Vascular wound closure system
Abstract
This record has no abstract on file.
Term
Term ended
Expired 5 December 2017, 8.8 years ago.
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38 claims: 5 independent, 33 dependent
- 1患者の血管構造において創傷を閉じ易くする装置であって、該患者の血管構造において創傷を閉じ易くする装置は、引っ込め部分に連結されたボディ部分を含み、前記引っ込め部分は、前記ボディ部分から延びる2つの移動可能な半体を有し、該2つの半体は、前記ボディ部分を介して互いに連結されており、かつ、互いに対して移動可能であり、前記2つの半体は、該2つの半体が互いに概して隣接して位置決めされるときに、前記引っ込め部分を通して完全に延びるチャンネルを形成し、前記ボディ部分に連結された制御部分をさらに含み、該制御部分は、互いに対して移動可能な2つの把手を備え、該把手および前記引っ込め部分の半体は、前記2つのハンドルの相対移動により前記引っ込め部分の2つの半体の相対移動を制御するように構成されており、開放近位端部と、開放遠位端部と、インジケータ穴とを有する中空拡張器をさらに含み、前記インジケータ穴は、前記近位端部と前記遠位端部との間の中空拡張器の外壁を通して形成されており、前記インジケータ穴は、血液を中空拡張器内に流入させることによって中空拡張器が血管構造内に挿入されたことを示すようになっており、前記中空拡張器は、前記装置の前記引っ込め部分の前記チャンネル内に嵌合され、前記移動可能な半体の遠位端がインジケータ穴の近位側に近接して配置されるように構成されていることを特徴とする患者の血管構造において創傷を閉じ易くする装置。
- 2前記制御部分は、前記2つの把手の相対位置を選択的に係止するように構成された係止機構を含むことを特徴とする請求項1に記載の装置。
- 3前記係止機構は、他方の把手に取り付けられたねじを取り囲む一方の把手から延びるループを備えることを特徴とする請求項2に記載の装置。
- 4前記移動可能な半体は、前記ボディ部分と実質的に垂直であることを特徴とする請求項2に記載の装置。
- 5前記中空拡張器は、該中空拡張器および前記近位端部および遠位端部を通って延びるようにガイドワイヤを受け入れるようになっていることを特徴とする請求項1に記載の装置。
- 6前記中空拡張器は、二重内腔カテーテルを備え、前記開放近位端部および開放遠位端部は、前記二重内腔カテーテルの第1の内腔に形成されており、前記インジケータ穴は、第2の内腔に開口していることを特徴とする請求項5に記載の装置。
- 7前記第2の内腔は、前記第1の内腔を実質的に取り囲んでいることを特徴とする請求項6に記載の装置。
- 8前記第2の内腔と流体連通している負圧源をさらに含む請求項6に記載の装置。
- 9前記負圧源は、注射器よりなることを特徴とする請求項8に記載の装置。
- 10前記ボディ部分は、金属でできていることを特徴とする請求項1に記載の装置。
- 11前記ボディ部分は、生体適合性工学ポリマーよりなることを特徴とする請求項1に記載の装置。
- 12前記ポリマーはポリプロピレン、ポリエチレンまたはポリテレフタレートよりなる群から選択されたものであることを特徴とする請求項11に記載の装置。
- 13前記拡張器は、その外面上にストッパを備え、該ストッパは、大腿動脈の壁の厚さと少なくともほぼ同じ距離だけインジケータ壁の近位側に配置されており、前記引っ込め部分の移動可能な半体の遠位端は前記ストップに配置されることを特徴とする請求項2に記載の装置。
- 14前記インジケータ穴を取り囲む拡張器の外面が持ち上がっており、前記インジケータ穴と、前記持ち上がった面の近位端との間の距離が、動脈壁の厚さと少なくとも同じであることを特徴とする請求項13に記載の装置。
- 15前記拡張器は、前記インジケータ穴の近位側に位置決めされた膨らまし可能なバルーンを含むことを特徴とする請求項1に記載の装置。
- 16前記バルーンは、動脈壁の厚さと少なくとも同じ距離だけ前記インジケータ穴から間隔を隔てて配置されていることを特徴とする請求項15に記載の装置。
- 17前記拡張器は、前記インジケータ穴の遠位側に配置された第2の膨らまし可能なバルーンをさらに含むことを特徴とする請求項16に記載の装置。
- 18前記拡張器は、該拡張器の外壁に取り付けられた圧力センサを含むことを特徴とする請求項1に記載の装置。
- 19前記半体の近位端部上に嵌まるようになっているキャップをさらに含むことを特徴とする請求項1に記載の装置。
- 20前記拡張器は、前記インジケータ穴の近位側に切欠きを含み、該切欠きは、前記半体の遠位端部を受け入れるようになっていることを特徴とする請求項1に記載の装置。
- 21患者の血管構造において創傷を閉じ易くする装置であって、遠位のボディ部分と、近位の把手部分と、を備えたリトタクタを含み、前記ボディ部分から延びている2つの分離可能な引っ込め部分を含み、該2つの分離可能な引っ込め部分は、開放位置と閉鎖位置との間で互いに対して移動するようになっており、前記2つの分離可能な引っ込め部分は、閉鎖位置にあるときに、これらの2つの引っ込め部分の間にチャンネルを形成し、前記把手部分は、少なくとも2つの把手を備え、該少なくとも2つの把手は、互いに対して移動可能であり、該把手の相対移動によって、開放位置と閉鎖位置との間での前記引っ込め部分の相対移動を制御するようになっており、前記チャンネルに挿通されるのに適したカテーテルをさらに含み、該カテーテルは、該カテーテルの近位端部から遠位端部まで延びる内腔を有しており、該内腔は、該内腔を通してガイドワイヤを受け入れるようになっており、インジケータ穴が、前記近位端部と前記遠位端部との間の中空拡張器の外壁を通して形成されており、前記インジケータ穴は、該インジケータ穴を含むカテーテルの部分が患者の血管構造内に挿入されたときに血液を中空拡張器内に流入させるようになっており、インジケータ穴の近位側のカテーテルの外面上にストッパが形成されており、前記インジケータ穴と前記ストッパとの間の距離は、大腿動脈の壁の厚さと少なくともほぼ同じであり、前記引っ込め部分の遠位端部は、前記インジケータ穴が患者の血管構造に入ったときに、前記引っ込め部分の遠位端部が血管創傷の近位側にあるように前記ストッパあるいはその近くに配置されることを特徴とする患者の血管構造において創傷を閉じ易くする装置。
- 22前記ストッパは、前記インジケータ穴を取り囲むカテーテルの外面の上昇部分よりなり、該上昇表面部分の近位端は、大腿動脈の壁の厚さと少なくとも同じである距離に配置されていることを特徴とする請求項21に記載の装置。
- 23前記内腔は、負圧源に取り付けられていることを特徴とする請求項21に記載の装置。
- 24前記カテーテルは、第1の内腔と、第2の内腔とを備え、前記第1の内腔は、前記ガイドワイヤを摺動可能に収容するようになっており、前記第2の内腔は、前記インジケータ穴と連通していることを特徴とする請求項21に記載の装置。
- 25前記第2の内腔が、前記負圧源に取り付けられていることを特徴とする請求項24に記載の装置。
- 26前記第2の内腔は、前記第1の内腔を同心的に取り囲んでいることを特徴とする請求項24に記載の装置。
- 27前記カテーテルの外壁を通して延び、前記第2の内腔に開口している第2のインジケータ穴をさらに備え、該第2のインジケータ穴は、前記カテーテルの遠位端から第1のインジケータ穴と実質的に同じ距離に配置されていることを特徴とする請求項26に記載の装置。
- 28前記把手部分は、前記2つの把手の間の距離を制御するように構成された係止機構を備えることを特徴とする請求項21に記載の装置。
- 29遠位端部を有する外科クリップアプリケータをさらに含み、該外科クリップアプリケータの遠位端部には、2つの横方向に突出した羽根が取り付けられており、該羽根は、前記リトタクタの前記ボディ部分のチャンネル内に嵌まるようになっていることを特徴とする請求項21に記載の装置。
- 30前記外科クリップアプリケータは、その前記遠位端部に取付けられてそこから横方向に延びるガイドを備えており、該ガイドは前記ガイドワイヤを受入れるようになっていることを特徴とする請求項29に記載の装置。
- 31前記引っ込め部分は、細長く、前記ボディ部分から遠くへ角度をなして延びていることを特徴とする請求項21に記載の装置。
