention 18 is preferably a flexible and elastic material such as Teflon (polytetrafluoroethylene). material or other similarly flexible, elastic materials. natural or artificial polymers materials (polyester fiber, Dacron, Mylar, rayon, cellulose) acetate, cellulose butinate) can also be used. Constructing the aortic joint 18 The material is biochemically inert and compatible with the tissue into which the aortic graft will be implanted. It is important that the Many materials of this kind are known. There is.

本発明の実施例においては、大動脈継ぎ木18は複数のアタッチメント手段22 とダブルバルーンカテーテルシステム35を有している。継ぎ木は、大動脈の直 径の計測する第1のカテーテルシステム、アタッチメント手段22を有する大動 脈18、ダブルバルーンカテーテルシステムである第2のカテーテルシステム、 及び保持リング45を存する第3のバルーンカテーテルシステム48を有するキ ットとし5て衛生的(τ取扱われパッケージされている。本発明の大動脈継ぎ木 18、ダブルバルーンカテーテルシステム35及び第3のカテーテルシステム4 8は様々なサイズに形成され本発明のシステムか個個の患者の大動脈瘤のサイズ や形に適合するようになっている。In an embodiment of the invention, the aortic splint 18 has a plurality of attachment means 22. and a double balloon catheter system 35. The joint is directly connected to the aorta. A first catheter system for diameter measurement, a large catheter system having attachment means 22; pulse 18, a second catheter system that is a double balloon catheter system; and a third balloon catheter system 48 having a retaining ring 45. The aortic joint of the present invention is handled and packaged as a hygienic (τ) kit. 18, double balloon catheter system 35 and third catheter system 4 8 is formed into various sizes, depending on the system of the present invention or the size of the aortic aneurysm of an individual patient. It is designed to conform to the shape.

第2図に示されるように、本発明のアタッチメント手段22はベース手段23、 支柱手段24及びフック手段25を有している。フック手段25はチップ部26 を有しておりフック25による大動脈IIの通過を容易にし、やじり27を存し ており大動脈11に対する取付は位置において取付は手段を弾性的に保持してい る。本発明の好適実施例においては、大動脈継ぎ木18は、継ぎ木18の頭部1 9及び尾部20端に取付けられた複数の取付は手段22を備えている。As shown in FIG. 2, the attachment means 22 of the present invention includes a base means 23, It has strut means 24 and hook means 25. The hook means 25 has a tip portion 26 to facilitate passage of the aorta II by the hook 25, and has a bevel 27. The attachment to the aorta 11 elastically holds the attachment in position. Ru. In a preferred embodiment of the invention, the aortic splint 18 includes a head 1 of the splint 18. 9 and a plurality of attachments attached to the tail 20 ends are provided with means 22.

本発明の好適実施例においてベース手段23は金属やプラスチック等の生化学的 に相性のいい材料からなる。In a preferred embodiment of the invention, the base means 23 is a biochemical material such as metal or plastic. Made of materials that are compatible with.

ベース23は大動脈継ぎ木18の軸の対してほぼ平行な金属性平坦小片である。The base 23 is a flat piece of metal approximately parallel to the axis of the aortic graft 18.

ベース23は大動脈継ぎ木18の頭部19及び尾部20端に取付けられる。この 取付けは、これに限定されるものではないが、接着、溶接、リベット、単なるベ ース23の位置決め等によりなされ、ベース23の末端は大動脈継ぎ木18の内 腔の末端面に当接し支柱24の力により保持される。The base 23 is attached to the head 19 and tail 20 ends of the aortic splice 18. this Attachment may include, but is not limited to, gluing, welding, riveting, or simply attaching. The end of the base 23 is positioned within the aortic joint 18. It abuts the distal surface of the cavity and is held by the force of the strut 24.

支柱手段24は好ましくはベース23に対してほぼ直角な方向に向いた支柱であ る。本発明の好適実施例C二おいては、支柱24はベース23の末端面に取付け られ支柱24は、大動脈継ぎ木18に取付けられたとき大動脈継ぎ木18から径 方向外側に延在する。ベース23は生化学的に安定して支柱24をベース23に 固着できる接着、リベット、溶接等の様々な手段を介して大動脈継ぎ木18に固 定できる。ベース23も大動脈継ぎ木18の内腔においてベース23を取付ける ことにより大動脈継ぎ木18に固定でき、ベース23の末端面が大動脈継ぎ木1 8の内腔基端面に当接し、支柱24は大動脈継ぎ木18を通過する。支柱24の 基端にかかった力によりべ゛−ス23と支柱24が保持される。The strut means 24 are preferably struts oriented generally perpendicular to the base 23. Ru. In preferred embodiment C2 of the invention, the strut 24 is attached to the distal end of the base 23. The strut 24 extends radially from the aortic splice 18 when attached to the aortic splice 18. Extend outward in direction. The base 23 is biochemically stable and the support 24 is attached to the base 23. Secure to the aortic splice 18 via various means such as adhesive bonding, rivets, welding, etc. Can be determined. The base 23 is also attached in the lumen of the aortic splice 18. By this, it can be fixed to the aortic joint 18, and the distal surface of the base 23 can be fixed to the aortic joint 18. 8 and the strut 24 passes through the aortic splice 18 . of pillar 24 The base 23 and the strut 24 are held by the force applied to the proximal end.

