CN1230132C - 跨接侧向支脉管的脉管移植物 - Google Patents
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Abstract
一种用于主脉管(22)内并可跨接侧向支脉管(24)的脉管移植物(20)。该移植物具体用于形成一种支承在侧向支脉管之一侧的主脉管内的主移植物的管件,移植物具有互相隔开一个间隙的第一管段和第二管段。跨接件(54)将第一管段(50)越过间隙与第二管段相连接起来,并具有一个刚性较大的支撑件,以限制两个管段之间的轴向相对移动。移植物可具有一个、两个或多个跨接件以形成一个、两个或多个可让血液从移植物内流到侧向支脉管的孔。移植物具有柔性的(最好是织物的)并由可自膨胀的或由气囊膨胀的丝制支架支承的本体。上述移植物可在肾动脉之两侧的腹部动脉内展开,并具有两个可让血液从动脉流到肾内的孔。肾下方的管段为用于治疗腹部动脉瘤而延伸到髂动脉的叉状移植物的主干部分提供平滑的管状固定表面。
Description
技术领域
本发明涉及修复脉管的移植物,尤其涉及一种用于主脉管内并可跨接侧向支脉管具体地用于构成一种支承安置在侧向支脉管之一侧的主脉管内的主移植物的管件的脉管移植物。
背景技术
动脉瘤是由于疾病或其他原因引起动脉弱化而造成的动脉壁的隆起。如不治疗,动脉瘤可能发生破裂,造成严重失血并可能导致死亡。腹部动脉内的动脉瘤是最常见的动脉瘤。腹部动脉连接心脏部位的上行动脉与躯干和下体的循环系统,腹部动脉从脊柱前面的心脏并平行于脊柱向下延伸,通过胸部和腹部,并分叉成多条侧脉管。在其他的分支脉管中,腹部动脉通过相向的肾动脉对两个肾供给血液。腹部动脉在肾动脉的下方延伸到大致与第四腰椎同一水平,并在Y形连接处分成向下肢供给血液的左、右髂动脉。
常出现动脉瘤的部位是肾动脉与髂动脉之间的动脉段。若不起快进行外科手术而发生腹部动脉破裂将是致命的,因为在动脉内有大量的血液流通。通常的外科手术包括穿透腹壁进入动脉瘤的部位,加强或更换有病的动脉段。一般用管状的修复移植物替换动脉的可能发生破裂的部分的区域,或者说近区和毗邻的远区。遗憾的是,普通的外科手术会导致高的发病率,起码要使康复期延长。而且,成本和其他限制因素也影响着对血管内手术的长期应用。
近年来,研制出一批不需要打开腹壁来治疗动脉瘤的方法和装置。这些新技术通常包括将导管承载的管状移植物从股动脉向上移送并通过髂动脉进入动脉瘤区。上述的移植物通常具有由一种可膨胀(自身膨胀或气囊膨胀)的支架(Stent)支承的管状移植物本体。气囊膨胀型支架本身需要一个膨胀气囊,而自身膨胀型支架则可从管状壳体的端部简单地展开即可。内部置入术的出现正在冲击着两种公知的技术。
如果动脉瘤影响到腹部动脉与髂动脉之间的Y形连接部位,通常要采用叉状移植物。将该叉状移植物的主干部分固定到腹部动脉的紧接在肾动脉下面的健康部分上,而移植物的分支部分则固定在每条髂动脉内(有时是通过管状移植物的延伸段来固定)。这一手术不包括心肺旁路,因此,血液可连续向下流过腹部动脉。将移植物固定到脉管内壁上有些困难,因为在手术进行中及其之后有大量血液流过。的确,移植物在脉管内移位的危险在许多部位(不仅在腹部动脉内)都是一个问题。另外,腹部动脉出现动脉瘤的部位可能很靠近肾动脉,而此部位对于固定修复移植物来说基础很差。实际上,外科医生提出脉管内移植物修复手述之前,就需要在肾动脉下方有最低限度的各种长度的健康动脉壁,否则就要采用通常的带侵害性的技术。而且,在其他部位(具体说是锁骨下的支动脉附近或颈部动脉附近的动脉部分)进行手术时,同样要考虑主脉管也要有最低限度的健康部分。
已提出多种将移植物固定到脉管壁上的技术,其中引入注目的是采用从移植物向外伸出的且本身嵌入脉管壁内的倒钩或者说钩状物。虽然这些装置可固定移植物,但它们会损伤脉管壁,并且会带来麻烦。另外,移植物支架可能会由于预先偏压的或形状记忆偏压或由于该区域内的气囊膨胀而伸长到移植物本体之上游端之外并向外弯曲至与脉管壁相接触。
