CN113907836A - Thrombus taking device for hemodialysis access - Google Patents
Thrombus taking device for hemodialysis access Download PDFInfo
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- CN113907836A CN113907836A CN202111362091.XA CN202111362091A CN113907836A CN 113907836 A CN113907836 A CN 113907836A CN 202111362091 A CN202111362091 A CN 202111362091A CN 113907836 A CN113907836 A CN 113907836A
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- embolectomy
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- 208000007536 Thrombosis Diseases 0.000 title claims abstract description 106
- 238000001631 haemodialysis Methods 0.000 title claims abstract description 26
- 230000000322 hemodialysis Effects 0.000 title claims abstract description 26
- 238000013151 thrombectomy Methods 0.000 claims abstract description 34
- 238000013156 embolectomy Methods 0.000 claims abstract description 29
- 230000004323 axial length Effects 0.000 claims abstract description 14
- 238000009941 weaving Methods 0.000 claims description 7
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- 230000007246 mechanism Effects 0.000 description 3
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- 208000020832 chronic kidney disease Diseases 0.000 description 1
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- A61B17/22031—Gripping instruments, e.g. forceps, for removing or smashing calculi
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- A61B17/221—Gripping devices in the form of loops or baskets for gripping calculi or similar types of obstructions
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- A61B17/22031—Gripping instruments, e.g. forceps, for removing or smashing calculi
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- A61B17/22031—Gripping instruments, e.g. forceps, for removing or smashing calculi
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- A61B2017/22038—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for with a guide wire
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- A61B2017/22079—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for with suction of debris
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- A61B17/221—Gripping devices in the form of loops or baskets for gripping calculi or similar types of obstructions
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Abstract
The invention provides a thrombus removal device for a hemodialysis access. It includes: a thrombus taking support and a conveying assembly; the thrombectomy support comprises: the support device comprises N support units, wherein each support unit is a net-shaped support which is large in the middle, gradually reduces towards two ends and is sealed at the two ends; the conveying assembly comprises: the device comprises an outer sheath tube, a pushing tube, an inner tube, a guide head and a suction catheter; the proximal end of the embolectomy support is connected with the distal end of the pushing tube, the inner tube penetrates through the pushing tube and the embolectomy support, the distal end of the inner tube, the distal end of the embolectomy support and the proximal end of the guide head are connected, and the inner tube can axially move relative to the pushing tube to adjust the axial length of the embolectomy support; the push tube can axially move relative to the outer sheath tube, the outer sheath tube is used for accommodating the thrombus removal support in a compressed state, and the thrombus removal support can be released to an expanded state by controlling the outer sheath tube to axially move towards the near end relative to the push tube; the sheath pipe is arranged in the suction catheter in a penetrating way, and the thrombus taking support can be pulled back to the suction catheter when the thrombus taking support is in an expansion state, so that the thrombus taking effect is improved.
Description
Technical Field
The invention relates to the technical field of medical instruments, in particular to a thrombus removal device for a hemodialysis channel.
Background
The stable dialysis access is a life line of a hemodialysis patient with end-stage renal disease, thrombosis secondary to stenosis of an autologous Arteriovenous Fistula (AVF) and an artificial Arteriovenous Fistula (AVG) is the most common complication of the hemodialysis vascular access, the efficiency of hemodialysis is seriously influenced, and blood flow of a large number of patients with uremia is reduced due to the stenosis of the access, and AVF intimal hyperplasia is accompanied with thrombosis, so that the dialysis access needs to be reconstructed if the untimely surgical intervention is not performed, or the life is threatened. At present, the treatment scheme for AVF stenosis with acute thrombosis is intracavity thrombus breaking or surgical thrombus removal, and the AVF reconstruction is required for emergency treatment of patients with unsatisfactory flow after thrombus removal. Therefore, loss of internal fistula work in combination with thrombosis is a difficult point of treatment relative to the narrowing of the dialysis pathway.
The inventor finds that: the traditional Forgarty thrombus taking catheter is used for recanalizing pure acute thrombus, and thrombus taking is incomplete when the Forgarty thrombus taking catheter is applied to a complex outflow tract, so the Forgarty thrombus taking catheter is not suitable for all patients, particularly long-term hemodialysis patients are often accompanied by multiple venous end tumor-like expansion, and a large amount of mural thrombus is in tumor cavities.
