A kind of pulmonary embolism protection dispels device with thrombusTechnical field
The present invention relates to medical instruments field, more particularly to a kind of thrombus to protect and dispel device, specifically a kind ofPulmonary embolism is protected dispels device with thrombus.
Background technology
Venous thromboembolism (Venous thromboembolism, VTE) is common potential mortality acute disease, includingDeep vain thrombosis and pulmonary embolism, incidence are 4%~20%；Acute pulmonary embolism (Acute pulmonary embolism,APE the common disease of cardiovascular system in China, case fatality rate 30%) have been turned into, acute massive pulmonary embolism is sudden deathCommon cause.In the U.S., year of pulmonary embolism morbidity number is 600,000, and case fatality rate is 25%~30%, be common three substantiallyOne of dead property angiocardiopathy, main cause is Deep vain thrombosis (deep venous thrombosis, DVT) morbidityRate is high；Meanwhile DVT can not such as be removed in time, syndrome after Deep vain thrombosis, diseased region are with the passing of time then formedObvious tumefaction, nigrescence, skin ulcer, have a strong impact on quality of life of patients.Therefore, DVT is dispelled in time (in especiallyCalm thrombus), prevent pulmonary embolism caused by thrombus breaks loose, be the significant challenge that we face.
Vena cava filter (Vena cava filter, VCF) (also known as Vena cava filter) is a kind of for prevention Deep venou boltThe device that son comes off, prevents pulmonary embolism from occurring and design, in spite of a variety of filters, but is mainly used in lower-limb deep veins thrombusProtection；For superior vena cava, venae brachiocephalicae, jugular vein and subclavian vein thrombus, inferior caval vein especially renal vein level withOn inferior vena cava thrombosis, because anchoring space is small, Vena cava filter Chang Wufa gives full play to protective action；Meanwhile filter screen is in itselfRemoving thrombus can not be removed.Capturex thrombus filters be Straub medical companies (Switzerland) release in recent years can be used for upper and lower chamberThe thrombus filtering unit of vein, European CE certifications are obtained, not yet put into clinical practice in China；If it interceptes thrombus, togetherSample, which needs thrombus removal device to coordinate, could remove thrombus, will increase medical expense.Chinese invention patent CN201210484480.4,CN201610093259.4 is then to prevent that the emboluses such as arteriosteogenesis patch, thrombus from coming off thrombus filter in art, but it is pinArterial disease especially sustainer embolus is designed, rather than DVT is removed and intercepted.
Compared with bolt being taken with surgical operation, percutaneous intracavitary Thrombectomy (Transluminal removal ofThrombus, TRT) have the advantages that wound is small, it is fast to recover, common method has contact Catheter Thrombolysis, Fogarty foley's tubesBolt and percutaneous mechanical thrombus is taken to cut off (Percutaneous mechanical thrombectomy, PMT).But FogartyHigh recurrence rate after Balloon catheter embolectomy, seldom use at present；The contact Catheter Thrombolysis time is long, easily remains thrombus, and effect is normalIt can not be satisfied with；According to percutaneous mechanical thrombus excision (PMT) principle of device difference can be divided into revolving wormgear formula (Amplatz,Trellis), hydrokinetic type (AngioJet, Oasis) and supersonic melting formula (Acolysis, EKOS) device.List within 2008'sS thrombus suction catheters (are used cooperatively) (Switzerland), in November, 2011 in China with Straub medical treatment dynamical systemsIt is the clinical PMT devices used recently that the Angiojet thrombus of approval listing, which removes art device (U.S.), is mainly used in peripheral bloodPipe.These devices mostly equipment is complicated, expensive, at present only in less several hospital applications.Meanwhile no matter which kind of is through bellowsInterior thrombus remove device, the thrombus to come off can not be intercepted, it is preoperative often to insert Vena cava filter to prevent pulmonary embolism.
At present, DVT is intercepted with dispelling is respectively frequently with mode：Vena cava filter implantation, Operative thrombectomy,Thromboembolism treatment, conduit inhale bolt.
Vena cava filter implantation, it is to place vagina vasorum by puncturing femoral vein or jugular vein, row inferior vena cavography is sentencedDisconnected inferior caval vein diameter and inferior vena cava thrombosis is whether there is, and position renal vein level；Intravascular is intrathecal to be filtered by means for communicating handleDevice is sent into inferior caval vein (1cm under renal vein), after radiography confirms that filter discharges successfully, removes means for communicating and vagina vasorum.(herePicture schematic diagram, not with photo, it may be considered that only retain Fig. 3 schematic diagram)
Existing filter generally can be divided into provisional filter, permanent filter, the class of recyclable filter three.Commonly use in the worldPermanent filter mainly have Greenfield (Boston, the U.S.), Vena Tech LP (B.Braun, Germany), Simon (Bard,The U.S.), Birds neck (Cook, the U.S.) etc., its shortcoming is to be chronically implanted can trigger inferior caval vein perforation, filter to move in vivoPosition, secondary thrombus formation cause the complication such as inferior vena, therefore limit its application.
