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WO2000056227A1 - Dispositif de fermeture perfectionne - Google Patents

Dispositif de fermeture perfectionne Download PDF

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Publication number
WO2000056227A1
WO2000056227A1 PCT/IB2000/000302 IB0000302W WO0056227A1 WO 2000056227 A1 WO2000056227 A1 WO 2000056227A1 IB 0000302 W IB0000302 W IB 0000302W WO 0056227 A1 WO0056227 A1 WO 0056227A1
Authority
WO
WIPO (PCT)
Prior art keywords
blood vessel
deformable
spikes
spike
engaging structures
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Ceased
Application number
PCT/IB2000/000302
Other languages
English (en)
Inventor
Amir Loshakove
Ido Kilemnik
Dvir Keren
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
By Pass Inc
Original Assignee
By Pass Inc
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Priority claimed from PCT/IL1999/000284 external-priority patent/WO1999062415A1/fr
Priority claimed from PCT/IL1999/000285 external-priority patent/WO1999062408A1/fr
Priority claimed from PCT/IL1999/000670 external-priority patent/WO2000056226A1/fr
Priority to BR0016251-5A priority Critical patent/BR0016251A/pt
Application filed by By Pass Inc filed Critical By Pass Inc
Priority to AU33136/00A priority patent/AU3313600A/en
Priority to US09/936,796 priority patent/US6726704B1/en
Priority to CA002393508A priority patent/CA2393508A1/fr
Priority to AU75527/00A priority patent/AU7552700A/en
Priority to IL15000300A priority patent/IL150003A0/xx
Priority to JP2001542803A priority patent/JP2004513670A/ja
Priority to AU75525/00A priority patent/AU7552500A/en
Priority to BR0016247-7A priority patent/BR0016247A/pt
Priority to IL15005100A priority patent/IL150051A0/xx
Publication of WO2000056227A1 publication Critical patent/WO2000056227A1/fr
Priority to PCT/IL2000/000611 priority patent/WO2001041624A2/fr
Priority to CA002393486A priority patent/CA2393486A1/fr
Priority to JP2001542802A priority patent/JP2003515416A/ja
Priority to EP00964603A priority patent/EP1237485A2/fr
Priority to PCT/IL2000/000609 priority patent/WO2001041623A2/fr
Priority to EP00964605A priority patent/EP1259169A2/fr
Priority to AU2001244497A priority patent/AU2001244497A1/en
Priority to JP2001568293A priority patent/JP2004500209A/ja
Priority to AU2001244496A priority patent/AU2001244496A1/en
Priority to IL15169301A priority patent/IL151693A0/xx
Priority to CA002403289A priority patent/CA2403289A1/fr
Priority to PCT/IL2001/000266 priority patent/WO2001070090A2/fr
Priority to PCT/IL2001/000267 priority patent/WO2001070091A2/fr
Priority to EP01917421A priority patent/EP1265535A2/fr
Priority to US10/239,364 priority patent/US20040097973A1/en
Priority to BR0109396-7A priority patent/BR0109396A/pt
Anticipated expiration legal-status Critical
Priority to US10/459,407 priority patent/US20040073247A1/en
Ceased legal-status Critical Current