在治疗腹部动脉内的动脉瘤方面,一些制造厂商提供了可设在越过肾动脉的叉状移植物的上端处的移植物支架。例如,美国佛罗里达州Sunrise的World Medical公司供应的牌号为TALENT的脉管内移植物支架具有一种延伸到移植物本体上方的用于在肾上方固定的波浪形的丝支架。还有,美国印第安州Bloomington的Cook公司供应的牌号为ZENITH AAA的脉管内移植物采用一种用于在肾上方固定移植物的带有倒钩的波浪形丝支架。但是,由于这些丝制件延伸过分支肾动脉的开口,故会阻碍血液流过。而且,任何置于血流通道内的构件都会引发成串的血块,这些血块又会形成有害地冲击由受影响的侧向支脉管供血的肾或其他器官的自由漂浮的血栓。由于肾对于来自上述血栓的侵入造成的伤害十分敏感,所以极希望避免在肾动脉口上出现血块(即使是一种可能性,也要避免)。
尽管在这个竞争激烈的领域内做了很多的工作,但是仍然需要更多的可将叉状移植物固定到腹部动脉内的装置。更具体地说,需要更多的将管状的移植物固定在侧向支脉管附近的主脉管内的固定装置。
发明内容
根据本发明的一种安置在血脉管内并跨接侧向支脉管的脉管移植物,它具有:一个界定外表面的管状构件,上述外表面第一部分的大小要能与侧向支脉管之一侧的血脉管相接触并支承该血脉管,上述外表面的第二部分的大小要能与侧向支脉管之另一侧的血脉管相接触并支承该血脉管,上述的管状构件界定一个与侧向支脉管对准的孔,以便使血液在血脉管与侧向支脉管之间流通,其特征在于,该外表面的第一与第二部分分别是管状的,且包括一柔性移植物本体和支承支架;且上述的第一和第二部分互相隔开一个间隙,还包含至少一个越过该间隙并将上述第一和第二部分连接起来以防止在两部分植入后沿轴向相互分离的跨接件,上述的孔被界定在上述跨接件与上述第一和第二部分之间;所述脉管移植物另外还包括射线透不过的标记。
本发明包含一种可安置在主血脉管内并适合于跨接侧向支脉管的脉管移植物,该移植物包括:一个具有外表面的管状构件,上述外表面的第一部分的大小可与侧向支脉管之一侧的血脉管相接触并支承该血脉管,上述外表面的第二部分的大小可与侧向支脉管之另一侧的血脉管相接触,并支承该血脉管。上述管状构件具有一个与侧向支脉管对准的孔以便让血液在血脉管与侧向支脉管之间流通。
上述管状件的外表面的第一和第二部分相隔一个间隙,上述移植物还具有至少一个越过上述间隙并将上述第一和第二部分相连接以防止上述两个部分在植入后发生轴向相对分离的跨接件,在该跨接件与上述的第一和第二部分之间形成上述的孔。最好是至少有两个跨接件和两个孔,还可能有4个跨接件和4个孔。而且,跨接件可以具有刚性较大的支撑件。
通过参看说明书的其余部分和附图将会更加了解本发明的特征和优点。
附图说明
图1是通过腹部动脉的剖视图,示出分叉的肾动脉和髂动脉,并示出本发明的用于支承叉状移植物(以点划线示出)的主干部分的移植物的一种实施例;
图2是图1的移植物的透视图;
图3是本发明的另一种具有两个平的跨接件的移植物的透视图;
图4是本发明的又一种具有两个丝状跨接件的移植物的透视图;
图5是本发明的再一种具有4个跨接件的移植物的透视图;
图6是肾动脉区的腹部动脉的剖视图,示出本发明的用于支承叉状的移植物(以点划线表示)的主干部分的移植物的又一个实施例;
图7是图6所示移植物的透视图;
图8是图6所示移植物的正视图,示出一些轴向尺寸;
图9是肾动脉区的腹部动脉的轴向剖视图,示出一些解剖学上的尺寸。
具体实施方式
图1示出本发明的配置在主脉管(在本实施例中是腹部动脉)22内的移植物20,图中示出一对侧向支脉管24在垂直于主脉管的大致同一轴向位置上与主要脉管22相交。如图所示,在腹部动脉22的范围内,两条重要的侧向支脉管是肾动脉24。腹部动脉22从肾动脉24向下延伸,并在Y形接合处26分叉成左、右髂的动脉28。
