JP4951942B2 - Aortic dissection treatment tool - Google Patents

Description

  The present invention relates to a therapeutic device for aortic dissection used when treating aortic dissection.

  In recent years, the occurrence of aortic dissection has increased as one of the aortic diseases caused by arteriosclerosis and the like. Aortic dissection means that blood flowing through the aorta from an entry where a part of the intima tissue of the aorta has collapsed flows between the intima and adventitial tissues of the aorta. This is a pathological condition that causes a dissociation space. This aortic dissection consists of a DeBakey type I in which the dissection space extends from the ascending aorta to the descending thoracic aorta, a DeBakey type II in which the dissociation space remains in the ascending aorta, The remaining DeBakey IIIa type and the DeBakey IIIb type in which the dissection space extends from the thoracic descending aorta to the abdominal aorta.

  Among these types of aortic dissection, in the case of DeBakey type I and DeBakey type II (also called Stanford type A), where the dissection space extends to the ascending aorta, the dissection space compresses the entrance of the coronary artery or the aortic valve Because the patient is distorted and fatal during the acute phase, surgical treatment is urgently needed. On the other hand, in the case of DeBakeyIIIa type and DeBakeyIIIb type (also called Stanford B type) where the dissociation space is not in the ascending aorta, unless there is aortic rupture, aneurysm formation, perfusion disturbance to each branch artery, etc. The policy of treating with antihypertensive therapy that maintains strict rest while lowering blood pressure is commonly used in medical facilities. In this antihypertensive therapy, strict management with ICU is required for about one week from the onset until the blood in the dissociation space becomes a thrombus and the dissociation state settles. If this ICU management continues for about a week, patients may develop complications such as restlessness, atelectasis, and pneumonia. When such complications occur, there are cases where the management at the ICU is prolonged and the hospitalization period is prolonged to about 3 to 4 weeks.

Therefore, when treating the above-mentioned DeBakeyIIIa type and DeBakeyIIIb type aortic dissection by antihypertensive therapy, for example, an endovascular indwelling artificial blood vessel as disclosed in Patent Document 1, that is, a stent graft is inserted into the true lumen of the aorta. It can be considered to be used as a closing member for entry. When the occlusion member is inserted to a position corresponding to the entry of the true lumen and the entry is closed, the blood flow that tries to flow into the dissociation cavity from the true lumen through the entry is blocked. As a result, blood flow almost disappears in the dissociation space, blood can quickly become a thrombus, the dissociation state can be settled early, and the management period at the ICU can be shortened. Can be shortened.
JP 2005-58434 A

  However, even if the aortic dissection is classified into the above DeBakeyIIIa and DeBakeyIIIb types, the progress of arteriosclerosis, the size of the entry, the position of the entry, and the shape of the dissociation cavity vary depending on the patient. The shape of the part into which the closing member is inserted is greatly different. Therefore, when an antihypertensive therapy for aortic dissection is performed using an occlusion member as in Patent Document 1, the shape of the occlusion member is matched to the true lumen shape for each patient in order to reliably occlude the entry by the occlusion member. It is necessary to design in detail. That is, the antihypertensive therapy using the occlusion member of Patent Document 1 can be performed only in a limited medical facility having a device that can accurately grasp the shape of the true lumen, a design tool, and the like.

  The present invention has been made in view of such points, and an object of the present invention is to allow entry to be occluded without finely designing an entry occlusion member for each patient when performing antihypertensive therapy for aortic dissection. The goal is to make antihypertensive therapy available in many medical facilities.

  In order to achieve the above object, in the present invention, a membrane-like occlusion member is fixed to the intimal tissue of the aorta, and this occlusion member is brought into contact with the peripheral edge of the entry by blood pressure to occlude the entry.

  Specifically, in the first aspect of the invention, aortic dissection occurs when blood in the aorta flows between an intimal tissue and an adventitial tissue of the aorta from an entry formed in the intimal tissue of the aorta. The object is a therapeutic tool for aortic dissection for the treatment.

