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CN112220586A - A stent-graft for intrahepatic portosystemic shunt with self-adaptive adjustment of the covered length - Google Patents

A stent-graft for intrahepatic portosystemic shunt with self-adaptive adjustment of the covered length Download PDF

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CN112220586A
CN112220586A CN202011202642.1A CN202011202642A CN112220586A CN 112220586 A CN112220586 A CN 112220586A CN 202011202642 A CN202011202642 A CN 202011202642A CN 112220586 A CN112220586 A CN 112220586A
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tectorial membrane
membrane
length
self
stent
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CN112220586B (en
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肖江强
张明
诸葛宇征
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Nanjing Drum Tower Hospital
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Nanjing Drum Tower Hospital
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    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02Prostheses implantable into the body
    • A61F2/04Hollow or tubular parts of organs, e.g. bladders, tracheae, bronchi or bile ducts
    • A61F2/06Blood vessels
    • A61F2/07Stent-grafts
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/82Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/86Stents in a form characterised by the wire-like elements; Stents in the form characterised by a net-like or mesh-like structure
    • A61F2/90Stents in a form characterised by the wire-like elements; Stents in the form characterised by a net-like or mesh-like structure characterised by a net-like or mesh-like structure
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/95Instruments specially adapted for placement or removal of stents or stent-grafts
    • A61F2/962Instruments specially adapted for placement or removal of stents or stent-grafts having an outer sleeve
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02Prostheses implantable into the body
    • A61F2/04Hollow or tubular parts of organs, e.g. bladders, tracheae, bronchi or bile ducts
    • A61F2/06Blood vessels
    • A61F2/07Stent-grafts
    • A61F2002/075Stent-grafts the stent being loosely attached to the graft material, e.g. by stitching
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2210/00Particular material properties of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2210/0061Particular material properties of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof swellable

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  • Health & Medical Sciences (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Public Health (AREA)
  • Transplantation (AREA)
  • Cardiology (AREA)
  • Veterinary Medicine (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Vascular Medicine (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Gastroenterology & Hepatology (AREA)
  • Pulmonology (AREA)
  • Prostheses (AREA)
  • Media Introduction/Drainage Providing Device (AREA)

Abstract

本发明涉及一种可自适应调节覆膜长度的肝内门体分流用覆膜支架,包括管状骨架和覆膜,覆膜包括依次相连的覆膜上自卷曲段、覆膜中间固定段和覆膜下自卷曲段,覆膜中间固定段固定在管状骨架上,覆膜上自卷曲段和覆膜下自卷曲段包覆在管状骨架上,管状骨架位于覆膜下方位置构成下裸支架。本发明的覆膜支架放置后,通过球囊扩张方式使覆膜支架膨开,两头的覆膜自卷曲段向中间自然卷曲,受阻即停止卷曲,从而使覆膜长度与肝实质区一致,大大减小覆膜长度与实际所需长度不一致而产生的不利影响,减少并发症的发生。

Figure 202011202642

The invention relates to a covered stent for intrahepatic portosystemic shunt which can adaptively adjust the length of the covering. The self-curling section under the membrane, the middle fixed section of the membrane is fixed on the tubular frame, the self-curling section on the membrane and the self-curling section under the membrane are wrapped on the tubular frame, and the tubular frame is located below the membrane to form a lower bare stent. After the stent-graft of the present invention is placed, the stent-graft is expanded by balloon expansion, and the membranes at both ends are naturally curled from the curling section to the middle, and the curling stops when blocked, so that the membrane-covering length is consistent with the liver parenchyma area, greatly reducing Reduce the adverse effects of the inconsistency between the length of the film and the actual required length, and reduce the occurrence of complications.