本发明提供一种安置在主脉管内的管状移植物,用于支承在侧向脉管附近的主脉管内的另一个管状移植物。因此,必须明白,虽然附图和说明中所述的是腹部动脉内的用于支承肾动脉区内的另一个移植物的移植物,但是,同样的原理可适用于任何主脉管或侧向脉管。例如,如图1所示,移植物20也可用在髂动脉28内的侧向支脉管30附近。适合于本发明的移植物修复的典型病症是上述的腹部动脉瘤(AAA)、胸部动脉瘤(TAA),和单髂动脉瘤(AUI)。但是,为了便于说明,术语“侧向支脉管”可与上述的“肾动脉”互换地使用,术语“主脉管”可与“腹部动脉”互换地使用。
如图1所示,借助于移值片20固定叉状移植物36的主干部分34(图中以虚线表示)。该叉状移植物36通常具有在中隔膜38处分成一对支路40的主干部分34。支路40中的一个或两个可延伸一段足够的距离而形成在髂动脉28内的一个密封件,或者形成一个管状延伸段42来达到上述目的。最终的结果是,叉状移植物36(或任意的管状延伸段42)从腹部动脉22的健康部位44跨越过动脉瘤区46延伸到两条髂动脉28。一旦叉状移植物36安装就位,血液就可流过,而且在动脉瘤46与移植物内部之间的血压就降低,最后,动脉瘤46围绕仍在原位的移植物向内萎陷。
参看图1和2,本发明的移植物20具有一个第一管段50和一个通过至少一个跨接件54与第一管段相连接的第二管段52。第一管段50与第二管段52相隔一定间隙,该间隙与上述的跨接件54一起构成一个供血液流过的孔56。如果第一管段50与第二管段52是共线的,那么,跨接件54通常沿轴向设置。另一方面,若要将移植物20植入弯曲的脉管内,那么,第一和第二管段50、52可沿弯曲的轴线对准,在此情况下,跨接件54通常也将沿同样的曲线设置。再者,移植物20可以是多曲率的例如S形的,在此情况下,第一和第二管段50、52以及跨接件54都将遵循多曲线的形式。
如图1所示,孔56至少与一条侧向支脉管24对准。在一个优选实施例中,移植物20用于在邻近肾动脉24处支承叉状移植物36,因此形成两个孔56,每个孔56都与一条肾动脉对准。在此范围内,第一管段50与腹部动脉22的肾上部部分相接触而固定,而第二管段52则与肾下部部分相接触而固定。孔56的尺寸要大到足以使移植物20一点也不进入肾动脉24的血液流道内,而且要大到足以容纳沿轴线彼此稍稍偏离的肾动脉。
具体参看图2,移植物20具有一个由移植物支架62在内部支承的管状移植物本体60。该管状移植物本体60可由单件或多件组成,通常由诸如聚酯一类(例如聚对苯二酸酯)的生物相容织物制成。另一方面,移植物本体60可以是挤压的聚四氟乙烯(PTFE)管。在一个具体实施例中。移植物本体60是一个整体件,并带有由在片体上切出的径向对置的大致为卵形的窗口64构成的孔56,该孔56沿圆周绕片体60延伸至彼此接近处。在移植物20的第一与第二管段50、52之间具有两个移植物本体60的跨接段66,该跨接段66将窗口64隔开。跨接段66最好绕移植物本体60沿圆周相对于相邻窗口64延伸一小段圆弧,以便使血液流通孔56具有最大的尺寸。在一个实施例中,跨接段66分别绕移植物本体60沿圆周延伸约1~90°,最好是分别延伸5~10°。
血液流通孔56的尺寸要做成能适应各种尺寸的侧向支脉管。当然,该具体尺寸是由窗口64的取决于整个移植物的直径和长度的轴向尺寸和圆周弧度决定的。例如,用于小动脉和小的侧向支脉管的移植物可设计成具有小的直径和小的窗口尺寸。另外,如果移植物仅用于跨接一条侧向支脉管,那么就只需要一个窗口。在一个优选实施例中,用于在腹部动脉22内跨接肾动脉24的移植物20,其直径约为19~33mm,其长度约为22~46mm,其相对的窗口的轴向长度约为6~20mm,并沿圆周绕移值片体60延伸过大约90°~189°。肾动脉24的直径一般约为8~10mm,因此要求窗口64的尺寸大些,以保证血液畅通地流过肾,并符合两个肾的偏离或者说偏移。
