CN1271980C - 分支动脉的腔内移植 - Google Patents

分支动脉的腔内移植 Download PDF

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CN1271980C
CN1271980C CNB961995785A CN96199578A CN1271980C CN 1271980 C CN1271980 C CN 1271980C CN B961995785 A CNB961995785 A CN B961995785A CN 96199578 A CN96199578 A CN 96199578A CN 1271980 C CN1271980 C CN 1271980C
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G·H·怀特
于蔚云
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Endogad Research Pty Ltd
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Abstract

本发明公开了一种用于在主管腔分支为两个分支管腔处附近对主管腔的扩张区进行架桥的分支移植物装置。该装置具有在分支点分支为两个管状延伸部的管状主部分的分支移植物和至少一个确定了大小从而连接于分支移植物的管状延伸部之一和各自的分支管腔之间的管状移植物。

Description

分支动脉的腔内移植
发明领域
本发明涉及一种在管腔如分支动脉内放置一种腔内移植物的方法。
背景技术
众所周知，人体内的动脉由于疾病极易被延展的肉瘤如动脉瘤的发展影响，而这种动脉瘤则容易破裂。传统上动脉瘤是完全由外科行手术移植更换的。这种治疗方法对患者来说危险较大，并且在许多病例中由于患者已存在其他疾病而无法施行。新近提出了许多在腔内放置腔内移植物以架桥于动脉瘤囊内的方法，从而使一条活性动脉导管与动脉瘤囊隔离开来。其中的一种方法在澳大利亚专利申请78035/94号中有所阐述。
当动脉瘤是始于一条单一动脉而延伸至一条或多条分支动脉时，放置上述腔内移植物则面临困难。在这种情况下须启用一种所谓的“裤形-移植物”。这种移植物由一个单一的管状体顺血流方向分支为两个较小的管状体，目的在于其单一的管状体被置于单一的动脉内而两个较小的管状体则分别置于两条分支动脉内(如见Barone的美国专利5,360,443号)。实践证明很难有效地放置这种裤形移植物。
发明公开
根据第一方面，本发明涉及一种在患者体内的分支管腔中放置一种腔内移植物的方法，该管腔包括一条单一的分支前管腔，该单一的分支前管腔分支成一对分支后管腔，该方法包括：
(a)经一侧分支后管腔将第一个腔内移植物完全导入分支前管腔，该第一腔内移植物的体部在其第一端所具有的一个管状部分可以被撑开，从而与分支前管腔的周壁相接触，而其第二端则分支第一与第二管状移植物延伸部；
(b)将具有一个可膨胀管状体的第二个腔内移植物导入一侧分支后管腔，其中该管状体尚具有一个上游端和一个下游端；移动第二个移植物，直到使其上游端位于第一个腔内移植物的一管状移植物延伸部之内或包绕着该延伸部，并使其下游端位于上述分支后管腔内，从而使第二个腔内移植物的管状体与上述管状移植物延伸部及该管腔接合而形成流体通道；
(c)将具有一个可膨胀管状体的第三个腔内移植物导入对侧分支后管腔，该管状体具有一个上游端与一个下游端；移动第三个移植物，直到使其上游端位于第一个腔内移植物的另一管状移植物延伸部之内或包绕着该延伸部，并使其下游端位于对侧分支后管腔内，从而使第三个腔内移植物的管状体与上述管状移植物延伸部及该管腔接合而形成体流通道。
在本发明上述方面的一个优选实施方案中，第一个腔内移植物经第一分支后管腔导入，而第二个腔内移植物经对侧分支后管腔导入。随后第三个腔内移植物再经第一分支后管腔导入。
