EP1139916A1

EP1139916A1 - Device for placing an aortic endoprosthesis

Info

Publication number: EP1139916A1
Application number: EP99959407A
Authority: EP
Inventors: Mario Lachat
Original assignee: Fumedica Intertrade AG
Current assignee: Fumedica Intertrade AG
Priority date: 1998-12-16
Filing date: 1999-12-11
Publication date: 2001-10-10
Also published as: AU1658500A; DE29822381U1; WO2000035377A1; US20010049534A1; CA2355665A1

Abstract

Known devices for placing aortic endoprostheses comprise a guide wire by means of which the opening of the main prosthesis already positioned in the aneurysm is sounded prior to insertion of the extension. This is a long and risky procedure. According to the device provided for in the invention a second guide wire for the extension is fixed to the first guide wire used for the main prosthesis in such a way that said second wire can be aligned with the first. In this way the opening for receiving the extension can be sounded from the interior both rapidly and safely.

Description

Device for inserting an aortic endoprosthesis

The invention relates to a device for inserting aortic endoprostheses, in particular in the treatment of abdominal aortic aneurysms.

For minimally invasive surgical treatment of the abdominal aortic aneurysm, it is known to implant an endoprosthesis in the form of a coated stent, which relieves the aortic wall in the area of the aneurysm 2 (FIG. 1) from blood pressure and prevents its further expansion and tearing. This stent must protrude upwards and downwards beyond the area of the aneurysm 2, i.e. Start at the top in the unstretched area of aorta 1 and lead to both pelvic arteries 3, 4. The stent is usually composed of two parts, a main prosthesis 5 covering the aorta and the subsequent branch of a pelvic artery 3 and an extension 6 covering the branch of the other pelvic artery 4. When inserting is first on one side, for. B. right, punctured the femoral artery, a guide wire and then a lock pushed into the aorta 1 and finally released the main prosthesis by pulling back the lock. Then a further guide wire 7 (FIG. 2) is pushed through the left femoral artery to the aorta 1, with the end of which the short leg of the main prosthesis 5 must be probed. This process is difficult and often time consuming. The extension 6 is then placed on the left side by means of the additional guide wire so that it connects the main prosthesis 5 with the pelvic artery 4 that is contralateral to the main prosthesis.

The object of the invention is to provide a device with which the extension can be used more easily, quickly and safely.

This object is achieved by a device according to the main claim. The terms proximal and distal are intended to refer to the patient here; accordingly, the leading end of the guidewire is said to be proximal.

In the first position of the alignment member, the second guide wire is spread apart from the first by 20 to 40 degrees. This condition occurs after the proximal end of the first guidewire has been inserted into the main prosthesis already inserted in the aorta. By slightly withdrawing the device according to the invention, it is easily achieved that the distal end of the second guide wire passes through the short end of the main prosthesis and is provided with a further guide which is inserted via the contralateral arteria femoralis and provided at the end with a wire loop ("lasso"). guidewire can be detected. The extension can then be inserted along this guide wire. In the first position, the device according to the invention can also be inserted from the outside into the aorta through a catheter tube, the catheter effecting the parallel guidance of both wires.

In the second position of the alignment member, the first and second guide wires are approximately parallel. In this position, they can be withdrawn from the area of the aortic aneurysm through the iliac artery and femoral artery.

The material and diameter of the two connected guide wires correspond to those customary according to the prior art described above.

The second can be attached to the first guide wire by laser welding.

The ends of the guide wires are advantageously curved in an arc of 90 to 210 degrees with a radius of 2 to 20 mm. This avoids vascular lesions when inserted.

In another advantageous embodiment, this is as Alignment catheter tube closed at the proximal end and provided with a tapered rounded tip. In this case, the proximal ends of the guide wires are not bent.

By attaching a hamostatic valve to the distal end of the catheter tube, unnecessary blood loss can be avoided.

While, according to the known method, the probing of the main prosthesis and the insertion of the extension can take up to 30 minutes, this time can be reduced to 5 minutes with the new device.

The invention is further illustrated by way of example with reference to drawings. Show it:

1 shows the surroundings of the aneurysm with the two-part endoprosthesis used,

2 probing according to the prior art,

3 shows a device according to the invention as claimed in claim 2 in the first position of the alignment member;

4 shows a device according to the invention as claimed in claim 2 in the second position of the alignment member;

5 shows a device according to the invention as claimed in claim 3 in the first position of the alignment member;

6 shows a device according to the invention according to claim 3 in the second position of the alignment member;

7 shows the device shown in FIG. 3 in the operating area;

Fig. 8 this device in the second position of the Alignment member in the operating area;

9 shows a device according to the invention as claimed in claim 5 in the second position of the alignment member;

10 shows an enlarged detail of FIG. 9 in section.