移植物支架62实际上包含位于第一管段50内的第一支架和位于第二管段52内的第二支架。该第一和第二支架可根据需要做成结构上大致相同,或做成互不相同。熟悉本技术的人们将会明白,可以采用各种不同类型的移植物支架从内部支承管状的移植物本体。
在一个优选实施例中,上述的移植物支架62包含多个独立的并且互相隔开的丝制件70,这些丝制件70分别做成波浪式或者说正弦波式件,每个丝制件70包含交替的峰和谷,这些峰或谷都是织入移植物本体的。更具体地说,如图2所示,在第一管段50内有3排沿轴向隔开的丝制件70,而在第二管段52内有4排轴向隔开的丝制件70。各排波浪形丝制件70的峰或谷是穿过移植物本体60上形成的切口72编织的,这样就可防止丝制件70在移植物本体60内沿轴向相互位移,从而对柔性的移植物本体提供了一种十分均匀的内支承结构。如前所述,每个丝制件在气囊膨胀时可沿径向自扩张成所示的形状,或可以产生塑性变形。在上述的每种情况下,移植物支架62(含有一排丝制件70)可将移植物本体60压靠到管状血脉管的内壁上,并在它们之间形成流体密封。而且,也可用某些部件和/或管套状构件来加强移植物20的外部与脉管壁之间的密封,并且,可与本发明相结合使用。
在移植物本体62的外表面可看见多条皱缩74,该皱缩74将每个含有一个或多个弯曲成波浪式并弯曲成所需圆环状的丝段的丝制件70的自由端连接在一起。虽然皱缩74不是很突出,但是它们在移植物20的外面形成一种不规则的表面结构,因此,有助于将移植物固定在脉管内适当的位置上。
图1和图2所示的跨接件54具有一个加强支撑件80和上面提到的移植物本体60的跨接段66。上述的加强支撑件80是连接移植物20的第一与第二管段50、52的刚性较大的长形件。在一个优选实施例中,加强支撑件80是一种两端固定到移植物本体60或移植物支架62上的生物相容的金属(例如不锈钢)条或棒。如果加强支撑件80的端部如图所示那样固定在移植物本体60上,通常就采用缝线来缝合加强支撑件两端上形成的小眼、钩形物或其他类似特征(未示出)。如果加强支撑件80的端部固定在移植物支架62上,那么最好在最接近的丝制件的并置的两端与加强支撑件之间采用皱缩。如图所示,最好将加强支撑件80安置在跨接段66之外,当然,相反的结构也是可以的。
跨接件54用于使移植物20的第一和第二管段50、52彼此相对固定,并且最好使两个管段之间保持一定间距,同时,又要极少出现在结构方面可能发生的堵塞,或者换句话说不妨碍主脉管22与受影响的侧向支脉管24之间的血液流通。跨接件54必须具有一定的抗拉强度,以便能承受容易使第一和第二管段50、52分离的位移力。在一种典型的结构中,上游段50或52可通过它与跨接件54的连接而固定下游段。另外,跨接件54可具有较大的刚性,其意思是说,它们具有足以防止管段50、52在植入后发生彼此相向位移的纵向强度。
跨接件54的径向尺寸大致与移植物20的本体尺寸相同,也就是说,它们不会沿径向凸出到移植物的侧壁内或凸出到移植物的侧壁外。每个跨接件54的圆周宽度取决于移植物20的预定用途。就是说,如果移植物20如附图所示那样用于在腹部动脉22内跨接肾动脉24,那么,两个跨接件54便沿径向占有较窄的圆周宽度。这样,跨接件54分别沿腹部动脉22的壁从开口至肾动脉24沿轴向延伸90°方向,这就不会发生腹部动脉22与肾动脉24之间的血流堵塞。但是,如果只有一条侧向支脉管。那么就只需要一个圆周宽度比图中所示的宽度大的跨接件。就是说,跨接件可绕移植物延伸过180°或更多,而相应的窗口则在其他部分打开。一般来说,只要仔细使窗口的取向对准侧向支脉管,跨接件是不会堵塞血液流通的。
图1和2的实施例示出用例如钢丝制成的刚性较大的跨接件54,但是,跨接件54也可以是具有可防止下游管段52发生相对于上游管段50位移的抗拉强度的生物相容的织物带,甚至可以是缝线。在所示的实施例中,上游管段50将移植物20(具体地说是下游管段52)相对于肾动脉24固定之。在这方面,可将管段50、52中的一个或另一个设计成能较好地将移植物20固定在主动脉22内,而另一管段则履行另一种功能例如加强动脉的破损部分,从而使另一个移植物可以固定在侧向支脉管24附近。当然,如果移植物20是用于修复经过侧向支脉管的上游和下游的脉管的破损部分的话,管段50、52都可以做成具有相同的固定和支承脉管的特性。