本発明の好適実施例においては、フック手段25は支柱24の末端に取付けられ たフックである。フック25はベース23に対してほぼ平行であり、従って大動 脈11に取付けられたとき大動脈継ぎ木18の軸線に平行である。本発明の好適 実施例においては、チップ26が位置するフック25の手の部分はチップ26か らのフック25の端部よりも支柱23からの長さが長い。さらにフック25は取 付は手段22を保持する1つ以上のやじり27と大動脈瘤11の上下における腹 部動脈の頭部I2及び尾部13の大動脈14に固定された大動脈継ぎ木18を保 持している。In a preferred embodiment of the invention, the hook means 25 is attached to the distal end of the post 24. It is a hook. The hook 25 is approximately parallel to the base 23 and therefore It is parallel to the axis of the aortic splice 18 when attached to the vein 11. Advantages of the present invention In the embodiment, the hand portion of the hook 25 where the tip 26 is located is the tip 26. The length from the support column 23 is longer than the ends of the other hooks 25. Furthermore, the hook 25 is removed. Attached are one or more prongs 27 that hold the means 22 and the abdomen above and below the aortic aneurysm 11. The aortic splice 18 fixed to the aorta 14 of the head I2 and tail 13 of the partial artery is maintained. I have it.

大動脈継ぎ木手段lOはダブルバルーンカテーテルシステム35を介して腹部大 動脈11に取付けられている。Aortic splicing means lO is inserted into the abdomen via a double balloon catheter system 35. It is attached to the artery 11.

本発明のダブルバルーンカテーテルシステム35は、バルーンがふくらんだとき フック25のチップ26かほぼ平行な関係ではなく動脈11の壁に係合してフッ ク25が本発明の大動脈継ぎ木18を大動脈11に固定するのを容易にするよう に方向づけられている。The double balloon catheter system 35 of the present invention has the advantage that when the balloon is inflated, Tip 26 of hook 25 engages the wall of artery 11 rather than in a generally parallel relationship, causing the hook to engage the wall of artery 11. 25 to facilitate securing the aortic splice 18 of the present invention to the aorta 11. is oriented to.

添付請求の範囲において本発明の取付は手段22の構造や取付けを様々に変更す ることは当業者にとって自明である。例えば支柱24のそれぞれの側のフック2 5の相対的な長さは変更できる。また支柱24は、支柱24の端部か大動脈継ぎ 木18から径方向に延びて大動脈IIを通過していれば様々な形状を有すること ができる。Within the scope of the appended claims, the mounting of the present invention may involve various changes in the structure and mounting of the means 22. It is obvious to those skilled in the art. For example, the hook 2 on each side of the post 24 The relative lengths of 5 can be changed. The strut 24 is also connected to the end of the strut 24 or the aortic joint. If it extends radially from the tree 18 and passes through the aorta II, it can have various shapes. Can be done.

またフック25は大動脈継ぎ木が大動脈11に取付けられたとき近くの器管を傷 つけないように方向づけられていれば様々な形状や方向をとることができる。さ らに取付は手段22は、大動脈11を通過しないように回転して大動脈11を単 純に押えつけるように方向づけてもよい。従って、本発明は、添付請求の範囲に おいて様々な変更が可能である。The hook 25 may also damage nearby organs when the aortic splint is attached to the aorta 11. It can take on a variety of shapes and orientations as long as it is oriented so that it does not stick. difference In addition, the mounting means 22 is rotated so as not to pass through the aorta 11 so as to simply attach the aorta 11. It may be oriented to simply press down. Accordingly, the invention lies within the scope of the appended claims. Various changes are possible.