也可以不需要首先安置分支形移植物，而是先安置移植物的一条“腿”，其后再放置整个分支形移植物。因此，本发明的第二个方面涉及一种在患者体内的分支管腔中放置一种腔内移植物的方法，该分支管腔包括由单支分支前管腔分支成一对分支后管腔该方法包括：
(a)将包括一个可膨胀管状体的第一个腔内移植物导入一侧分支后管腔，该管状体具有一个上游端及一个下游端撑开其下游端使之与该管腔相接触；
(b)将第二个腔内移植物导入对侧分支后管腔并使其完全位于分支前管腔内，第二个腔内移植物的体部在第一端具有的一个管状部分可被撑开从而与分支前管腔的周壁相接触，在第二端分支成第一和第二管状移植物延伸部；撑开第二个移植物的第一端使其与分支前管腔的管壁相接触，并使一管状移植物延伸部与第一个腔内移植物相接合而形成流体通道；以及
(c)将包括一个可膨胀管状体的第三个腔内移植物导入对侧分支后管腔，该管状体具有一个上游端与一个下游端，移动第三个腔内移植物直到使其上游端位于第二个腔内移植物的另一管状移植物延伸部之内或包绕该延伸部，并使其下游端位于对侧分支后管腔内，从而使第三个腔内移植物的管状体与该管腔接合而形成流体通道。
本发明的又一个方面涉及一种在患者体内的分支管腔(由单支分支前管腔分支成一对分支后管腔)中放置一种腔内移植物的方法，该方法包括：
(a)将包括一个可膨胀管状体的第一个腔内移植物导入一侧分支后管腔，该管状体具有一个上游端及一个下游端，撑开至少其下游端使之与该管腔相接触；
(b)将第二个腔内移植物导入上述分支后管腔，该第二腔内移植物在其体部第一端具有的一个管状部分可被撑开从而与分支前管腔的周壁相接触，在第二端分支成第一和第二腔状移植物延伸部，其中一个管状移植物延伸部较另一管状移植物延伸部略长；将第二个腔内移植物穿过第一个腔内移植物直到使其第一端位于分支前管腔内而上述另一管状移植物延伸部脱离第一个腔内移植物；撑开第二个移植物的第一端使之与分支前管腔的管壁相接触从而使第一管状移植物延伸部与第一个腔内移植物相接合形成流体通道；
(c)将包括一个可膨胀管状体的第三个腔内移植物导入对侧分支后管腔，该管状体具有一个上游端及一个下游端，移动第三个移植物直到使其上游端位于第二个腔内移植物的另一管状移植物延伸部之内或包绕着该延伸部，并使其下游端位于对侧分支后管腔内，从而使第三个腔内移植物的管状体与上述管状移植物延伸部及该管腔相接合而形成流体通道。
在以上每一方面，本方法均可选一步包括以下步骤：
(d)将包括一个可膨胀管状体的又一个腔内移植物导入一侧和/或对侧分支后管腔，该管状体具有一个上游端及一个下游端，移动此移植物直到使其上游端位于分支后管腔中原有腔内移植物的下游端之内，并使其管状体与分支后管腔内原有移植物的下游端和包绕着的分支后管腔相接合形成流体通道。
在上述方面的一个实施方案中，将第一个腔内移植物放置于一侧分支后管腔的步骤按顺序可分为如下几步：
(a)经一侧分支后管腔导入第一根细导丝并优选至少进入分支前管腔；
(b)沿第一根细导丝导入第一根细鞘管并至少使其进入分支前管腔；
(c)抽出第一根细导丝；
(d)经第一根细鞘管插入第二根相对硬的导丝并使其至少进入分支前管腔；
(e)抽出第一根细鞘管；
(f)经第二根导丝导入第二根直径相对大的鞘管并使其至少进入分支前管腔；
(g)在第二根直径较大的鞘管内沿第二根导丝导入第一根运送导管，该导管的第一端具有一个未膨胀的球囊，球囊外围安置有第一个腔内移植物的下游端；
(h)放置第一根运送导管以使第一个移植物位于分支后管腔内；
(i)部份抽出第二根鞘管以游离第一个腔内移植物；以及
(j)膨胀球囊以撑开第一个腔内移植物的下游端直到使其与该分支后管腔的管壁紧密接合。
依照本发明而设计的发明方案最为典型的应用是用于单支管腔分支为两支管腔的情况下，例如由主动脉分支为髂动脉。亦可用于多支管腔由单支管腔分出时，如主动脉弓部位。
在尤其优选体现本发明上述方面的一个实施方案中，腔中移植物具有澳大利亚专利申请78035/94号所描述移植物的特点，该专利作为参考在此被引证。