图3示出本发明的另一种移植物90,它的第一管段92与第二管段94相隔一个间隙96,并由两个越过间隙96的跨接件98相连接。另外,移植物90具有一个移植物本体100和一个内部支架102。移植物本体100可以是一种生物相容的织物管,在所示的实施例中,移植物本体100被间隙96分成两个分别为第一和第二管段92、94的管状部分。由于移植物本体100的该两个管状部分的相对的边是环形的,所以上述的间隙是管状的。上述的移植物支架102也具有多个互相隔开的环形丝制件,但是,请注意,第一管段92仅有单个丝制件104。
跨接件98是由刚性较大的材料例如不锈钢或合适的聚合物制成的长形的平板或条材,它们直接与支架102相连接,或直接在第一和第二管段92、94处与移植物本体100相连接。另外,跨接件98必须具有一定的抗拉强度,以便承受在移植物植入后可能产生的会使第一和第二管段92、94分离的位移力。同时,还必须不会堵塞或者说不会阻碍主脉管与所影响的侧向支脉管之间的血液流通。但是,跨接件98与可以是织物带(例如聚酯纤维织物带)或这种用途的缝线,而不用刚性较大的材料。
图4示出本发明的又一种移植物110,它的第一管段112与第二管段114相隔一个间隙116,并由两个跨接件118越过间隙116相连接。另外,移植物110也具有一个移植物本体120和一个内部支架122。上述的移植物本体120可以是一种生物相容的织物管,在所示的实施例中,移植物本体120由间隙116分成两个分别为第一和第二管段112、114的管状部分。在本实施例中,移植物本体120的两个管状部分相对的边由于设置多个缺口123而变得不平坦,因此间隙116也是参差不齐的。移植物支架122也具有多个互相隔开的环形丝制件,其中,第一管段112具有两个丝制件,而第二管段114具有2个丝制件。
跨接件118分别具有多个从支架122分离出来的或者由一个或多个丝制件的伸长段形成的丝段。如果跨接件118是从支架122分离出来的,那么它们可通过例如皱缩124直接与支架相连接,或者通过合缝126直接与移植物本体120相连接。在所示的典型实施例中,跨接件118通过皱缩124在第一管段112内与最下面的丝制件的自由端相连接,并且在第二管段114内与移植物本体120相缝合。
图5示出本发明的又一个典型的移植物130,它的第一管段132与第二管段134相隔一个间隙136,并通过4个跨接件138越过间隙136相连接。另外,移植物130也具有一个移植物本体140和一个支架142,移植物本体140最好是生物相容的织物管,移植物支架142也具有多个互相隔开的环状丝制件,但第一管段132只有单个设置在移植物本体140之外面的丝制件144。该外部丝制件144可以是如上所述织入到移植物本体140上的狭缝的,或者,也可以采用缝线固定到移植物本体140上。
4个跨接件138沿移植物130的圆周呈大致等距离分布,每个跨接件138具有一个织物条146和一个加强支撑件148,该加强支撑件148也用例如皱缩直接与支架142相连接,或者也可以通过合缝149直接与移植物本体140相连接。当含有较小的分支脉管时,采用4个跨接件138对于稳定性是有利的,因此不需要在跨接件之间形成像前面所述实施例那么大的窗口。
图6和7示出本发明的又一个实施例的移植物150,该移植物150是一种管状构件,它具有一个第一管段152和一个越过间隙156与第一管段152隔开的第二管段154。两个跨接件158在上述的第一与第二管段152、154之间大致沿轴向延伸,并将第一与第二管段152、154相连接,以防止它们在植入过程中和植入之后发生相对移动。在本实施例中,管状构件的第一管段152只设置一个支架160,而第二管段154则由一个从内部支承管状移植物本体164的支架162支撑。