Disclosure of Invention
The embodiment of the invention aims to provide a thrombus removal device for a hemodialysis access, aiming at improving thrombus removal effect in a hemodialysis access cavity, effectively preventing broken thrombus from escaping in a thrombus removal process and improving success rate of thrombus removal operation under the condition of avoiding open operation reconstruction.
In order to solve the above technical problem, an embodiment of the present invention provides a thrombus removal device for hemodialysis access, including:
a thrombus taking support and a conveying assembly;
the thrombectomy support is an expandable and contractible support structure, and comprises: n support units, wherein N is a non-zero natural number; when N is larger than 1, the N bracket units are arranged at intervals along the axial direction; each support unit is a net-shaped support with a large middle part, gradually reduced towards two ends and closed two ends;
the delivery assembly comprises: the device comprises an outer sheath tube, a pushing tube, an inner tube, a guide head and a suction catheter;
the near end of the embolectomy support is connected with the far end of the pushing pipe, the inner pipe penetrates through the pushing pipe and the embolectomy support, the far end of the inner pipe, the far end of the embolectomy support and the near end of the guide head are connected, and the inner pipe can axially move relative to the pushing pipe to adjust the axial length of the embolectomy support;
the pushing tube can axially move relative to the outer sheath tube, the outer sheath tube is used for accommodating the embolectomy stent in a compressed state, and the embolectomy stent can be released to an expanded state by controlling the axial and proximal movement of the outer sheath tube relative to the pushing tube;
the sheath tube penetrates through the suction catheter and can move axially relative to the suction catheter, and the embolectomy support can be pulled back into the suction catheter when the embolectomy support is in an expansion state.
In addition, the thrombus taking support is integrally formed by weaving a plurality of weaving wires; the peripheral wall of the thrombus removal support is provided with a dense mesh structure for adhering thrombus.
In addition, the support unit is in a spindle shape or a waist drum shape.
In addition, the holder unit includes: the long conical section and the short conical section are smoothly connected; wherein the short tapered section has an axial length less than an axial length of the long tapered section.
In addition, the embolectomy support comprises a plurality of support units; wherein the long tapered section of the most distal stent unit is adjacently connected to the long tapered section of the stent unit adjacent to the most distal stent unit.
In addition, the embolectomy support comprises a plurality of support units; wherein the long tapered section of the stent unit at the distal-most end is adjacently connected to the short tapered section of the stent unit adjacent to the distal-most end.
Further, a ratio of axial lengths of the long tapered section to the short tapered section is greater than or equal to 1.5 and less than or equal to 2.5.
In addition, when the thrombectomy stent comprises a plurality of stent units, the plurality of braided wires are braided into a mesh structure between adjacent stent units.
In addition, the number of the bracket units is 2 or 3.
In addition, the diameter of the far end of the outer sheath tube is smaller than or equal to the diameter of the near end of the guide head, and the guide head and the outer sheath tube are coaxially arranged.
According to the technical scheme, the invention has at least the following advantages and positive effects:
each support unit of the thrombus removal device for the blood permeable passage is of a filter screen structure which is large in the middle, gradually reduces towards two ends and is closed at two ends, when the thrombus removal support is released to the far end of thrombus, the middle part of each support unit can be attached to the inner wall of a supporting blood vessel to effectively load the thrombus, the filter screen structures closed at two ends of each support unit can well attach and filter the thrombus, and meanwhile, the thrombus removal support can better adapt to different blood vessel diameters by adjusting the axial length of the thrombus removal support, so that the thrombus in the blood permeable passage can be fully removed, and the thrombus removal effect is improved.
Drawings
In order to more clearly illustrate the embodiments of the present invention or the technical solutions in the prior art, the drawings used in the description of the embodiments or the prior art will be briefly introduced below, it is understood that the drawings in the following description are only embodiments of the present invention, and for those skilled in the art, other drawings can be obtained according to the provided drawings without creative efforts.