And an occlusion member that is formed in a membrane shape larger than the entry and is inserted into the true lumen of the aorta, contacts the peripheral edge of the entry of the intimal tissue by the pressure of blood flowing through the aorta, and closes the entry; A fixing member for fixing the occlusive member to the intimal tissue, the occlusive member extending from the central side to the distal side of the aorta and configured to be deformed by the pressure of blood flowing through the aorta, The fixing member is made of an elastic material that elastically deforms radially outward of the aorta and presses the intimal tissue, and the elastic material is fixed to an end of the occlusion member on the central side of the aorta so that the occlusion member is While being pressed against the intimal tissue, the occlusion member is configured to be separated from the distal side of the aorta .

  According to this configuration, the occlusion member can be fixed to the intimal tissue of the aorta by the fixing member in a state where the occlusion member is inserted to a position corresponding to the entry of the true lumen of the aorta. Since the occlusion member fixed to the intimal tissue is in the form of a membrane, it is easily deformed and brought into contact with the shape of the entry peripheral edge of the intimal tissue by the pressure of blood flowing through the true lumen. As described above, since the occlusion member contacts the peripheral edge of the entry of the intimal tissue by the blood pressure, the entry is occluded by the occlusion member without designing the occlusion member finely even if the shape of the true lumen is greatly different for each patient. It becomes possible. This occlusion member blocks the flow of blood from the true lumen through the entry into the dissociation space, and as a result, the blood in the dissociation space can be made into a thrombus at an early stage to calm the dissociation state. become.

Further , the elastic member presses the intimal tissue, whereby the blocking member is sandwiched between the elastic material and the intimal tissue.

In the invention of claim 2, in the invention of claim 1 , the elastic material is formed so as to extend in the blood flow direction of the aorta.

  According to this configuration, since the elastic material extends in the blood flow direction, it is possible to reduce the degree to which the true blood flow is inhibited by the elastic material.

In the invention of claim 3, in the invention of claim 2, a plurality of elastic members are arranged in the circumferential direction of the true lumen.

  According to this configuration, a plurality of locations of the closing member are sandwiched between the elastic material and the intimal tissue.

According to a fourth aspect of the present invention, in the invention according to any one of the first to third aspects, the elastic member is provided with an engaging portion with which the recovery tool is engaged.

  According to this configuration, when the aortic dissection treatment tool is recovered from the true lumen as in the case where the treatment using the aortic dissection treatment tool is completed, the recovery tool is engaged with the engaging portion, The collection tool enables reliable and easy collection.

According to a fifth aspect of the present invention, in any one of the first to fourth aspects of the present invention, the closing member is formed in a cylindrical shape.

  According to this configuration, when the occlusion member is inserted to a position corresponding to the entry of the true lumen, the occlusion member is cylindrical and continuous in the circumferential direction of the true lumen. The entry can be reliably covered without rotating in the circumferential direction.

According to a sixth aspect of the present invention, in any one of the first to fourth aspects of the present invention, the closing member is configured to be interrupted in the circumferential direction of the true lumen.

  According to this configuration, when the entry is formed in the vicinity of the branch artery in the aorta, the occlusion member is inserted to a position corresponding to the entry of the true lumen, and then the interrupted portion of the occlusion member is removed from the branch artery. By matching with the entrance, the entrance of the branch artery is prevented from being blocked by the occlusion member.

According to a seventh aspect of the present invention, in the invention according to any one of the first to sixth aspects, the occluding member is provided with a reinforcing portion extending in a blood flow direction.

  According to this configuration, since the occlusion member is reinforced by the reinforcing portion, it is possible to suppress the occlusion member from being turned up into the entry by the blood flow that is about to enter the dissociation cavity from the entry.

According to an eighth aspect of the present invention, in any one of the first to seventh aspects, the closing member is made of a bioabsorbable material.

  According to this configuration, after the occlusion member contacts the peripheral edge of the entry of the intimal tissue to occlude the entry, the occlusion member is gradually absorbed by the intimal tissue and eventually disappears from the aorta.

  According to the first aspect of the present invention, the membrane-like occlusion member inserted into the true lumen of the aorta is fixed to the intima tissue by the fixing member, and the occlusion member is brought into contact with the peripheral edge of the entry of the intima tissue by the pressure of the true lumen blood. Therefore, even if the shape of the true lumen differs greatly depending on the patient, the entry can be closed with the closing member without designing the closing member finely for each patient. This eliminates the need for devices and instruments for finely designing the occlusion member, and allows antihypertensive therapy to be performed in many medical facilities.