大動脈継ぎ木手段10の動作及び取付けは、ダブルノくルーンカテーテルシステ ム35の動作により最もよく説明できる。本発明の大動脈継ぎ木手段の埋設は多 くのスチップを有している。まず大腿大動脈17または腸骨大動脈16に切込み を入れ、大動脈瘤12に接近する。第3図に示すように、本発明による好適実施 例においては、第1のバルーンカテーテル装置28は大動脈llのある重要な特 徴を計測する。実施例におけるように、第1のバルーンカテーテル28はガイド ワイヤ29、バルーン30、供給チューブ31、第1のバルーンカテーテルシー ス32及び投影剤33を有している。ガイドワイヤ29は第1のカテーテル装置 28で大腿大動脈17または腸骨大動脈16の切込みを介して挿入される。バル ーン30は電波投影剤33で満たされており、電波映像手段で可視化する。カテ ーテル装置28は、そのバルーン30が腹部大動脈11の動脈瘤12に挿入され るまで大腿大動脈17または腸骨大動脈16の開口に供給される。The operation and installation of the aortic splicing means 10 is performed using a double loop catheter system. This can best be explained by the operation of system 35. The implantation of the aortic splicing means of the present invention is It has many chips. First, cut into the femoral aorta 17 or iliac aorta 16. to approach the aortic aneurysm 12. As shown in FIG. 3, a preferred implementation according to the present invention In the example, the first balloon catheter device 28 is located at a certain critical feature of the aorta II. Measure the symptoms. As in the embodiment, the first balloon catheter 28 is a guide Wire 29, balloon 30, supply tube 31, first balloon catheter sheath 32 and a projection agent 33. Guidewire 29 is the first catheter device It is inserted at 28 through an incision in the femoral aorta 17 or the iliac aorta 16. bar The chamber 30 is filled with a radio wave projection agent 33, and is visualized by radio wave imaging means. cath The balloon 30 of the ether device 28 is inserted into the aneurysm 12 of the abdominal aorta 11. is supplied to the opening of the femoral aorta 17 or iliac aorta 16.

電波映像システム34を用いて、バルーン30は動脈瘤12の上の腹部大動脈1 1の頭部13と整合される。バルーン30は、動脈瘤12の直上の腹部大動脈1 1の頭部13の内面と係合するまで膨張される。映倫装置f34は大動脈瘤の上 の腹部大動脈の頭部の径を測定する。Using the radio imaging system 34, the balloon 30 is placed in the abdominal aorta 1 above the aneurysm 12. 1 is aligned with the head 13 of 1. The balloon 30 is attached to the abdominal aorta 1 directly above the aneurysm 12. 1 until it engages the inner surface of the head 13 of 1. Eirin device f34 is on the aortic aneurysm Measure the diameter of the head of the abdominal aorta.

第4図に示されるように第1のカテーテル装置28は、バルーン30が動脈瘤1 2の下方の腹部大動脈11の尾部14と整合するまで引かれる。バルーン30は 動脈瘤12の下方の腹部動脈11の尾部14において腹部大動脈11の内壁に到 達するまで再び膨張される。映像装置34は再び動脈瘤12の下方の腹部大動脈 の尾部における腹部動脈l】の径を測定する。この計測値は記録される。映像装 置を介して集められたデータを用いて腹部大動脈13の頭部12と腹部大動脈] 1の尾部14との間の距離か動脈瘤12の上下において大動脈11の頭部13と 尾部14の径と同様に決定される。この情報を用いて患者の大動脈継ぎ水装置1 0の適当な大きさか選択される。As shown in FIG. 4, the first catheter device 28 has a balloon 30 attached to the aneurysm. 2 until it is aligned with the caudal portion 14 of the abdominal aorta 11. Balloon 30 is The inner wall of the abdominal aorta 11 is reached at the tail 14 of the abdominal artery 11 below the aneurysm 12. It will be expanded again until it reaches The imaging device 34 again displays the abdominal aorta below the aneurysm 12. Measure the diameter of the abdominal artery at the caudal part of the abdomen. This measurement value is recorded. Video equipment The head 12 of the abdominal aorta 13 and the abdominal aorta] 1 or the head 13 of the aorta 11 above and below the aneurysm 12. It is determined similarly to the diameter of the tail portion 14. Using this information, the patient's aortic irrigation device 1 is An appropriate size of 0 is selected.

実施例に示されるように大動脈継ぎ木18は映像装置34により決定された腹部 大動脈11の頭部13及び尾部14の間の距離よりも好ましくは2〜10mrn 長くなっている。本発明の大動脈継ぎ水装置tIOは大動脈継ぎ木18、取付は 装置122&びダブルバルーンカテーテルシステム35を存している。ダブルバ ルーンカテーテル装置35も投影剤マーカー42を有している。投影剤マーカー 42はダブルバルーンカテーテル35の尾部バルーン39の末端部41と基端部 40と同様に頭部バルーン36の端37と末端38に設けられている。第5図に 示すように投影剤マーカー42と映像装置34を用いて大動脈継ぎ木10は、頭 部バルーン36か腹部大動脈IIの頭部13と整合し尾部バルーン39か腹部大 動脈11の尾部14と整合するまで大腿大動脈17または腸骨大動脈1Gに挿入 される。As shown in the example, the aortic splint 18 is located in the abdomen as determined by the imaging device 34. Preferably 2 to 10 mrn than the distance between the head 13 and tail 14 of the aorta 11 It's getting longer. The aortic water connecting device tIO of the present invention has an aortic connecting piece 18, and the installation is device 122 & double balloon catheter system 35. Double bar Lune catheter device 35 also has projectile markers 42 . projectile marker 42 denotes a distal end 41 and a proximal end of the tail balloon 39 of the double balloon catheter 35. 40 are provided at the ends 37 and distal ends 38 of the head balloon 36. In Figure 5 Using projective marker 42 and imaging device 34 as shown, aortic splint 10 is placed in the head. The tail balloon 39 aligns with the head 13 of the abdominal aorta II, and the tail balloon 39 aligns with the head 13 of the abdominal aorta II. Insert into femoral aorta 17 or iliac aorta 1G until aligned with tail 14 of artery 11 be done.