The provisional filter that the country uses is mainly that ((B.Braun, Germany), its shortcoming exists the filters of TempoFi lter IIIn such as intercepting larger thrombus, thrombolysis, or separately place permanent filter again is needed, medical treatment cost substantially increases, and operation is more difficult.MeshIt is preceding still to pass through FDA certifications without a.
The recyclable filter that the country uses mainly has：OptEasefilter (Cordis, the U.S.), the RecoveryFilter (Bard, the U.S.), Gunther Tulip filter (Cook, the U.S.), Denali filter (Bard, the U.S.), elder generationIt is good for recyclable filter (Shenzhen) etc..Chinese invention patent CN106725996A, CN106725997A, CN106618794A,CN106310392A, CN105943197A, CN105193521A etc., disclosed a variety of filters are recyclable filter.Its is commonShortcoming is：(1) filter needs to continue thrombolysis if embolus is captured, indwelling time in extension body (the filter intracorporeal indwelling time is short,It is typically only 2~3 weeks), overlong time is not easily taken out because filter is bonded with vascular wall；If thrombus is larger and can not dissolve,It is forced to stay for a long time in internal；(2) filter, which needs to take out, needs corresponding operating technology, increases medical treatment cost；(3) no matter which kind of filterRemoving thrombus can not be removed, combines thrombolysis, suction bolt etc. to go removing thrombus then to need, this need to be equipped with relevant device, and its medical expense is brightAobvious increase；(4) to inferior caval vein proximal part thrombus, superior vena cava, venae brachiocephalicae, jugular vein and subclavian vein thrombus, because of anchorIt is small to determine space, Vena cava filter can not often play protective action；(5) inferior caval vein diameter>35mm is that filter is implanted into contraindication.
Filter complication of implant：As do not opened in filter implantation process, filter metal branch fracture, after implantation filter tilt,Inferior caval vein perforation, filter come off, inferior vena cava thrombosis formation etc. around filter.Thrombotic incidence is around filter2%~30%, as thrombus breaks loose will cause pulmonary embolism；As thrombus can not remove, can concurrent inferior vena cava obstruction syndrome, causeLower limb obvious tumefaction, long then skin of leg blacks, ulcer..
Operative thrombectomy, Fogarty foley's tubes are commonly used through femoral vein thrombectomy.First, sterilize, spread office after aseptic towelFiber crops, cut the soft tissues such as side skin of groin, and anatomical isolation is cut femoral vein, stretched with Fogarty foley's tubes through femoral veinEnter iliac vein, take out iliac vein thrombus, assisted extrusion drives bolt or direct motion removes femoropopliteal vein thrombus.
Operative thrombectomy shortcoming is：(1) it is preoperative to be previously implanted IVCF, to prevent lung bolt caused by thrombus breaks loosePlug；(2) soft tissues such as surgical incision skin of groin are needed, anatomical isolation femoral vein, with respect to Catheter Thrombolysis, to inhale the wounds such as bolt big；(3) technically surgeon is needed to complete, Invasive Technology Department doctor oneself is unable to complete independently；(4) Postoperative recurrent rate is high, at present except stock is blue or greenOutside the serious DVT such as swollen, seldom Operative thrombectomy.
Thromboembolism treatment, it includes system thrombolysis and catheter contact thrombolysis.
System thrombolysis is to be pumped into urokinase, rt-PA through peripheral vein (such as dorsalis pedis vein)Thrombolytic drugs such as (Recombinant tissue plasminogen activator, r-tPA), with thrombus.
Catheter contact thrombolysis is typically to puncture to insert vagina vasorum through Deep venou (such as femoral vein), and intravascular sheath, which is inserted, leadsSilk, conduit, select corresponding vein to reach in DVT, insert thrombolysis catheter, urokinase, r- are pumped into through thrombolysis catheterThe direct thrombolysis of the thrombolytic drugs such as tPA.
Thromboembolism treatment shortcoming is：(1) it is preoperative to be often implanted into vena cava filter, cause pulmonary embolism to prevent thrombus breaks loose；(2) it is moltenBolt is not thorough, and thrombolytic drug specification is required to thrombolysis time window in thrombosis 12 hours, and thrombus shape when patient is medicalCheng Changyi was up to 3~5 days, or even the longer time, and often mixed for new and old thrombus, therefore thrombus can not be often completely dissolved；And system is moltenBolt is systemic administration, and thrombi drug concentration is low, and thrombolysis rate is lower；(3) duration is grown, and thrombolysis need to continue 2~3My god, 5~7 days if necessary；(4) bleeding risk is high during thrombolysis, wherein 3 times of increase of intracranialing hemorrhage.