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/0057—Implements for plugging an opening in the wall of a hollow or tubular organ, e.g. for sealing a vessel puncture or closing a cardiac septal defect
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/064—Surgical staples, i.e. penetrating the tissue
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/064—Surgical staples, i.e. penetrating the tissue
    • A61B17/0644—Surgical staples, i.e. penetrating the tissue penetrating the tissue, deformable to closed position
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/11—Surgical instruments, devices or methods for performing anastomosis; Buttons for anastomosis
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/32—Surgical cutting instruments
    • A61B17/3205—Excision instruments
    • A61B17/32053—Punch like cutting instruments, e.g. using a cylindrical or oval knife
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/34—Trocars; Puncturing needles
    • A61B17/3494—Trocars; Puncturing needles with safety means for protection against accidental cutting or pricking, e.g. limiting insertion depth, pressure sensors
    • A61B17/3496—Protecting sleeves or inner probes; Retractable tips
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/00234—Surgical instruments, devices or methods for minimally invasive surgery
    • A61B2017/00238—Type of minimally invasive operation
    • A61B2017/00243—Type of minimally invasive operation cardiac
    • A61B2017/00247—Making holes in the wall of the heart, e.g. laser Myocardial revascularization
    • A61B2017/00252—Making holes in the wall of the heart, e.g. laser Myocardial revascularization for by-pass connections, i.e. connections from heart chamber to blood vessel or from blood vessel to blood vessel
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/0057—Implements for plugging an opening in the wall of a hollow or tubular organ, e.g. for sealing a vessel puncture or closing a cardiac septal defect
    • A61B2017/00637—Implements for plugging an opening in the wall of a hollow or tubular organ, e.g. for sealing a vessel puncture or closing a cardiac septal defect for sealing trocar wounds through abdominal wall
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/0057—Implements for plugging an opening in the wall of a hollow or tubular organ, e.g. for sealing a vessel puncture or closing a cardiac septal defect
    • A61B2017/00646—Type of implements
    • A61B2017/00668—Type of implements the implement being a tack or a staple
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B2017/00831—Material properties
    • A61B2017/00867—Material properties shape memory effect
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/064—Surgical staples, i.e. penetrating the tissue
    • A61B2017/0641—Surgical staples, i.e. penetrating the tissue having at least three legs as part of one single body
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/11—Surgical instruments, devices or methods for performing anastomosis; Buttons for anastomosis
    • A61B2017/1107—Surgical instruments, devices or methods for performing anastomosis; Buttons for anastomosis for blood vessels
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/11—Surgical instruments, devices or methods for performing anastomosis; Buttons for anastomosis
    • A61B2017/1135—End-to-side connections, e.g. T- or Y-connections