FIG. 1 is a schematic structural view of a thrombus removal stent of a hemodialysis access thrombus removal device provided by an embodiment of the invention, which is accommodated in an outer sheath;
FIG. 2 is a schematic structural view of the thrombectomy stent of the thrombectomy device according to the embodiment of the present invention after being released;
fig. 3 is a schematic structural view of the thrombectomy stent of the thrombectomy device according to the embodiment of the present invention after being released.
Detailed Description
In order to make the objects, technical solutions and advantages of the embodiments of the present invention more apparent, embodiments of the present invention will be described in detail below with reference to the accompanying drawings. However, it will be appreciated by those of ordinary skill in the art that numerous technical details are set forth in order to provide a better understanding of the present invention in its various embodiments. However, the technical solution claimed in the present invention can be implemented without these technical details and various changes and modifications based on the following embodiments.
In the description of the present application, various terms indicating orientation or positional relationship such as "center", "upper", "lower", "inner", "outer", etc. are used for convenience of description only based on the orientation or positional relationship shown in the drawings, and do not indicate or imply that the referred device or element must have a specific orientation, be constructed in a specific orientation, or be operated, and thus, should not be construed as limiting the present application.
It should be noted that, unless expressly stated otherwise, the terms "connected," "connected," and the like are intended to be inclusive and mean, for example, that they may be fixedly connected, detachably connected, or integrally connected; they may be connected directly or indirectly through intervening media, or they may be interconnected between two elements.
Unless otherwise stated, the proximal and distal ends referred to in the present invention have the same meaning in the orientation, i.e., in the use state, the distal end is the end away from the operator, and the proximal end is the end close to the operator, and the operator controls the hemodialysis access thrombectomy device at the proximal end.
Referring to fig. 1 to 3, an embodiment of the present invention provides a thrombus removal device for a blood permeable passage, which can be used for removing thrombus in a blood vessel cavity of the blood permeable passage. As shown in fig. 1 to 3, the thrombus removal device for a hemodialysis access of the present embodiment mainly includes: a thrombus taking support and a conveying assembly.
The embolectomy support is an expandable and contractible support structure, and comprises: n support units 1, N is a non-zero natural number. When N is greater than 1, N stent units 1 are arranged at intervals in the axial direction. Each support unit 1 is a net-shaped support which is large in the middle, gradually reduces towards two ends and is closed at two ends. Each support unit 1 of the thrombus taking support is of a net-shaped support filtering structure with the middle large, two ends gradually reduced and two ends closed, the middle part of each support unit 1 can be attached to and supported on the inner wall of a blood vessel after expansion, and meanwhile, the net-shaped structure can attach to and filter broken thrombus in the process of pulling back the thrombus taking support, so that the thrombus is fully taken out. The expansion properties of the stent may be formed using a material having shape memory.
The conveying assembly comprises: an outer sheath tube 21, a pushing tube 22, an inner tube 23, a guide head 24 and a suction catheter 25. The proximal end of the embolectomy support is connected with the distal end of the pushing tube 22, the inner tube 23 penetrates through the pushing tube 22 and the embolectomy support, the distal end of the inner tube 23, the distal end of the embolectomy support and the proximal end of the guide head 24 are connected, and the inner tube 23 can axially move relative to the pushing tube to adjust the axial length of the embolectomy support. The push tube 22 is axially movable relative to the outer sheath 21, the outer sheath 21 is configured to receive the thrombectomy stent in a compressed state, and the thrombectomy stent can be released to an expanded state by controlling the axial proximal movement of the outer sheath 21 relative to the push tube 22. The sheath 21 is inserted into the suction catheter 25, axially movable relative to the suction catheter 25, and capable of pulling back the thrombectomy stent into the suction catheter 25 when the thrombectomy stent is in an expanded state.
As shown in fig. 1, the thrombectomy stent is completely accommodated in the outer sheath tube 21, and the outer sheath tube 21 and the guide head 24 form a thrombectomy stent conveying mechanism, so that the thrombectomy stent is conveyed to a thrombectomy position conveniently. Alternatively, the guide head 24 may be a tapered head with a pointed distal end. The diameter of the far end of the outer sheath tube 21 can be equal to the diameter of the near end of the guide head 24, and the guide head 24 and the outer sheath tube 21 are coaxially arranged, so that the far end of the outer sheath tube 21 and the near end of the guide head 24 can be circumferentially aligned, and the blood vessel can be conveniently pushed. It is understood that the diameter of the distal end of the sheath 21 may be slightly smaller than the diameter of the proximal end of the guiding head 24, and is not limited herein.