下面作为参考描述在一分支动脉内安置一种裤形移植物这一本发明的典型应用。然而，依照本发明而设计的方法亦可用于体内任何分支管腔进行裤形移植物的安置。除动脉外，这样的管腔还包括静脉、气管和小气管以及胆管。
既然用来实施本发明的移植物的管状体是可被撑开的(例如利用一根球囊导管)，那么至少第一个腔内移植物的某一管状部分可制成为可自动膨胀的斯坦特装置。该斯坦特装置可用于支持管状部分以便接受第二和第三个腔内移植物的管状体。
腔内移植物优选具有一定的长度，以便每一管状移植物延伸部均可延伸至动脉分支处的上游端。在这种情况下，另一单独的管状移植物被用来连接每一管状延伸部分与之相关的远端动脉。在另一种方案中，腔内移植物具有一个较长的管状延伸部以至可伸入第一支远端动脉中。此时另一个管状延伸部则延至分支处的上方，而第二个管状移植物将该延伸部与第二支远端动脉相连接。
附图简述
图1为部分剖开的患者正视轮廓图，显示了依本发明在患者的主动脉瘤内架设的腔内移植物；
图2显示了用于图1所描述方法中管状腔内移植物的一种实施方案的侧视图；
图3为图2所示腔内移植物的纵向沿直径剖开的剖视图；
图4为图2所示腔内移植物一端的详细视图；
图5为图4所示腔内移植物第一端的详细透视图，显示移植物端线的各个嵴在插入移植物的过程中是如何呈放射状向外推出的；
图6及6a为实施本方法时所应用的运送导管上安置的可分支移植物的两种实施方案的垂直剖视图；
图6b为导管及导丝游离端分别安置的可膨胀球囊在充气时的放大图；
图6c为图6b所示装置在球囊未充气时的纵向剖视图；
图6d为一根在游离端具有可膨胀伞状物的导丝的简明剖视图；
图6e为一根在游离端具有一个固体小珠的导丝的简明侧视图；
图7a至7i显示了实施本发明一种方法的各个步骤；
图8a至8e显示了实施本发明另一方法的各个步骤；
图9a至9f为可用于本发明方法的不同腔内移植物的简明侧视图；
图10为可用于实施本方法的一根运送导管上所安置的管状移植物的一种实施方案的垂直剖视图。
实施本发明的优选方案
应用一种包括三个腔内移植物10，10a及10b的分支形或裤形移植物经患者股动脉插入，可达到架桥和闭塞一个至少延伸入左髂动脉的主动脉瘤的目的。如图1所示，主动脉11与左、右髂动脉13、12相连。主动脉瘤位于肾动脉14、15及髂动脉12、13之间并向下至少延伸入左髂动脉13。
每一个腔内移植物(图2-5所示)可以包括一个由聚酯纺织而成的波形管16。其他材料包括聚四氟乙烯、聚氨酯及其复合物亦可应用于此。管腔16沿其长轴由一些不相连并有一定间距的不锈钢金属丝17进行加固(每一根金属丝可具有通常所描述的闭合正弦渡形)。金属丝17优选尽可能细，典型的直径为0.3至0.4毫米，金属丝17具有可塑性，可被弯曲成任何预先设计的形状，也就是说，它们并非在任何大的范围内均有弹性，因此它们必须由外力撑开而非靠自身的弹性撑开与主动脉相接合。每根金属丝17均被纺织于管腔16的纤维结构中，因此每根金属丝17的各个嵴突出于管腔16之外，而其余部分保留于管内部(除下文将提及的最末端的金属丝17a外)。每根金属丝17的末端均置于管16外并扭结在一起形成尾端18。各金属丝17的尾端18沿管腔16的外表面被弯成背向纵轴的方向。如有必要，金属丝17还可在管16的各个侧面与尾端18形成两个部分。
最末端的金属丝17a突出于管16的各个末端之外，以便金属丝的各个嵴在管16的末端之上沿纵轴方向延伸。金属丝17a的最末端优选具有大约6mm左右的振幅与一适当的波长，后者应使6～8个嵴环绕分布于直径为22mm的移植物之周壁。紧接的两根相邻金属丝17优选尽可能地靠近最末端的金属丝17a并分别具有4mm与5mm的振幅。这些金属丝将典型地与末端金属丝17a具有相同的波长。此后，沿移植物分布的金属丝17将具有15mm的间隔、6mm的振幅，并固定地具有与末端金属丝17a最初相同的波长。