The first guide wire 11 of the device shown in FIG. 3 according to claim 2 is preferably about 130 to 280 cm long. It has a curvature at the proximal end 12, i.e. the end 12 preceding when inserted. A preferably approximately 20 to 50 cm long second guide wire 13 is fastened with its proximal end to the wire 11 in such a way that it forms an angle of 20 to 40 degrees with the latter. The attachment point 14 is about 10 to 40 cm from the proximal end 12 of the first guidewire. A wire loop 16 located on a pull wire 15 wraps around the wire 11 proximal to the attachment point. The wire loop preferably has a diameter of 5 to 10 mm. The pull wire 15 is so long that its distal end remains accessible to the surgeon.

4 shows the device according to claim 2 in the second position of the wire loop 16 acting as an alignment member. This is now distal to the attachment point 14, wraps around both guide wires in the vicinity of the distal end 17 of the second guide wire 13 and holds them in an approximately parallel orientation . In this position, the device can be withdrawn from the femoral artery without difficulty.

5 shows a device according to claim 3 with the alignment member in the first position. A catheter tube 18, which has an opening 19 on the side through which the second guide wire 13 can pass without tension, acts as an alignment member. The catheter tube 18 is so long that its distal end remains accessible even after insertion into the aorta. The opening 19 is preferably about 5 to 20 cm from the proximal end of the catheter tube.

Fig. 6 shows the same device in the second position of the catheter tube 18. The catheter tube 18 is now retracted relative to the guide wires 11, 13, so that it holds in its interior in an approximately parallel orientation. In this position the device can be withdrawn from the femoral artery without difficulty.

7 shows the device according to claim 2 in the first position of the wire loop 16 fastened to the puller wire 15 after insertion into the abdominal aorta 1 and slight retraction. The second guide wire 13 is spread apart from the first 11 and emerges from the main prosthesis with its distal end. This end can now be easily grasped with a lasso 20, on which the displacement can finally be inserted and placed securely in the main prosthesis 5 and the pelvic artery 4.

8 shows the device according to claim 2 in the second position of the wire loop 16. After the extension 6 has been inserted, the lasso 20 has been detached from the second guide wire 13, the guide wire 11 has been inserted somewhat further and the wire loop 16 has been pulled over the fastening by means of the pull wire 15 - Junction 14 pulled down. As a result, the first and second guidewires are approximately parallel and can easily be pulled out through the arteria femoralis.

Analogously to FIGS. 7 and 8, the device according to claim 3 can also be used.

9 shows a further embodiment of the device according to the invention. The catheter tube 18 is closed here at the proximal end with a conically rounded tip 21. The proximal end of the first guidewire is not bent.

In FIG. 10, the area around the outlet opening 19 is the one in FIG Fig. 9 shown device shown enlarged in section. The first guidewire 11 and the second guidewire 13 lying in the upper area can be seen. To ensure reliable guiding of the wires, a partition 22 is also provided in the catheter tube and an outlet plug 23 for the distal end 17 of the second guidewire.

Device for inserting an aortic endoprosthesis

Reference list

Aorta aneurysm right pelvic artery left pelvic artery main prosthesis Extension of the prosthesis Probe for inserting the extension of the first guide wire proximal end of the first guide wire second guide wire Attachment point pulling wire Wire loop distal end of the second guide wire Catheter tube Opening of the catheter tube Lasso conical end Partition in the catheter tube Drainage plug

Claims

Device for inserting an aortic endoprosthesis

Expectations

A device for inserting a vascular endoprosthesis into an abdominal aortic aneurysm, comprising

a first straight elastic guide wire,

a second straight 10 to 30 cm long elastic guidewire, which is attached with its proximal end to the first guidewire in such a way that it forms an angle of 20 to 40 degrees with the proximal section in a tension-free state and the attachment point 20 to 40 cm from the proximal end the first guide wire is removed,

an alignment member which is displaceable along the first guide wire and which can assume a first position in which both guide wires are free of tension and a second position in which both guide wires are aligned approximately parallel to one another.

2. The apparatus of claim 1, wherein the alignment member consists of a puller wire and a wire loop, which in the first position wraps the first guide wire proximally and in the second position both guide wires distal to the attachment point.

3. The apparatus of claim 1, wherein the alignment member is a catheter tube surrounding the first guidewire and having a side opening allowing passage of the second guidewire.

4. Device according to one of the preceding claims, characterized in that the ends of the guide wires with a radius of 5 to 20 mm by 90 to 210 degrees are curved.

5. The device according to claim 3, wherein the catheter tube is closed at the proximal end and formed into a conical rounded tip.

6. The device of claims 3 to 5, wherein the first guide wire is passed through a hemostatic valve attached to the distal end of the catheter tube.