In addition , the fixing member is made of an elastic material that presses the intimal tissue, and the closing member is attached to the intimal tissue side of the elastic material, so that the displacement of the closing member can be suppressed, and the entry is surely performed. Can be occluded.

According to the invention of claim 2 , since the elastic material has a shape extending in the blood flow direction, the degree to which the true lumen blood flow is blocked by the elastic material can be reduced, and the true lumen blood flow volume is ensured. can do.

According to the invention of claim 3 , since the plurality of locations of the closing member can be held between the elastic material and the intimal tissue, the entry can be reliably closed by the closing member.

According to the invention of claim 4 , the aortic treatment tool can be reliably and easily recovered from the true lumen by engaging the recovery tool with the engaging portion.

According to the fifth aspect of the present invention, since the closing member is formed in a cylindrical shape continuous in the circumferential direction, the entry can be closed without rotating the closing member in the true lumen in the circumferential direction. . As a result, the procedure of closing the entry by the closing member can be simplified.

According to the invention of claim 6 , since the occlusion member is interrupted in the circumferential direction of the true lumen, by matching the interrupted portion of the occlusion member with the entrance of the branch artery, the entry to the branch artery is occluded while closing the entry. Blood flow can be secured.

According to the invention of claim 7 , it is possible to suppress the closing member from turning over into the entry, and it is possible to reliably close the entry.

According to the invention of claim 8 , since the occlusion member is made of a bioabsorbable material, the occlusion member disappears in the aorta over time after the entry is occluded. This eliminates the need for removing the occlusion member from the aorta, and enables minimally invasive treatment.

  Hereinafter, embodiments of the present invention will be described in detail with reference to the drawings. It should be noted that the following description of the preferred embodiment is merely illustrative in nature, and is not intended to limit the present invention, its application, or its use.

  FIG. 1 shows a treatment tool 1 for aortic dissection according to an embodiment of the present invention. This treatment tool 1 is used when treating aortic dissection classified into DeBakeyIIIa type and DeBakeyIIIb type, and as shown in FIG. 2, the entry E formed in the intimal tissue of the aorta 100 is occluded. The occlusion member 2 and the fixing member 3 that fixes the occlusion member 2 to the intimal tissue of the aorta 100 are configured. The closing member 2 is formed by forming a thin film-like resin material that is flexible and elastic into a cylindrical shape. The occlusion member 2 is configured to be easily deformed by a force about the pressure of blood flowing through the aorta 100. The diameter of the closing member 2 is set to 30 mm or more and 40 mm or less, and the length in the center line direction is set to 30 mm or more and 60 mm or less.

  On the outer surface of the closing member 2, a protruding portion 4 that protrudes radially outward of the closing member 2 and extends in the center line direction is integrally formed, and the thickness of the portion where the protruding portion 4 is formed. Is thicker than the thickness of other parts. A plurality of protrusions 4 are provided at intervals in the circumferential direction of the closing member 2. The protrusion 4 suppresses the occlusion member 2 from being turned up by the pulsation of blood flowing through the aorta 100. The said protrusion part 4 comprises the reinforcement part of this invention.

  The fixing member 3 includes a plurality of linear elastic members 5 as shown in FIG. As shown in FIG. 1, these elastic members 5 extend in the center line direction of the closing member 2 inside the closing member 2 and have a center line that substantially coincides with the center line of the closing member 2. It is arranged to make a shape. The elastic material 5 is made of, for example, a metal material or a resin material having a spring property such as Ni—Ti alloy or stainless steel, and presses the intimal tissue of the aorta 100 radially outward while being inserted into the true lumen 115. It is formed as follows.

  One end portion (the lower end portion in FIGS. 1 and 2) of the elastic member 5 is coupled and integrated with each other on the center line at one end portion in the center line direction of the fixing member 3. The other side (the upper side in FIGS. 1 and 2) of the elastic member 5 is curved in a direction away from the center line of the fixing member 3 in the radial direction, and therefore the elastic member 5 adjacent in the circumferential direction is formed. A gap is provided between them except for one end. The other end of the elastic member 5 is positioned on the same plane that is substantially orthogonal to the center line of the fixing member 3. The separation distance between the other end of each elastic member 5 and the center line of the fixing member 3 is set to be substantially the same.