由于动脉瘤自主动脉11延伸至髂动脉12、13的分支处或其上方，因此单个管状移植物尚不足以架桥于动脉瘤内而同时保证血液流向每支髂动脉12与13。本方法使用了三个独立的移植物10、10a与10b以代替单个的管状移植物。第一个移植物10(如图1所示)的下游端提供了一个分支以形成一对管状移植物延伸部19a、19b。管状移植物延伸部19a、19b可以被血流被动地撑开或被球囊膨胀主动地撑开或借助弹力自动撑开。
如图9a至f良好地显示那样用于延伸入各髂动脉12、13的移植物部分10a与10b分别具有一个相同直径的上游端。这些上游端分别与置于主动脉11中的移植物10的延伸部19a及19b相接合。这种接合优选地为上游端借助球囊膨胀或靠弹力自身膨胀而使各上游端分别与延伸部19a、19b的摩擦接合。
除具有圆柱形的直管外，移植物部分10a与10b的下游端35尚可被制成多种直径以适应该移植物部分10a与10b所植入的髂动脉的不同直径。
直径的变化是由一段较短的逐渐变细的部分31(见图9c)或一段逐渐变粗的部分32(见图9d)提供的，或者由一段沿移植物部分10a或10b的长轴方向延伸并逐渐变细的圆锥体部分33与34提供的(见图9e与9f)。
下面将参照图7a至7i讲述放置腔内移植物的一种方法。为实施该方法需行切开或穿刺以暴露一侧股动脉(即同侧)，该动脉延自相应的髂动脉，应用Seldinger穿刺技术将一根直径为0.035″，尖端柔软可弯曲的导丝插入并穿过股动脉、髂动脉12进入主动脉11以使其横越动脉瘤。随后将一根8弗伦奇的止血鞘沿导丝导入以止血。再导入一根管腔造影导管进行管腔造影以显示肾动脉14、15的位置以及患者体内其他有关的解剖结构。
随后插入一根Amplatz extra stiff(AES)导丝23(直径为0.035″)，使其穿过管腔造影导管进入主动脉11(见图7a)。抽出管腔造影导管，将硬导丝23留于体内。此后沿硬导丝23导入一根优选24弗伦奇的鞘管21与套针(见图7a)。再将一根球囊导管为24导入鞘管21。
如图6所示，球囊导管24是一根预先固定有分支移植物10的运送导管，分支移植物具有两个在分支点40分开的第一和第二管状移植物延伸部19a、19b，而一条含有导丝26的细导管25沿第一方向通过第一管状移植物延伸部19a延伸并沿第二个不同的方向进入第二管状移植物延伸部19b。
球囊导管24与细导管25可以在移植物10以下由一根共同的鞘管56连结在一起，以便更好地保证在管腔中安置移植物10时能准确放置细导管25与导丝26。除可在管状移植物延伸部19a、19b中滑动外，细导管25在将移植物10插入管腔之前可固定于移植物10中。导丝26可以被缝合、粘着或编织入移植物10体内。
由于图6显示导丝26被置于导管25之内，可以设想导丝26仅可被置于第一与第二管状移植物延伸部19a、19b内。在图6b所示的另一种方案中，导丝26被置于移植物10体内所形成的一条管状通道22内。通道22保证了导丝26在将移植物10固定于球囊20外之后、将球囊导管24置于主动脉11内之前能够保持于第一与第二管状移植物延伸部19a、19b内的预期位置。
当球囊导管24已被安置于主动脉11之内的预期位置之后，鞘管21将被部分抽出以游离移植物10，随后膨胀球囊(见图7b)。导管24上球囊20的膨胀撑开了第一个移植物10的上游端，并使其在动脉瘤的上方、肾动脉14与15的下游端与主动脉壁紧密接合。第一个移植物10所具有的长度将恰好使管状移植物延伸部19a、19b完全置于主动脉11内。此时将球囊20放气但仍保持球囊导管24于原位(见图7c)。球囊20放气后将使血液经移植物10内流下从而撑开各个管状移植物延伸部19a、19b。
细导管25优选为3弗仑奇，导丝26优选抗扭结材料以使导丝26能沿导管25向下游方向延伸(见图7c)。导丝26优选包括一个Nitinol核心与一个亲水性的外套，在图7所示的方法中，导管25与导丝26分别在其顶端具有一个小的可膨胀球囊50、55。有关上述球囊50、55的更详细描述见图6、6b及6c。球囊50、55膨胀后可有助于导管25及导丝26由血流携带而进入对侧髂动脉13。