Definitions

  • the present invention relates to hole closure devices for blood vessels.
  • An aspect of some preferred embodiments of the invention relates to mechanically decoupling the spikes of a hole closure device from a part of the device that controls the device general geometry.
  • the deformation of the spikes does not affect the device geometry and vice- versa.
  • this results in a separation between the forces that change the device geometry to close the hole and the forces that maintain the spikes in side the blood vessel. This separation is expected to prevent the geometric distortion of the device from inadvertently retracting the spikes form the blood vessel.
  • the decoupling is achieved by assuring that energy stored by the device for closing the hole in the blood vessel is not stored in the spikes or in structures that spring-load the spikes. Thus, release of the energy is less likely to affect the hold of the spikes on the vessels.
  • the spikes are configured so that the plastic deformation does not affect the spikes or parts of the device that spring- load the spikes.
  • An aspect of some preferred embodiments of the invention relates to providing a pivot bar for vessel-engaging spikes of a hole closure device.
  • the pivot bar is not part of the load bearing structure of the device.
  • a potential advantage of using a pivot bar is that a spike can be rotated around the pivot bar without bending the spike and without and protrusion from the plane of the device and/or the surface of the blood vessel.
  • the pivot bar defines at its ends or along its length hinges (or weakened points) for controlling the twisting of the bar relative to the rest of the device, however, this is not necessary.
  • An aspect of some preferred embodiments of the invention relates to spacing the spike used to engage the blood vessel away from a hole in the blood vessel. Preferably, this results in a lower probability of the spike inadvertently retracting from the blood vessel.
  • An aspect of some preferred embodiments of the invention relates to a hole-closure device design, in which two concentric structures are provided, an inner structure for controlling the device geometry and an outer structure for supporting spikes and/or other means of engaging the blood vessel.
  • the spikes are coupled to the inner structure only through tab means provided to bend the spikes out of plane.
  • An aspect of some preferred embodiments of the invention relates to providing a hinge in a hole closure device.
  • the distortion is controlled by the hinge, for example, being focused at the hinge or being prevented at the hinge.
  • the hinge is integral with the device.
  • the device is formed of two or more parts attached to each other by the hinge.
  • the device is designed for sealing an elongate cut in a blood vessel, by deforming between a substantially round configuration to a substantially ellipsoid configuration.
  • a multiple part device is provided, with all of the multiple parts being outside of the blood vessel and, preferably, being substantially equivalent in function.
  • an aspect of some preferred embodiments of the invention relates to a bi-stable hole closure device.
  • the device has at least two stable states, a first state in which the device defines an open lumen through which a catheter, cannula or other tube may be provided and a second state in which the lumen is significantly contracted or even closed.
  • an aspect of some preferred embodiments of the invention relates to an elastic clip for closing a hole in a blood vessel.
  • the clip is maintained in an open configuration, suitable for engaging a blood vessel, by inserting a spacer in the clip. After engaging the blood vessel, the spacer is moved or removed, so the clip can close.
  • the closure is elastic, super elastic or shape-memory based.
  • the closure may be plastic, as a result of the application of force.
  • a hole closure device comprising: at least two blood vessel engaging structures, each comprising a base; at least one second, deformable, structure, coupled to said at least two blood-vessel engaging structures and having a first deformation state and a second deformation state, wherein said at least one second deformable structure urges said two blood vessel engaging structures towards each other when going from said first deformation state to said second deformation state, wherein, said change in deformation state is at least partially mechanically decoupled from each of said blood-vessel engaging structures, such that it does not effect a substantial deformation of said blood-vessel engaging structure relative to said base.
  • said at least one second deformable structure comprises a deformable ringlike structure, adapted to enclose a blood vessel cannula-like tube in said first deformation state.
  • the device comprises a ring-like element on which said at least one deformable structure is mounted and wherein said at least one second deformable structure comprises at least two bending elements that couple said blood-vessel engaging structures to said ring-like element.
  • said ring-like element defines a lumen that has a substantially same radius in said deformation states.
  • said blood vessel engaging structures each comprise at least one spike adapted for insertion into a wall of a blood vessel.
