CN101909672B - 包括横向远侧开口的分裂末端导管 - Google Patents
包括横向远侧开口的分裂末端导管 Download PDFInfo
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- A61M1/36—Other treatment of blood in a by-pass of the natural circulatory system, e.g. temperature adaptation, irradiation ; Extra-corporeal blood circuits
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- A61M25/00—Catheters; Hollow probes
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Abstract
公开了一种用于放置在患者的脉管系统中并且在血液透析或其他适合的过程中使用的分裂末端导管。在一个实施方案中,所述分裂末端导管包括导管本体,所述导管本体限定第一内腔和第二内腔。所述导管本体还包括分裂远侧区域,所述分裂远侧区域包括静脉段和动脉段,所述静脉段限定所述第一内腔的远侧部分,所述动脉段限定所述第二内腔的远侧部分。所述静脉段包括从鼻状部分向近侧延伸的凹口;以及与所述第一内腔流体连通的横向开口。所述动脉段与所述静脉段分开并且以可移开的方式可就位于由所述静脉段提供的所述凹口中,以致其“嵌”于其中。所述动脉段还包括与所述第二内腔流体连通的横向开口。
Description
对相关申请的交叉引用:本申请要求下述申请的优先权:2008年10月17日提交的题目为“包括横向远侧开口的分裂末端导管(Split-Tip Catheter Including Lateral DistalOpening)”的美国专利申请No.12/253,870,以及下面的美国临时专利申请:2007年10月26日提交的题目为“在丝上的分裂末端导管(Over-The-Wire Split-Tip Catheter)”的申请No.60/983,032;2008年3月14日提交的题目为“具有横向远侧开口的分裂末端导管(Split-Tip Catheter Having Lateral Distal Opening)”的申请No.61/036,848;以及2008年8月1日提交的题目为“皮下隧穿设备(Subcutaneous Tunneling Device)”的申请No.61/085,748。本文通过引用将前面所引用的申请中的每一个的全部内容并入本申请。
发明内容
简要概述,本发明的实施方案涉及用于放置在患者的脉管系统中的分裂末端导管。所述导管被配置用来在血液透析治疗中使用,然而本发明的原理可以延伸到在除血液透析以外的其他应用中所用到的其他导管。
在一个实施方案中,所述分裂末端导管包括导管本体,所述导管本体限定第一内腔和第二内腔。所述导管本体还包括分裂远侧区域,所述分裂远侧区域包括静脉段和动脉段,所述静脉段限定所述第一内腔的远侧部分,所述动脉段限定所述第二内腔的远侧部分。所述静脉段包括从鼻状部分向近侧延伸的凹口,以及与所述第一内腔流体连通的横向开口。
所述动脉段在所述分裂远侧区域中与所述静脉段分开,并且是以可移开的方式可就位于由所述静脉段提供的所述凹口中,以致其“嵌(nest)”于其中。所述动脉段和所述静脉段的这一嵌套(nesting)为所述分裂远侧区域在其推进进入并通过患者脉管系统期间提供柱状轮廓,使所述远侧区域能够以整体(monolithic)结构推进,并且从而使其易于推进通过扭曲的路径以及越过通道障碍。所述段经由导丝被维持在其嵌套的状态,所述导丝穿过两个段并且在所述导管已经被适当地放置后是可移除的。类似于所述静脉段,所述动脉段也包括与所述第二内腔流体连通的横向开口。
在题目为“多内腔导管,特别地用于血液透析(Multilumen Catheter,Particularly forHemodialysis)”的美国专利No.6,001,079中,公开了可以包括本发明的实施方案的各方面的分裂末端导管的一实施例,通过引用将其全部内容并入本文。
本发明的这些和其他特征将从下面的说明和所附的权利要求书中变得更加完整清晰,或者可以通过对由下文所阐明的本发明的实践来获悉。
附图说明
为进一步阐释本发明的上述和其他优点和特征,将通过参考本发明的具体的实施方案提供对本发明的更加具体的描述,所述的具体实施方案在所附的附图中被图示说明。可以理解,这些附图仅描绘本发明的典型实施方案,因而不能被认为是对本发明范围的限制。将通过使用说明书附图来以附加的特征和细节对本发明进行描述和解释,其中:
图1为根据本发明的一个示例性实施方案配置的包括分裂末端远侧区域的导管组件的透视图;
图2为根据一个实施方案,包括分裂末端远侧区域和预先弯曲的导管本体的导管组件的透视图;
图3A-3D分别为图1的所述分裂末端导管的所述远侧区域的两个透视图、一侧视图以及一顶视图;
图4A和4B分别为图1的所述分裂末端导管的所述远侧区域的透视图和侧视图,其中导丝被插入穿过所述远侧区域来将静脉段和动脉段维持在嵌套的结构中;
图5A和5B为图1的所述分裂末端导管的所述远侧区域的侧视图,示出当所述导管被放置在患者的脉管系统中时,血流在“正(forward)”方向(图5A)和“反(reverse)”方向(图5B)穿过所述远侧区域;
图6A和6B分别为根据一个实施方案配置的分裂末端导管的远侧区域的透视图和侧视图;
图7为在插入患者的脉管系统后,图1的所述分裂末端导管的简化视图;
图8A为根据本发明的一个示例性实施方案配置的皮下隧穿器的透视图;
图8B为图8A所示的所述隧穿器的侧视图;
图8C和8D分别为图8A中所示的所述隧穿器的侧视图和顶视图;
图9A-9D示出在分裂末端导管(例如如图1中所示的)的远侧端插入图8A的所述皮下隧穿器的各种步骤;
图10-12为根据本发明的实施方案,用于图8A的所述隧穿器的钩结构的侧视图;
图13A-13C分别为根据本发明的一个实施方案配置的包括远侧区域的分裂末端导管的透视图、底视图以及顶视图;