As shown in fig. 2 and 3, after the thrombectomy stent is conveyed to the thrombectomy position, the thrombectomy stent can be released by retracting the outer sheath 21, and the stent unit 1 of the released thrombectomy stent can expand and cling to and support the inner wall of the blood vessel by means of self-expansion performance. Meanwhile, the near end of the inner tube 23 can freely slide in the push tube 22, and the inner tube 23 can be controlled to axially and relatively move in the push tube 22, so that each support unit 1 of the thrombus removal support can be axially extended or shortened, the radial size of the thrombus removal support can be adjusted, the thrombus removal support can better adapt to the shape of a target lesion blood vessel, and the good support performance can be achieved and the blood vessel wall is not easily damaged. After the thrombus taking stent is completely expanded, the thrombus can be completely carried into the suction catheter 25 to be carried out of the human body by integrally withdrawing the thrombus taking stent and the conveying mechanism thereof into the suction catheter 25. The suction catheter can be used for injecting thrombolytic medicaments for thrombolysis, and meanwhile, the suction catheter can be matched with a negative pressure suction device to suck thrombus in the retraction process of the thrombus taking support so as to prevent emboli from escaping. Therefore, the thrombus taking device can integrate functions of thrombus breaking, thrombus taking, thrombus dissolving and the like, overcomes the problems that the conventional thrombus taking device is not thorough in thrombus taking when applied to a complex outflow tract and only can restore a simple acute thrombus, and can better save a thrombus occlusion vascular access.
The thrombectomy rack may comprise one or more rack units 1. Illustratively, the number of the rack unit 1 may be plural, such as 2 or 3. Each stent unit 1 can adapt to the change of the diameter size of the internal fistula outflow tract blood vessel to keep the adherent state, and the old and subacute thrombus loading capacity to the adherent can be improved.
The stent unit 1 can be made into a spindle shape, so that the stent unit can deform according to the shape of a blood vessel, has strong plasticity, and can be well adapted to the AVF venous outflow tract with tortuosity and tumor-like expansion. When the inner tube 23 axially slides in the push tube 22, the thrombus removal stent can adapt to the shape of a blood vessel by freely stretching and retracting the spindle in the axial direction to adjust the size of the spindle, so that thrombus in the blood vessel with a complex anatomical shape can be removed.
It is worth mentioning that in some examples, the holder unit 1 may also be waist-drum shaped. The waist drum shaped bracket unit can also be well suitable for removing thrombus in the blood vessel with complicated anatomical morphology.
The bracket unit 1 can adopt a central symmetrical structure and can also adopt an asymmetrical structure. For example, the cradle unit 1 may include: a smoothly connected long conical section 11 and a short conical section 12. Wherein the axial length of the short conical section 12 is smaller than the axial length of the long conical section 11. When the embolectomy stent comprises a plurality of stent units 1, the long tapered section 11 of the most distal stent unit 1 is connected adjacent to the long tapered section 11 of the stent unit adjacent to the most distal stent unit 1. The long tapered section 11 is towards the proximal end, which not only provides a larger thrombus containing space, but also helps to reduce the resistance to withdrawing the thrombus support. Alternatively, the long tapered section 11 of the most distal stent unit is connected adjacent to the short tapered section 12 of the stent unit adjacent to the most distal stent unit 1.
Wherein the ratio of the axial lengths of the long conical section 11 and the short conical section 12 is greater than or equal to 1.5 and less than or equal to 2.5. Thereby the thrombus taking support has better deformation plasticity.