  • said blood vessel engaging structures each comprise at least two spikes adapted for insertion into a wall of a blood vessel.
  • said blood vessel engaging structures each comprise a pivot bar on which said spike is mounted.
  • said blood vessel engaging structures each comprise at least one tab, mounted on said pivot bar.
  • said tab comprises an anchor for holding said tab.
  • said pivot bar comprises a hinge at either end.
  • said pivot bar is straight.
  • said pivot bar is mounted on a spacer that spaces said pivot bar from said at least one second deformable structure.
  • said base is adapted for abutment against the blood vessel.
  • said bases are spaced apart a distance sufficient to prevent eversion of a blood vessel in which a hole is closed.
  • said bases are spaced apart a distance sufficient to cause at least partial eversion of a blood vessel in which a hole is closed.
  • said at least one second deformable structure comprises at least two deformable structures connected by at least one joint.
  • said joint is elastic.
  • said joint comprises a segment of a circle.
  • said joint is free turning for at least a range of angles.
  • said joint is integral with said at least two deformable structures.
  • said joint is formed by an interlocking of the two deformable structures.
  • said at least one deformable structure comprises a bar.
  • at least one of said blood vessel engaging structures is radially external to said at least one deformable structure.
  • at least one of said blood vessel engaging structures is radially internal to said at least one deformable structure.
  • a hole closure device comprising: at least one pivot bar; at least one spike mounted on said spike such that rotating said spike around said bar twists said pivot bar; and a base to which said at least one bar is coupled and which base does not encompass said bar.
  • the device comprises at least one structure which supports said pivot bar and which couples said pivot bar to said base.
  • said base comprises a deformable ring-like element.
  • said base comprises at least two hinges at opposite ends of said base.
  • a hole closure device comprising: a deformable ring-like structure; a plurality of spikes coupled to said structure, each of said spike comprising a base; and a coupling structure coupling said base to said ring-like structure, wherein said base is radially spaced from said ring-like structure by said coupling structure, at least the length of said spike.
  • said spikes are each mounted on a pivot bar.
  • a hole closure device comprising: a first body part comprising: a plurality of blood-vessel engaging structures, adapted to remain outside a blood vessel; and at least a first hinge part coupled to said plurality of blood vessel engaging structures; and a second body part comprising: a plurality of blood-vessel engaging structures adapted to remain outside a blood vessel; and at least a second hinge part coupled to said plurality of blood vessel engaging structures, wherein said first and said second hinge parts are adapted to interlock to form a hinge.
  • a blood vessel clip comprising: at least two spikes; at least one tab, perpendicular to at least one of said spikes; and an elastic body connecting the two spikes, said body having a greater inner dimension away from said spike than nearer said spike.
  • a bi-stable hole closure device comprising: at least two arms, coupled to each other at either end thereof, wherein: a first one of said arms is less flexible than a second one of said arms, and wherein said second arm is adapted to have two stable states, one state in which the second arm is spaced from said first arm and one state in which said second arm is adjacent said first arm; and a plurality of blood-vessel engaging elements mounted on each of said arms.
  • Fig. 1A is a plan view of a hole closure device in accordance with a preferred embodiment of the invention
  • Figs. IB- IE illustrate the deployment of the device of Fig. 1, in accordance with a preferred embodiment of the invention
  • Fig. 2A is a perspective view of a two part hole closure device, in accordance with a preferred embodiment of the invention.
  • Figs. 2B and 2C show the device of Fig. 2A, during deployment, in accordance with a preferred embodiment of the invention
  • Figs. 3A-3C illustrate hole closure devices in accordance with preferred embodiments of the invention
  • Figs. 3D-3E illustrate a deployment of one of the devices of Figs. 3A and 3B, in accordance with a preferred embodiment of the invention
  • Fig. 3F illustrates an alternative, deployed, hole closure device in accordance with a preferred embodiment of the invention
  • Figs. 4A and 4B illustrate a blood vessel clip, in accordance with a preferred embodiment of the invention.
  • Figs. 5A and 5B illustrate a bi-stable hole closure device, in accordance with a preferred embodiment of the invention.
  • Fig. 1A is a plan view of a hole closure device 100, in accordance with a preferred embodiment of the invention.
  • Device 100 comprises a body section 102 and a plurality of spike sections 106 attached to body section 102. Although six such sections are shown, the number may vary depending on the use of the device, for example, being 2, 3, 4, 5, 7, 9 or more.
  • body section 102 comprises two elongate elements 103, attached together at their ends by hinges 104.