图6b与6c显示了分别接于导管25及导丝26游离端的球囊50、55的放大图像。导管25具有两个腔52和53。导丝26穿过第一腔52。第二个腔53的两端是密闭的，而在导管25的外表面开有一个小孔51。在50a处一个乳胶球囊50被环形缚于导管25的外表面。当准备膨胀球囊50时，液体或气体经过第二个腔53向下注入，随后经孔51使球囊50膨胀。同样地，导丝26亦含有腔54，可经其注入气体以使置于导丝26游离端的球囊55膨胀。
尽管可膨胀球囊为优选的，但亦可设想采用其他的可膨胀装置。例如在另一实施方案中，导管25与导丝26上的球囊50、55可以被一种可撑开的伞形物所代替，图6d即显示了一种可被利用的伞形物类型的例子。伞形物70被安置于导丝26的游离端。图6d所示为伞形物70被撑开时的结构，它被一根经过导丝26内腔73的金属丝71所撑开。金属丝71附着于支撑物72上，当回抽金属丝71时，支撑物72联动撑开伞形物70。尽管导丝26上没有伞形物70，我们也可以设想在导管25上应用其它相似的装置。另一备选实施方案为将导丝26上的球囊55替换成由如环氧树脂或钛等所制成的固体小珠，如图60所示。优选小珠80的剖面尺寸大于导丝26。
在一实际操作中，希望一旦导管25被送至管腔中的预期位置，则膨胀导管游离端的球囊50，直到球囊50与管腔壁贴合并将导管25固定于管腔内的预期位置，从而可在导丝26通过管腔时起到成为另一支撑物的作用。
一旦导丝26被准确置于对侧股动脉内，则钳闭股动脉两端并于中间行动脉切开。如果导丝26已被完全导导入对侧股动脉，则经过动脉上所做的切口或穿刺点抽出导丝可轻易地重现导丝26。如果导丝26未被全部导入对侧股动脉，则可应用一网套或类似装置经对侧股动脉套住导丝26从而将其经切口或穿刺点抽出。抽出导丝26后即可由同侧抽出细导管25，并沿导丝26由对侧股动脉送入另一导管27至第一个移植物10内，并使其至少达到第二管状移植物延伸部19b的顶端(见图7d)。随后抽出细导丝26而经对侧股动脉向导管27内插入一根较粗的导丝30。再将导管27抽出，而沿硬导丝30导入一根优选为24弗仑奇的鞘管21a及套针(见图7e)。
在将导丝26伸入对侧髂、股动脉之前，可沿对侧股、髂动脉逆血流向上插入一鞘管(可类似于鞘管21)，从而减少这些动脉可能存在的曲度以利于导丝26的导入。
如图10所示的装有第二个管状移植物10a的第二根球囊导管24a可沿鞘管21a导入，直到其上端恰好位于第二管状移植物延伸部内而下端在髂动脉内。将导管24a上的球囊20a膨胀，使移植物10a的上端与第二管状移植物延伸部19b摩擦接合(见图7f)。在经同侧动脉12抽出第一根球囊导管24时导管24a上膨胀的球囊20a可对移植物10a起支撑作用。将导管24a上的球囊20a放气而仍保持导管24a于原位，以便其在放置第三个移植物10b时能够继续支撑主动脉11内的移植物10、10a。
此后取走鞘管21a(见图7f及7g)，沿导丝23导入安有管状移植物10b的第三根球囊导管(第三根球囊导管10b如图10所示)。将该第三根球囊导管不断伸入直至其上游端位于第一管状移植物延伸部19a之内。部分抽出鞘管21后膨胀球囊，置于第三根球囊导管上的第三个移植物随即向前推进，直到其上游端与第一管状移植物延伸部19a相接触，而其下游端与右髂动脉相接触(见图7h)。
现在抽出硬导丝23及30，缝合对侧切口或穿刺点。进行第二次管腔造影检查，如果移植物10，10a与10b准确放置且功能正常，则可抽出止血鞘管21，并缝合右股动脉。结果是有功能的裤形移植物架桥于动脉瘤内，如图7i所示。