图14A-14C分别为根据一个实施方案配置的包括远侧区域的分裂末端导管的透视图、底视图以及顶视图;
图15A-15C分别为根据一个实施方案配置的包括远侧区域的分裂末端导管的透视图、底视图以及顶视图;
图16A-16C分别为根据一个实施方案配置的包括远侧区域的分裂末端导管的透视图、底视图以及顶视图;
图17A-17C分别为根据一个实施方案配置的包括远侧区域的分裂末端导管的透视图、底视图以及顶视图;
图18A-18D分别为根据一个实施方案配置的包括远侧区域的分裂末端导管的透视图、底视图、顶视图以及剖视图;
图19A-19D分别为根据一个实施方案配置的包括远侧区域的分裂末端导管的透视图、底视图、顶视图以及剖视图;
图20A-20C分别为根据一个实施方案配置的包括远侧区域的分裂末端导管的透视图、底视图以及顶视图;以及
图21A-21C分别为根据本发明的一个实施方案配置的包括远侧区域的分裂末端导管的透视图、底视图以及顶视图。
图22A-22B为根据本发明的一个实施方案配置的包括远侧区域的分裂末端导管的透视图。
图23A-23C为根据本发明的一个实施方案配置的包括远侧区域的分裂末端导管的透视图。
具体实施方式
现在将参考附图,其中相似的结构将被提供以相似的参考编号。可以理解,附图为本发明的示例性实施方案的图解的和示意的表征,而非对本发明的限制,所述附图也无须按比例绘制。
图1-23C描绘了本发明的实施方案的各种特征,这些特征一般地涉及用于放置在患者脉管系统中的分裂末端导管。所述导管被配置用来在肾脏替代治疗(renal replacementtherapy)中使用,例如血液透析或血液净化,然而本发明的原理可以延伸到在除这些以外的其他应用中所用到的其他导管。这样的导管典型地被用在长期或慢性放置情形中,例如30日或更久的放置(placement),然而本文将描述的原理还可以应用于短期或中期导管放置。
根据一个示例性实施方案,所述导管的所述分裂末端部分包括分开的静脉和动脉段,在血液透析治疗期间,所述静脉和动脉段被用来从患者的脉管系统的静脉或其他脉管同时注入和抽吸血液。所述静脉和动脉段的所述远侧端可以为交错的(staggered),来降低刚刚通过所述静脉段送回脉管的处理过的血液通过所述动脉段再循环的可能性,从而提高导管效率。此外,所述静脉和动脉段被配置有开口,包括横向设置的开口,来在血液透析期间进一步调高导管效率。
本文将描述的所述分裂末端导管的实施方案还包括嵌套的分裂末端结构,其中所述导管的所述动脉段就位于由所述静脉段的一部分提供的相应地成形的凹口中。当以这一方式就位时,所述动脉段和所述静脉段一起限定一光滑、柱形的外表面,从而使所述导管能够被导引进入患者的脉管系统并在患者的脉管系统中被推进,同时避开否则会导致所述导管随之被绊住或缠住的障碍或阻碍。所述嵌套的分裂末端设计还提供导丝槽,用来使导丝能够穿过所述静脉和动脉段两者,以在导管插入脉管系统期间将这两个段维持为嵌套结构。一旦所述导管被适当地定位,所述导丝可以被移除,并且所述静脉和动脉段在脉管内为彼此自由分开的,从而提供所述静脉段和动脉段之间期望的分开。本文还提供皮下隧穿器(tunneler),用来帮助以皮下方式隧穿所述导管。
为清楚起见,将理解到的是,词语“近侧的(proximal)”涉及相对地更靠近使用本文将描述的所述设备的临床医生的方向,而词语“远侧的(distal)”涉及相对地更远离临床医生的方向。例如,被放置在患者体内的导管的端被认为是所述导管的远侧端,而所述导管仍保留在体外的端为所述导管的近侧端。另外,如本文(包括权利要求书)所使用的词语“包括(including)”、“具有(has)”以及“具有(having)”,应当具有同词语“包括(comprising)”相同的意思。
首先参考图1,图1描绘了根据本发明的一个示例性实施方案的血液透析分裂末端导管组件的各种特征,一般地被标明为10。如所示出的,导管10包括细长的导管本体11,所述导管本体11包括近侧端11A和远侧端11B。细长的导管本体11限定自导管本体11的近侧端11A纵向延伸到远侧端11B的第一内腔12和第二内腔14(图3B)。内腔12和14可以沿其各自的长度具有一个或更多个截面形状,包括圆、椭圆以及D截面形状。
在所述导管本体近侧端11A包括分叉套(bifurcating hub)15,分别提供在第一和第二内腔12、14与动脉延伸腿16和静脉延伸腿18之间的流体连通。延伸腿16、18的每一个都包括鲁尔连接器(luer connector)16A、18A和夹子16B、18B。如这样配置的,延伸腿16、18提供与第一和第二内腔12和14的流体连通,从而使流体能够注入或能够从静脉或其他脉管或患者脉管系统的一部分抽吸。这样,流体注入或抽吸设备,例如血液透析装置,可以经由鲁尔连接器16A、18A被连接到导管组件10,从而提供对患者的血管进入。导管本体11还包括箍19,用来当所述导管组件被进行皮下隧穿时提供所述导管本体进入身体组织的锚定。
参考图2,图2根据另一示例性实施方案示出导管组件10,其中导管本体11包括介于导管本体11的近侧端和远侧端11A、11B之间的预先弯曲部分18C。也就是说,在非受力的(unstressed)结构中,所述导管呈现如图2所示的形状。一旦所述导管组件的所述远侧部分已经被放置在脉管系统中,预先弯曲部分18C使导管组件10的外部近侧部分能够靠着患者的身体向下延伸。
图1和图2都进一步包括远侧末端区域,一般地被标明为20,所述远侧末端区域是根据本发明的一个示例性实施方案被配置的,下面给出其细节。应当理解的是,将在下面描述的所述远侧末端区域可以被包括于血液透析导管,例如图1和2所示出的导管,或者包括于其他导管,例如中心静脉导管。
现在参考图3A-3D,图3A-3D描绘了关于如上面简要讨论过的图1的远侧末端区域20的各种细节。远侧末端区域20一般地包括导管组件10的所述分裂末端远侧部分,包括限定了第一内腔12的远侧部分的远侧静脉段22,以及限定了第二内腔14的远侧部分的远侧动脉段24。如图3B所示,静脉段和动脉段22、24沿导管本体11的共同隔膜是分裂的,所述隔膜使第一内腔12与第二内腔14分开。
