CN110393605B

CN110393605B - Aortic arch area branch tectorial membrane support blood vessel composite set

Info

Publication number: CN110393605B
Application number: CN201810364045.5A
Authority: CN
Inventors: 黄健兵
Original assignee: Individual
Current assignee: Individual
Priority date: 2018-04-23
Filing date: 2018-04-23
Publication date: 2022-11-04
Anticipated expiration: 2038-04-23
Also published as: CN110393605A

Abstract

The invention discloses a blood vessel combination device of a covered stent with branches at an aortic arch part, which comprises three artificial blood vessel components: (1) a section of U-shaped artificial aorta vessel with three branches, wherein a main vessel at the left part of the branch is internally provided with a stent; (2) coating a small stent blood vessel; (3) a straight cylindrical stent blood vessel with a section of naked stent and a section of covered stent. By using the blood vessel component, aortic lesions of an aortic arch part and ascending aorta can be isolated, branch arterial blood flow can be rebuilt, normal blood vessel forms can be furthest reserved, the blood vessel component is suitable for various common branch walking blood vessels, the application range is wide, the customized support is avoided, batch production can be realized, surgical wounds are effectively reduced, and the operation is simple and convenient.

Description

Aortic arch area branch tectorial membrane support blood vessel composite set

Technical Field

The invention relates to the field of implantable blood vessels, in particular to a covered stent assembly capable of being used for an aortic arch part with three branches.

Background

The thoracic aortic aneurysm and aortic dissection are serious lesions seriously threatening the lives of the masses, the natural disability rate is not actively treated, and the death rate is high. In recent years, the incidence of thoracic aortic aneurysm and aortic dissection has increased significantly with the increase in incidence of hypertension, hyperlipidemia, hyperglycemia, and trauma. At present, the aortic intracavity stent repair method has the advantages of good curative effect, small wound and simple and convenient operation. However, aortic arch aneurysm and aortic dissection which involve the openings of innominate artery, left common carotid artery and left subclavian artery are always the difficulties of the treatment technology. In order to ensure a secure fixation of the stent within the aorta while preventing blood flow from leaking out of the stent from the proximal or distal end of the stent, currently used aortic vascular stents require an anchoring zone of at least 15mm at the proximal or distal end. When thoracic aortic aneurysm or arterial dissection involves the aortic arch with openings of innominate artery, left common carotid artery and left subclavian artery, the stent in the market at present blocks branch arterial vessels to different degrees when treating the aortic arch, thereby affecting the functions of related limbs to a certain extent; when the occlusion relates to a neck blood vessel, a blood vessel bypass operation is required, the wound is large, and even the treatment by an intracavity technology cannot be carried out.

Due to the 3 branch vessels emanating from each patient's aortic arch: the unknown artery, the left common carotid artery and the left subclavian artery have different traveling, and the distances among the openings of the three branch blood vessels, the arrangement angles and the thicknesses of the branch blood vessels are different, so that the three-branch blood vessels on the arch part formed by the combination have extremely different forms, and the arch part blood vessels of different patients cannot be matched completely through a prefabricated bracket. Once the stent is not matched to the vessel, intraluminal repair therapy cannot be completed. The aorta branch stent is specially customized according to the specific anatomical conditions of the patient abroad. In the operation, when the aorta stent blood vessel is implanted into the aorta lesion part, the side hole of the aorta stent blood vessel is required to be aligned to the branch artery at the same time, so that the blood flow of the branch artery is ensured to be smooth, and then the small stent is implanted into the branch artery. However, this method has the following disadvantages: the bracket is specially customized according to the specific anatomical condition of a patient, the cost is high, and the mass production cannot be realized; 2. the customized bracket takes longer time and cannot be used for emergency operation patients; 3. the operation is complex, each side hole is required to be respectively and accurately aligned to the involved branch artery when the stent is released, if deviation exists, the blood flow of the branch artery can be obstructed, corresponding complications can occur, and the life can be threatened when the deviation is serious.