In addition, thrombolysis has a variety of contraindications：1) recent (<14 days) there are active hemorrhage (gastroduodenal ulcer, coughBlood, hemorrhoid, bleeding etc.), operation, biopsy, CPR (external cardiac massage, intracardiac injection, trachea cannula), can notImplement the vascular puncture and trauma history at compressing position；2) there is severe trauma history in nearly 4 weeks or receive excessive operator；3) nearly 3There are cranium brain activity internal haemorrhage history or cerebral infarction history in individual month；4) unmanageable hypertension (systolic pressure>180mmHg, diastolic pressure>110mmHg), or dissecting aneurysm of aorta person can not be excluded；5) gestation, bacterial endocarditis, mitral lesion and there is roomQuiver and the person that has thrombus in strong suspicion left ventricular cavity；6) diabetes merge PVR person；7) serious Liver and kidney function obstacle andProgressive disease, hypofibrinogenemia；8) man at an advanced age's dosage is preferably careful.
Conduit inhales bolt：Directly inhaled including conduit bolt,S conduits inhale bolt and AngioJet conduits inhale bolt etc..
Conduit directly inhale bolt be through femoral vein 8F guiding catheters (or long sheath) insert thrombosed Deep venou near-end orIn fresh thrombus, thrombus is absorbed through negative pressure caused by the attraction of external use syringe；Or after pigtail catheter stirring makes thromboclasis,Absorbed through guiding catheter (or long sheath).
S conduits need to be inserted with Straub dynamical systems with the use of suction bolt is carried out through femoral veinS conduits are reached in thrombosed Deep venou near-end or maximum fresh thrombus, catheter proximal end and external Straub powerSystem connects.S catheter shafts have a high speed rotating auger, and Straub dynamical systems can produce 40000r/minRotating speed, pass through aspirator produce negative pressure, suction remove thrombus.
AngioJet inhales to tie to unite mainly to be made up of drive device and suction bolt conduit two parts, is a kind of medicine-mechanical phaseThe therapeutic device of coupling.Operation principle：AngioJet is inhaled bolt conduit through femoral vein to insert in Deep venou in formation thrombus, drivingDevice, which produces pulse and physiological saline is injected through AngioJet conduits and reversely sprayed at a high speed through conductor housing side hole, to be washed awayThrombus, while low-pressure area is locally being produced, the thrombus of fragmentation is suctioned out by conduit tap.
Conduit is directly inhaled the shortcomings that bolt and is：(1) it is preoperative to be often implanted into IVCF, to prevent lung caused by thrombus breaks looseEmbolism；(2) efficiency is low, is once only capable of absorbing fritter or a small amount of thrombus, need to inhale bolt repeatedly to bulk, a large amount of thrombus；(3) it is remainingThrombus is more, can not in most cases absorb thrombus completely, needs to combine bolt with reference to thrombolysis method etc. more.
The shortcomings that S conduits, AngioJet conduits inhale bolt is：It is (1) preoperative to be implanted into IVCF,With pulmonary embolism caused by pre- thrombus breaks loose；(2) somewhat expensive,S conduits need to be used cooperatively with Straub dynamical systems,Except patient needs to payOutside, hospital need to be equipped with Straub dynamical systems (about 700,000 to S conduits expense (every about 30,000 yuan)Member)；About 2.8 ten thousand yuan of every, AngioJet conduits；Hospital, which need to be equipped with, needs drive device (more than about 1,000,000 yuan)；(3) it is adapted to intravascularThe thrombus being full of, because its caliber is limited, the Intravascular Thrombus absorption to Large Diameter Pipelines such as lateral thrombus, superior and inferior vena cavas is often endlessEntirely, it is impossible to reach the purpose of fully erased thrombus；(4) lose blood more, operate patient every time and lose blood about 120~200ml.(5)Some red blood cells destroy during AngioJet conduits inhale bolt, and hemoglobinuria, or even renal insufficiency occurs in patient.
It was found from discussed above, existing thrombus filtering unit, the thrombus in bolt technology, above-mentioned patent document is taken to filter dressPin device is put and takes, all with one or more defect.Therefore, it is necessary to the further improvement of prior art, desired designIt is a kind of to have thrombus filtering concurrently with taking the system and device that bolt acts on.
The content of the invention
In order to solve above-mentioned technical problem, intravascular thrombus filtering, lung bolt are had concurrently it is an object of the invention to provide a kind ofThe system and device of function is dispelled in plug protection with thrombus.Thrombus interception is dispelled the two with thrombus and is combined by the device, simple in construction,It is easy to operate, safe and reliable, advantageously reduce medical expense and postoperative complication.Specifically, the present invention provides one kind and had concurrentlyThe system and device of function is dispelled in thrombus filtering, pulmonary embolism protection with thrombus, it is characterised in that：Including thrombus screen pack and take boltBasket；Wherein thrombus screen pack includes outer net, Intranet, the total sheath of conveying；Wherein Intranet can be total from conveying by, outer net from outer net intracavitarySheath is by taking bolt basket can be from Intranet intracavitary by and Intranet, outer net, taking bolt basket to be respectively provided with deployable and recover part.