Figure 202011202642

Description

Intrahepatic portal body shunt tectorial membrane support capable of adaptively adjusting tectorial membrane length
Technical Field
The invention belongs to the technical field of medical instruments, and particularly relates to a covered stent capable of adaptively adjusting the length of a covered membrane for intrahepatic portal body shunt.
Background
Transjugular Intrahepatic Portosystemic Shunt (TIPS) establishes a shunt between the portal vein and the hepatic vein within the liver parenchyma via a covered stent. In addition, with the technical progress, a portal shunt released by ultrasonic endoscopy or percutaneous puncture is expected to appear. The intrahepatic portosystemic shunt can reduce portal vein pressure, and can be combined with esophageal and gastric fundal vein embolization to completely treat alimentary tract hemorrhage caused by liver cirrhosis portal vein high pressure.
At present, the covered stent for intrahepatic portosystemic shunt mainly comprises a self-expanding nickel-titanium alloy stent, a low-permeability polytetrafluoroethylene membrane (PTEF membrane) is coated outside the stent, and the covered stent is divided into an intrahepatic covered area and a portal vein bare area according to the functional areas of the covered stent. However, based on the existing stent graft structure and medical technology, there is no way to precisely control the stent graft to have its graft portion just completely located in the liver parenchyma (generally, the graft portion is larger than the liver parenchyma portion), resulting in the following problems: firstly, the flow distribution efficiency is low; secondly, vortex is easy to form, and thrombus is further formed, so that the stent is occluded.
In addition, the existing covered stent needs to be expanded and formed by exchanging the balloon after being placed in the liver for positioning, the steps are complicated, the guide wire is easy to fall off (after the puncture is successful, the guide wire is placed, the stent is exchanged, and the exchange balloon catheter is expanded, and the exchange is carried out for at least 3 times), and the subsequent operation is influenced.
Disclosure of Invention
In view of the problems pointed out in the background art, the invention provides a covered stent for intrahepatic portal body shunt, which can adaptively adjust the length of a covered membrane.
The technical scheme adopted by the invention is as follows:
the utility model provides a but intrahepatic portal body reposition of redundant personnel of self-adaptation regulation tectorial membrane length is with tectorial membrane support, includes tubulose skeleton and tectorial membrane, the tectorial membrane is from curling section, tectorial membrane middle fixed section and tectorial membrane down from curling section in the tectorial membrane that links to each other in proper order, the fixed section is fixed in the middle of the tectorial membrane on the tubulose skeleton, on the tectorial membrane from curling section with under the tectorial membrane from curling section cladding on the tubulose skeleton, the tubulose skeleton is located naked support under the tectorial membrane below position constitution.
Furthermore, the self-curling section on the coating film, the middle fixing section of the coating film and the self-curling section under the coating film are made of polytetrafluoroethylene; the self-curling section on the film and the self-curling section under the film are embedded with memory metal wires which can be curled according to the forming set radian.
Further, the length of the tubular framework is 10cm, the length of the middle fixing section of the coating film is 5cm, the lengths of the self-curling section on the coating film and the self-curling section under the coating film are both 2cm, and the length of the lower bare stent is 1 cm.
Further, the tubular framework is a tubular structure formed by weaving nickel-titanium metal wires.
Furthermore, the outer sheath tube with the protection function is sleeved outside the intrahepatic portosystemic shunt tectorial membrane stent.
Further, the covered stent capable of adaptively adjusting the length of the covered membrane for intrahepatic portal body shunt further comprises a balloon expansion system, wherein the balloon expansion system comprises a balloon and an inner core for penetrating and connecting a guide wire, the balloon is embedded and arranged in the tubular framework, the inner core axially penetrates through the balloon, and the head end of the raised inner core is clamped at the end part of the covered stent for intrahepatic portal body shunt; the sacculus is connected with a sacculus communicating pipe for externally connecting a pressure pump.
The invention has the beneficial effects that:
after the covered stent is placed, the covered stent is expanded in a balloon expansion mode, covered membranes at two ends are naturally curled from the curling section to the middle and are stopped when being blocked, so that the covered membrane length is consistent with the parenchymal area of the liver, the adverse effect caused by the fact that the covered membrane length is inconsistent with the actually required length is greatly reduced, and the occurrence of complications is reduced.
Drawings
FIG. 1 is a schematic structural view of a stent graft of the present invention;
FIG. 2 is a schematic structural view of a tubular skeleton;
FIG. 3 is a schematic view of the film in a curled state from a curled segment;
FIG. 4 is a schematic view of the stent graft of the present invention in an in vivo state;
FIG. 5 is a schematic view of the stent graft of the present invention in an operational state;
FIG. 6 is a schematic structural view of a stent graft of the system for balloon-indwelling dilatation;
FIG. 7 is a cross-sectional view of FIG. 6;