頭部バルーン36はここで膨張される。第6図に示すように頭部バルーン36は 頭部バルーン36の端部38から膨張され始める。頭部バルーン36の末端38 か膨張されると当接した取付は手段22か回転し、レース23の末端か大動脈継 ぎ木18の軸線から径方向外側に移動しベース23の基端部は大動脈継ぎ木18 の軸線近くに残る。この回転によりフック25の先端部26が腹部大動脈11に 対してほぼ非平行になる。FJr1部バルーン36かさらに膨張するとチップ2 6は腹部大動脈11と係合する。頭部バルーン36の膨張により先端26は腹部 大動脈壁11を通過しフック25か大動脈壁11内に延びる。やじり27は通過 しフック25の先端26とやじり27が腹部大動脈壁11を通過しその外壁面に 位置する。Head balloon 36 is now inflated. As shown in FIG. 6, the head balloon 36 Inflation begins at end 38 of head balloon 36. Distal end 38 of head balloon 36 When inflated, the abutting attachment means 22 rotates and the distal end of the race 23 or aortic joint. The proximal end of the base 23 moves radially outward from the axis of the aortic joint 18 remains near the axis of This rotation causes the tip 26 of the hook 25 to connect to the abdominal aorta 11. It becomes almost non-parallel to the When FJr1 part balloon 36 is further expanded, tip 2 6 engages with the abdominal aorta 11. Due to the inflation of the head balloon 36, the tip 26 reaches the abdomen. The hook 25 extends through the aortic wall 11 and into the aortic wall 11 . Yajiri 27 passed The tip 26 of the hook 25 and the spear 27 pass through the abdominal aorta wall 11 and touch the outer wall surface of the abdominal aorta. To position.

第7図に示されるように頭部バルーン36の膨張が続けられ、頭部バルーン36 か完全に膨張するまで腹部大動脈壁11に取付は装置22が取付けられる。頭部 バルーン36が完全に膨張すると大動脈継ぎ木18の頭部I9上の取付は装置2 2は頭部13の腹部大動脈壁1jを通過し腹部大動脈11に大動脈継ぎ木18を 永久的に固着する。頭部バルーン36は完全に膨張し取付は装置22と大動脈継 ぎ木18の頭部19は血管壁11の基部13に固着し頭部バルーンは完全に膨張 されたままとなる。頭部バルーン36の膨張により残る手術の開腹部大動脈1】 を通る血流は効果的に開かれる。頭部バルーン36の膨張により大動脈継ぎ木1 8の頭部か保持され大動脈継ぎ木の尾部20は腹部大動脈11の尾部に取付けら れる。Inflation of the head balloon 36 continues as shown in FIG. The attachment device 22 is attached to the abdominal aortic wall 11 until fully inflated. head Once the balloon 36 is fully inflated, the attachment of the aortic splint 18 onto the head I9 of the device 2 2 passes through the abdominal aorta wall 1j of the head 13 and connects the aortic splice 18 to the abdominal aorta 11. permanently fixed. Head balloon 36 is fully inflated and attached to device 22 and aortic joint. The head 19 of the graft 18 is firmly attached to the base 13 of the blood vessel wall 11, and the head balloon is completely inflated. It remains as it was. Open abdominal aorta 1 for surgery remaining due to inflation of head balloon 36] Blood flow through the is effectively opened. Aortic splicing 1 due to inflation of head balloon 36 The head of 8 is retained and the tail 20 of the aortic splice is attached to the tail of the abdominal aorta 11. It will be done.

第8図に示されるように大動脈継ぎ木18の尾部2゜は尾部バルーン39の基端 40におけるダブルバルーンシステム35の尾部バルーン39を膨張することに より腹部大動脈11の尾部14に取付けられる。尾部バルーン390基端40が 膨張されると、大動脈継ぎ木18の尾部20の取付は装置22か頭部19に対し て上述のように回転し継ぎ木18の尾部の取付は装置22か第9図に示されるよ うに腹部大動脈11の尾部14に永久的に取付けられる。As shown in FIG. 8, the tail 2° of the aortic splice 18 is the proximal end of the tail balloon 39 Inflating the tail balloon 39 of the double balloon system 35 at 40 It is attached to the caudal part 14 of the abdominal aorta 11. The proximal end 40 of the tail balloon 390 is When inflated, the attachment of the tail 20 of the aortic splice 18 to the device 22 or the head 19 The attachment of the tail of splice 18 by rotating as described above is accomplished by means of apparatus 22 or as shown in FIG. It is permanently attached to the caudal portion 14 of the abdominal aorta 11.