  The outer diameter of the fixing member 3 increases as it goes to the other side in the center line direction (the upper side in FIGS. 1 and 2) due to the curved shape of the elastic material 5. The outer diameter of the other end portion in the center line direction of the fixing member 3 is set to be substantially the same as the inner diameter of the closing member 2. The length of the fixing member 3 in the center line direction is set to be shorter than the length of the closing member 2 in the center line direction.

  A hole 6 is provided at the other end of the elastic member 5. The hole 6 is formed by bending the other end of the elastic material 5 in an annular shape toward the outside of the fixing member 3, and is integrally formed with the elastic material 5. An annular member 7 made of, for example, a thread is inserted through the hole 6. The other end of the elastic member 5 is connected in the circumferential direction by the annular member 7. Thereby, the other end part of the elastic member 5 is prevented from being displaced too much in the diameter expansion direction of the fixing member 3. The annular member 7 and the elastic member 5 constitute a fixing member 3.

  A hook portion 9 that protrudes from the fixing member 3 in the center line direction is provided at one end portion of the fixing member 3 in the center line direction. The hook portion 9 is integrally formed with the elastic material 5 and has a curved shape so that the collection tool 30 is not caught and detached, as will be described in detail later. This hook portion 9 is the engaging portion of the present invention.

  As shown in FIG. 1, the other end in the center line direction of the fixing member 3 protrudes from the end opening of the closing member 2. In this state, the other end side in the center line direction of the fixing member 3, that is, the side pressing the intimal tissue of the aorta 100 outward in the radial direction is bonded to the inner surface of the occluding member 2 using, for example, an adhesive. The closing member 2 may be fixed to the fixing member 3 using, for example, a thread.

  Next, a case where aortic dissection is treated using the treatment tool 1 for aortic dissection constructed as described above will be described. First, the pathology of the aorta 100 system and aortic dissection will be described with reference to FIG. The aorta 100 includes an ascending aorta 101, an arch aorta 102, a thoracic descending aorta 103, and an abdominal aorta 104. A coronary artery 105 branches off from the beginning of the ascending aorta 101. From the arch aorta 102, a right brachiocephalic artery 106, a left common carotid artery 107 and a left subclavian artery 108 are branched. From the abdominal aorta 104, the main four branches of the abdomen, that is, the left renal artery 110, the right renal artery 111, the celiac artery 112, and the superior mesenteric artery 113 are branched. Reference numeral 109 denotes a diaphragm.

  When the entry E is formed in the intimal tissue in the distal side of the bifurcation of the left subclavian artery 108 in the arch aorta 102, the blood in the arch aorta 102 is transferred from the entry E to the intima and outer membranes. Flows in between. The blood flowing between the intima tissue and the outer membrane tissue destroys the inner membrane tissue, and the intima tissue and the outer membrane tissue are peeled toward the distal side, so that a dissociation cavity 114 is formed. In other words, in this aortic dissection, a true lumen 115 and a dissociation chamber 114 that form a normal blood flow path are formed in the arch aorta 102, the thoracic descending aorta 103, and the abdominal aorta 104. The inner diameter of the true lumen 115 is smaller than the inner diameter of the normal arch aorta 102 and smaller than the dissection cavity 114. The entry E has a slit shape that is long in the circumferential direction of the arch aorta 102, and the longitudinal dimension is about 20 to 30 mm, and the width dimension is about 10 mm.

  As shown in FIGS. 4 and 5, the treatment tool 1 is inserted into the arch aorta 102 while being accommodated in the catheter 20. The catheter 20 is generally used in the medical field and is made of a resin material having flexibility. When the treatment tool 1 is inserted into the catheter 20, the outer diameter of the fixing member 3 is made smaller than the inner diameter of the catheter 20 by elastically deforming the elastic member 5 inward in the radial direction of the fixing member 3. The closure member 2 is slackened by reducing the outer diameter of the fixing member 3. The slack portion of the closing member 2 is folded in the circumferential direction. Thus, the treatment tool 1 sized to be inserted into the catheter 20 is inserted into the distal end portion of the catheter 20 in the insertion direction from one end side in the center line direction of the fixing member 3 and accommodated in the catheter 20. A wire 21 is inserted into the catheter 20, and one end portion of the wire 21 is engaged with the hook portion 9 of the fixing member 3. The other end portion of the wire 21 protrudes outward from the proximal end portion of the catheter 20.