以下参照图8a～8e讲述放置腔内移植物的另一种方法(相似的部件的参考数字同前)。如图7所示的方法，实施该方法时需在来自一相应髂动脉12的一侧股动脉(即同侧)上行切开或穿刺以暴露该侧股动脉，应用Seldinger穿刺技术将一根直径为0.035″、尖端柔软的可弯曲的导丝插入并穿过该侧股动脉、髂动脉12以进入主动脉11，使其横越动脉瘤。随后沿导丝导入一根8弗仑奇的止血鞘以止血。导入一根管腔造影导管，在患者体内行管腔造影以显示肾动脉14、15的位置以及患者体内的其他相关的解剖结构。
随后插入一根Amplatz ertra stiff(AES)导丝23(直径为0.035″)，使其穿过管腔造影导管进入主动脉11(见图8a)。抽出管腔造影导管后，将硬导丝23仍留于体内。此后沿硬导丝23将一根优选为24弗仑奇的鞘管21与套针导入该髂动脉(见图8a)。再将一根球囊导管24a(如图10所示)导入鞘管21。此次球囊导管24a被预先安置有管状移植物10b。当导管24a被放置于髂动脉12后，部分抽出鞘管21以游离移植物10b，随后膨胀球囊20a(见图8b)。导管24a上球囊20a的膨胀撑开了移植物10b的下游端，使其在动脉瘤下方与髂动脉的管壁紧密接合。然后将球囊20a放气并抽出导管24a。
接着沿硬导丝23将鞘管21穿过移植物10b导入主动脉11，并将球囊导管24(如图6所示)导入鞘管21。球囊导管24预先安置有一个分支形移植物10，该移植物包括一个分支点40，两个管状移植物延伸部19a、19b，一根细导管25以及一根导丝26。带有或安置有移植物10的球囊导管24穿过管状移植物10b并放置在主动脉11内。一旦球囊导管24被放置于主动脉11中，即部分抽出鞘管21以游离移植物10，并膨胀导管24上的球囊20。球囊20的膨胀撑开移植物10的上游端，使其在动脉瘤的上方、肾动脉14、15的下游端与主动脉壁接合(见图8c)。该方法中所应用的伸入移植物10b中的移植物10的管状移植物延伸部19a略长于管状移植物延伸部19b，由此保证了当球囊导管24准确放置于主动脉11中时，移植物延伸部19a可与移植物10b部分重叠，而管状移植物延伸部19b从移植物10b中脱离出来。随后将球囊20放气并部分抽出至管状移植物10b的上游端，在该处将其重新膨胀以撑开管状移植物延伸部19a，并使其与部分与之重叠的移植物10b相接触，从而在移植物10与10b间形成流体通道。
其后将细导管25及导丝26按类似于图7所示方法向下游方向延伸。一旦导丝26被准确放置于对侧股动脉中，则钳闭两端股动脉并行动脉切开。如同已经描述的经同侧股动脉切开处抽出细导管25的那样，可以重新获得导丝26。随后沿导丝26经对侧股动脉向上伸入另一根导管27，直到使其位于第一个移植物10中并至少到达移植物延伸部19b的顶端。抽出细导丝26，经对侧股动脉向导管27内插入一根粗导丝30(见图8d)。移走导管27，按类似于图7所示的方法沿硬导丝30导入一根鞘管21a(优选为24弗仑奇)及套针。
其后经鞘管21a导入带有第二个管状移植物10a的第三根球囊导管(具有如图10所示导管的特点)，直到其上端恰好位于管状移植物延伸部19b中。膨胀第三根球囊导管上的球囊，使移植物10a的上端与移植物延伸部19b摩擦接合。随后再将第三根导管上的球囊放气并经对侧股动脉抽出球囊导管(见图8e)。
将导管24上位于移植物10b上游端的仍充气的球囊20放气并全部抽出导管24a。最后抽出鞘管21a、导丝23及导丝30并缝合对侧切口或穿刺点。与本文描述的前种方法相同，此时行第二次管腔造影，如果移植物10、10a与10b已被准确放置且功能正常，则抽出止血鞘21并缝合同侧股动脉。结果是一个如图7i所示的有功能的裤形移植物置于体内。
关于在分支管腔中放置移植物10、10a、10b的另一种改良方法如图8a～8e所示，包括将裤形移植物10b置入右髂动脉口，经左髂动脉13向主动脉内导入带有移植物10的运送导管24。一旦移植物10被安置于预期部位且移植物10与10a接合良好，则移植物20b可通过左髂动脉13被导入并准确放置，从而完成整个裤形移植物的置入。
以上多种手术方法中可以采用全身麻醉、硬膜外麻醉或在合适的病例中仅采用局部麻醉。