第10図に示されるように頭部バルーン36と尾部バルーン39とか完全にふく らまされると継ぎ木18は腹部大動脈IIの上下に位置する。このとき継ぎ木1 8の頭部19及び尾部20によりさらに上下の血液が動脈瘤11に効果的に達し ないようにしている。継ぎ木18の本体21は動脈瘤12の腹部動脈壁+1とし て働(。第1O図に示されるように継ぎ木18が腹部大動脈11の頭部13と尾 部14とに完全に位置するとダブルバルーンカテーテルシステム35は取除かれ る。大動脈継ぎ木18は腹部大動脈11を循環する全圧力及びストレスを受け動 脈瘤12を効果的に俳除し動脈瘤にかかるストレスを取除く。As shown in Figure 10, the head balloon 36 and tail balloon 39 are completely wiped. When fixed, the joint 18 is positioned above and below the abdominal aorta II. At this time, splicing tree 1 The head 19 and tail 20 of 8 further allow upper and lower blood to effectively reach the aneurysm 11. I try not to. The main body 21 of the joint 18 is the abdominal artery wall of the aneurysm 12 +1. (As shown in Figure 1O, the joint 18 connects the head 13 and tail of the abdominal aorta 11. Once fully located in section 14, double balloon catheter system 35 is removed. Ru. The aortic splice 18 receives all the pressure and stress circulating in the abdominal aorta 11. To effectively eliminate an aneurysm 12 and remove stress on the aneurysm.

本発明の好適実施例において大動脈継ぎ水装置IOは保持手段45を存している 。保持手段45は人動[11に継ぎ木18を保持する弾性リングである。実施例 においてはりテーカ−45は本体46とロック手段47とを存している。第11 図に示されるように本発明の好適実施例においてはりテーカ−45は割りリング の2つの橋かスムーズなリングを形成するように形づくられた割りリングである 。In a preferred embodiment of the invention, the aortic irrigation device IO comprises retaining means 45. . The holding means 45 is an elastic ring that holds the joint 18 on the human hand [11]. Example The beam taker 45 includes a main body 46 and a locking means 47. 11th In a preferred embodiment of the invention, the beam taker 45 is a split ring as shown in the figure. is a split ring shaped to form two bridges or smooth rings of .

請求の範囲において本発明の取付は装置22の構造及び取付けには多くの変更が 可能である。例えばリテーナ−45は第12図に示されるような弾性メツシュ材 であってもよい。メツシュ材の本体46は好ましくは互いに取付けられるレッグ を有しておりメツシュ材は挿入用に折りたたみ可能であり一旦取付けられ膨張さ れるとロックされる。従って本発明は請求の範囲において多くの変更例が可能で あることは明らかである。Within the scope of the claims, the installation of the invention may include many modifications to the structure and installation of device 22. It is possible. For example, the retainer 45 is made of an elastic mesh material as shown in FIG. It may be. The mesh material body 46 preferably has legs that are attached to each other. The mesh material is collapsible for insertion and once installed and expanded. It will be locked if it is entered. Therefore, the present invention is capable of many modifications within the scope of the claims. It is clear that there is.

第1O図に示されるようにダブルバルーンカテーテル35か腹部大動脈11から 取除かれるとガイドワイヤ29は残ったままである。第13図に示されるように リテーナ−45は第3のカテーテルシステム48を用いて腹部大動脈11に挿入 される。リテーナ−45と第3のカテーテル装置48か腹部大動脈11に挿入さ れると映像装置34か腹部大動脈14の頭部13.19と大動脈継ぎ木18に対 してリテーナ−45の位置を追跡する。From the double balloon catheter 35 or the abdominal aorta 11 as shown in Figure 1O. Once removed, guidewire 29 remains. As shown in Figure 13 Retainer 45 is inserted into abdominal aorta 11 using third catheter system 48. be done. The retainer 45 and the third catheter device 48 are inserted into the abdominal aorta 11. When the imaging device 34 is connected to the head 13.19 of the abdominal aorta 14 and the aortic joint 18, to track the position of the retainer 45.

腹部大動脈14の頭部12.19と大動脈継ぎ木18に対してリテーナ−45か 整合すると頭部バルーン49が膨張される。頭部バルーン49が膨張されるとロ ック手段47が開放位置の大動脈11の固定リテーナ−と係合する。バルーン3 0が完全に膨らみリテーナ−45が完全に膨張すると、リテーナ−45は大動脈 継ぎ木18と大動脈11とを膨張させ大動脈継ぎ木18と取付は装置22を腹部 大動脈11の頭部13に押付ける。Retainer 45 for the head 12.19 of the abdominal aorta 14 and the aortic joint 18 Once aligned, head balloon 49 is inflated. When the head balloon 49 is inflated, the The locking means 47 engages the fixed retainer of the aorta 11 in the open position. Balloon 3 When the retainer 45 is completely inflated, the retainer 45 is completely inflated. The splice 18 and the aorta 11 are inflated and the aorta splice 18 and the device 22 are attached to the abdomen. Press against the head 13 of the aorta 11.