The thrombus removal support can be integrally formed by weaving a plurality of weaving wires. The braided wire can be made of alloy wire with shape memory capability, such as nitinol wire. However, the stent may be formed by co-weaving an alloy wire and a polymer wire having a shape memory ability. The plurality of knitting wires can be in a forward and reverse spiral structure and are interlaced to form one or more support units. When the thrombus removal support comprises a plurality of support units, a plurality of knitting wires are knitted between adjacent support units 1 to form a mesh tube structure, and the inner tube 23 is arranged in the mesh tube in a penetrating manner. The peripheral wall of the thrombus taking bracket is provided with a dense mesh structure for attaching thrombus. The fusiform dense net weaving framework of the thrombus taking support can be adaptive to the shape of a blood vessel and deform to be attached to the blood vessel wall, thrombus can be removed when the thrombus taking support is withdrawn, and meanwhile, the structure of the whole dense net can remove the thrombus and does not block the smoothness of blood flow. The mesh structure of the circumferential wall of the embolectomy stent can be diamond-shaped or other polygons.
The method of using the hemodialysis access thrombus removal device of the present embodiment with reference to fig. 1 to 3 is as follows:
in the operation, a conveying mechanism of the thrombus taking bracket loaded with the outer sheath tube 21 and the like of the thrombus taking bracket is pushed along the suction catheter 25 until reaching the target lesion part, the outer sheath tube 21 is withdrawn to release the thrombus taking bracket, the shape memory performance of the thrombus taking bracket is utilized to adapt to the diameter of the target lesion blood vessel cavity to be attached to the inner wall of the supporting blood vessel, then the outer sheath tube and the thrombus taking bracket are withdrawn towards the near end integrally to pull the thrombus to the suction catheter, and simultaneously the negative pressure suction of the suction catheter is matched to withdraw the thrombus taking bracket into the suction catheter, and finally the thrombus in the blood vessel is removed to the outside.
Based on the technical scheme, the invention at least has the following advantages and positive effects:
aiming at the complexity of clearing thrombus in a dialysis access, the hemodialysis access thrombus taking device provided by the embodiment of the invention adopts a fusiform reticular filtering support structure with a large middle part, two closed ends and the like, can deform according to the shape of a blood vessel, and has strong plasticity, so that the hemodialysis access thrombus taking device can be well adapted to AVF venous outflow tracts which are circuitous and expanded like tumors; in addition, the thrombus taking bracket adopts a dense mesh design, so that thrombus can be better attached to the bracket; meanwhile, the suction catheter of the thrombus taking device can be matched with the negative pressure suction device to suck thrombus, so that the escape of embolus can be reduced in the process of taking out the bracket, the acute thrombus in the AVF can be better cleared, the success rate of thrombus taking operation is improved, and a patient can benefit.
It will be understood by those of ordinary skill in the art that the foregoing embodiments are specific examples for carrying out the invention, and that various changes in form and details may be made therein without departing from the spirit and scope of the invention in practice.
Claims (10)
1. A hemodialysis access thrombectomy device, comprising: a thrombus taking support and a conveying assembly;
the thrombectomy support is an expandable and contractible support structure, and comprises: n support units, wherein N is a non-zero natural number; when N is larger than 1, the N bracket units are arranged at intervals along the axial direction; each support unit is a net-shaped support with a large middle part, gradually reduced towards two ends and closed two ends;
the delivery assembly comprises: the device comprises an outer sheath tube, a pushing tube, an inner tube, a guide head and a suction catheter;
the near end of the embolectomy support is connected with the far end of the pushing pipe, the inner pipe penetrates through the pushing pipe and the embolectomy support, the far end of the inner pipe, the far end of the embolectomy support and the near end of the guide head are connected, and the inner pipe can axially move relative to the pushing pipe to adjust the axial length of the embolectomy support;
the pushing tube can axially move relative to the outer sheath tube, the outer sheath tube is used for accommodating the embolectomy stent in a compressed state, and the embolectomy stent can be released to an expanded state by controlling the axial and proximal movement of the outer sheath tube relative to the pushing tube;
the sheath tube penetrates through the suction catheter and can move axially relative to the suction catheter, and the embolectomy support can be pulled back into the suction catheter when the embolectomy support is in an expansion state.
2. The thrombus removal device according to claim 1, wherein the thrombus removal support is integrally formed by weaving a plurality of woven wires; the peripheral wall of the thrombus removal support is provided with a dense mesh structure for adhering thrombus.
3. The hemodialysis access thrombectomy device of claim 2, wherein the scaffold unit is spindle-shaped or waist-drum-shaped.