静脉段22在其远侧端处包括鼻状部分30。在本实施方案中,鼻状部分30一般地限定一逐渐变细的圆锥形状,然而如将在下面进一步看到的,这一形状可以被改变。鼻状部分30的所述锥形形状在放置期间减少插入力并使在所述鼻状部分表面和脉管(所述导管的所述远侧区域被放置到所述脉管中)壁之间的磨损最小化。静脉远侧开口32A被限定在鼻状部分30的所述锥形部分上,并与由所述静脉段限定的第一内腔12的所述远侧部分流体连通。导丝槽32B从被限定在鼻状部分30的所述远侧端的孔向近侧延伸,并以下面所描述的方式与动脉段24的第二内腔14连通,以在导管插入期间使所述动脉段与静脉段22能够选择嵌套。当然,这些开口,以及下面将描述的其他导管开口,可以在本文所明确描述的尺寸及布局上发生变化。
静脉段22还限定邻近鼻状部分30的凹口36,凹口36被选择尺寸以对应动脉段24的外表面的形状。从而,动脉段24可以选择性地和可移开地就位,或“嵌”于凹口36中,从而在导管组件10通过皮下隧道或脉管系统路径推进期间,为导管本体11的远侧末端区域20提供光滑、柱形的外表面轮廓。
更详细地,并且如在图3C中最佳地可见的,凹口36限定与动脉段24的远侧表面24A的凸形状相对应的成凹形状的远侧表面36A。注意到,弯曲远侧表面24A的上部分是成圆形的,从而在脉管系统导引期间减少动脉段24的障碍。
动脉段24的远侧端包括被限定在动脉段24的弯曲远侧表面24A上的动脉远侧端开口34。动脉远侧端开口34与由动脉段24限定的动脉内腔14的所述远侧部分流体连通。此外,当动脉段24嵌套并就位于静脉段22的凹口36中时,动脉远侧端开口34同轴地对准静脉鼻状部分30的导丝槽32B。如这样定位的,导丝46可以穿过静脉鼻状部分30的导丝槽32B、动脉远侧端开口34以及第二内腔14,如图4A和4B所示,来将动脉段24维持为在静脉段22的凹口36中的嵌套的结构。这一嵌套的结构还可以以其他方式实现,包括在一个实施方案中的生物可溶解的粘合剂,所述粘合剂在完成将导管放置到脉管系统中之前,临时将这两个段结合在一起,在将导管放置到脉管系统中之后,所述粘合剂溶解以使所述段能够分开。
在动脉段24嵌套于在静脉鼻状部分30后的凹口36中时,导管组件10的远侧末端区域20呈现为具有锥形鼻状结构的低阻、柱状结构。这一结构有助于在放置期间或使用例如丝上(over-the-wire)技术的导管调换过程期间,引导远侧末端区域20通过患者的软组织和脉管系统。随后,当导管组件10被适当的定位时,由于被用来使所述导管定位的导丝的移除,例如如图3C所示,静脉段22和动脉段24可以在脉管内彼此分开。动脉段和静脉段22和24的这种分开帮助在血液透析过程期间,减少处理过的血液的再循环。在此注意到的是,在另一实施方案中,所述远侧末端区域的所述嵌套结构可以是互换的,从而所述凹口是由所述动脉内腔限定的而所述静脉内腔嵌套于其中。
图3A-3D还将静脉段22描绘为包括沿其长度邻近鼻状部分30限定的静脉横向开口42。类似地,动脉段24包括邻近动脉段24的所述远侧端限定的动脉横向开口44。如将在下面进一步示出的,横向开口42和44可以具有各种形状和结构,但在本实施方案中,所述横向开口由通过各自的段22或24的外表面的复合角横向钻孔(cross-drilled)的切口来限定,以建立与各自的第一或第二内腔12、14的连通。在一个实施方案中,这样的切口被称为“削割(skive)”切口。
在一个实施方案中,横向开口42、44的每一个横向切口的纵轴限定与各自的静脉段或动脉段22、24的纵轴成约35度的角,然而这一角度可以在一个实施方案中从约20度到约90度变化。在一个实施方案中,横向开口42、44的每一个横向切口的纵轴还限定与将第一内腔12和第二内腔14一分为二的平面成约15度的角,所述平面即与邻近远侧末端区域20使所述第一和第二内腔分开的所述隔膜共面,然而这一角度可以在一个实施方案中从约0度到约45度变化。这一成角度的特性赋予横向开口42或44的流体流出一横向分量,如在图3D中由流动箭头所表征的。
此外,横向开口42、44的纵轴彼此之间在方向上是相反对称的,如在图3D中最佳地可见的,从而确保流体从所述横向开口的进入和离开发生在导管组件10的相反侧,因而减少已处理过的血液的再循环。更进一步地,即使在流体流动穿过导管组件10是反向的时候,这一对称性确保实现相似的流体流动特性。再者,横向开口42、44环绕各自的静脉段或动脉段22或24的圆周的一部分延伸,从而帮助防止与抽吸相关的抵靠脉管壁的所述段的吸住。注意到的是,在一个实施方案中,横向开口42、44的尺寸是这样的,以致每一个均可以适应流动通过其各自的第一或第二内腔12、14的流体的全部。因而,使横向开口42、44包括和其相对应的远侧开口32A、34提供了冗余系统,以致任何发生在一个开口处的凝结将不会显著影响各自的静脉段或动脉段的流体吞吐量。
应当理解的是,如在上面描述所述分裂末端导管的各种部件中所使用的称号(label)“静脉”和“动脉”,是用来为了在对本发明的实施方案的各方面的描述中的方便。的确,尽管通常在血液透析过程中,所述动脉段被用来从血管(所述导管被放置到其中的血管)中抽吸血液,而所述静脉段用来将已被处理过的血液送回血管,但这可以是反向的,从而血液经由所述动脉段被送回而由所述静脉段抽吸。这样,本发明应当不能被认为是受使用这种或其他本文的描述性术语限制的。
如可以在图3D和4B中所见的,静脉段22的鼻状部分30被这样配置,以致当所述动脉段开始与所述静脉段接触时(例如当其就位于所述静脉段的凹口36中时),鼻状部分30为动脉段24提供“隐蔽处(shadow)”。换言之,鼻状部分30的外径与邻近远侧末端区域20处的导管本体11的外径相似,以致当与凹口36嵌套时,动脉段24由所述鼻状部分“遮蔽”。这使导管的插入相对容易,例如当远侧末端区域20在最初导管放置期间穿过具有阀门的导引装置(introducer),或在丝上导管调换过程中穿过皮下隧道。