FIG. 8 is a cross-sectional view of FIG. 6;
FIG. 9 is a schematic view of a release stent graft using an indwelling balloon dilation system;
reference numerals: 1-tubular framework, 101-lower bare stent section, 2-coating, L21-self-curling section on coating, L22-coating middle fixing section, L23-self-curling section under coating, 3-outer sheath tube, 4-sacculus, 5-sacculus communicating tube, 6-inner core, 601-inner core head end.
Detailed Description
The stent graft for intrahepatic portal shunt capable of adaptively adjusting the length of the stent graft according to the present invention will be described in detail with reference to the accompanying drawings and specific examples.
As shown in fig. 1 to 3, a covered stent for intrahepatic portal body shunt capable of adaptively adjusting the length of a covered membrane comprises a tubular framework 1 and a covered membrane 2, wherein the covered membrane 2 comprises an upper self-curling section L21, a middle fixing section L22 and a lower self-curling section L23 which are sequentially connected, the middle fixing section L22 of the covered membrane is an inner-outer double-layer covered membrane and is fixed on the tubular framework 1 (namely, an inner-outer double-side covered membrane is arranged at the middle position of the tubular framework 1, the fixing modes are bonding, interweaving or spraying, the upper self-curling section L21 of the covered membrane and the lower self-curling section L23 of the covered membrane are both single-layer covered membranes and are connected with the outer-layer covered membrane of the middle fixing section L22 of the covered membrane), the upper self-curling section L21 of the covered membrane and the lower self-curling section L23 of the covered membrane are covered on the tubular framework.
In this embodiment, the material of the self-curling section L21 on the coating film, the middle fixing section L22 of the coating film and the self-curling section L23 under the coating film is polytetrafluoroethylene, and the material has a stable structure and is difficult to corrode. Wherein, a memory metal wire which can be curled according to the forming set radian is embedded in the self-curling section L21 on the coating film and the self-curling section L23 under the coating film. The length of the tubular framework 1 is 10cm, the length of the middle fixing section L22 of the film covering is 5cm, the lengths of the self-curling section L21 on the film covering and the self-curling section L23 under the film covering are both 2cm, and the length of the lower bare stent 101 is 1 cm.
The tubular framework 1 is a tubular structure formed by weaving nickel-titanium metal wires.
Further, as shown in fig. 6 to 8, the stent graft for intrahepatic portosystemic shunt of the present invention is covered with an outer sheath tube 3 for protection.
Above-mentioned intrahepatic portosystemic reposition of redundant personnel is with tectorial membrane support still includes sacculus expansion system, and sacculus expansion system includes sacculus 4 and is used for the inner core 6 of cross-under seal wire, and sacculus 4 scarf joint sets up in tubulose skeleton 1, and inner core 6 axial passes sacculus 4, and bellied inner core head end 601 card is in intrahepatic portosystemic reposition of redundant personnel with tectorial membrane support tip. The sacculus 4 is connected with a sacculus communicating pipe 5 which is externally connected with a pressure pump.
The application method of the tectorial membrane stent for intrahepatic portosystemic shunt comprises the following steps:
the stent graft and balloon dilatation system of the present invention are used in conjunction with COOK RUPS100 sheaths (or similar sheaths), and when used, the outer sheath 3, which protects the stent graft during its own transport, is discarded when it enters the RUPS100 sheath. The covered stent and the built-in balloon dilatation system enter a designated area along a RUPS100 sheath tube, after the position is confirmed, the balloon 4 is dilated by using a pressure pump, after the balloon 4 is completely opened, the covered self-curling sections at the two ends of the covered stent automatically curl along the sheath tube (when the tail end of the covered self-curling section is free due to stress, a memory metal wire embedded in the covered self-curling section drives the covered self-curling section to curl with a radian set during forming), until the position is fixed after being blocked, the covered area just covers the liver parenchyma at the moment, and the covered stent is completely released, as shown in figure 9.
Referring to fig. 4, before the balloon 4 is expanded, the covered area is relatively large (at this time, the covered membranes at the two ends tightly wrap the tubular framework 1 from the curled section), portal blood flow into the liver is affected, and a vortex is easily formed (similar situations occur in the covered area of the conventional stent). Referring to fig. 5, after the saccule 4 is expanded, the tectorial membrane self-curling sections at the two ends of the tectorial membrane stent are curled in place to form a tectorial membrane area matched with the parenchyma of the liver, thereby not influencing portal blood flow and having better shunting effect.
According to the invention, the tectorial membrane stent is internally provided with the balloon dilatation system, so that the tectorial membrane stent can be integrally formed after being placed, and the purpose of simplifying operation is achieved.
The above description is only an embodiment of the present invention, but the scope of the present invention is not limited thereto, and any alternative or alternative method that can be easily conceived by those skilled in the art within the technical scope of the present invention should be covered by the scope of the present invention.