本领域技术人员应该知道具体实施方案在不背离本发明上述精神与范畴的前提下，本发明可如某些具体实施方案所示的那样进行多种变异和/或修饰。因此，不论从何方面而言，这些实施方案均为说明性的而非限制性的。

Claims (21)

1.一种用于在主管腔分支为两个分支管腔处附近对主管腔的扩张区进行架桥的分支移植物装置，该装置包含：
具有在分支点分支为两个管状延伸部的管状主部分的分支移植物，该分支移植物包含由主部分和管状延伸部中的多个不相连和具有一定间距的金属丝加固的移植物体，其中至少主部分中的金属丝编织通过移植物体，且其中至少一根在管状延伸部末端的金属丝可通过弹力自动撑开；和
至少一个确定了大小从而连接于分支移植物的管状延伸部之一和各自的分支管腔之间的管状移植物，管状移植物具有由金属丝加固的移植物体，管状移植物具有第一端，该第一端具有第一端直径，其中管状移植物的该第一端的金属丝是可塑性的，管状移植物第一端重叠于管状延伸部内部并且可以向外扩张，与管状延伸部的末端摩擦接合形成移植物装置，管状移植物具有第二端，该第二端具有第二端直径，其中第二端直径与第一端直径不同，并且，其中第二端直径的选择是基于该管状移植物将要移植进入的分支管腔的直径。
2.权利要求1的分支移植物装置，其中有一对确定了大小从而连接于分支移植物的两个管状延伸部和各自的分支管腔之间的管状移植物，每个管状移植物具有由金属丝加固的移植物体，其中每个管状移植物第一端的金属丝是可塑性的，每个管状移植物第一端重叠于管状延伸部内部并且可以向外扩张，与管状延伸部的末端摩擦接合形成移植物装置。
3.权利要求1的分支移植物装置，其中每一根编织通过移植物体的金属丝具有通常的闭合正弦形，相邻的嵴延伸于相反的方向，其中该金属丝一般置于移植物体内，其中波谷部分的嵴通过移植物体到达移植物体外部，波峰部分的嵴位于移植物体内部。
4.权利要求1的分支移植物装置，其中每一根编织通过移植物体的金属丝具有通常的闭合正弦形，该正弦形具有一定振幅。
5.权利要求4的分支移植物装置，其中主部分的至少一根金属丝与其它金属丝具有不同的振幅。
6.权利要求5的分支移植物装置，其中距离主部分末端最近的金属丝比主部分的其它金属丝的振幅大。
7.权利要求1的分支移植物装置，其中分支移植物主部分的金属丝是可塑性的。
8.一种用于在主管腔分支为两个分支管腔处附近对主管腔的扩张区进行架桥的分支移植物装置，该装置包含：
具有在分支点分支为两个管状延伸部的管状主部分的分支移植物，该分支移植物包含由主部分和管状延伸部中的多个不相连和具有一定间距的金属丝加固的移植物体，每一金属丝具有通常的闭合正弦形，至少一根在管状延伸部末端的金属丝可通过弹力自动撑开，第一根金属丝邻近于分支移植物体的主部分末端，使得第一根丝的交替嵴伸出超过末端的至少一部分；和
至少一个确定了大小从而连接于分支移植物的管状延伸部之一和各自的分支管腔之间的管状移植物，管状移植物具有由金属丝加固的移植物体，管状移植物具有第一端，该第一端具有第一端直径，其中管状移植物的该第一端的金属丝是可塑性的，管状移植物第一端重叠于管状延伸部内部并且可以向外扩张，与管状延伸部的末端摩擦接合形成移植物装置，管状移植物具有第二端，该第二端具有第二端直径，其中第二端直径与第一端直径不同，并且，其中第二端直径的选择是基于该管状移植物将要移植进入的分支管腔的直径。
9.权利要求8的分支移植物装置，其中有一对确定了大小从而连接于分支移植物的两个管状延伸部和各自的分支管腔之间的管状移植物，每个管状移植物具有由金属丝加固的移植物体，其中每个管状移植物第一端的金属丝是可塑性的，每个管状移植物第一端重叠于管状延伸部内部并且可以向外扩张，与管状延伸部的末端摩擦接合形成移植物装置。
10.权利要求8的分支移植物装置，其中分支移植物主部分的金属丝是可塑性的。
11.权利要求8的分支移植物装置，其中分支移植物体主部分的末端包含一个位于第一根金属丝的每一个伸出的嵴之间的边缘。