In addition, chinese patent application publication nos. CN102641164A and CN102973303B disclose two branched aortic vascular systems, including an aortic stent blood vessel and three branched arterial stent blood vessels, wherein a depression is provided at a middle section of the aortic blood vessel, the depression is provided with three side holes, and the three branched arterial stent blood vessels are separately installed in the three side holes. Although the two branch type aortic blood vessel systems can isolate aortic lesions which are affected with the aortic arch part and ascending aorta, can reconstruct blood flow of branch arteries, avoid customizing stents, can be produced in batch and used for emergency operations, the two branch type aortic blood vessel systems both need to reserve a concave part with a larger space to adapt to the placement of the branch arterial stent, otherwise the branch arterial stent can be seriously twisted and pressed and blood flow is not smooth, however, the space of the concave part is larger, and the space of the lower part of the concave part correspondingly narrows, so the blood flow supply of the aortic stent is necessarily influenced.

The application publication No. CN202821490U side branch type covered stent comprises a main stent, a side branch stent and a soft connecting part for connecting the main stent and the side branch stent, and can be used for treating aortic arch part lesion. However, the stent can not completely prefabricate three branches of blood vessels with different calibers, and when the position variation of the branch opening is large, the blood vessel at the opening is easy to be distorted and pressed, and the blood vessel membrane at the branch blood vessel at the large bending side has no support, so that the vascular disease at the large bending side is easy to have internal fistula. The three branch vessels are difficult to place accurately, and particularly when the branch variation is large, the blood flow of the branch vessels and the lumen of the main vessel are affected.

Disclosure of Invention

The invention provides a stent graft type blood vessel assembly with a branch covered on the aortic arch part, which can solve the defects of the existing stent blood vessel.

The invention provides a blood vessel combination device of an aortic arch part with a branch covered stent, which comprises three artificial blood vessel components: (1) a section of U-shaped artificial aorta blood vessel (1) with three branch blood vessels (8), wherein the artificial aorta blood vessel at the left part of the branch blood vessel (8) is internally provided with a blood vessel stent (9), and the blood vessel (10) at the right part of the branch blood vessel (8) and the branch blood vessel (8) are internally provided with no stent; (2) coating a small stent blood vessel (2); (3) a straight cylindrical stent blood vessel (3) with a section of naked stent (13) and a section of covered stent; when the blood vessel combination is carried out, the small covered stent blood vessel (2) is sequentially arranged in three branch blood vessels (8) of the artificial aorta blood vessel (1), then the straight cylindrical stent blood vessel (3) is arranged in the artificial aorta blood vessel (1), the bare stent (13) of the straight cylindrical stent blood vessel (3) is positioned in a branch blood vessel (10 a) with a stent of the artificial aorta blood vessel (1), and the combined U-shaped artificial aorta blood vessel and the three branches are covered blood vessels with stents in the whole process.

Preferably, the section of the U-shaped artificial aorta vessel (1) with the three branch vessels (8) is a section of a U-shaped straight cylindrical vessel, the first third section of the U-shaped artificial aorta vessel is provided with a vessel stent (9), the middle third section (10 a) is provided with the three branch vessels (8), the middle third section of the U-shaped artificial aorta vessel (10 a) and the branch vessels (8) as well as the rear third section of the U-shaped artificial aorta vessel (10 b) are not provided with a stent.

Preferably, the three branch vessels (8) are located on the outer lateral surface of the arc of the middle third section (10 a).

Preferably, the artificial aorta stent also comprises connecting parts between three branch blood vessels (8) and the artificial aorta blood vessel (1), wherein the connecting parts are designed in a cone shape, the openings of the branch blood vessels (8) on the artificial aorta blood vessel (1) are larger, and the branch blood vessels are tapered towards the far end, so that after the branch blood vessels (8) are implanted, the openings are ensured to have a certain moving range in each direction while the opening has enough pipe diameter, and the artificial aorta blood vessel can adapt to different branch shape positions and angles.