Further, it is characterised in that：The outer net includes outer net dictyosome, outer net sheath, conversion button and haemostatic valve, describedOuter net dictyosome is the deployable and recovery section of outer net, and it is cone barrel, and its near-end is connected solid with the distal end tube wall of outer net sheathIt is fixed, port corresponding with its outer net sheath bore is formed, is communicated with outer net sheath tube chamber, outer net sheath near-end is by conversion button connectionHaemostatic valve.
Further, it is characterised in that：The Intranet includes Intranet dictyosome, Intranet sheath and haemostatic valve, wherein Intranet netBody is the deployable and recovery section of Intranet, and its near-end is connected with Intranet sheath distal end tube wall, in formation and Intranet sheathThe corresponding port in footpath, communicated with Intranet sheath tube chamber, Intranet sheath near-end connection haemostatic valve.
Further, it is characterised in that：Bolt basket is taken to include the string bag, basket open, basket beam, sending and receiving wirerope and handle, wherein describedBasket open is to take the expandable part of bolt basket, and it includes 1~3 scale and shell shape structure being made up of wire；The scale and shell structureTop is respectively connected through a basket beam with sending and receiving wirerope；Basket beam is preferably made up of shape-memory material or highly elastic material, and one end connectsConnect and be fixed on basket open, the other end collects and is connected with sending and receiving wirerope；The string bag is that the braiding being connected with basket open is closely softSilk screen.
Further, it is characterised in that：In described thrombus screen pack, convey total sheath, outer net sheath, Intranet sheath, takeBolt basket conveying sheath internal-and external diameter is sequentially reduced, and can pass sequentially through upper level sheath, its tube chamber is coaxial.
Further, it is characterised in that：The total sheath of the conveying is the sheath being relatively large in diameter, be outer net, Intranet release, returnReceive and transfer passage is provided；The outer net sheath both can be through conveying total sheath intracavitary by that can provide conveying for Intranet again, recovery is led toRoad；The Intranet sheath both can be through outer net sheath intracavitary by that can be to take the offer such as bolt basket conveying, recovery approach again.
Further, it is characterised in that：The dictyosome includes one to multiple longitudinal ridge, forms cone barrel skeleton, there is provided longitudinal directionHolding power, network structure is formed coated with the shape-memory material or gauze material of richer compliance.
Further, it is characterised in that：The cone that the dictyosome is formed by shape-memory material by engraving, plastotype or braidingTubular network structure is formed.
Further, it is characterised in that：Also including conversion wirerope, the haemostatic valve can be removed from the proximal segment of outer net sheath,After removing, outer net sheath can detain connection conversion wirerope by changing, to take out the total sheath of conveying；Then haemostatic valve is reconnected, canThe outer net long period is set to retain the embolus such as filtration thrombus in vivo.
Further, it is characterised in that：Described conversion wirerope one end, which is connected, changes bolt, can connect outer net sheath proximal segmentConversion button, to facilitate the total sheath of the conveying of removal of thromboses screen pack；When need to withdraw outer net, conversion wirerope can be reconnected, will be defeatedSend total sheath to be made a gift to someone along conversion wirerope intravascular, withdraw outer net.
Invention effect：
There is advantages below using technical solution of the present invention：
First, changing, existing vena cava filter or thrombus filter only have thrombus filtration, thrombus is dispelled device and is only capable ofThe situation of bolt is gone, a kind of thrombus interception is designed with the systemic device for taking both bolts to be combined, protects and dispel to reach pulmonary embolismThe purpose of bolt；
Second, can be transported to superior vena cava (including its proximal part), cavity of resorption quiet for thrombus screen pack (thrombus interception part)Arteries and veins (including its proximal part), can intercept the threat from systemic vein embolus；
Third, thrombus screen pack is divided into Intranet, outer net, there is Double-protection, also can be by it even if there is a large amount of thrombus breaks loosesIntercept and take out external；It is more efficient meanwhile thrombus screen pack can intercept the smaller embolus of more traditional filter；
Fourth, thrombus screen pack has good compliance and radial support power, adherence quality is good, and same specification thrombus mistakeFilter screen adapts to different-diameter central vein；
Fifth, thrombus screen pack has good longitudinal bracing, even if its one end is placed in atrium dextrum, also it is unlikely withBlood flow drifts about；
Sixth, the barb that thrombus screen pack designs without traditional vena cava filter for anti-displacement, small to vascular damaged；
Seventh, thrombus filtering outer net is longer, it has the dual support of filter screen and sheath, and stability is good, is not easy to shift；
Eighth, thrombus screen pack is connected with hollow sheath, take bolt basket (taking stud portion) that thrombus portion can be reached by sheathPosition, by sheath removal of thromboses, realization takes bolt, anti-bolt to be combined；
Ninth, taking bolt basket to have good compliance, same specification takes bolt basket to adapt to blood vessel diameter in certain limitChange；Simultaneously can be equipped with diameter it is smaller take bolt basket, to adapt to the less blood vessel requirement of diameter；
Tenth, taking bolt basket that there is the longer string bag, a large amount of thrombus can be accommodated, bolt efficiency high of dispelling；
Its 11, take bolt basket to take bolt from the near-end of thrombus, bolt can be taken from the distal end of thrombus again, flexibly and easily；
Its 12, take bolt process safety, even if thrombus breaks loose in operation, there is the protection of thrombus screen pack, also unlikely generation lungEmbolism；
Its 13, thrombus screen pack with take bolt basket place, recovery operation it is simple, it is safe and reliable；
Its 14, the present invention need not be equipped with external drive device, low cost, advantageously reduce Medical Expense for Patients and hospitalBurden..