  Then, the skin of the patient's lower limb (not shown) is incised, and the catheter 20 is inserted into the artery of the lower limb. The catheter 20 is moved in the direction of insertion into the artery, and the distal end of the catheter 20 passes from the common iliac artery 116 shown in FIG. 3 through the abdominal aorta 104 and the descending thoracic aorta 103, and as shown in FIG. Is positioned at a predetermined position on the distal side of entry E.

  Thereafter, the other end portion of the wire 21 is pushed into the catheter 20 from the proximal end portion of the catheter 20, and the treatment tool 1 is pushed out from the distal end portion of the catheter 20 into the true lumen 115 as shown in FIG. The predetermined position of the distal end portion of the catheter 20 is set so that the other end portion in the center line direction of the fixing member 3 of the treatment instrument 1 pushed out from the catheter 20 is located more centrally than the entry E. Specifically, the other end in the center line direction of the fixing member 3 is set to a position about 10 mm away from the entry E toward the center.

  When the treatment tool 1 is pushed out from the catheter 20, the other end side in the center line direction of the elastic member 5 of the fixing member 3 is deformed radially outward, and the outer diameter of the fixing member 3 is increased. When the outer diameter of the fixing member 3 is increased, the slackness in the circumferential direction of the closing member 2 is reduced. When the treatment tool 1 is completely pushed out of the catheter 20, the other end side in the center line direction of the elastic member 5 of the fixing member 3 is displaced outward in the radial direction of the arch aorta 102 as shown in FIG. Press the tissue.

  Accordingly, the closing member 2 is sandwiched between the elastic material 5 and the intimal tissue, and the entry E is covered by the closing member 2. At this time, since the protrusion 4 is formed on the closing member 2, the closing member 2 turns up into the entry E due to the flow of blood from the true lumen 115 through the entry E into the dissociation cavity 114. Can be suppressed. Further, since the closing member 2 has a cylindrical shape, the entry E can be closed regardless of the circumferential position of the closing member 2.

  Then, blood flowing from the central side of the arch aorta 102 flows into the occluding member 2, passes through the gap of the elastic material 5, and flows to the distal side of the true lumen 115. The direction of blood flow and the direction in which the elastic material 5 extends are substantially the same direction. Further, the extending direction of the protrusion 4 is also substantially the same as the blood flow direction.

  Due to the pressure of blood flowing in the closing member 2, a radially outward force acts on the inner surface of the closing member 2. Since the occlusion member 2 that has received the blood pressure has a thin film shape, it easily deforms and contacts with the shape of the periphery of the entry E of the intimal tissue.

  As described above, since the occlusion member 2 is deformed by the blood pressure and contacts the periphery of the entry E, even if the shape of the true lumen 115 is greatly different for each patient, the entry E can be obtained without finely designing the occlusion member 2. Can be blocked. As a result, the flow of blood from the entry E to the dissociation cavity 114 is blocked. By blocking the blood that flows into the dissociation cavity 114, blood hardly flows in the dissociation cavity 114, so that the blood in the dissociation cavity 114 can be made into a thrombus at an early stage to settle the dissociation state. It becomes possible. At this time, the blood pressure of the patient is lowered using a medicine or the like. In addition, the thrombus gradually becomes smaller and disappears.

  When the dissociation state is settled and the treatment tool 1 becomes unnecessary, the treatment tool 1 is recovered from the true lumen 115. In this collection, the catheter 20 and the collection tool 30 are used as shown in FIG. The collection tool 30 is configured by a wire that can be inserted into the catheter 20, and a connection portion 31 having a shape that is hooked on the hook portion 9 of the fixing member 3 is provided at one end portion. The catheter 20 and the recovery tool 30 are inserted from the lower limb artery into the arch aorta 102 in the same manner as when the treatment tool 1 is inserted. Thereafter, the connecting portion 31 of the collecting tool 30 is projected from the distal end portion of the catheter 20 and hooked to the hook portion 9 to be connected. When the collecting tool 30 is pulled from the proximal end portion of the catheter 20, the fixing member 3 is moved in the center line direction. It is accommodated in the catheter 20 from one end side. In the process in which the fixing member 3 is accommodated in the catheter 20, the elastic member 5 is elastically deformed radially inward of the fixing member 3 and the outer diameter of the fixing member 3 is reduced. On the other hand, since the occlusion member 2 is in sliding contact with the catheter 20 in the process of being accommodated in the catheter 20, the occlusion member 2 is accommodated in a state where the portions other than the bonding portion with the fixing member 3 are turned up. Thus, after accommodating the treatment tool 1 in the catheter 20, the treatment tool 1 is taken out together with the catheter 20.