在一个实施方案中,鼻状部分30通过射频(“RF”)末端成形(tipping)工艺来限定,其中双内腔导管被分裂来在其远侧末端区域限定两个内腔段,即所述静脉段和动脉段。所述内腔段的所述远侧部分经由RF末端成形被结合在一起来限定如图3A-3D中所示的所述鼻状部分的形状。然后,所述远侧末端区域被切开以限定凹口36并使所述动脉段从所述静脉段分开。请注意,根据其他实施方案并且如本领域技术人员所理解的,也可以使用其他的形成工艺来限定所述远侧末端区域。
现在参考图5A和5B,描述了相对于所述导管组件10的远侧末端区域20的所述分裂末端结构的流动特性。图5A和图5B示出在导管组件10已经被适当地定位在患者的脉管中后的远侧末端区域20,其中动脉段24相对于静脉段22在其解除就位状态。箭头48示出血流在患者的脉管内通过远侧末端区域20的方向。
更具体地,图5A示出流体在“正”方向流动通过远侧末端区域20,其中,为了从身体移出并由血液透析装置处理或为了一些其他适合的目的,血液由第二内腔14或“吸取(uptake)”的内腔抽吸。被抽吸的血液经由动脉段24的动脉远侧端开口34和动脉横向开口44两者进入第二内腔14。然而,因为第二内腔14在抽吸期间处于负压,由于相对于在邻近脉管区域中的压差(pressure differential)动脉横向开口44相对更近侧的位置,由所述第二内腔抽吸的血液的大部分经由动脉横向开口44被移出。
类似地,在由血液透析装置处理或一些其他适合的目的后,血液由第一内腔12或“送回”内腔被注入或被送回到脉管。被注入的血液从静脉段22的静脉远侧开口32A和静脉横向开口42离开第一内腔12。然而,因为第二内腔12在注入期间受到正压,由于相对于在邻近脉管区域中的压差静脉远侧开口32A相对更远侧的位置,由所述第一内腔送回到血流的血液的大部分经由静脉远侧开口32A离开。请注意,这样的安排在“正”方向于主抽吸位置(即动脉横向开口44)和主注入位置(静脉远侧开口32A)之间产生有效的交错距离F。这一有效的交错距离和横向开口42、44的横向定向一起提供了在脉管内的已被处理过的血液的低再循环,再循环被定义为经由所述静脉内腔被送回到血流中的已被处理过的血液立即被所述动脉段抽吸以进行再次处理。由于这导致更低的处理效率和更长的处理时间,这样的再循环是不期望的。
在血液透析过程期间,有时需要使通过导管组件10的血流反向。图5B示出在这样的“反”流动情况下,流体流动通过远侧末端区域20。和图5A的正流动情况形成对照,图5B中的第二内腔14被用来经由动脉段24将血液注入脉管,而第一内腔12经由静脉段22从脉管抽吸血液。在这一结构中,注入的血液的大部分经由动脉段24的动脉远侧开口34进入脉管,而抽吸的血液的大部分经由静脉段22的静脉横向开口42被移出。这样的安排在“反”方向于主抽吸位置(即静脉横向开口42)和主注入位置(即动脉远侧开口34)之间产生有效的交错距离R。因而,可以看到,不管所述导管在什么方向被操作,均可实现在所述主注入和主抽吸点之间期望的交错。
请注意,远侧末端区域20的结构可以根据需要或设计而变化。图6A和6B示出一种这样的变体,其中静脉段22的鼻状部分31包括静脉远侧开口32A,所述静脉远侧开口32A在所述鼻状部分的所述远侧端处而不是沿锥形表面(如在图1的结构中)。此外,导丝槽33只是从静脉远侧开口32A内延伸并穿过鼻状部分31,从而当所述动脉和静脉段22被嵌套时,建立与动脉段24的动脉远侧开口34的连通。因而,在所述远侧末端区域中的这些和其他变体被预期落入本发明的原理中。
现在参考图8A-8D,描述了用来在患者身体中皮下隧穿导管组件10的一部分的皮下隧穿设备(“隧穿器(tunneler)”)的各方面,一般地被标明为60。图7描绘导管组件10这样的隧穿状态,其中介于导管本体11的所述近侧和远侧端中间的一被隧穿区域52被设置在患者50皮肤下方。如所示的,导管组件10的的所述近侧部分(包括套15和延伸腿16和18),在邻近被隧穿区域52处是显露的。相应地,导管组件10的远侧部分被示出在被隧穿区域52的远侧并通过切口位置54被插入到患者脉管系统中,以致远侧末端区域20被定位在期望的位置,例如上腔静脉(“SVC”)的较低的区域。箍19(图1)被包括在导管组件10的被隧穿区域52中,以致可以实现组织内生进入所述箍,来以皮下方式将所述导管锚定到患者的身体并防止所述导管不期望的移动。实现如图7所示的所述隧穿结构的方法被称为顺行(antegrade)隧穿。
如图8A-8D所示,隧穿器60一般地包括杆62、可滑动地安装在所述杆上的套筒(sleeve)64以及导管连接器66。由包括有延展性的(malleable)不锈钢或其他适合的材料构成,在隧穿过程期间,杆62被用来限定所述导管将被拉动通过的所述隧道。杆62逐渐减小到第一端62A并包括导管连接器64所附接到的第二端62B。所述杆包括作为套筒64的滑动止动部分的弯曲部分62C。
套筒64由包括柔韧塑料(例如聚乙烯)的材料构成,并且包括可滑动地接纳杆62穿过其中的空心内孔74(图9D)。套筒64的内孔74在逐渐缩小的第一端64A和第二端64B之间延伸,所述第二端64B被选择尺寸以选择性地滑动到导管连接器66上。因而,套筒64从一缩回位置和一伸展位置是选择性地可滑动的,在缩回位置逐渐缩小的第一端64A止挡杆弯曲部分62C,在伸展位置所述套筒覆盖导管连接器66的全部。
由包括例如生物相容的塑料的材料构成,导管连接器66包括限定用于使临床医生能够握持隧穿器60的握持部分68的本体,以及在所述导管连接器和杆62的第二端62B的附接点处的阶梯状端68A。鼻状止动部分70被包括在导管连接器66上,并被按照与所述导管(所述导管连接器将附接到的导管)的所述远侧部分相对应的方式成形。如将会看到的,这会在隧穿之前使临床医生能够知晓何时所述导管连接器已与所述导管完全结合。
包括一个或更多个钩72A的带钩的延伸部分72自导管连接器鼻状止动部分70延伸,并且被配置来延伸进入所述导管(隧穿器60将连接到的导管)的内腔,从而提供相互之间的固位(retention)力。请注意,带钩的延伸部分72从导管连接器66的中心纵轴偏置,然而这一结构可以根据所述导管(所述导管连接器将被连接到的导管)的设计而修改。
现在参考图9A-9D,描述了在隧穿器60和导管(例如图1中所示的导管组件10)的远侧端之间的附接方式。特别地,图9A示出在导管组件10的远侧端和隧穿器60之间的对准,其中在所述带钩的延伸部分插入所述导管之前,带钩的延伸部分72与静脉段22的静脉远侧开口32A轴向对准。