4. The hemodialysis access thrombectomy device of claim 2, wherein the rack unit comprises: the long conical section and the short conical section are smoothly connected; wherein the short tapered section has an axial length less than an axial length of the long tapered section.
5. The hemodialysis access thrombectomy device of claim 4, wherein the thrombectomy rack comprises a plurality of rack units; wherein the long tapered section of the most distal stent unit is adjacently connected to the long tapered section of the stent unit adjacent to the most distal stent unit.
6. The hemodialysis access thrombectomy device of claim 4, wherein the thrombectomy rack comprises a plurality of rack units; wherein the long tapered section of the stent unit at the distal-most end is adjacently connected to the short tapered section of the stent unit adjacent to the distal-most end.
7. The hemodialysis access thrombectomy device of any one of claims 4-6, wherein the ratio of the axial length of the long conical section to the short conical section is greater than or equal to 1.5 and less than or equal to 2.5.
8. The hemodialysis access thrombectomy device of claim 2, wherein when the thrombectomy stent comprises a plurality of stent units, the plurality of braided wires are braided into a mesh structure between adjacent stent units.
9. The hemodialysis access thrombectomy device of claim 2, wherein the number of the rack units is 2 or 3.
10. The hemodialysis access thrombectomy device of claim 1, wherein the distal diameter of the outer sheath is less than or equal to the proximal diameter of the guide head, and the guide head is coaxially disposed with the outer sheath.
Priority Applications (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CN202111362091.XA CN113907836A (en) | 2021-11-17 | 2021-11-17 | Thrombus taking device for hemodialysis access |
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| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CN202111362091.XA CN113907836A (en) | 2021-11-17 | 2021-11-17 | Thrombus taking device for hemodialysis access |
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| CN113907836A true CN113907836A (en) | 2022-01-11 |
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| Application Number | Title | Priority Date | Filing Date |
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| CN202111362091.XA Pending CN113907836A (en) | 2021-11-17 | 2021-11-17 | Thrombus taking device for hemodialysis access |
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| CN114469260A (en) * | 2022-01-14 | 2022-05-13 | 北京久事神康医疗科技有限公司 | Suction-matched embolectomy support and embolectomy system with same |
| CN114469261A (en) * | 2022-02-11 | 2022-05-13 | 科塞尔医疗科技（苏州）有限公司 | Mechanical thrombus suction device |
| CN115530924A (en) * | 2022-09-21 | 2022-12-30 | 上海恩盛医疗科技有限公司 | Thrombus taking device |
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| CN116269649A (en) * | 2023-03-29 | 2023-06-23 | 北京氧富医疗科技有限公司 | Vascular thrombus clearing device |
| CN116327318A (en) * | 2023-05-30 | 2023-06-27 | 北京久事神康医疗科技有限公司 | Novel thrombus taking device |
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| CN114469261B (en) * | 2022-02-11 | 2024-05-03 | 科塞尔医疗科技（苏州）有限公司 | Mechanical thrombus suction device |
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| CN117137578A (en) * | 2022-11-01 | 2023-12-01 | 上海珩畅医疗科技有限公司 | Thrombolysis device, thrombus treatment device and using method thereof |
| CN117137578B (en) * | 2022-11-01 | 2024-04-23 | 上海珩畅医疗科技有限公司 | Thrombolysis device, thrombus treatment device and using method thereof |
| CN116269651B (en) * | 2022-12-06 | 2023-10-10 | 杭州亿科医疗科技有限公司 | Prevent that thrombus extraction net from releasing in advance's thrombus extraction device |
| CN116269651A (en) * | 2022-12-06 | 2023-06-23 | 杭州亿科医疗科技有限公司 | Prevent that thrombus extraction net from releasing in advance's thrombus extraction device |
| CN116269649A (en) * | 2023-03-29 | 2023-06-23 | 北京氧富医疗科技有限公司 | Vascular thrombus clearing device |
| CN116269968B (en) * | 2023-05-24 | 2023-09-26 | 北京久事神康医疗科技有限公司 | Vascular stent conveying system |
| CN116269968A (en) * | 2023-05-24 | 2023-06-23 | 北京久事神康医疗科技有限公司 | Vascular stent conveying system |
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