  • the design of hinges 104 is such that when device 100 is distorted for implantation to define a circular or elliptical lumen (See Figs. 1B-
  • a spike section 106 comprises a pivot bar 108, having a spike 110 mounted on one side and a tab 112 mounted on another side thereof.
  • a spacing structure 114 spaces bar 108 from body section 102.
  • the lumen of device 100 is defined by alternating ring segments and spike sections.
  • the spike sections may be inside the ring segment, so they are not spaced away from the lumen of the device.
  • tab 112 is coupled to bar 108, it is not required that tab 112 be opposite spike 110 in order to control the positions of the spikes.
  • a plurality of spikes 110 and/or tabs 112 may be provided on each spike section 106.
  • tab(s) 112 and spike(s) 110 do not all have to be in a same plane.
  • the tabs are not in a same plane as the spikes, so that when deployment is complete (Fig. IE, below), the tabs can be flat with the surface of the blood vessel.
  • the tabs may also be curved.
  • the bar may be curved or angular.
  • the bar is radially expandable or can provide elastic force perpendicular to the bar, along the spike.
  • the spikes may be long or short (relative to the length of pivot bar 108 and the distance of bar 108 from body section 102). Although straight spikes are preferred, curved spikes, curved in either of the two directions perpendicular to the spike, may be used. As shown, bar 108 does not include designated twisting regions. Alternatively one or more such regions, which twist more or less than the rest of bar 108, may be provided. In one example, a more easily twisting region is provided at each of the ends of bar 108. Twisting areas may be, for example, thinner, narrower or include apertures.
  • Figs. IB-IE illustrate the deployment of device 100, in accordance with a preferred embodiment of the invention.
  • device 100 is mounted on a cannula 122, that pierces a blood vessel 120.
  • tabs 112 are held by a tab holding tube 126 against a contra-element tube 124.
  • Tab-holding tube 126 may include thinner portions 128 for defining a hollow between tube 126 and tube 124, for the tabs.
  • closure device 100 can be advanced along cannula 122 to engage blood vessel 120, as shown.
  • Fig. 1C is a top view along the cannula axis, with the holding and contra tubes 124 and 126 not shown.
  • Body section 102 of device 100 is shown distorted to define a lumen through which cannula 122 is provided.
  • Fig. ID shows the effect of removing tab holding tube 126, which allows the pivot bar 108 to partially twist back so that spikes 110 engage vessel 120 better.
  • FIG. 2A is a perspective view of a multi-part hole closure device 200, in accordance with a preferred embodiment of the invention.
  • Device 200 as shown, comprises only two parts 201 and 205, however, a larger number of device segments could be provided as well, for example the device being formed of three or four links.
  • Each of parts 201 and 205 comprises an elongate element 203 and a plurality of spike sections 206, corresponding to the same parts in Fig. lC.
  • Parts 201 and 205 have, at the ends of elements 203, hinge parts, for example an eye 216 on part 201 and a hook 218 on part 205. Hook 218 and eye 216 engage to form a hinge.
  • Other interlocking element types may also be used.
  • Alternative types of joints may be provided, for example crimp joints that are formed by crimping the hinge parts together or by deforming one or both of the hinge parts. It is noted that unlike hinge 104 of device 100, the hinge of device 200 does not necessarily (although it may) store any elastic energy when the device is distorted. Rather, any such energy is preferably stored by bending body elements 203.
  • Fig. 2B shows device 200 on a cannula 122.
  • the mounting method can be exactly the same as that of Fig. IB.
  • Fig. 2C is a top view along the cannula axis, with the holding and contra tubes 124 and 126 not shown. This figure is also very similar to Fig. 1C, with an important difference, a hinge 220 is provided by the interlocking of eye 216 and hook 218.
  • Figs. 3A-3C illustrate hole closure devices in accordance with preferred embodiments of the invention.
  • Fig. 3A illustrates a device 300, in which a plurality of spikes 302 are defined to be outside of a structural ring 304 of the device.
  • ring 304 does not distort during deployment.
  • a pair of tabs 306 are provided, each tab associated with two of spikes 302, such that when the tabs are bent, the spikes also twist with them.
  • a bending strip 310 is provided as a hinge between tab 306 and ring 304.
  • spikes 302 are coupled to ring 304 only via tab(s) 306, so that they are substantially decoupled from ring 304.
  • Tab 306 may include an anchor, such as a hole 308, for engagement during deployment.
  • Spikes 302 preferably comprise a base portion 303 that is substantially wider than the spike.
  • Fig. 3B illustrates a device 320 which is a variant of device 300, in which an inner ring
  • Tabs 321 extends to the ends of device 320 and takes over the function of holes 308 and/or bending strip 310. Tabs 326 are significantly shorter than tabs 306.