- 32前記把手は、前記ボディ部分に連結されていることを特徴とする請求項21に記載の装置。
- 33前記把手は、互いに連結されていることを特徴とする請求項32に記載の装置。
- 34患者の血管構造において創傷を閉じ易くする装置であって、開放近位端部および開放遠位端部を有する中空カテーテルであって、該中空カテーテルを通してガイドワイヤを受け入れるようになっている中空カテーテルを含み、インジケータ穴が、前記近位端部と前記遠位端部との間の中空カテーテルの外壁を通して形成されており、前記インジケータ穴は、該インジケータ穴を含むカテーテルの部分が患者の血管構造内に挿入されたときに血液を中空カテーテル内に流入させるようになっており、近位端部および遠位端部を有するボディ部分を備えたリトラクラをさらに含み、前記ボディ部分は2つの半体を有し、該半体の各々は、溝が形成された内面を有し、それによって、前記内面が互いに当接しているときに、前記溝は、前記近位端部から前記遠位端部まで前記ボディ部分を通して完全に延びるチャンネルを形成し、キャップをさらに含み、該キャップは、該キャップを通して形成された穴を有し、該キャップの穴が前記チャンネルと連通することができるように前記ボディ部分の近位端部に選択的に係合するように構成されている、患者の血管構造において創傷を閉じ易くする装置において、前記チャンネルおよび穴は、これらに挿通されるカテーテルを受け入れるように構成されており、前記リトラクタの半体は、前記ボディ部分の遠位端部が前記インジケータ穴の近位側に患者の血管の厚さと少なくともほぼ同じ距離のところに配置されるようにカテーテルの周囲に配置されることを特徴とする患者の血管構造において創傷を閉じ易くする装置。
- 35前記キャップが雌ねじを備え、前記リトタクタのボディ部分が雄ねじを備え、前記キャップが前記リトタクタのボディ部分上に螺合されることを特徴とする請求項34に記載の装置。
- 36前記リトタクタのボディ部分が遠位端部に向かって全体的にテーパしていることを特徴とする請求項34に記載の装置。
- 37前記リトタクタのボディ部分が把手を備えることを特徴とする請求項36に記載の装置。
- 38前記リトタクタのボディ部分が前記把手の遠位側でテーパしていることを特徴とする請求項37に記載の装置。
Independent claims38
1 paragraph, as filed
<u style="single">Field of invention</u>The present invention relates to a device that assists in closing a puncture wound or other wound in a patient's vascular structure. In particular, the invention locates the wound in the vascular structure, isolates the wound, guides a suitable wound closure device to that location, and closes the wound using a surgical clip, thread or staple. Regarding subsidized vascular wound closure devices.<u style="single">Background of the invention</u>Transluminal balloon angioplasty is used to treat peripheral angioplasty that increases or restores blood flow through significantly narrowed arteries in the limbs. It is also used to treat occlusion of coronary arteries. In fact, coronary angiogenesis has emerged as a major viable modification to bypass surgery for vascular renewal of stenotic and occluded coronary arteries. Unlike bypass surgery, angioplasty does not require general anesthesia, chest wall opening, cardiopulmonary machine use, or blood transfusion. Angioplasty is not only less invasive or traumatic to the patient, but also less expensive due to the shorter hospital stay and shorter recovery time. Transluminal balloon angioplasty is performed by first inserting a hollow needle through the skin and then into the femoral artery of the patient. The guide wire is advanced into the artery through a hollow needle and then along the patient's vascular structure towards the occluded vessel or ventricle to be treated. X-ray image formation is used to help move the guide wire through the vascular system to just past the stenosis to be treated. The balloon catheter is then passed over the guide wire and the balloon catheter is advanced until the contraction balloon is within the stenosis. The balloon is then repeatedly inflated to widen the narrowed blood vessels. After the procedure is complete, the catheter and guidewire are removed from the vessel and patient. Angiography, which is used to detect diseases that alter the appearance of blood vessels, is performed in a similar manner. First, a hollow needle is inserted through the skin and inserted into the femoral artery, and then a guide wire is inserted through the needle and inserted into the affected blood vessel. The catheter is then passed over a guide wire using radiography to guide the catheter to the desired location and inserted into the vessel to be examined. A contrast medium is then injected and a rapid radiograph is taken so that the blood flow along the affected blood vessel can be examined. Upon completion, the catheter and guidewire are removed from the patient's body. The catheter and guidewire used during angioplasty