图9B示出带钩的延伸部分72被完全插入到静脉远侧开口32A中,从而将隧穿器60和导管组件10连接。在这一位置,静脉段22的鼻状部分30与导管连接器66的鼻状止动部分70结合,从而使临床医生能够确定何时所述连接器与导管组件10完全结合。请注意,带钩的延伸部分72的钩72A经由静脉远侧开口32A与第一内腔12结合,以致在紧邻所述钩的地方所述段的外表面向外延伸。
如图9C所示,一旦隧穿器60的导管连接器66被完全连接到导管组件10的所述远侧端,套筒64被向前滑动以覆盖所述导管连接器及其与所述导管的结合处的全部。如图9D所示,向前滑动所述套筒,直到被限定在内孔74中的肩76与所述导管连接器的阶梯状端68A邻接。请注意,套筒内孔74被选择尺寸从而压紧所述导管邻近其与导管连接器66的结合处的所述远侧部分,因而增进钩72A与第一内腔12的结合。
如这样附接后,隧穿器60然后可以被使用来在患者体内限定皮下隧道并如图7所示,在被适当地定位于其中之前,拉动导管组件10穿过所述隧道。一旦导管组件10被适当地定位,可以向后滑动套筒64以使导管连接器66显露出来。然后,可以拉动导管连接器66,从而使带钩的延伸部件从静脉段22的第一内腔12移出,这样使隧穿器60与导管组件10分离。
请注意,导管连接器66及其带钩的延伸部分72被配置来提供充足的固位力来使导管组件10能够由所述隧穿器拉动穿过所述皮下隧道,但所述固位力又足够低从而防止有害的拉伸负荷被施加到所述导管的所述远侧端。照此,导管连接器66被这样配置,以致其可以从与导管组件10的结合处以预先确定的拉伸负荷(低于所述导管远侧端的最大拉伸强度)被拉出。再者,请注意,如本文所描绘的隧穿器60与导管组件10的结合仅仅是示例性的,并且可以理解的是,所述隧穿器可以和具有各种结构的导管一起使用。
还应当理解的是,所述隧穿器结构可以根据需要或设计而变化。图10-12给出可替换的带钩的延伸部分78、80和82的实施例,每一个分别具有不同结构的钩78A、80A和82A。因此,针对隧穿器60的这些和其他修改被预期落入本发明的原理中。此外,注意到的是,如果期望,所述导管组件可以在隧穿的和非隧穿的实施方式中使用。
现在总地参考图13A-23C,描绘了根据本发明的附加示例性实施方案的分裂末端导管组件的变化的结构。由于下面将描述的实施方案包括类似于与上面结合图1-5B所描述的所述导管组件相结合描述的部件,下面将仅讨论随后的实施方案的挑选的部件。
图13A-13C描绘分裂末端导管组件的远侧末端区域120,远侧末端区域120包括静脉段122和选择性地就位或嵌套于由所述静脉段限定的凹口中的动脉段124。静脉段122的鼻状部分130包括与导管本体11的第一内腔流体连通的静脉远侧开口132A和导丝槽132B。动脉段124包括与导管本体11的第二内腔流体连通的动脉远侧开口134。当所述动脉段与静脉段122嵌套时,动脉段124还与导丝槽132B连通。
静脉段122包括邻近鼻状部分130的静脉横向开口142,而动脉段124包括邻近其所述远侧端的动脉横向开口144。横向开口142和144以类似于图1所示的实施方案的方式被横切或削割,并且分别与导管本体11的第一和第二内腔流体连通。请注意,本实施方案的鼻状部分130具有成圆形的形状,与图1的锥形鼻状部分30形成对照,然而可以理解的是,各种鼻状部分的形状结构都是可能的。
图14A-14C描绘分裂末端导管组件的远侧末端区域220,远侧末端区域220包括静脉段222和选择性地就位或嵌套于由所述静脉段限定的凹口中的动脉段224。静脉段222的鼻状部分230包括鼻状部分开口232,当动脉段224与静脉段222嵌套时,鼻状部分开口232凭借其与动脉段224的动脉远侧开口234的对齐而起到导丝槽的作用。动脉远侧开口234还与导管本体11的第二内腔流体连通。这样,穿过所述第二内腔、动脉远侧开口234以及鼻状部分开口232的所述导丝槽的导丝使静脉和动脉段222、224在导管插入期间被维持为嵌套结构。
静脉段222包括邻近鼻状部分230的静脉横向开口242,而动脉段224包括邻近其所述远侧端的动脉开口248。横向开口242以类似于图1所示的实施方案的方式被横切或削割,而动脉开口248限定一三角形开口。开口242、248分别与导管本体11的所述第一和第二内腔流体连通。本实施方案的鼻状部分230具有成圆形的形状,与图1的锥形鼻状部分30形成对照,然而可以理解的是,各种鼻状部分的形状结构都是可能的。再者,可以理解的是,所述开口可以每一个限定各种结构中的一种。
图15A-15C描绘分裂末端导管组件的远侧末端区域320,远侧末端区域320包括一起限定鼻状部分330的静脉段322和动脉段324。静脉段322包括与导管本体11的第一内腔流体连通的静脉远侧开口332A。动脉段324包括与导管本体11的第二内腔流体连通的动脉远侧开口334。
静脉段322包括邻近鼻状部分330的静脉横向开口342,而动脉段324包括邻近其远侧端的动脉横向开口344。横向开口342、344以类似于图1所示的实施方案的方式被横切或削割。横向开口342、344分别与导管本体11的所述第一和第二内腔流体连通。静脉段322和动脉段324的所述远侧端相对于彼此为非交错的,从而使两个横向开口能够被设置在患者的脉管系统中的单一的期望位置中,例如在SVC中。
本实施方案的鼻状部分330具有成圆形的形状,与图1的锥形鼻状部分30形成对照,然而可以理解的是,各种鼻状部分的形状结构都是可能的。再者,可以理解的是,所述横向开口可以每一个限定各种结构中的一种。
图16A-16C描绘分裂末端导管组件的远侧末端区域420,远侧末端区域420包括静脉段422和选择性地就位或嵌套于由所述静脉段限定的凹口中的动脉段424。静脉段422的鼻状部分430包括鼻状部分开口432,当动脉段424与静脉段422嵌套时,鼻状部分开口432凭借其与动脉段424的动脉远侧开口434的对齐而起到导丝槽的作用。动脉远侧开口434还与导管本体11的第二内腔流体连通。这样,穿过所述第二内腔、动脉远侧开口434以及鼻状部分开口432的所述导丝槽的导丝使静脉和动脉段422、424在导管插入期间被维持为嵌套结构。