第14図に示されるように尾部バルーン50は膨張さね11テーナー45を大動 脈継ぎ未2oの尾部と大動脈14をロックする。第3のカテーテルシステム48 はガイドワイヤ29にそって取除かれる。手術か行なわれた大腿大動脈17また は腸骨大動脈16の切込み部は閉じられる。下肢の循環は回復され大動脈継ぎ木 18か循環から大動脈瘤12を除去する。As shown in FIG. Lock the tail of the vein splice 2o and the aorta 14. Third catheter system 48 is removed along guidewire 29. The femoral aorta that underwent surgery also The incision in the iliac aorta 16 is closed. Circulation in the lower extremities is restored and the aorta is spliced. 18 Remove the aortic aneurysm 12 from the circulation.

本発明について様々な変更が請求の範囲において可能なことは当業者にとって明 らかである。特に大動脈継ぎ木装置10はリテーナ−45とともに用いても用い なくてもよい。リテーナ−45は様々な保合及びサイズを育し大動脈継ぎ木装置 10と腹部大動脈14とを固定させる機能を存している。取付は装置22もその 形状について請求の範囲内において多くの変更か可能である。さらにダブルバル ーン力テーテルシステム35のそれぞれのバルーンが膨らまされる方向は取付は 装置22がバルーンの頭部36尾部39の膨張方向に対して方向づけられ大動脈 IIの通過が容易にてきればよい。従って本発明は請求の範囲において多くの変 更例か可能である。It will be obvious to those skilled in the art that various modifications to the present invention are possible within the scope of the claims. It is clear. In particular, the aortic splicing device 10 can also be used with the retainer 45. You don't have to. Retainer-45 is an aortic splicing device that grows various retention and sizes. 10 and the abdominal aorta 14. The installation is done with the device 22 as well. Many changes in shape are possible within the scope of the claims. More double bar The direction in which each balloon of the balloon force terminating system 35 is inflated is determined by the mounting direction. The device 22 is oriented with respect to the direction of inflation of the head 36 and tail 39 of the balloon and the aorta. It would be good if passing II was easy. Accordingly, the invention may be subject to many variations within the scope of the claims. An amendment is possible.

FIG、I FIG、2 FIG、 5 FIG、6 FIG、 7 FIG、8 FIG、9 FIG、IO UVV、、7 1+−r〜−1 %−一−N1FIG.I FIG.2 FIG. 5 FIG.6 FIG. 7 FIG.8 FIG.9 FIG, I.O. UVV, 7 1+-r~-1 %-1-N1

Claims (14)