  Therefore, according to the aortic dissection treatment tool 1 according to this embodiment, the membranous occlusion member 2 is inserted into the true lumen 115 and then fixed to the intimal tissue of the arch aorta 102 by the fixing member 3. 2 is brought into contact with the periphery of the entry E of the intima tissue by the pressure of blood in the true lumen 115, so that the entry E can be closed without finely designing the closing member 2 for each patient. Thereby, the apparatus, instrument, etc. for designing the obstruction | occlusion member 2 finely become unnecessary, and antihypertensive therapy can be performed in many medical facilities.

  In addition, since the fixing member 3 includes a plurality of elastic members 5, a plurality of portions of the closing member 2 can be sandwiched between the elastic members 5 and the intimal tissue. Thereby, the position shift of the closing member 2 can be suppressed, and the entry E can be reliably closed.

  In addition, since the hook portion 9 is provided on the fixing member 3, the aortic treatment device 1 can be reliably and easily recovered from the true lumen 115 by engaging the recovery tool 30 with the hook portion 9.

  Further, since the closing member 2 is formed in a continuous cylindrical shape in the circumferential direction, the entry E can be closed without rotating the closing member 2 in the true lumen 115 in the radial direction of the true lumen 115. The procedure of closing the entry E with the closing member 2 can be simplified.

  Moreover, since the protrusion part 4 is formed in the closure member 2, it can suppress that the closure member 2 turns up into the entry E, and the entry E can be obstruct | occluded reliably.

  Furthermore, since the elastic material 5 extends in the blood flow direction with the fixing member 3 disposed in the true lumen 115, the degree to which the blood flow in the true lumen 115 is inhibited by the elastic material 5 can be reduced. The blood flow volume of the true lumen 115 can be ensured.

  In the above embodiment, the closing member 2 is formed in a cylindrical shape. However, for example, as in the first modification shown in FIG. The closing member 2 of this modification 1 is formed in a substantially rectangular shape that covers about half of the fixing member 3 in the circumferential direction.

  The treatment tool 1 according to the first modification is suitable for use when the entry E is formed in the vicinity of a branch artery such as the left subclavian artery 108, for example. That is, when the treatment instrument 1 is inserted into the true lumen 115, the interrupted portion of the occlusion member 2 is matched with the entrance of the branch artery, so that the entrance of the branch artery is occluded by the occlusion member 2 while closing the entry E. The blood flow to the branch artery can be maintained.

  Moreover, as a structure of the fixing member 3, you may make it like the modification 2 shown in FIG. 10, for example. In the second modification, the elastic material 5 is formed in a thin line shape, and one end portion of the elastic material 5 is joined and integrated at one end portion in the center line direction of the fixing member 3. The other end side of the elastic member 5 is formed so as to be radially away from the center line of the fixing member 3 and curved in the circumferential direction. A hole 6 is formed in the other end of these elastic members 5. As in the second modification, the elastic material 5 is formed into a thin line, so that when the fixing member 3 is inserted into the true lumen 115, the degree to which the blood flow in the true lumen 115 is inhibited by the elastic material 5 is reduced. can do. Furthermore, in this modified example 2, since the elastic member 5 has a spiral shape around the center line of the fixing member 3, when the recovery tool 30 collects the recovery tool 30 on the hook portion 9, By pulling the hook portion 9 into the catheter 20 while rotating the hook portion 9 in the spiral direction of the elastic member 5 by the collection tool 30, the fixing member 3 can be smoothly reduced in diameter and accommodated in the catheter 20.