静脉段422包括邻近鼻状部分430的静脉横向开口442,而动脉段424包括邻近其远侧端的动脉横向开口444。横向开口442、444以类似于图1所示的实施方案的方式被横切或削割。横向开口442、444分别与导管本体11的所述第一和第二内腔流体连通。本实施方案的鼻状部分430具有成圆形的形状,与图1的锥形鼻状部分30形成对照,然而可以理解的是,各种鼻状部分的形状结构都是可能的。再者,可以理解的是,所述横向开口可以每一个限定各种结构中的一种。
图17A-17C描绘分裂末端导管组件的远侧末端区域520,远侧末端区域520包括静脉段522和选择性地就位或嵌套于由所述静脉段限定的凹口中的动脉段524。静脉段522的鼻状部分530包括鼻状部分开口532,当动脉段524与静脉段522嵌套时,鼻状部分开口532凭借其与动脉段524的动脉远侧开口534的对齐而起到导丝槽的作用。动脉远侧开口534还与导管本体11的第二内腔流体连通。这样,穿过所述第二内腔、动脉远侧开口534以及鼻状部分开口532的所述导丝槽的导丝,使静脉和动脉段522、524在导管插入期间被维持为嵌套结构。
静脉段522包括邻近鼻状部分430的静脉横向开口542,而动脉段524包括邻近其所述远侧端的动脉横向开口544。如在图17B和17C中最佳地可见的,横向开口542、544在形状上是半圆的。横向开口542、544分别与导管本体11的所述第一和第二内腔流体连通,并被这样选择尺寸和配置,从而帮助散开(fan out)从此处离开的流体。本实施方案的鼻状部分530具有成圆形的形状,与图1的锥形鼻状部分30形成对照,然而可以理解的是,各种鼻状部分的形状结构都是可能的。再者,可以理解的是,所述横向开口可以每一个限定各种结构中的一种。
图18A-18D描绘分裂末端导管组件的远侧末端区域620,远侧末端区域620包括一起限定鼻状部分630的静脉段622和动脉段624。静脉段622包括与导管本体11的第一内腔流体连通的静脉远侧开口632A。动脉段624包括作为导丝槽632B的一部分的远侧开口。如在图18D中最佳地可见的,导丝槽623B与导管本体11的第二内腔流体连通,但为成一角度的,从而也与由静脉段622限定的所述第一内腔连通。因而,所述导丝槽由动脉段624和静脉段622共同限定。如这样配置,导丝从所述第一内腔的近侧部分向远侧延伸并穿过由静脉段622限定的所述第一内腔的所述部分,然后通过导丝槽632B以离开在动脉段624的所述远侧端上与其相对应的开口,所述导丝使所述静脉和动脉段能够在导管插入期间被维持为接合结构。
静脉段622包括邻近鼻状部分630的静脉横向开口642,而动脉段624包括邻近其所述远侧端的动脉横向开口644。横向开口642、644限定三角形的形状并分别与导管本体11的所述第一和第二内腔流体连通。本实施方案的鼻状部分630具有成圆形的形状,与图1的锥形鼻状部分30形成对照,然而可以理解的是,各种鼻状部分的形状结构都是可能的。再者,可以理解的是,所述横向开口可以每一个限定各种结构中的一种。
图19A-19D描绘分裂末端导管组件的远侧末端区域720,远侧末端区域720包括一起限定鼻状部分730的静脉段722和动脉段724。静脉段722包括与导管本体11的第一内腔流体连通的静脉远侧开口732A。动脉段724包括作为导丝槽732B的一部分的远侧开口。如在图19D中最佳地可见的,导丝槽723B与导管本体11的第二内腔流体连通,但为成一角度的,从而也与由静脉段722限定的所述第一内腔连通。因而,所述导丝槽由动脉段724和静脉段722共同限定。如这样配置,导丝从所述第一内腔的近侧部分向远侧延伸并穿过由静脉段722限定的所述第一内腔的所述部分,然后通过导丝槽732B以离开在动脉段724的所述远侧端上与其相对应的开口,所述导丝使所述静脉和动脉段能够在导管插入期间被维持为接合结构。
静脉段722包括邻近鼻状部分730的静脉横向开口742,而动脉段724包括邻近其所述远侧端的动脉横向开口744。横向开口742、744限定三角形的形状并分别与导管本体11的所述第一和第二内腔流体连通。本实施方案的鼻状部分730具有成圆形的形状,与图1的锥形鼻状部分30形成对照,然而可以理解的是,各种鼻状部分的形状结构都是可能的。再者,可以理解的是,所述横向开口可以每一个限定各种结构中的一种。
图20A-20C描绘分裂末端导管组件的远侧末端区域820,远侧末端区域820包括静脉段822和动脉段824。静脉段822包括与导管本体11的第一内腔流体连通的静脉开口848。类似地,动脉段824包括与导管本体11的第二内腔流体连通的动脉开口846。开口846、848被设置在各自的静脉和动脉段822、824的远侧端(即与所述远侧端相符合)并从此处向近侧以一成角度的方向延伸,从而形成三角形的开口。此外,静脉开口848被相反地设置作为动脉开口846的镜像,从而每一个在流体注入到脉管期间均可引导流体从另一个开口离开,因而减少再循环并提高导管效率。再有,开口846、848被选择尺寸来帮助散开从此处离开的流体。另外,远侧末端区域820的所述分裂末端结构还使静脉开口848与动脉开口846分开,进一步改善导管效率。当然,可以理解的是,本实施方案的所述静脉和动脉开口可以每一个限定各种结构中的一种。
导丝孔850被包括在静脉段822和动脉段824两者的向内指向(inward-pointing)的远侧表面上,从而使导丝46能够穿过其中以在导管插入过程期间将这两个段维持为接合或接触的结构。
图21A-21C描绘分裂末端导管组件的远侧末端区域920,远侧末端区域920包括许多类似于上面接合图20A-20C所讨论的实施方案的部件,包括限定静脉开口948的静脉段922,限定动脉开口946的动脉段924以及导丝孔950。然而,与上述实施方案形成对照,动脉段924是被缩短的,从而相对于静脉段922向近侧形成交错以使开口进一步分开。