Brief description of the drawings：
Fig. 1 is outer net structure chart of the present invention, and wherein A is front view, and B is right view.
Fig. 2 is internal web structure figure of the present invention.
Fig. 3 is outer net, Intranet and the structural representation for taking the example that bolt basket fits together of the present invention.
Fig. 4 is accommodated in the structure for conveying total sheath for the Intranet dictyosome of the present invention, Intranet sheath, outer net dictyosome, outer net sheathSchematic diagram.
The structure that Fig. 5 is accommodated in conversion sheath for the Intranet dictyosome of the present invention, Intranet sheath, outer net dictyosome, outer net sheath is shownIt is intended to.
Fig. 6 is the structural representation of the example of the conversion wirerope of outer net sheath of the present invention.
Fig. 7 is the structural representation for the example that the present invention takes bolt basket, and wherein A is front view, and B is right view.
Fig. 8 is the structural representation of the example of the invention for taking bolt basket to be pre-installed on conveying sheath.
Fig. 9 is the schematic diagram through the example of thrombus in right side femoral vein taking-up right side venae brachiocephalicae, superior vena cava.
Figure 10 is the schematic diagram through the example of thrombus in right internal jugular vein taking-up right side venae brachiocephalicae, superior vena cava.
Figure 11 is the schematic diagram for the example that the massive for being shed to Intranet dictyosome is taken out through right side femoral vein.
Embodiment：
" distal end " and " near-end " of term refers to the position relative to operator in this text, is away from operator side" distal end ", Proximity operation person side are " near-end "；
As shown in figures 1-8, a kind of system dress for having thrombus filtering, pulmonary embolism protection and thrombus concurrently and dispelling function of the inventionPut, including thrombus screen pack is with taking bolt basket；Thrombus screen pack includes conveying total sheath 1, outer net, Intranet；Bolt basket is taken to include the defeated string bag18th, basket open 19, basket beam 20, sending and receiving wirerope 21 and handle 22.
Wherein, as shown in figure 1, outer net includes outer net dictyosome 2, outer net sheath 4, conversion button 8, haemostatic valve 9.Outer net dictyosome 2For cone barrel, its near-end and the distal end tube wall of outer net sheath 4 are connected, and form port corresponding with its internal diameter of outer net sheath 4,Communicated with the tube chamber of outer net sheath 4；Outer net sheath 4 is connected proximally by conversion button 8 with haemostatic valve 9；；Haemostatic valve 9 can be from outer net sheathThe near-end of pipe 4 is removed, also can be by changing the connection of button 8.Outer net dictyosome 2 includes one to multiple longitudinal ridge 6, forms cone barrel skeleton, carriesFor longitudinal holding power, network structure 7 is formed coated with the shape-memory material or gauze material of richer compliance；Preferably, instituteStating longitudinal ridge 6 can be formed by one to multiple shape-memory material or highly elastic material by engraving or plastotype.It is preferred that the longitudinal ridge is 6~12.The cone barrel network structure structure that outer net dictyosome 2 can also be formed by shape-memory material by engraving, plastotype or braidingInto to intercept the emboluses such as thrombus that come off.Preferably, outer net dictyosome 2 contains impermeable X ray material, can be made by Digital Subtraction blood vesselShadow instrument (DSA) monitors its position.
Fig. 2 shows the Intranet of thrombus screen pack of the present invention, and it includes Intranet dictyosome 3, Intranet sheath 5 and haemostatic valve 13.The dictyosome 3 of Intranet is similar to the structure of dictyosome 2 of outer net, and its near-end and the distal end tube wall of Intranet sheath 5 are connected, formed with it is interiorThe corresponding port of the internal diameter of net sheath 5, communicated with the tube chamber of Intranet sheath 5.The near-end of Intranet sheath 5 connects haemostatic valve 13.Intranet dictyosome 3Also longitudinal ridge 14 can be formed by engraving or plastotype by one to multiple shape-memory material or highly elastic material, coated with more rich in submissiveProperty shape-memory material or gauze material form network structure 15；Intranet dictyosome 13 can also be passed through carving by shape-memory materialThe cone barrel network structure that quarter, plastotype or braiding form forms dictyosome, to intercept the emboluses such as thrombus that come off.Preferably, Intranet netBody 3 contains impermeable X ray material, and the position of Intranet 3 can be monitored by digital subtraction angiography instrument (DSA).