Claims (6)

1. The utility model provides a but tectorial membrane support is used in intrahepatic portal body reposition of redundant personnel of self-adaptation regulation tectorial membrane length, including tubular skeleton (1) and tectorial membrane (2), a serial communication port, tectorial membrane (2) are including consecutive tectorial membrane on from crimping section (L21), fixed section (L22) in the middle of the tectorial membrane and tectorial membrane from crimping section (L23) down, fixed section (L22) are fixed on tubular skeleton (1) in the middle of the tectorial membrane, on the tectorial membrane from crimping section (L21) and tectorial membrane under from crimping section (L23) cladding on tubular skeleton (1), tubular skeleton (1) are located tectorial membrane (2) below position and constitute under naked support (101).
2. The intrahepatic portal shunt stent capable of adaptively adjusting the length of a tectorial membrane as claimed in claim 1, wherein the self-curling segment (L21) on the tectorial membrane, the middle fixing segment (L22) of the tectorial membrane and the self-curling segment (L23) under the tectorial membrane are made of polytetrafluoroethylene; a self-curling section (L21) on the coating film and a self-curling section (L23) under the coating film are embedded with memory metal wires which can be curled according to the forming setting radian.
3. The intrahepatic portal shunt stent capable of adaptively adjusting the length of a covering membrane according to claim 1, wherein the length of the tubular framework (1) is 10cm, the length of the middle fixing section (L22) of the covering membrane is 5cm, the length of each of the self-curling section (L21) on the covering membrane and the self-curling section (L23) under the covering membrane is 2cm, and the length of the lower bare stent (101) is 1 cm.
4. The intrahepatic portal shunt tectorial membrane stent capable of adaptively adjusting the length of the tectorial membrane according to claim 1, wherein the tubular framework (1) is a tubular structure woven by nickel titanium wires.
5. The intrahepatic portosystemic shunt stent capable of adaptively adjusting the length of a cover according to any one of claims 1 to 4, wherein the intrahepatic portosystemic shunt stent is externally sheathed with a protective sheath tube (3).
6. The intrahepatic portal shunt tectorial membrane stent capable of adaptively adjusting the length of the tectorial membrane according to claim 5, characterized by further comprising a balloon dilatation system, wherein the balloon dilatation system comprises a balloon (4) and an inner core (6) for threading a guide wire, the balloon (4) is embedded and arranged in the tubular framework (1), the inner core (6) axially penetrates through the balloon (4), and the head end (601) of the raised inner core is clamped at the end of the intrahepatic portal shunt tectorial membrane stent; the sacculus (4) is connected with a sacculus communicating pipe (5) for being externally connected with a pressure pump.
CN202011202642.1A 2020-11-02 2020-11-02 A covered stent for intrahepatic portosystemic shunt with adaptively adjustable covering length Active CN112220586B (en)

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Citations (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20030036792A1 (en) * 1998-10-26 2003-02-20 Jacob Richter Balloon expandable covered stents
US20030139797A1 (en) * 2002-01-24 2003-07-24 Kirk Johnson Covered segmented stent
CN203815663U (en) * 2014-04-14 2014-09-10 林晨 Caliber-adjustable jacket-type aorta aortamembrana tectoria support
CN108785754A (en) * 2017-05-05 2018-11-13 赛诺医疗科学技术股份有限公司 Medical overlay film frame
CN210330823U (en) * 2019-03-21 2020-04-17 北京爱琳医疗科技有限公司 Blood flow controllable covered stent
CN213525686U (en) * 2020-11-02 2021-06-25 南京鼓楼医院 A stent-graft for intrahepatic portosystemic shunt with self-adaptive adjustment of the covered length

Patent Citations (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20030036792A1 (en) * 1998-10-26 2003-02-20 Jacob Richter Balloon expandable covered stents
US20030139797A1 (en) * 2002-01-24 2003-07-24 Kirk Johnson Covered segmented stent
CN203815663U (en) * 2014-04-14 2014-09-10 林晨 Caliber-adjustable jacket-type aorta aortamembrana tectoria support
CN108785754A (en) * 2017-05-05 2018-11-13 赛诺医疗科学技术股份有限公司 Medical overlay film frame
CN210330823U (en) * 2019-03-21 2020-04-17 北京爱琳医疗科技有限公司 Blood flow controllable covered stent
CN213525686U (en) * 2020-11-02 2021-06-25 南京鼓楼医院 A stent-graft for intrahepatic portosystemic shunt with self-adaptive adjustment of the covered length

Non-Patent Citations (3)

* Cited by examiner, † Cited by third party
Title
张海涛 等: "全覆膜自膨式可回收金属支架在治疗肝移植 术后胆管吻合口狭窄中的应用价值", 《腹部外科》, vol. 31, no. 3, 30 June 2018 (2018-06-30), pages 199 - 202 *
张登潇 等: "球扩式覆膜支架在经颈静脉直接肝内门体分流术中的应用1例", 《介入放射学杂志》, vol. 32, no. 5, 31 May 2023 (2023-05-31), pages 517 - 518 *
郑晖 等: "采用Viatorr覆膜支架行经颈静脉肝内门体分流术", 《中国介入影像与治疗学》, vol. 14, no. 10, 31 October 2017 (2017-10-31), pages 597 - 601 *

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