or angiography were removed Later, the puncture wound in the femoral artery must be closed to stop bleeding from the puncture site in the artery. Currently, ice packs and pressure are applied to the arteries for a period of several hours in an attempt to stop bleeding. However, as the patient moves, there is a significant risk that the wound will reopen and begin to bleed again. Efforts have been made to close the puncture wound using staples, clips and sewing threads, but these efforts are primarily to clearly locate and visualize the puncture wound in the femoral artery. It didn't work because I couldn't do it. It is also difficult to locate and approach other wounds in the patient's vascular structure. Thus, devices and methods that facilitate closure of wounds in a patient's vascular structure, such as femoral artery puncture wounds, according to intraluminal balloon angioplasty and angiography are extremely advantageous. Devices capable of locating puncture wounds and assisting in closing the wound using staples, clips or sewing threads currently eliminate the long-term bleeding associated with such wounds.<u style="single">Outline of the invention</u>The wound closure device of the present invention helps to locate and isolate a puncture wound in a patient's vascular structure. This device is used in conjunction with guide wires that are normally inserted into the vascular structure during diagnostic and therapeutic procedures. The device of the present invention assists the physician in closing the wound and thus eliminates the long-term bleeding associated with these procedures. According to one feature of the present invention, there is provided a device that facilitates closing a wound in the femoral artery. This retractor has a separable body part in two halves, each of which has a flat inner surface with a groove, and when the inner surfaces abut against each other, the groove passes through the entire length of the body part. It is designed to form a channel. The retractor has a collar portion at one end having at least one guide passage that crosses both halves of the body portion, and has at least one pin that can be inserted into the guide passage. A handle extends laterally from the pin to allow the user to easily operate the device. At least one set screw hole should be provided in the collar portion at right angles to the guide passage and at least one set screw should be inserted into the set screw hole to secure the device to the pin. The device is preferably made of a biocompatible engineering polymer such as polypropylene, polyethylene or polyterephthalate. As a modification, elastomers or metals can also be used to manufacture the device. Preferably, a hollow dilator that is designed to accept the guide wire is used in collaboration with the retractor. The dilator is inserted into a channel in the body portion of the retractor and extends beyond the distal end of the retractor. The dilator preferably has at least one indicator hole positioned at its distal end, which extends beyond the end of the dilator. The dilator has an inflatable balloon with a double sleeve located at the distal end just proximal to the indicator hole and a second inflatable balloon located just distal to the indicator hole. Have. These balloons hold the dilator in place and contact the puncture wound through the indicator hole. Help to get closer. Guide wires are used to guide the insertion of the dilator. The guide wire is inserted through the hollow dilator and the dilator is advanced along the guide wire to its proper position. Another feature of the invention is a device for facilitating wound closure in a patient's vascular structure. This