The outer net 13, Intranet 15 are bonded closely after opening with blood vessel, and the thrombus that comes off can be intercepted during bolt is taken,Double protection effect is provided, the two can both be used cooperatively or can be used alone；The Intranet 15 can both intercept the thrombus that comes off, there is providedProtective action, conjunction bolt basket removal of thromboses can be matched somebody with somebody again；Intranet, outer net are respectively provided with enough radial supporting forces to ensure that its is adherent goodIt is good, thrombus is intercepted and is taken out by Intranet first；If just in case Intranet fails to intercept frangible thrombus in operation, ensure by outer netIntercept, prevent pulmonary embolism.
Fig. 3 shows outer net, Intranet and the example for taking bolt basket to fit together of thrombus screen pack of the present invention.Thrombus filtersThe outer net sheath 4 of net is placed in the total sheath 1 of conveying, and Intranet sheath 5 is placed in outer net sheath 4, takes bolt basket to be placed in through Intranet sheath 5 interiorThe distal end of net sheath, outer net dictyosome 2, Intranet dictyosome 3 and takes bolt basket basket open 18 to deploy.
The Intranet dictyosome 3 of Fig. 4 displaying present invention, Intranet sheath 5, outer net dictyosome 2, outer net sheath 4 are accommodated in the total sheath 1 of conveyingA kind of example state.The total sheath 1 of conveying is the sheath being relatively large in diameter, and provides conveying for outer net, the release of Intranet, recovery and leads toRoad；The outer net sheath 4 both can be from total intracavitary of sheath 1 be conveyed by that can provide conveying, recovery approach for Intranet again；The IntranetSheath 5 both can be from the intracavitary of outer net sheath 4 by that can be to take the offer such as bolt basket conveying, recovery approach again；Convey total sheath 1 be sent to it is quietAfter the near-end of arteries and veins thrombus, Intranet dictyosome 3, the dictyosome of outer net 2 can be transported to the near-end of phlebothrombosis through conveying total intracavitary of sheath 1, interceptThe emboluses such as thrombus.
Fig. 5 shows that Intranet dictyosome 3 of the invention, Intranet sheath 5, outer net dictyosome 2, outer net sheath 4 are accommodated in conversion sheathA kind of 16 example state.Before being transported to thrombosed vein, Intranet dictyosome 3, outer net dictyosome 2 are accommodated in conversion sheath 16；Conversion sheath 16 can be sent into the total sheath 1 of conveying by conveying the haemostatic valve 17 of total sheath 1 when being needed during clinical practice interception thrombus,And then the near-end of phlebothrombosis can be transported to.
Fig. 6 shows the conversion wirerope 11 of outer net sheath 4 of the present invention.The haemostatic valve 9 of the near-end of outer net sheath 4 is from outer netAfter the near-end of sheath 4 is removed, outer net sheath 4 can be by changing the connection conversion wirerope 11 of button 8, to take out the total sheath 1 of conveying；Then againHaemostatic valve 9 is connected, the outer net long period can be made to retain the embolus such as filtration thrombus in vivo；The conversion near-end of wirerope 11 has handle12, it is easy to operation；Its distal end is connected conversion bolt 10, can connect the conversion button 8 of the near-end of outer net sheath 4, so as to from outer net sheathThe total sheath 1 of conveying is removed outside pipe 4, the outer net long period can be made to stay in filtration embolus in vivo；When needing to withdraw outer net, it can connect againConversion wirerope 11 is connect, total sheath 1 will be conveyed intravascular, withdrawal outer net is sent to along conversion wirerope 11 and outer net sheath 4.
Fig. 7 shows that the present invention takes the exemplary construction schematic diagram of bolt basket, takes bolt basket to include the string bag 18, basket open 19, basket beam 20, receiptsSend wirerope 21 and handle 22.1~3 scale and shell shape structure that basket open 19 is made up of wire is formed, and scale and shell shape structure is wireTwo diamond structures formed are formed, and scale and shell structure near-end center is prominent and is connected with basket beam, makes basket open be easy to withdraw with basket beamAnd shrink, it can be bonded closely after opening with blood vessel, and the top of scale and shell structure is respectively through a basket beam 20 and the phase of sending and receiving wirerope 21Connection, basket open are opened after being discharged from conveying sheath 24, can closed up again through Intranet sheath 5；Basket beam 20 sets 1~3, preferably by shapeShape memory material or highly elastic material are formed, and one end is connected and fixed on basket open 19, and the other end collects and is connected with sending and receiving wirerope 21It is fixed；The string bag 18 is the braiding being connected with basket open 19 closely soft silk screen, can accommodate removal of thromboses, deformability is strong；The string bagBottom can be connected in sending and receiving wirerope 21 by means of suspension 23, and suspension can be made up of wire.When the string bag is made for wire, then need notSuspension connects；Handle 22 is connected with sending and receiving wirerope 21, is easy to convey, is withdrawn and take bolt basket etc. to operate.The end of the string bag 18, basket open 19 containImpermeable X ray material, the position of Intranet 3 can be monitored by digital subtraction angiography instrument DSA.