图22A-22B描绘根据一个实施方案的分裂末端导管组件的远侧末端区域1020,远侧末端区域1020包括静脉段1022和选择性地就位或嵌套于由所述静脉段限定的凹口中的动脉段1024。静脉段1022的鼻状部分1030包括与导管本体11的第一内腔12流体连通的静脉远侧开口1032A和导丝槽1032B。动脉段1024包括与导管本体11的第二内腔14流体连通的动脉远侧开口1034。如所示的,在鼻状部分1030A的远侧端和动脉段1024的远侧端之间存在有间隔S,在其上面被限定有动脉远侧开口1034。从而,尽管就位于静脉段1022的所述凹口中,动脉段1024并未占据所述凹口的全部。导丝可以跨过在鼻状部分1030和动脉远侧开口1034之间的间隔S来将动脉段1024维持为就位于静脉段1022的所述凹口中。
静脉段1022包括多个邻近鼻状部分1030的静脉横向开口1042,而动脉段1024也包括多个邻近其所述远侧端的动脉横向开口1044。横向开口1042和1044分别与导管本体11的第一和第二内腔12、14流体连通,并被间隔开以防止或减轻脉管壁吸住。
图23A-23C描绘分裂末端导管组件的远侧末端区域1120,远侧末端区域1120包括一起限定鼻状部分1130的静脉段1122和动脉段1124。静脉段1122包括与导管本体11的第一内腔流体连通的静脉远侧开口1132A。动脉段1124包括与导管本体11的第二内腔流体连通的动脉远侧开口1134。静脉和动脉段1122、1124的远侧端是成角度的,从而以锥形的形状限定鼻状部分1130。
静脉段1122包括多个邻近鼻状部分1130的静脉外部横向开口1142A和静脉内部横向开口1142B。同样地,动脉段1124包括多个邻近鼻状部分1130的动脉外部横向开口1144A和动脉内部横向开口1144B。横向开口1142A、B和1144A、B分别与导管本体11的所述第一和第二内腔流体连通,并且被间隔开以防止或减轻脉管壁吸住。
静脉段1122和动脉段1124的所述远侧端相对于彼此为非交错的,从而使横向开口组合1142A、B和1144A、B能够被放置到患者脉管系统中的单一期望位置中,例如在SVC中。例如,可以通过使用延伸穿过内部横向开口1142B、1144B的导丝将静脉段1122和动脉段1124维持为接触结构。
本发明可以以其他具体的形式实施,而不偏离其精神或本质特征。所述已描述的实施方案应被认为是在各方面都仅是作为图示说明性的而非限制性的。因而,本发明的范围由所附的权利要求书而非前述说明书所指明。在权利要求书的含义和等同范围内的所有变化都应被包含在本发明的范围内。
Claims (40)
1.一种用于针对患者的脉管系统提供脉管进入的分裂末端导管,所述分裂末端导管包括:
导管本体,所述导管本体限定第一和第二内腔,所述导管本体包括分裂远侧区域,所述分裂远侧区域包括:
动脉段,所述动脉段限定所述第二内腔的远侧部分;以及
静脉段,所述静脉段与所述动脉段分开并且限定所述第一内腔的远侧部分,所述静脉段还限定一凹口,在所述凹口中,所述动脉段被可移开地定位于沿所述凹口的长度形成连续的柱状外表面的嵌套结构中。
2.如权利要求1所述的分裂末端导管,其中所述静脉段包括在所述静脉段的鼻状部分上的静脉远侧开口,所述静脉远侧开口与所述第一内腔流体连通,所述鼻状部分被设置在所述静脉段的远侧端,并且其中所述动脉段包括在所述动脉段的远侧端上的动脉远侧开口,所述动脉远侧开口与所述第二内腔流体连通。
3.如权利要求2所述的分裂末端导管,其中通过延伸穿过所述静脉段和所述动脉段的导丝,将所述动脉段维持为所述嵌套结构。
4.如权利要求3所述的分裂末端导管,其中所述导丝经由被限定在所述静脉段的所述鼻状部分中的导丝槽穿过所述静脉段,并且其中所述导丝经由所述动脉远侧开口穿过所述动脉段。
5.如权利要求4所述的分裂末端导管,其中所述静脉段的所述鼻状部分在所述凹口的远侧被设置。
6.如权利要求5所述的分裂末端导管,其中所述鼻状部分为锥形的。
7.如权利要求6所述的分裂末端导管,其中所述静脉远侧开口被限定在所述鼻状部分的锥形区域上。
8.如权利要求7所述的分裂末端导管,其中所述导丝槽被限定在所述鼻状部分的远侧末端。
9.如权利要求2所述的分裂末端导管,其中所述静脉段还包括从所述静脉段的所述鼻状部分向近侧被限定的静脉横向开口,并且其中所述动脉段还包括从所述动脉远侧开口向近侧被限定的动脉横向开口。
10.如权利要求9所述的分裂末端导管,其中所述静脉和动脉横向开口的每一个由复 合角横向切口来限定,从而赋予来自所述静脉或动脉横向开口的流体流出一横向分量。
11.如权利要求9所述的分裂末端导管,其中所述动脉段从所述静脉段的凹口的解除就位使所述静脉横向开口和所述动脉横向开口之间的分开能够实现。
12.如权利要求9所述的分裂末端导管,其中当被插入患者的脉管系统时:
在第一操作结构状态,血液主要经由所述动脉横向开口从脉管系统抽吸,并且血液主要通过所述静脉远侧开口注入脉管系统;以及
在第二操作结构状态,血液主要经由所述静脉横向开口从脉管系统抽吸,并且血液主要通过所述动脉远侧开口注入脉管系统。
13.如权利要求2所述的分裂末端导管,其中导丝槽被限定为从所述动脉段的远侧端到由所述静脉段限定的所述第一内腔,从而提供从所述动脉段到所述静脉段的导丝路径并且在所述导丝穿过所述导丝槽时将所述动脉段和所述静脉段维持为被接合的结构。
14.如权利要求1所述的分裂末端导管,其中所述导管本体是基本上为直的。
15.如权利要求1所述的分裂末端导管,其中所述导管为长期透析导管。
16.一种分裂末端导管,包括:
导管本体,所述导管本体限定第一内腔和第二内腔,所述导管本体包括分裂远侧区域,所述分裂远侧区域包括:
静脉段,所述静脉段限定所述第一内腔的远侧部分,所述静脉段包括:
鼻状部分,所述鼻状部分限定与所述第一内腔流体连通的静脉远侧开口,所述鼻状部分还限定导丝槽,所述导丝槽自所述鼻状部分的近侧端延伸到所述鼻状部分的远侧端;
凹口,所述凹口从所述鼻状部分向近侧延伸;以及
静脉横向开口,所述静脉横向开口与所述第一内腔流体连通;以及
动脉段,所述动脉段与所述静脉段分开并且限定所述第二内腔的远侧部分,所述动脉段以可移开的方式可就位于由所述静脉段提供的所述凹口中,所述动脉段包括:
动脉远侧开口,所述动脉远侧开口与所述第二内腔流体连通,当所述动脉段被可移开地定位于沿所述静脉段的所述凹口的长度形成连续的柱状外表面的嵌套结构中时,所述动脉远侧开口对准所述鼻状部分的所述导丝槽;以及