上支架160是一个具有交替的波峰168和波谷170并做成按曲线段172延伸的环形丝制件166。做出上述的曲线段172是为了在移植物150处于径向压缩状态时可以嵌套在一起,从而使移植物能压缩到较小的体积。丝制件166包含由一个或多个皱缩174连接成环状的一个或多个丝段。下支架162具有多个如前面所述的织入移植物本体164的沿轴向隔开的波浪形丝制件。
跨接件158分别具有从支架160、162分离出来的丝段或由一个或多个丝制件的延长段形成的丝段。如果跨接件158是从支架160、162分离出来的,那么它们可通过皱缩176直接与上支架160相连接,并通过皱缩直接与下支架162相连接,或通过合缝178间接地与移植物本体164相连接。在所示的典型实施例中,跨接件158通过皱缩176在第一管段152内与丝制件166的自由端相连接,并在第二管段154内与移植物本体164相缝合。
图6示出安装在主脉管180(例如腹部动脉)内并跨接两个相对的侧向支脉管182(例如肾动脉)的移植物150。其第一管段152在侧向支脉管182的一侧与主脉管180相接触并支承该主脉管180,而第二管段154则在侧向支脉管182的另一侧与主脉管180相接触并支承该主脉管。设置的间隙156使血液可在主脉管180与侧向支脉管182之间流动(如箭头184所示)。跨接件158沿轴向延伸越过间隙156而支承与侧向支脉管182约成90°的主脉管180的壁。在第二管段154内设置了另一个移植物186(例如叉状移植物的主干),用这种方法将移植物186固定在均匀的管段154内,管段154又借助于其自身与脉管壁相接触的力并于通过跨接件158与第一管段152相连接而固定在主脉管180内,这种移植物间互相支承的结构可使移植物定位在十分接近侧向支脉管182之处,在主脉管扩张到十分接近侧向支脉管的情况下尤其有效。
上面所述的各种移植物的轴向尺寸要选择成与受影响的侧向支脉管周围的具体动脉的尺寸相匹配。就是说,移植物(包括两个相互间带有间隙或孔隙的管段和连接该管段的跨接件)的尺寸要做成可让血液流过受影响的侧向支脉管以及其他相邻的侧向支脉管。例如,图6和7所示的移植物150设置成其第一管段152位于肾动脉182之上,而第二管段154则位于肾动脉的下方。
图8和9较为详细地示出移植物150和腹部动脉180靠近肾动脉182的部位的相对轴向尺寸。图9除了示出肾动脉182外,还示出上部的mezzenteric动脉190和髂动脉192的开口。这些动脉与沿侧向延伸的肾动脉不同,一般沿向后的方向伸出,并且位于肾动脉的上游但靠近肾动脉之处。设定从动脉190或192的最底部至肾动脉182最顶部的距离为A,从肾动脉最顶部的上游侧至肾动脉最底部的下游侧的距离为B,从肾动脉最底部的下游侧至腹部动脉180的诊断为健康部分的上端之间的距离为C。此外,设定一条肾动脉182的直径为D,设定移植物150的整个管状结构部分的轴向长度为L(见图8),其中第一管段152的长度为L1,间隙156为L2,第二管段154为L3。
在一个优选实施例中,L2>D,如果肾动脉182是偏离的,则L2>B,另外,最好是L1小于或等于A,以便使第一管段152不会堵塞动脉190或192。最后,第二管段154的长度L3最好是小于腹部动脉180的健康部分的长度C,但也可以大于C。
在一个用于腹部动脉180内跨接肾动脉182的具体实施例中,移植物150的直径约为9~30mm,长度L约为22~46mm。肾动脉182的直径一般约为5~10mm,两个肾动脉中心与中心之间的偏离可达10cm。因此,间隙156的轴向长度约为6~20mm。最好是尺寸加大一些,以保证血液顺利流过肾动脉,并可适应肾动脉的偏离,换言之,可适应轴线不重合的一对肾动脉。第一管段152的长度L1最好约为6mm,但也可根据需要改变之。腹部动脉180的健康部分的长度C至少应为5mm,以便能以动脉合适地密封第二管线154,该尺寸小于现时指出的血管内要修复的尺寸。第二管段154的长度L3至少应为6mm,较合适的是约10~20mm,当然,如果移植物20作为主移植物用于修复较长的脉管段时,第二管段的长度L3可大于20mm,甚至采用目前能接受的直管状血管移植物的最大长度。