【特許請求の範囲】[Claims] 1.大動脈の部分の吻合をする大動脈継ぎ木であって、頭部端及び尾部端を有し かつ軸線を有する大動脈継ぎ木装置と、 前記大動脈継ぎ木装置の前記頭部端及び尾部端に取付けられ前記大動脈継き木装 置を前記大動脈に固定する複数の取付け装置を有しており、前記取付け装置は、 前記大動脈継ぎ木装置に取付けられ前記大動脈継ぎ木装置の前記軸線にほぼ平行 に指向したベース装置と前記ベース装置に取付けられ前記大動脈継ぎ木装置から ほぼ径方面外側に延びた支柱装置と、前記軸線に対しほぼ平行に指向し前記支柱 装置の末端に取付けられ前記大動脈を通過し前記継き木装置を前記大動脈に固定 するフック装置を袴していることを特徴とする大動脈継ぎ木。1. An aortic splice for anastomosing parts of the aorta, the aortic splice having a cranial end and a caudal end. and an aortic splicing device having an axis; said aortic splicing device attached to said head end and said caudal end of said aortic splicing device; a plurality of attachment devices for securing the device to the aorta, the attachment devices including: attached to the aortic splicing device and substantially parallel to the axis of the aortic splicing device; a base device oriented to and attached to said base device and from said aortic splint device; a strut device extending substantially radially outward; and a strut device oriented substantially parallel to the axis; attached to the distal end of the device and passing through the aorta to secure the splinter device to the aorta; An aortic joint characterized by having a hook device attached thereto. 2.請求の範囲第1項記載の大動脈継ぎ木において、前記大動脈継ぎ木装置がほ ぼ円筒状であることを特徴とする大動脈継ぎ木。2. The aortic splicing device according to claim 1, wherein the aortic splicing device comprises: An aortic joint characterized by its almost cylindrical shape. 3.請求の範囲第1項記載の大動脈継ぎ木において、前記大動脈継き木装置が弾 性可撓性材料を有していることを特徴とする大動脈継ぎ木。3. The aortic splicing device according to claim 1, wherein the aortic splicing device is elastic. An aortic splice comprising a flexible material. 4.請求の範囲第1項記載の大動脈継ぎ木において、前記大動脈継ぎ木装置が体 液に対して不活性な材料を有することを特徴とする大動脈継ぎ木。4. The aortic splicing device according to claim 1, wherein the aortic splicing device Aortic splice characterized in that it has a material that is inert to fluids. 5.請求の範囲第1項記載の大動脈継ぎ木において、前記フック装置がやじりフ ックを有していることを特徴とする大動脈継ぎ木。5. The aortic splice according to claim 1, wherein the hook device is a heckler. An aortic joint characterized by having a joint. 6.請求の範囲第1項記載の大動脈継ぎ木において、前記大動脈継ぎ木装置がリ テーナーリング装置を有しており前記大動脈継ぎ木の前記第1及び第2の端を前 記大動脈の部分に係合当接して保持することを特徴とする大動脈継ぎ木。6. The aortic splicing device according to claim 1, wherein the aortic splicing device is a tenter ring device to forward the first and second ends of the aortic splint; 1. An aortic splice, characterized in that it engages and abuts on and holds a portion of the aorta. 7.大動脈の部分を吻合させる大動脈継き木であって、第1及び第2の端を有す るほぼ円筒伏の大動脈継ぎ木装置と、前記大動脈継ぎ木装置の前記第1及び第2 の端部に取付けられ前記大動脈継ぎ木装置を前記大動脈に固定する複数の取付け 装置とを有しており、前記取付け装置は、前記大動脈継ぎ木装置の長手軸線とほ ぼ平行に前記大動脈継き木装置に第1及び第2の端で取付けられたベース部材と 、前記大動脈継ぎ木装置から径方向に延びて前記ベース部材に取付けられた支柱 装置と前記大動脈を貫通して前記大動脈に前記継ぎ木装置を固定する前記支柱装 置の末端に取付けられたフック装置とを有し、前記フック装置がやじりフックを 有していることを特徴とする大動脈継ぎ木。7. an aortic splice for anastomosing portions of the aorta, the aortic splice having first and second ends; a generally cylindrical aortic splicing device; and the first and second aortic splicing devices of the aortic splicing device; a plurality of attachments attached to the ends of the aorta to secure the aortic splint device to the aorta; and the attachment device is approximately parallel to the longitudinal axis of the aortic splicing device. a base member attached at first and second ends to the aortic splint device substantially parallel to each other; , a strut extending radially from the aortic splice device and attached to the base member. the strut device passing through the aorta and securing the splice device to the aorta; a hook device attached to the end of the rack, the hook device having a heckler hook; An aortic joint characterized by having. 8.請求の範囲第7項記載の大動脈継き木において、前記大動脈継ぎ木装置が弾 性可撓性材料を有していることを特徴とする大動脈継ぎ木。8. The aortic splicing device according to claim 7, wherein the aortic splicing device is elastic. An aortic splice comprising a flexible material. 9.請求の範囲第7項記載の大動脈継ぎ木において、前記大動脈継ぎ木装置が体 液に対して不活性な材料を有することを特徴とする大動脈継ぎ木。9. The aortic splicing device according to claim 7, wherein the aortic splicing device Aortic splice characterized in that it has a material that is inert to fluids. 10.請求の範囲第7項記載の大動脈継ぎ木において、前記大動脈継ぎ木装置が 前記大動脈の結合部に前記第1及び第2の端部を係合保持するリテーナーリング 装置を有していることを特徴とする大動脈継ぎ太。10. The aortic splicing device according to claim 7, wherein the aortic splicing device comprises: a retainer ring that engages and holds the first and second ends at the junction of the aorta; An aortic joint comprising a device. 11.大動脈の部分を吻合する大動脈継ぎ木であって、第1及び第2の端を有す るほぼ円筒状の大動脈継ぎ木と前記大動脈継ぎ木装置の前記第1及び第2の端に 取付けられ前記大動脈継ぎ木装置を前記大動脈に固定する復数の取付け装置を有 しており、前記取付け装置が、前記大動脈継ぎ木装置の第1及び第2の端で前記 大動脈継ぎ木装置の内面に当接し前記大動脈継ぎ木装置の長手軸線にほぼ平行で あるベース部材と前記ベース部材に取付けられ前記大動脈継ぎ木装置から径方向 に前記大動脈継ぎ木装置の第1及び第2の端を通して延びている支柱装置と前記 支柱装置の末端に取付けられ前記大動脈を通過して前記大動脈に前記継ぎ木装置 を固定するフックとを有しており、前記フック装置がやじりフックを有しており 、前記大動脈の結合部に前記第1及び第2の端を維持するリテーナーリング装置 を備えていることを特徴とする大動脈継ぎ木。