  Further, the shape of the closing member 2 is not limited to a cylindrical shape or a rectangular shape, and may be any shape that can close the entry E. Moreover, in this embodiment, although the protrusion 4 of the closing member 2 is provided on the outer surface of the closing member 2, it may be provided on the inner surface of the closing member 2, that is, on the fixed member 3 side. Further, the protrusion 4 of the closing member 2 can be omitted.

  Further, as in Modification 3 shown in FIG. 11, the other side in the center line direction of the elastic member 5 is protruded from the closing member 2, and the intimal tissue of the true lumen 115 is also pressed by this protruding portion. Also good. The other side in the center line direction of the elastic material 5 of the modified example 3 has substantially the same shape as the portion covered with the closing member 2 that is one side of the elastic material 5. Therefore, the other end portion in the center line direction of the elastic member 5 is combined and integrated with each other on the center line at the other end portion in the center line direction of the fixing member 3. A hook portion 9 similar to the one end portion is provided at the other end portion in the center line direction of the elastic member 5. In Modification 3, since the hook portions 9 are provided at both ends of the fixing member 3 in the center line direction, when the treatment tool 1 is recovered from the true lumen 115, either the distal side or the central side of the aorta 100 is collected. Can be recovered by the recovery tool 30.

  Moreover, as a structure of the fixing member 3, you may make it like the modification 4 shown in FIG. In Modification 4, the material constituting the elastic material 5 is a superelastic material such as a Ni—Ti alloy, for example, and the wire diameter of the elastic material 5 is about 0.2 mm. The number of elastic members 5 is eight, and one end portions of these elastic members 5 are combined and integrated with each other at one end portion in the center line direction of the fixing member 3. The other end side of the elastic member 5 is formed so as to be separated from the center line of the fixing member 3 in the radial direction and curved in the circumferential direction to form a spiral shape. The other end portion of the elastic member 5 is coupled and integrated with each other at the other end portion in the center line direction of the fixing member 3. Hook portions 9 are provided at both ends of the fixing member 3 in the center line direction. Although not shown, the closing member 2 is fixed to the elastic material 5 with an adhesive, a bioabsorbable thread, or the like. Each elastic member 5 is twisted. This twisting process is a process performed by applying a twisting force to the elastic member 5 by rotating the other end portion around the center line of the elastic member 5 with one end portion of the elastic member 5 fixed. . By twisting the elastic material 5 in this way, the surface of the elastic material 5 becomes spirally undulated, and when the elastic material 5 comes into contact with the intimal tissue of the true lumen 115, the elastic material 5 However, it becomes difficult to slide against the intimal tissue.

  Since the fixing member 3 of Modification 4 is made of a superelastic material, when the hooks 9 are pulled away from each other in the direction of the center line of the fixing member 3, the fixing member 3 is generally reduced in diameter, When the length in the center line direction becomes long and the tensile force is removed, the shape of the base is restored. For this reason, the fixing member 3 can be easily inserted into the catheter 20 at the start of treatment, and the hook member 9 is pulled by the recovery tool 30 when recovering from the true lumen 115. It can be easily accommodated in the catheter 20.

  In this embodiment, the case where the aortic dissection in which the entry E is formed in the arch aorta 102 is treated has been described. However, the present invention deals with the aortic dissection in which the entry is formed in the descending aorta 103 or the abdominal aorta 104, for example. It can also be applied when treating.

  Moreover, the material which comprises the said obstruction | occlusion member 2 may be bioabsorbable materials, such as a polyglycolic acid fiber and a collagen fiber, for example. The type of the bioabsorbable material is not particularly limited as long as it is conventionally used as a material for sutures and suture assisting materials in the medical field, for example, Medifit manufactured by JM Co., Ltd. (Registered trademark). By configuring the occluding member 2 with a bioabsorbable material in this manner, the occluding member 2 is integrated with the thrombus and is not separated from the intimal tissue when the blood in the dissociation hole 114 is solidified to become a thrombus. Then, the occluding member 2 is gradually absorbed into the intimal tissue of the aorta 100 over time, and eventually disappears from the aorta 100. Therefore, after the dissociated state has settled, only the fixing member 2 has to be recovered by the recovery tool 30, and the occlusion member 2 does not have to be taken out from the aorta 100. Thereby, a minimally invasive treatment can be performed.