The sending and receiving wirerope 21 has certain degree of hardness and deformable；For conveying and withdrawal takes bolt basket, bolt task is gone in completion；
The delivery sheath 24 is the sheath containing hollow inner core, and thrombus distal end can be reached along preset seal wire, and inner core has branchThe effect of support expansion delivery sheath 24；, can be to take the release of bolt basket, recovery to provide transfer passage and (lead after withdrawing from seal wire and inner coreSilk is conventional intervention equipment, and guide function is provided for other intervention equipment intravasations)；
Described takes bolt basket handle 22 to be connected with sending and receiving wirerope 21, is easy to convey, withdraws the manipulation taken during bolt basket；
In described thrombus screen pack, total sheath 1, outer net sheath 4, Intranet sheath 5, the pipe for taking bolt basket delivery sheath 24 are conveyedChamber is coaxial, and its internal-and external diameter is sequentially reduced, and can pass sequentially through previous stage sheath.
In described thrombus screen pack, convey between total near-end of sheath 1 and outer net sheath 4, outer net sheath 4 and Intranet sheath 5Between have locking device, behind outer net in-position, pin locking device can prevent from conveying total near-end of sheath 1 and outer net sheath 4Between, be mutually displaced between outer net sheath 4 and Intranet sheath 5.
The outer net of thrombus screen pack of the present invention, Intranet and the components such as bolt basket are taken to contain impermeable X ray material, canThe position of impermeable X ray thing is monitored by digital subtraction angiography instrument (DSA), to understand the outer net of thrombus screen pack, IntranetAnd take the position of bolt basket；
The total sheath 1 of conveying of thrombus screen pack of the present invention, outer net sheath 4, outer net, Intranet sheath 5, Intranet, take boltThe delivery sheath 24 of basket, basket open 19, basket beam 20, the surface of sending and receiving wirerope 21 scribble certain lubricant coating, lubricant coating dropLow push resistance, apparatus it is handling more preferably；Preferably, coating material is PTFE coatings or hydrophilic coating.
The total sheath 1 of conveying, outer net sheath 4, Intranet sheath 5, the conveying sheath for taking bolt basket of thrombus screen pack of the present inventionPipe 24 is polymeric material, for example, polytetrafluoroethylene (PTFE)；
Fig. 8 shows the example that the present invention takes bolt basket to be pre-installed on delivery sheath 24.Bolt basket is taken to be pre-installed in delivery sheath 24,It easily can not be marked through Intranet sheath 5 or outer net sheath 4 or through having been placed in intravenous blood vessel sheath and be sent to phlebothrombosisDistally, with removal of thromboses.
Illustrate the course of work of apparatus of the present invention below in conjunction with the accompanying drawings：
Fig. 9 shows the example through thrombus in right side femoral vein taking-up right side venae brachiocephalicae, superior vena cava.Through right side femoral vein25 puncture, and insert the total sheath 1 of conveying, establish right lateral thigh vein inferior caval vein 26 to the passage of superior vena cava 27；In having pre-installedThe conversion insertion of sheath 16 of net, outer net conveys the haemostatic valve 17 of total sheath 1, is sent to Intranet dictyosome 3, outer net dictyosome 2 through conveying total sheath 1The near-end of thrombus 28 in superior vena cava 27, withdraw the total sheath 1 of conveying and deploy Intranet dictyosome 3, outer net dictyosome 2, may be come off with interceptingThe embolus such as thrombus；Conveying between total near-end of sheath 1 and outer net sheath 4, between outer net sheath 4 and Intranet sheath 5 has locking deviceDo not mark, behind outer net, Intranet in-position, pin locking device can prevent from conveying between total near-end of sheath 1 and outer net sheath 4,It is mutually displaced between outer net sheath 4 and Intranet sheath 5；The delivery sheath 24 of bolt basket is taken to be sent to through the intracavitary of Intranet sheath 5 prepackageRight side venae brachiocephalicae, the right internal jugular vein 29 of superior vena cava thrombus distal end, withdraw the release of delivery sheath 24 and take bolt basket basket open 19And the string bag 18, it is hand-held take bolt basket handle 22 and pull back take bolt basket, through taking bolt basket basket open 19 by right side venae brachiocephalicae, superior vena cavaThrombus pocket take to the string bag 18, continuing to pull back takes bolt basket, takes out thrombus 28 to external through Intranet dictyosome 3, Intranet sheath 5., can be with taking bolt basket repeatedly to take bolt, until complete removal of thromboses as do not taken net thrombus once.Then Intranet is withdrawn through conveying total sheath 1And outer net, the total sheath 1 of conveying, point of puncture pressure dressing are finally withdrawn from, completion takes bolt overall process.