12.权利要求8的分支移植物装置，其中至少主部分中的金属丝编织通过移植物体，其中该金属丝一般置于移植物体内并且具有交替的嵴，其中波谷部分的嵴通过移植物体到达移植物体外部，波峰部分的嵴位于移植物体内部。
13.权利要求8的分支移植物装置，其中每一根编织通过移植物体的编织金属丝具有通常的闭合正弦形，该正弦形具有一定振幅。
14.权利要求13的分支移植物装置，其中主部分的至少一根金属丝与其它金属丝具有不同的振幅。
15.权利要求14的分支移植物装置，其中距离主部分末端最近的金属丝比主部分的其它金属丝的振幅大。
16.权利要求1的分支移植物装置，其中管状移植物的第一端的直径大于第二端的直径。
17.权利要求1的分支移植物装置，其中管状移植物的第一端的直径小于第二端的直径。
18.权利要求1的分支移植物装置，其中直径的差异是通过选自具有圆锥形的中间部分、逐渐变粗的部分或逐渐变细的部分的机制提供的。
19.权利要求8的分支移植物装置，其中管状移植物的第一端的直径大于第二端的直径。
20.权利要求8的分支移植物装置，其中管状移植物的第一端的直径小于第二端的直径。
21.权利要求8的分支移植物装置，其中直径的差异是通过选自具有圆锥形的中间部分、逐渐变粗的部分或逐渐变细的部分的机制提供的。
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AUPN6512A AUPN651295A0 (en) 1995-11-10 1995-11-10 Intraluminal grafting of a bifurcated artery
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AU7486296A (en) 1997-06-05
WO1997017911A1 (en) 1997-05-22
US6045557A (en) 2000-04-04
AU728276B2 (en) 2001-01-04
JP2004089718A (ja) 2004-03-25
EP0955952A1 (en) 1999-11-17
CA2236905C (en) 2004-03-16
EP0955953A4 (en) 2009-07-15
EP0955953A1 (en) 1999-11-17
JP2007319694A (ja) 2007-12-13
RU2179003C2 (ru) 2002-02-10
BR9611441A (pt) 1999-12-28
WO1997017910A1 (en) 1997-05-22
JP4036844B2 (ja) 2008-01-23
JP2006312081A (ja) 2006-11-16
JP2000500046A (ja) 2000-01-11
WO1997018006A1 (en) 1997-05-22
RU2179421C2 (ru) 2002-02-20
CA2236602C (en) 2004-03-30
JP2004202277A (ja) 2004-07-22
CN1207658A (zh) 1999-02-10
AU7486496A (en) 1997-06-05
CA2236602A1 (en) 1997-05-22
AU706084B2 (en) 1999-06-10
CN1207659A (zh) 1999-02-10
AU7486396A (en) 1997-06-05
EP0955952A4 (en) 2008-10-01
JP2000500047A (ja) 2000-01-11
US6099558A (en) 2000-08-08
JP3876246B2 (ja) 2007-01-31
CA2236905A1 (en) 1997-05-22
CN1195459C (zh) 2005-04-06

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