  Moreover, as a material which comprises the annular member 7, the above-mentioned bioabsorbable material, rubber | gum, etc. may be sufficient, for example. By using the annular member 7 as a bioabsorbable material, the annular member 7 will eventually disappear from the aorta 100. Therefore, after the dissociated state has settled, only the elastic material 5 needs to be recovered by the recovery tool 30, and this can also perform minimally invasive treatment.

  As described above, the treatment device for aortic dissection according to the present invention is used to treat, for example, DeBakeyIIIa type and DeBakeyIIIb type aortic dissection in which an entry is formed slightly distal to the left subclavian artery of the arch aorta. Is suitable.

It is a perspective view of the treatment tool for aortic dissection which concerns on embodiment of this invention. (A) is a perspective view of a fixing member, (b) is a perspective view of a blocking member. It is the schematic which shows the aortic system which aortic dissection developed. It is a figure explaining the state which accommodated the treatment tool for aortic dissection in the catheter. FIG. 4 is an enlarged view of FIG. 3 showing a state where a catheter containing a treatment tool for aortic dissection is inserted into a true lumen. FIG. 6 is a view corresponding to FIG. 5 showing a state in which a part of the aortic dissection treatment tool is pushed out of the catheter. FIG. 6 is a view corresponding to FIG. 5 showing a state in which the treatment tool for aortic dissection is placed in the true lumen. FIG. 6 is a view corresponding to FIG. 5 and showing a state in the middle of collecting the treatment tool for aortic dissection with the collection tool. FIG. 6 is a view corresponding to FIG. 1 according to a first modification of the embodiment. FIG. 2A is a diagram corresponding to FIG. 2A according to a second modification of the embodiment. It is FIG. 1 equivalent view which concerns on the modification 3 of embodiment. It is FIG. 2A equivalent figure which concerns on the modification 4 of embodiment.

DESCRIPTION OF SYMBOLS 1 Aortic dissection treatment tool 2 Occlusion member 3 Fixing member 4 Projection part (reinforcement part)
5 Elastic material 9 Hook part (engagement part)
100 Aorta 115 True lumen E Entry

Claims (8)

A therapeutic tool for aortic dissection for treating aortic dissection that occurs when blood in the aorta flows between an intimal tissue and an outer membrane tissue of the aorta from an entry formed in the intimal tissue of the aorta. And
An occlusion member that is formed into a larger membrane than the entry and is inserted into the true lumen of the aorta, and contacts the peripheral edge of the entry of the intimal tissue by the pressure of blood flowing through the aorta to occlude the entry;
A fixing member for fixing the occlusion member to the intimal tissue ,
The occlusion member extends from the central side to the distal side of the aorta and is configured to be deformed by the pressure of blood flowing through the aorta,
The fixing member is made of an elastic material that elastically deforms radially outward of the aorta and presses the intimal tissue,
The elastic member is fixed to an end portion of the occlusion member on the central side of the aorta and presses the occlusion member against the intimal tissue, while being formed so as to be separated from the peripheral side of the aorta of the occlusion member. Aortic dissection treatment tool. The treatment tool for aortic dissection according to claim 1 ,
A therapeutic tool for dissecting an aorta characterized in that the elastic material is formed to extend in the direction of blood flow of the aorta. The treatment tool for aortic dissection according to claim 2 ,
A therapeutic device for aortic dissection, wherein a plurality of elastic materials are arranged in the circumferential direction of the true lumen. The treatment tool for aortic dissection according to any one of claims 1 to 3 ,
A therapeutic tool for aortic dissection, wherein the elastic member is provided with an engaging portion with which the recovery tool is engaged. The treatment tool for aortic dissection according to any one of claims 1 to 4 ,
The aortic dissection treatment tool, wherein the occlusion member is formed in a cylindrical shape. The treatment tool for aortic dissection according to any one of claims 1 to 4 ,
A therapeutic device for aortic dissection, wherein the occlusion member is interrupted in the circumferential direction of the true lumen. The treatment tool for aortic dissection according to any one of claims 1 to 6 ,
A treatment tool for dissecting an aorta characterized in that the occluding member is provided with a reinforcing portion extending in the blood flow direction. The treatment tool for aortic dissection according to any one of claims 1 to 7 ,
A therapeutic device for aortic dissection, wherein the occlusion member is made of a bioabsorbable material.

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