动脉横向开口,所述动脉横向开口与所述第二内腔流体连通。
17.如权利要求16所述的分裂末端导管,其中所述动脉段在就位状态和解除就位状态之间是可移动的,在所述就位状态所述动脉段被接纳于所述静脉段的所述凹口中,在所述解除就位的状态所述动脉段未被接纳于所述静脉段的所述凹口中。
18.如权利要求17所述的分裂末端导管,其中一间隔在所述鼻状部分和所述动脉段的远侧端之间的所述凹口中纵向延伸。
19.如权利要求16所述的分裂末端导管,其中所述动脉段的远侧端成圆形,从而提供光滑的轮廓。
20.如权利要求16所述的分裂末端导管,其中所述静脉段和所述动脉段中的二者均可以在所述导管被插入患者的脉管系统时,被用来进行血液抽吸和血液注入。
21.如权利要求20所述的分裂末端导管,其中所述静脉横向开口被选择尺寸以使来自所述第一内腔的总流量能够通过所述静脉横向开口,并且其中所述动脉横向开口被选择尺寸以使来自所述第二内腔的总流量能够通过所述动脉横向开口。
22.如权利要求21所述的分裂末端导管,其中所述静脉和动脉横向开口被限定为绕所述分裂远侧区域圆周的至少一部分,从而防止脉管壁吸住。
23.如权利要求20所述的分裂末端导管,其中所述静脉和动脉横向开口被这样切削,以致每一个横向开口的纵轴限定一相对于各自的静脉或动脉段纵轴的锐角,并且以致来自静脉或动脉段的流体流出被赋予一横向的流方向。
24.如权利要求20所述的分裂末端导管,其中导丝可以通过所述静脉段鼻状部分的所述导丝槽、所述动脉远侧开口以及所述第二内腔被接纳,从而将所述动脉段维持为就位结构。
25.如权利要求16所述的分裂末端导管,其中所述静脉横向开口在所述静脉段相对于所述凹口的相反的表面上。
26.如权利要求16所述的分裂末端导管,其中所述导管本体包括预先弯曲的结构。
27.如权利要求16所述的分裂末端导管,其中当被就位于所述凹口中时,所述动脉段占据所述凹口的全部。
28.一种分裂末端导管,包括:
导管本体,所述导管本体限定第一内腔和第二内腔,所述导管本体包括分裂远侧区域,所述分裂远侧区域包括:
静脉段,所述静脉段限定所述第一内腔的远侧部分,所述静脉段包括至少一个与所述第一内腔流体连通的静脉横向开口;
动脉段,所述动脉段与所述静脉段分开并且限定所述第二内腔的远侧部分,所述动脉段包括至少一个与所述第二内腔流体连通的动脉横向开口,所述静脉段的远侧部分和所述动脉段的远侧部分一起限定所述分裂末端导管的鼻状部分,其中所述动脉段被可移开地定位于形成具有所述静脉段的连续的柱状外表面的嵌套结构中;
导丝槽,所述导丝槽用于使导丝能够穿过所述静脉段的一部分和所述动脉段;以及
至少一个远侧开口,所述至少一个远侧开口由所述静脉段和所述动脉段中的一个限定,所述至少一个远侧开口与所述第一内腔和所述第二内腔中的各自的一个流体连通。
29.如权利要求28所述的分裂末端导管,其中所述鼻状部分限定锥形轮廓。
30.如权利要求29所述的分裂末端导管,其中所述静脉段包括多个横向开口,并且其中所述动脉段包括多个横向开口。
31.如权利要求28所述的分裂末端导管,其中所述鼻状部分限定一圆形的轮廓。
32.如权利要求28所述的分裂末端导管,其中所述静脉段限定第一远侧开口并且所述动脉段限定第二远侧开口。
33.如权利要求28所述的分裂末端导管,其中所述导丝槽被包括在所述至少一个远侧开口中。
34.如权利要求28所述的分裂末端导管,以上其中所述静脉段包括与所述静脉段的远侧端相符合的第一横向开口,并且其中所述动脉段包括与所述动脉段的远侧端相符合的第二横向开口。
35.如权利要求34所述的分裂末端导管,其中所述第一和第二横向开口从所述静脉段和动脉段中的所述各自的远侧端以一角度向近侧延伸。
36.如权利要求28所述的分裂末端导管,其中所述静脉段的至少一个横向开口和所述动脉段的至少一个横向开口的每一个限定一半圆形状。
37.如权利要求28所述的分裂末端导管,其中所述静脉段的至少一个横向开口和所述动脉段的至少一个横向开口的每一个限定一三角形状。
38.一种分裂末端导管,包括:
导管本体,所述导管本体限定第一内腔和第二内腔,所述导管本体包括分裂远侧区域,所述分裂远侧区域包括:
静脉段,所述静脉段限定所述第一内腔的远侧部分,所述静脉段还限定所述分裂末端导管的远侧鼻状部分;
动脉段,所述动脉段与所述静脉段分裂开并且限定所述第二内腔的远侧部分,所述动脉段的远侧端被设置为邻近所述静脉段的所述鼻状部分,其中所述动脉段是可定位的, 以致所述动脉段不会径向地延伸超过由所述静脉段的所述鼻状部分的最外层的周边限定的边界。
39.如权利要求38所述的分裂末端导管,还包括:
导丝槽,所述导丝槽用于使所述导丝能够穿过所述静脉段的一部分和所述动脉段以将所述动脉段维持在适当的位置,其中所述动脉段不会径向地延伸超过由所述静脉段的所述鼻状部分的最外层的周边限定的边界。
40.如权利要求38所述的分裂末端导管,其中所述鼻状部分在所述分裂末端导管通过患者身体内的路径向远侧推进期间遮蔽所述动脉段。
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2008
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CN101909672A (zh) | 2010-12-08 |
US20160121040A1 (en) | 2016-05-05 |
US20120059304A1 (en) | 2012-03-08 |
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US20090112153A1 (en) | 2009-04-30 |
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US20190240393A1 (en) | 2019-08-08 |
WO2009055332A1 (en) | 2009-04-30 |
US9233200B2 (en) | 2016-01-12 |
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