Preferably, the diameters of the distal ends of the three branch blood vessels (8) are designed to be 3-5 mm larger than the maximum diameter of the common branch blood vessel.

Preferably, the film-coated small stent blood vessel (2) comprises a small stent blood vessel part (11) in a straight barrel shape at the upper part and a stent bottom part (12) at the lower part, the upper section (11 a) of the small stent blood vessel part (11) is a stent blood vessel with a film, the lower section (11 b) is a bare stent without a film, and the stent bottom part (12) is in a horn mouth shape and is a bare stent without a film.

Preferably, among the small stent-graft vessels (2), the upper stent vessel part (11) has a diameter in the range of 5 to 20mm, and various types of stents are produced in stages.

Preferably, the straight cylindrical stent vessel (3) with a section of the bare stent (13) and a section of the covered stent comprises: the proximal part (13) is a bare stent without a coating, and the distal part (14) is a stent blood vessel with a coating.

Preferably, the length of the blood vessel bare stent part (13) is larger than that of the branched blood vessel (10 a).

Preferably, the length of the distal part (14) is larger than the length of the rear third part of the blood vessel (10 b) without branch.

Preferably, all stents are metal stents with good biocompatibility and holding power. Can be made of the same stent components of the large blood vessel stents on the market, such as stainless steel, nickel-titanium alloy and the like. The stent covering film and the blood vessel film without the stent can be various artificial blood vessel film materials on the market, such as polytetrafluoroethylene films, polyester fiber films, polyamide films or polypropylene films.

An aortic arch branch stent graft assembly. Three vascular components are included: (1) a section of U-shaped artificial aorta vessel with three branches, wherein, the artificial blood vessel at the left part of the branch is internally provided with a stent; (2) coating a small stent blood vessel; (3) a straight cylindrical stent with a section of naked stent and a section of covered stent.

As can be seen from the above description of the structure of the present invention, compared with the prior art, the present invention has the following advantages:

1. the bow-part branch tectorial membrane blood vessel assembly adopts the design that the blood vessel membrane and the bracket are separately arranged, can well adapt to the original blood vessel shape, and can ensure enough blood vessel support after combination. The design of the branch vessel stent-free vascular membrane can adapt to the running distribution of three main branch vessels, and the branch vessel stent-free vascular membrane is not required to be customized according to the specific anatomical condition of a patient. The small covered stent can be freely selected according to the thickness of each branch blood vessel of a patient, can fully support each branch blood vessel and prevent branch blood leakage. The placement of the straight-tube type bare stent can ensure sufficient aortic support and prevent blood leakage. The application of the assembly can select the most suitable bracket vascular system according to the specific vascular form of each patient, and fully maintains the original vascular form. The bracket can be prevented from being customized, the batch production can be realized, the time is effectively saved, and the operation is convenient.

2. The stent vascular assembly can safely and effectively isolate the pathological changes of an involved aortic arch and an ascending aorta, and has wide application range and simple stent release procedure. Because the design of releasing the branch vessel without the stent first is adopted, the branch artery at the aortic arch part can be safely and conveniently reconstructed, the original vessel shape is maintained to the maximum extent, the physiological state is more met, the full aortic arch replacement operation can be replaced, and the trauma and the risk of the thoracotomy operation are avoided.

3. The invention creatively designs the vascular membrane and the bracket separately, can ensure enough supporting and anchoring areas, has good stability and can prevent internal fistula. Compared with various chimney supports with different designs at home and abroad at present, the chimney support does not need a chimney structure at all, and the branch blood vessel can keep the original shape, so that the defects of various chimney supports, such as pressure deformation and distortion of the branch blood vessel, internal fistula, reduction of an effective lumen of an aorta and the like, can be avoided, and the chimney support is more in line with physiology.