  • Fig. 3C illustrates a simpler device 330, in which a plurality of spikes 334 are mounted on a ring 332. As shown, spikes 334 are wide at their base, preventing the spikes themselves from bending, when ring 332 is twisted. A particular feature of this device (and some of the previous devices) is that a lumen remains in the device even after the hole is closed. This lumen is useful if an attempt is made to insert a cannula again into the vessel, at the device location. The cannula would be able to enter through the lumen, without damaging the blood vessel.
  • Figs. 3D-3E illustrate a deployment of one of devices 300, 320 or 330, in accordance with a preferred embodiment of the invention.
  • device 300 is assumed, however, all the devices may be similarly deployed.
  • a catheter 422 is inserted through ring 304 (catheter shown here with a guide wire 423).
  • Tabs 306 are held in place between a tab holding tube 426 and a contra-element tube 424.
  • the bending of bending element 310 is preferably supported by a curved portion 427 of contra- element tube 424. In this configuration, spikes 302 are pointed straight ahead and can easily engage vessel 120.
  • Fig. 3E which shows a cross-section of vessel 120
  • contra-element 426 is removed, releasing tabs 306.
  • Base portions 303 Fig. 3 A
  • these events will occur even if catheter 422 is not removed.
  • catheter 422 is removed, the lips of the hole in vessel 120 will be pressed against each other and prevent leakage.
  • This mechanism may not be suitable for all blood vessels, for example being suitable for veins and the femoral artery, but not for the aorta in situations when a radial hole closure is desired.
  • spikes 302 can be designed to penetrate vessel 102 to greater than the vessel wall thickness. Possibly, the spikes are made jagged at their edges, to allow them to engage both lips of the blood vessel, when deployed.
  • the energy required to distort device 300 to seal the hole in vessel 120 is stored in bending element 310 and, possibly to some extent in ring 304. In contrast, in device 320, the energy is stored in ring 321.
  • Fig. 3F illustrates an alternative hole closing device 340, similar to device 330, as deployed on vessel 120.
  • Device 340 comprises a pair of tabs 346, possibly including holes 348 and a plurality of spikes 342 (only their base is shown).
  • the spikes do not exactly face each others in pairs, allowing the spikes to be longer than half the distance between the spike bases. This also allows the spike bases to be close together, to promote eversion.
  • FIGs. 4A and 4B illustrate a blood vessel clip 430, in accordance with a preferred embodiment of the invention.
  • Clip 430 comprises a pair of spikes 432 coupled together by a body 431.
  • a pair of tabs 434 is provided.
  • tabs 434 act as tissue stops to prevent over insertion of spikes 432 in vessel 120.
  • tabs 434 act as anchor points which can be used to hold clip 430 and/or advance it.
  • a spacer element 436 is provided inside clip 430.
  • a contour 438 is provided in clip 430 to hold spacer element 436, however this is not essential.
  • Clip 430 is then advanced into vessel 120, with one spike on either side of the opening in the vessel. Elastic energy for closing of the clip is preferably stored in body 431.
  • spacer element 436 is retracted to a more spacious part 440 of body 431, allowing the spikes to move towards each other and close the hole in the blood vessel.
  • the clip may be removed.
  • it is left in the body.
  • part 440 may be at an angle, or even perpendicular to the plane of spikes 432.
  • no body part 440 is provided.
  • the spring action of body part 440 is provided by a flat spring.
  • a larger number such as three or four may be provided, spaced apart along a line perpendicular to the figure plane.
  • these spikes may be mounted on a pivot bar.
  • Spacer element 436 is preferably removed by moving it perpendicular to the spike.
  • spacer element 436 is a perpendicular protrusion on an elongate delivery tool.
  • Figs. 5 A and 5B illustrate a bi-stable hole closure device 500, in accordance with a preferred embodiment of the invention.
  • Fig. 5A shows device 500 in an open configuration, a thick arm 540 and a thin arm 502 defining a lumen, into which project a plurality of spikes 506.
  • thin arm 502 is distorted to be concave, rather than convex, so that it substantially conforms to the curve of arm 504, rather than mirroring it.
  • Spikes 506 are embedded in a vessel 120, so they are not shown.
  • Various bi-stable mechanisms which may be suitable, are described in PCT publication WO98/32412, the disclosure of which is incorporated herein by reference.
  • the above devices are preferably formed of stainless steel or a titanium alloy and use elastic, super elastic and/or shape-memory properties to distort when cannula 122 or other constraint is removed.
  • the devices may be formed of a plastic material, especially a bio-absorbable material.
  • the devices utilize a plastic deformation, for example deformation by an externally applied force.
  • the above devices can be adapted to a wide variety of blood vessels and/or other hollow body lumens, such as ducts, intestines, esophagus and trachea. It is noted however, that the devices of Figs. 1 and 2 are better suited for an aorta, while the devices of Figs. 3 and 5 are better suited for a femoral artery. The device of Fig. 4 is better suited for veins, where the pressure is lower.
  • the hole closure devices are provided mounted on standard cannulas and catheters.