为了保证移植物具有合适的尺寸/结构,外科医生首先采用微细血管显微镜确定解剖的形貌,也就是说,通过喷射一种对比介质,并用X射线装置观测其流过受影响脉管时的情况,从而获得图9所示的尺寸。最好购买具有不同尺寸范围的移植物,然后由外科医生选择符合上述优选原则的与解剖模型相匹配的移植物。
在植入过程中,外科医生可通过移植物上的射线透不过的标记确保本发明的移植物的合适位置和取向。例如,移植物支架(或它的部分)可以是射线透不过的,或者将标记固定到支架上或移植物本体上。例如,在图7中,丝制件160和支架162中的上丝制件最好是射线透不过的,以便使外科医生能监测接近间隙156的轴向边缘的准确位置。另外,跨接件158或皱缩176也可以是射线透不过的,以便能相对于相应的侧向支脉管或支脉管而转动移植物的取向。
下面参考图6说明按照本发明的在侧向支脉管附近的主血脉管中的管状主移植物的支承方法。首先,将管状移植物150植入主脉管180内,从而使第一管段152与侧向支脉管182(在本实施例中是两条肾动脉)之一侧的主脉管相接触并支承该主脉管,第二管段154则与侧向支脉管之另一侧的主脉管相接触并支承该主脉管。可以通过从合适位置上的导管壳体内释放一种可自膨胀式的移植物,或者设置一种气囊膨胀式的移植物并吹胀移植物内部的气囊的方法来植入管状移植物150。然后在径向受限的状态下将主移植物186移至与第二管段154的端部搭接的部位,并使其沿径向膨胀至互相接触。上述的主移植物186也可以是自膨胀式的或气囊膨胀式的。
另一种方法是在植入主移植物186后再植入管状移植物150。就是说,管状移植物150的第二管段154是向外自膨胀或气囊膨胀至与主移植物186相接触。主移植物186确实可在认为需要用管状移植物150来支承之前很早就植入脉管内。
如上所述,移植物的一个管段可起到固定作用以保持另一个可能具有或不具有同样的固定特性的管段的位置。例如,侧向支脉管上游处的移植物管段可固定下游处的管段,后者又可由主脉管加强、增补或封闭,以便可将另一个移植物安装在该部位上。在上文中,按照用于可自膨胀或气囊膨胀而固定的支架说明了本发明,但是,熟悉本技术的人们会知道还有其他的固定方法。例如,U形钉、弯头或螺丝钉已越来越先进和有效,都可用来固定。说实在的,任何能固定移植物之一个管段的方法都是可采用的。
虽然上面完整地说明了本发明的优选实施例,但是,还可以采用各种替换方案、改进和等效方案。而且,很显然,某些其他的改进方案都可以在所附权利要求的范围内予以实施。
Claims (6)
1.一种安置在血脉管内并跨接侧向支脉管的脉管移植物,它具有:
一个界定外表面的管状构件,上述外表面第一部分的大小要能与侧向支脉管之一侧的血脉管相接触并支承该血脉管,上述外表面的第二部分的大小要能与侧向支脉管之另一侧的血脉管相接触并支承该血脉管,上述的管状构件界定一个与侧向支脉管对准的孔,以便使血液在血脉管与侧向支脉管之间流通,其特征在于,该外表面的第一与第二部分分别是管状的,且包括一柔性移植物本体和支承支架;且
上述的第一和第二部分互相隔开一个间隙,还包含至少一个越过该间隙并将上述第一和第二部分连接起来以防止在两部分植入后沿轴向相互分离的跨接件,上述的孔被界定在上述跨接件与上述第一和第二部分之间;所述脉管移植物另外还包括射线透不过的标记。
2.根据权利要求1的脉管移植物,其特征在于,该移植物包含至少两个跨接件和两个孔。
3.根据权利要求1的脉管移植物,其特征在于,该移植物包含4个跨接件和4个孔。
4.根据权利要求1的脉管移植物,其特征在于,上述跨接件包含一支撑件。