Drawings

FIG. 1 is a schematic view of a three-branched U-shaped artificial aortic vessel of the present invention;

FIG. 2 is a schematic diagram showing the connection between the branch vessel and the main vessel of the U-shaped artificial aorta vessel with three branches according to the present invention;

FIG. 3 is a schematic view of a stent graft of the present invention;

FIG. 4 is a schematic view of a straight tubular stent vessel of the present invention with a section of bare stent and a section of covered stent;

FIG. 5 is a schematic representation of the thoracic aorta and its three branches;

FIG. 6 is a schematic view of the assembly (1) after release of the three-branched U-shaped artificial aortic vessel in the thoracic aorta and its three branches;

FIG. 7 is a schematic view of a stent graft with an assembly (2) placed in three branch vessels after the assembly (1) is released in the thoracic aorta;

FIG. 8 is a schematic view after the release of the components (1) and (2) is completed and the component (3) is released in the main vessel cavity of the component (1);

in actual use, after the three components are combined, the stent and the blood vessel are tightly attached to form a complete artificial blood vessel system with the vascular stent, and the components are layered and marked in the figure for understanding.

Detailed Description

The reference numerals in the figures denote: 1. a U-shaped artificial aorta vessel with three branches; 2. coating a small stent blood vessel; 3. a straight cylindrical stent vessel with a section of bare stent and a section of covered stent; 4. the thoracic aorta; 5. innominate artery; 6. the left common carotid artery; 7. the left subclavian artery; 8. a branch vessel of an artificial main vessel; 9. the artificial main vessel front section is provided with a bracket part; 10. the far section of the artificial main vessel is not provided with a stent part; 10a, a part with three branches in the middle section of the artificial main blood vessel; 10b, artificial main vessel far-section; 11. the upper part of the straight-tube blood vessel part of the tectorial membrane small bracket blood vessel; 11a, a blood vessel is supported by the upper section of the straight tube blood vessel part with a blood vessel membrane part; 11b, a bare stent part without a membrane at the lower section of the straight blood vessel part; 12. coating the bottom of the blood vessel of the small stent; 13. the blood vessel of the straight cylindrical stent is not provided with a naked stent part of a membrane; 14. a straight cylindrical stent blood vessel with a membrane stent blood vessel part; 15. u-shaped main vessel lumen of artificial aorta vessel

Fig. 1 to 8 show an aortic arch part branch stent graft blood vessel combination device and a use example thereof.

The aortic arch part branch covered stent blood vessel combination device comprises three artificial blood vessel components: (1) a section of U-shaped artificial aorta blood vessel (1) with three branch blood vessels (8), wherein the artificial aorta blood vessel at the left part of the branch blood vessel (8) is internally provided with a blood vessel stent (9), and the blood vessel (10) at the right part of the branch blood vessel (8) and the branch blood vessel (8) are internally not provided with stents; (2) coating a small stent blood vessel (2); (3) a straight cylindrical stent blood vessel (3) with a section of naked stent (13) and a section of covered stent; when in combination, the small covered stent blood vessel (2) is firstly sequentially arranged in three branch blood vessels (8) of the artificial aorta blood vessel (1), then the straight cylinder-shaped stent blood vessel (3) is arranged in the artificial aorta blood vessel (1), the bare stent (13) of the straight cylinder-shaped stent blood vessel (3) is positioned in a branch blood vessel (10 a) of the artificial aorta blood vessel (1), and the combined U-shaped artificial aorta blood vessel and the three branches are covered blood vessels with stents in the whole process.

Preferably, the three branch vessels (8) are located on the outer side of the middle third section (10 a) of the arc.

Preferably, the film-coated small stent blood vessel (2) comprises a small stent blood vessel part (11) in a straight barrel shape at the upper part and a stent bottom part (12) at the lower part, the upper section part (11 a) of the small stent blood vessel part (11) is a blood vessel with a film stent, the lower section part (11 b) is a bare stent without a film, and the stent bottom part (12) is in a horn mouth shape and is a bare stent without a film.