device has a retractor as described above, a hollow dilator that is adapted to accept the guide wire, and a guide wire. The guide wire is inserted through the dilator and the dilator is routed through the retractor channel. Preferably, a guide assembly is used that is designed to be reversibly attached to the surgical clip applicator. This guide assembly accepts the guide wire and helps guide the clip applicator to the puncture site. The dilator preferably has a negative pressure source connected to a hollow dilator at its proximal end in a fluid communication state. This negative pressure source may be a syringe or any other suitable source. It also describes how to facilitate wound closure in the patient's vascular structure. First, the guidewire is inserted through the wound into the patient's vascular structure until the distal end of the guidewire is within the vascular structure and the proximal end remains outside the patient's body. The proximal end of the guide wire is inserted into the distal end of a hollow dilator having a double-sleeved balloon and a second balloon distal to the double-sleeved balloon. Advance the dilator along the guide wire until it reaches the wound. Inflate the balloon to secure the dilator in place and insert the proximal end of the dilator into the distal end of the retractor. Advance the retractor between the two sleeves of the double-sleeved balloon. The two halves of the retractor are separated and the dilator and the inner sleeve of the double-sleeved balloon are removed from the patient. Using the retractor and the outer sleeve of the balloon as a guide, approach the wound and close the wound by means such as clipping, stapling or sewing. Preferably, it is placed at the proximal end of the negative pressure source dilator during insertion until blood is sucked from the vascular structure into the dilator. This helps the user determine when to properly position the dilator. A hollow indicator tube provided in the surgical clip applicator is preferably used to close the wound. Advance the applicator along the guide wire through the retractor channel until it touches the wound. To aid in proper insertion, a negative pressure source is provided at the proximal end of the indicator tube until blood is drawn from the vascular structure into the indicator tube. In yet another embodiment of the retractor used to facilitate wound closure, the retractor has a body portion and a handle portion. The body portion has a retracted portion at its distal end, which retracted portion has two movable halves extending away from the body portion. The halves are formed so that their inner surfaces are in contact with each other, forming channels that extend completely through the retracted portion. The handle part is connected to the body part and controls the movement of the two movable halves. Preferably, the handle portion comprises two handles and a loop extending from one handle to the other. This loop surrounds a screw on the other handle. This locking mechanism acts to secure the position of the handle and the retracted portion of the retractor. Hollow catheters with open proximal and open distal ends that are designed to receive through guide wires are used in conjunction with the retractor. A hollow catheter is inserted through the retractable channel of the retractor. The catheter is preferably a double-chamber catheter having an medial lumen that is adapted to receive guidewires and a soothing lumen that surrounds the medial lumen. The lateral lumen has at least one indicator hole positioned in the lateral wall for aspiration of blood through it. This helps position the catheter within the patient's body. Retractors