5.根据权利要求4的脉管移植物,其特征在于,上述的支撑件直接与上述支架相连接。
6.根据权利要求4的脉管移植物,其特征在于,上述的支撑件直接与相应的柔性移植物本体相连接。
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US09/473,618 US6344056B1 (en) | 1999-12-29 | 1999-12-29 | Vascular grafts for bridging a vessel side branch |
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- 2000-01-19 KR KR1020027008433A patent/KR20020075882A/ko not_active Application Discontinuation
- 2000-01-19 JP JP2001549580A patent/JP2003518982A/ja active Pending
- 2000-01-19 NZ NZ519318A patent/NZ519318A/xx not_active IP Right Cessation
- 2000-01-19 AU AU28580/00A patent/AU2858000A/en not_active Abandoned
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CN111067664A (zh) * | 2019-12-25 | 2020-04-28 | 先健科技(深圳)有限公司 | 覆膜支架 |
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EP1242003A1 (en) | 2002-09-25 |
WO2001049211A1 (en) | 2001-07-12 |
NZ519318A (en) | 2003-01-31 |
CZ20022292A3 (cs) | 2003-10-15 |
CA2392659A1 (en) | 2001-07-12 |
IL149776A0 (en) | 2002-11-10 |
DE60034810T2 (de) | 2007-10-11 |
JP2003518982A (ja) | 2003-06-17 |
NO20023140L (no) | 2002-06-28 |
DE60034810D1 (de) | 2007-06-21 |
AU2858000A (en) | 2001-07-16 |
EP1242003B1 (en) | 2007-05-09 |
KR20020075882A (ko) | 2002-10-07 |
MXPA02006522A (es) | 2002-12-09 |
ATE361720T1 (de) | 2007-06-15 |
BR0016820B1 (pt) | 2008-11-18 |
BR0016820A (pt) | 2002-10-01 |
CN1414840A (zh) | 2003-04-30 |
AU2005234630A1 (en) | 2005-12-15 |
NO20023140D0 (no) | 2002-06-28 |
AU2009200491B2 (en) | 2011-04-21 |
RU2002120503A (ru) | 2004-01-27 |
AU2009200491A1 (en) | 2009-03-05 |
US6344056B1 (en) | 2002-02-05 |
CA2392659C (en) | 2009-07-07 |
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