Preferably, the straight cylindrical stent vessel (3) with a section of naked stent (13) and a section of covered stent comprises: the proximal part (13) is a bare stent without a coating, and the distal part (14) is a stent blood vessel with a coating.

Preferably, all stents are metal stents with good biocompatibility and holding power. Can be made of the same stent components of the large blood vessel stents which are already on the market, such as stainless steel, nickel-titanium alloy and the like. The stent covering film and the blood vessel film without the stent can be various artificial blood vessel film materials on the market, such as a polytetrafluoroethylene film, a polyester fiber film, a polyamide film or a polypropylene film.

When the stent is used, the components (1), (2) and (3) are implanted in sequence to form a complete artificial blood vessel kit with the stent, so that the shape of an original blood vessel can be better kept and the lesion of the blood vessel at the arch part of the aorta can be isolated.

The component (1) is a U-shaped artificial aorta blood vessel with three branches, and the left part of the artificial blood vessel is internally provided with a stent and can be fixed in the aorta to ensure the positioning of the rear stentless blood vessel. The three branch vessels are designed into cone-shaped soft vessels, the autonomous blood vessel cavities are upward funnel-shaped, the distal end openings have a certain moving range, and the distal end openings can be placed in three target branch vessels at different angles and intervals better.

After subassembly (1) release was accomplished, placed subassembly (2) respectively to three branch's blood vessel in proper order through the main blood vessel intracavity of subassembly (1), formed the support of branch's blood vessel, the tectorial membrane part of while small support blood vessel overlaps with the branch's blood vessel membrane of subassembly (1), can guarantee that the artificial blood vessel membrane of branch's blood vessel fully supports the cover, prevents to leak blood. Subassembly (2) little support blood vessel bottom's the design of the naked support of loudspeaker form can guarantee that the artificial blood vessel membrane of branch's vascular opening portion fully adheres to the wall and guarantees that branch's vascular open-ended is unobstructed, and the naked support does not influence the blood flow in main vascular chamber, and the vascular opening portion of branch can be fixed to the naked support in bottom of broadness simultaneously, avoids little support slippage. The independent design of the small stent vessel of the component (2) can ensure that the stent vessel with the corresponding diameter is selected individually for each branch vessel, and the adaptability is good.

After the components (1) and (2) are released, the component (3) is released in the main vessel cavity of the component (1), the component (3) is completely overlapped with the blood vessel (10) without the stent part of the component (1), and the blood vessel covered stent support of the blood vessel section (10) can be completed. The design of the bare stent without the vascular membrane of the front section (13) of the component (3) correspondingly supports (10 a) in the vascular section of the branch in the component (1), can ensure smooth blood flow of the branch, and can support the wide and large substrate of the component (2) at the same time to further fix the vascular branch of the stent. The rear section (14) of the component (3) with the vascular stent is overlapped with the rear section blood vessel of the component (1), so that the rear section blood vessel can be ensured to have no blood leakage.

The components (1), (2) and (3) are sequentially released to form a complete covered stent system with a three-branch aortic arch part, so that vascular lesions of the aortic arch part can be completely isolated, and blood can pass through the cavity of the combined system.

The foregoing is only a preferred embodiment of the present invention and is not intended to limit the present invention in any manner. Although the present invention has been described with reference to the preferred embodiments, it is not intended to be limited thereto. Those skilled in the art can make numerous possible variations and modifications to the disclosed embodiments, or modify equivalent embodiments, without departing from the scope of the invention, using the teachings disclosed above. Therefore, any simple modification, equivalent change and modification of the above embodiments according to the technical essence of the present invention should fall within the protection scope of the technical solution of the present invention.

The most fundamental innovation of the invention is that the stent of the covered stent vessel for isolating aortic lesions and the artificial vessel are designed separately, and the branch vessel is designed independently. According to the specific use requirement, the positions and the ranges of the pure stent, the pure blood vessel and the blood vessel with the stent can be changed to adapt to other releasing sequences or releasing directions different from the above examples, and finally the complete blood vessel covered stent vascular system is combined.