11. an aortic splice for anastomosing portions of the aorta, the aortic splice having first and second ends; a generally cylindrical aortic splice and a generally cylindrical aortic splice at the first and second ends of the aortic splice device; a plurality of attachment devices attached to secure the aortic splint device to the aorta; and the attachment device is attached to the aortic splice device at the first and second ends. abutting against the inner surface of the aortic splicing device and substantially parallel to the longitudinal axis of said aortic splicing device; a base member and a radial direction from the aortic splicing device attached to the base member; a strut device extending through the first and second ends of the aortic splint device; The splice device is attached to the distal end of the strut device and passes through the aorta to the aorta. and a hook for fixing the device, and the hook device has a heckle hook. , a retainer ring device for maintaining the first and second ends at the junction of the aorta; An aortic joint characterized by comprising: 12.請求の範囲第11項記載の大動脈継ぎ木において、前記大動脈継ぎ木装置 が弾性可撓性材料を有していることを特徴とする大動脈継ぎ木。12. The aortic splicing device according to claim 11, wherein the aortic splicing device an aortic splice, characterized in that it has an elastically flexible material. 13.請求の範囲第11項記載の大動脈継ぎ木において、前記リテーナーリング 装置は圧縮に対し前記リテーナーリングの径を弾性的に保持し互いに引っかかる 一連の短い部分を脅していることを特徴とする大動脈継ぎ木。13. The aortic splice according to claim 11, wherein the retainer ring The device elastically holds the diameter of the retainer ring against compression and hooks onto each other. Aortic splice characterized by a series of short threatening sections. 14.バルーンカテーテル及び大動脈継ぎ木を用いて大動脈瘤を治療する方法に おいて、前記動脈瘤に投影剤が満たされたカテーテルを、悪影響されていない血 管組織に当接するように前記動脈瘤の以上の基端部まで挿入し、前記動脈瘤の直 上の基端部の大動脈の径を計測し、前記投影剤で満たされたバルーンカテーテル を引いて、影響されていない血管組織に当接する動脈瘤の直下の末端部に悪影響 された血管にカテーテルを再位置決めし、前記投影剤で満たされたバルーンを再 膨張させ前記動脈瘤の直下の基端部の血管の径を計測し、前記投影剤で満たされ たバルーンカテーテルを除去し、電波映像技術により前記頭部と尾部との距離を 測定し、前記頭部及び尾部における前記大動脈のサイズよりほぼ1〜10mm大 きい第1及び第2の端部を有する継ぎ木をダブルバルーンカテーテルにそって挿 入し、頭部バルーンの末端から前記頭部バルーンを膨らませ前記継ぎ木の頭部の 末端部のフックを前記頭部大動脈と整合させ、前記頭部バルーンが完全に膨らみ 前記基端部のフックが前記頭部の基端部における前記大動脈と整合するまで前記 頭部バルーンの末端部から前記頭部バルーンを膨張させつづけ、尾部バルーンを 膨らませながら前記頭部バルーンの膨張を維持し、前記尾部バルーンの基端部か ら前記尾部バルーンを膨らませ前記継ぎ木の尾部の前記基端位置のフックを前記 尾部における大動脈と整合させ、前記尾部バルーンが完全に膨らみ前記末端のフ ックが前記尾部大動脈の前記末端の大動脈と係合するまで前記尾部バルーンの前 記基端部から前記尾部バルーンを膨らませ続け、前記ダブルバルーンカテーテル 装置を除去し、1つ以上のリテーナーを挿入し第3のバルーンカテーテル装置を 挿入し、大動脈内の頭部尾部位置にリテーナーを保持し継ぎ木を取付け、全ての カテーテルとワイヤを除去し、全ての大動脈の切り口を治し、大腿または腸骨大 動脈に近づく切り口を治すことを特徴とする方法。14. Method for treating aortic aneurysm using balloon catheter and aortic splicing The catheter filled with projecting agent is then inserted into the aneurysm using unaffected blood. Insert it to the proximal end of the aneurysm so that it contacts the ductal tissue, and insert it directly into the aneurysm. Measure the diameter of the aorta at the proximal end above the balloon catheter filled with the projecting agent. negative effects on the immediate distal end of the aneurysm that abuts unaffected vascular tissue. Reposition the catheter in the stained blood vessel and reposition the projecting agent-filled balloon. Measure the diameter of the blood vessel at the proximal end just below the aneurysm and fill it with the projecting agent. The balloon catheter was removed, and the distance between the head and tail was measured using radio imaging technology. approximately 1-10 mm larger than the size of the aorta in the cranial and caudal regions. Insert the splice with narrow first and second ends along the double balloon catheter. and inflate the head balloon from the end of the head balloon to open the head of the joint. Align the distal hook with the cranial aorta and ensure the cranial balloon is fully inflated. until the proximal hook is aligned with the aorta at the proximal end of the head. Continue to inflate the head balloon from the distal end of the head balloon, and then inflate the tail balloon. While inflating, maintain the inflation of the head balloon and close the proximal end of the tail balloon. Then inflate the tail balloon and attach the hook at the proximal end of the tail of the joint. Align the aorta at the tail until the tail balloon is fully inflated and the distal flap in front of the tail balloon until the hook engages the distal aorta of the tail aorta. Continue to inflate the tail balloon from the proximal end of the double balloon catheter. Remove the device, insert one or more retainers and replace the third balloon catheter device. Insert and hold the retainer in a craniocaudal position within the aorta and attach the splint, Remove catheters and wires, heal all aortic cuts, and remove femoral or iliac incisions. A method characterized by healing the cut close to the artery.
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