Figure 10 shows the example through thrombus in the taking-up of right internal jugular vein 29 right side venae brachiocephalicae, superior vena cava.Through right lateral thighVein 25 punctures, and inserts the total sheath 1 of conveying, establishes right lateral thigh vein inferior caval vein 26 to the passage of superior vena cava 27；Will be pre-The haemostatic valve 17 changed the insertion of sheath 16 and convey total sheath 1 of Intranet dictyosome 3, outer net dictyosome 2 is filled, through conveying total sheath 1 by Intranet, outer netThe near-end of thrombus 28 in superior vena cava 27 is sent to, the total sheath 1 of conveying is withdrawn and deploys Intranet dictyosome, outer net dictyosome, may be taken off with interceptingThe emboluses such as the thrombus fallen；Punctured through right internal jugular vein 29, insert blood vessel sheath and do not mark, prepackage is taken to the delivery sheath of bolt basket24 intravascular sheaths are sent to right side venae brachiocephalicae, the proximal part of superior vena cava thrombus, withdraw the release of delivery sheath 24 and take bolt basket basketMouthfuls 19 and the string bag, it is hand-held take bolt basket handle 22 and pull back take bolt basket, through taking bolt basket basket open to take thrombus pocket to the string bag, it is preceding push away it is defeatedSheath 24 is sent to close basket open 19, continuing to pull back takes bolt basket, and intravascular sheath takes out thrombus 28 to external.Can be with taking bolt basket multipleBolt is taken, until complete removal of thromboses.
Figure 11 shows the example that the massive for being shed to Intranet dictyosome 3 is taken out through right side femoral vein.Such as take big during boltBlock thrombus breaks loose can take the conveying sheath of bolt basket through being placed in the Intranet sheath 5 of right side femoral vein 25 to the dictyosome 3 of Intranet by pre-installingPipe 24 is sent to the distal end of the thrombus 28 of Intranet dictyosome 3, withdraws the release of delivery sheath 24 and takes bolt basket basket open 19 and the string bag 18, hand-held to take boltBasket handle 22 is simultaneously pulled back and takes bolt basket, through taking bolt basket basket open pocket to take 3 thrombus 28 in Intranet dictyosome, through Intranet sheath 5 by thrombus 28Take out to external；Can be with taking bolt basket repeatedly to take bolt., also can be during Intranet be withdrawn if there is a small amount of remaining thrombus chip not take onlyTake out in the lump；It even if there is thrombus chip 30 to be overflowed from Intranet dictyosome 3, can also be intercepted by outer net dictyosome 2, outer network process can withdrawnIn take out in the lump.Also Catheter Thrombolysis can be inserted through outer net sheath 4.Finally, Intranet and outer net are withdrawn through conveying total sheath 1, most dropped backGo out to convey total sheath 1, point of puncture pressure dressing, completion takes bolt overall process.
As needed other diagnoses and treatment to operate, outer net sheath 4 can be connected by the conversion wirerope 11 of outer net sheath, from outer net sheathPipe removes the total sheath 1 of conveying；Intranet is withdrawn through outer net sheath 4, then inserts seal wire, angiography catheter, thrombolysis catheter through outer net sheath 4Deng the corresponding operation of diagnosis and treatment of carry out.Outer net can also stay in vena cave the long period, prevent pulmonary embolism.Wait to need to withdraw outer netWhen, it is again coupled to change wirerope 11, total sheath 1 will be conveyed intravascular, withdrawal outer net is sent to along conversion wirerope 11 and outer net sheath 4,The total sheath 1 of conveying is withdrawn from, completes operation.
Compared with prior art, both there is the present invention thrombus filtering, the thrombus of pulmonary embolism protection to come to play, and dispel againRemoving thrombus takes bolt basket, accomplishes the preventing of thrombus, takes and be combined；Thrombus screen pack is bilayer, accomplishes that embolus protects during taking boltIt is perfectly safe；
The thrombus screen pack of the present invention includes outer net, Intranet etc., and it forms skeleton by cone barrel longitudinal ridge, there is provided longitudinal direction branchHolding force, coated with resilient wire mesh structure, scheme, this programme can be effectively reduced apparatus and mutually block pressure compared with prior art,Simple in construction, compliance is good, easy to operate；Take bolt basket simple in construction, act freely, take bolt efficiency high.The present invention need not be equipped withExternal drive device, low cost, advantageously reduce Medical Expense for Patients and hospital's burden.
The thrombus screen pack of the present invention is to include Intranet, the double-decker of outer net, and the two can both be used cooperatively, again can be singleSolely use.
The device and its component of the present invention cannot be only used for venous system, also can arterial system.
Described above is only the preferred embodiment of the present invention, it is noted that for the ordinary skill people of the artFor member, under the premise without departing from the principles of the invention, some improvements and modifications can also be made, these improvements and modifications also shouldIt is considered as protection scope of the present invention.In addition, although used some specific terms in this specification, but these terms are onlyFor convenience of explanation, any restrictions are not formed to the present invention.