Claims

1. The utility model provides an aortic arch portion area branch tectorial membrane support blood vessel composite set, includes three artificial blood vessel subassemblies: (1) a section of U-shaped artificial aorta blood vessel (1) with three branch blood vessels (8), wherein the artificial aorta blood vessel at the left part of the branch blood vessel (8) is internally provided with a blood vessel stent (9), and the blood vessel (10) at the right part of the branch blood vessel (8) and the branch blood vessel (8) are internally not provided with stents; (2) coating a small stent blood vessel (2); (3) a straight cylindrical stent blood vessel (3) with a section of bare stent (13) and a section of covered stent (14), wherein the left part of the straight cylindrical stent blood vessel is the bare stent (13) without a covered membrane, and the right part of the straight cylindrical stent blood vessel is the covered stent blood vessel (14); during combination, the small covered stent blood vessel (2) is sequentially arranged in three branch blood vessels (8) of the artificial aorta blood vessel (1), then the straight cylindrical stent blood vessel (3) is arranged in the artificial aorta blood vessel (1), a bare stent (13) of the straight cylindrical stent blood vessel (3) is positioned in the middle third section (10 a) of the branch blood vessel of the artificial aorta blood vessel (1), and the combined U-shaped artificial aorta blood vessel and the three branches are covered blood vessels with stents in the whole process.

2. The aortic arch stent graft vascular assembly of claim 1, wherein the section of the U-shaped artificial aortic vessel (1) with three branch vessels (8) is a section of a U-shaped straight cylindrical vessel, the first third section of the vessel stent (9) is provided, three branch vessels (8) are arranged above the middle third section (10 a), the middle third section of the vessel (10 a) and the branch vessels (8), the rear third section of the vessel (10 b) is without stent, the U-shaped main vessel is a straight vessel, and the U-shaped artificial aortic arch vessel can automatically adapt to the shape of the target vessel after implantation to be U-shaped.

3. The aortic arch stent graft assembly as claimed in claim 2, wherein three branch vessels (8) are located on the middle third of the arc-shaped outer side of the section (10 a).

4. The aortic arch stent graft combination as claimed in claim 3, further comprising three connecting portions between the branch vessels (8) and the artificial aorta vessel (1), wherein the connecting portions are designed to be conical, the openings of the branch vessels (8) on the artificial aorta vessel (1) are larger, and the branch vessels taper towards the distal end, so that after the branch vessels (8) are implanted, the openings have a certain range of motion in all directions while ensuring sufficient pipe diameters, so as to adapt to the positions and angles of different branch arches.

5. The aortic arch part branch stent graft combination device as claimed in claim 3, wherein the diameter of the distal end of the three branch vessels (8) is designed to be 3-5 mm larger than the maximum diameter of the target branch vessel.

6. The aortic arch part branch stent graft blood vessel combination device as claimed in claim 1, wherein the small stent graft blood vessel (2) comprises an upper straight cylindrical small stent graft part (11) and a lower stent bottom part (12), the upper section (11 a) of the small stent graft part (11) is a stent graft blood vessel with a membrane, the lower section (11 b) is a bare stent without a membrane, and the stent bottom part (12) is a bell mouth shape and is a bare stent without a membrane.

7. The aortic arch stent graft combination as claimed in claim 6, wherein the small stent graft (2) is made by grading the diameter of the upper stent vessel part (11) in the range of 5-20 mm.

8. The aortic arch stent graft combination as claimed in claim 1, wherein the straight cylindrical stent vessel (3) with a bare stent (13) and a stent graft (14) has a length of the bare stent (13) greater than the length of the middle branched vessel portion (10 a) of the artificial aortic vessel (1).

9. The aortic arch stent graft combination as claimed in claim 2, wherein the length of the right part (14) of the straight cylindrical stent vessel (3) is greater than the length of the posterior third segment (10 b) of the vessel without branch of the artificial aortic vessel (1).