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  • Prostheses (AREA)

Abstract

L'invention se rapporte à un dispositif (100) d'obturation de trous, qui comporte au moins deux structures (106) conçues pour pénétrer dans un vaisseau sanguin, de préférence des pointes, comportant chacune une base (102); au moins une seconde structure déformable (112), couplée à la (aux) structure(s) (106) conçue(s) pour pénétrer dans le vaisseau sanguin et possédant un premier état de déformation et un second état de déformation, ladite seconde structure déformable (112) étant conçue pour forcer les deux structures (106) conçues pour pénétrer dans le vaisseau sanguin à se déplacer l'une vers l'autre, lorsqu'elle passe du premier état de déformation au second état de déformation. Le changement d'état de déformation est au moins partiellement découplé de chacune des structures (106) conçues pour pénétrer dans le vaisseau sanguin.
PCT/IB2000/000302 1998-05-29 2000-03-20 Dispositif de fermeture perfectionne Ceased WO2000056227A1 (fr)

Priority Applications (27)

Application Number Priority Date Filing Date Title
BR0016251-5A BR0016251A (pt) 1999-12-08 1999-12-09 Dispositivo de ligação vascular para vedar uma abertura entre dois rebordos de condutos sanguìneos, e, método para vedar uma abertura entre dois rebordos de condutos sanguìneos.
AU33136/00A AU3313600A (en) 1999-03-19 2000-03-20 Advanced closure device
US09/936,796 US6726704B1 (en) 1998-05-29 2000-03-20 Advanced closure device
JP2001542802A JP2003515416A (ja) 1999-12-08 2000-09-28 吻合装置および方法
EP00964603A EP1237485A2 (fr) 1999-12-08 2000-09-28 Dispositifs et procedes d'anastomose
PCT/IL2000/000609 WO2001041623A2 (fr) 1999-05-30 2000-09-28 Dispositifs et procedes d'anastomose
CA002393486A CA2393486A1 (fr) 1999-12-08 2000-09-28 Attache des levres d'un vaisseau sanguin
EP00964605A EP1259169A2 (fr) 1999-12-08 2000-09-28 Attache des levres d'un vaisseau sanguin
IL15000300A IL150003A0 (en) 1999-12-08 2000-09-28 Anastomotic devices and methods
JP2001542803A JP2004513670A (ja) 1999-12-08 2000-09-28 血管縁部結合器
AU75525/00A AU7552500A (en) 1999-12-08 2000-09-28 Anastomotic devices and methods
BR0016247-7A BR0016247A (en) 1999-12-08 2000-09-28 Anastomotic devices and methods
IL15005100A IL150051A0 (en) 1999-05-30 2000-09-28 Blood vessel lip attachment
AU75527/00A AU7552700A (en) 1999-12-08 2000-09-28 Vessel lip attachment
PCT/IL2000/000611 WO2001041624A2 (fr) 1999-05-30 2000-09-28 Attache des levres d'un vaisseau sanguin
CA002393508A CA2393508A1 (fr) 1999-12-08 2000-09-28 Dispositifs et procedes d'anastomose
BR0109396-7A BR0109396A (pt) 2000-03-20 2001-03-20 Dispositivo de ligação vascular para vedar uma abertura entre dois lábios de canal de sangue, sistema de colocação de conector, método papa puxar de volta os dedos de um conector de anel, e, aparelho para anastomose
US10/239,364 US20040097973A1 (en) 2000-03-20 2001-03-20 Transvascular bybass method and system
EP01917421A EP1265535A2 (fr) 2000-03-20 2001-03-20 Mise en place d'une greffe et d'un connecteur
AU2001244497A AU2001244497A1 (en) 2000-03-20 2001-03-20 Transvascular bypass method and system
PCT/IL2001/000267 WO2001070091A2 (fr) 2000-03-20 2001-03-20 Procede et systeme de pontage transvasculaire
JP2001568293A JP2004500209A (ja) 2000-03-20 2001-03-20 グラフトおよびコネクタの移送
AU2001244496A AU2001244496A1 (en) 2000-03-20 2001-03-20 Graft and connector delivery
IL15169301A IL151693A0 (en) 2000-03-20 2001-03-20 Graft and connector delivery
CA002403289A CA2403289A1 (fr) 2000-03-20 2001-03-20 Mise en place d'une greffe et d'un connecteur
PCT/IL2001/000266 WO2001070090A2 (fr) 2000-03-20 2001-03-20 Mise en place d'une greffe et d'un connecteur
US10/459,407 US20040073247A1 (en) 1998-05-29 2003-06-11 Method and apparatus for forming apertures in blood vessels

Applications Claiming Priority (9)

Application Number Priority Date Filing Date Title
IL129067 1999-03-19
ILPCT/IL99/00285 1999-05-30
ILPCT/IL99/00284 1999-05-30
PCT/IL1999/000285 WO1999062408A1 (fr) 1998-05-29 1999-05-30 Dispositif de fermeture de perforations dans le systeme vasculaire
PCT/IL1999/000284 WO1999062415A1 (fr) 1998-05-29 1999-05-30 Techniques et dispositifs de chirurgie vasculaire
ILPCT/IL99/00670 1999-12-08
PCT/IL1999/000670 WO2000056226A1 (fr) 1999-03-19 1999-12-08 Chirurgie vasculaire
ILPCT/IL99/00674 1999-12-09
PCT/IL1999/000674 WO2000056223A1 (fr) 1999-03-19 1999-12-09 Dispositif d'obturation vasculaire

Related Child Applications (2)

Application Number Title Priority Date Filing Date
US10/459,407 Continuation-In-Part US20040073247A1 (en) 1998-05-29 2003-06-11 Method and apparatus for forming apertures in blood vessels
US10/809,274 Continuation-In-Part US20050038454A1 (en) 1998-05-29 2004-03-25 Anastomotic delivery system

Publications (1)

Publication Number Publication Date
WO2000056227A1 true WO2000056227A1 (fr) 2000-09-28

Family

ID=56289999

Family Applications (2)

Application Number Title Priority Date Filing Date
PCT/IB2000/000302 Ceased WO2000056227A1 (fr) 1998-05-29 2000-03-20 Dispositif de fermeture perfectionne
PCT/IL2000/000611 Ceased WO2001041624A2 (fr) 1998-05-29 2000-09-28 Attache des levres d'un vaisseau sanguin

Family Applications After (1)

Application Number Title Priority Date Filing Date
PCT/IL2000/000611 Ceased WO2001041624A2 (fr) 1998-05-29 2000-09-28 Attache des levres d'un vaisseau sanguin

Country Status (1)

Country Link
WO (2) WO2000056227A1 (fr)

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