and double lumen catheters are used as follows. The retractor is approximately 0. Behind the indicator hole located on the outer wall of the catheter. It is located 5 mm outside the distal end of the catheter. As a result of the diagnostic or therapeutic procedure, the proximal end of the waiya, which is already in place for the patient, is inserted into the distal end of the medial lumen of the double lumen catheter, with the catheter and retractor as a single unit. Advance along the guide wire. Preferably, a negative pressure source is provided at the proximal end of the lateral lumen of the dual lumen catheter during advancing. As soon as blood is sucked into the outer lumen through the indicator hole, it stops the catheter and retractor from advancing. The wound is then exposed by separating the two halves of the retracted area, the catheter and guidewire are removed, and the wound is closed. In addition, it is advisable to use a second catheter with an inflatable balloon at the distal end. If the retractor and double lumen catheter are in place, the guidewire is removed from the patient through the medial lumen of the double lumen catheter. An medial catheter with an inflatable balloon provided at the distal end is inserted into the patient through the medial lumen of the double lumen catheter. Once inside the vascular structure, the balloon is inflated and pulled proximally until resistance is struck. This helps to secure the catheter in place as well as stop bleeding during wound closure. The double lumen catheter is removed and the medial catheter is used to guide the closure device to the wound. Finally, take out the retractor. The present invention advantageously provides a simple safety method that facilitates closure of a wound in a patient's vascular structure, and a device that facilitates this method. Retractors used in collaboration with guidewires, dilators or catheters help identify and isolate the patient's puncture wound. When the retractor is advanced into the patient, it moves the surrounding tissue laterally, acting as a guide for the doctor to find the exact location of the wound. The retractor is preferably used in combination with a surgical clip applicator that delivers the clip to the wound site, but can also be used with other wound closure methods such as thread fastening and staple fastening. The present invention relates to current cardiac diagnostic and therapeutic procedures.<u style="single">[Simple explanation of drawings]</u>FIG. 1 is a side view of a part of the human body showing a portion of a thigh artery that is typically approached and stabbed during angioplasty and angiography. FIG. 2 is a perspective view of an embodiment of the wound closing device of the present invention. FIG. 3 is an exploded perspective view of the wound closing device of the present invention. Figure 4 shows a thigh artery approached via a hollow needle and a guide wire fitted with an inflatable balloon and inserted into the thigh artery through the hollow needle. It is a cross-sectional view of a part. FIG. 5 is a side view of the distal end of a surgical clip applicator used in conjunction with the wound closure device of the present invention. Figure 6 positions the guide wire to show the arteries in the thigh, a cross-sectional view of a portion of the human body, and a guide with the distal tip at the site of the arterial puncture in the thigh. It is a perspective view of the retractor of this invention positioned on a wire. FIG. 7 is a side view of the retractor with the cap removed and the surgical clip applicator inserted into the groove in the retractor. Figure 8 is the crossing cotton of the clip applicator and retractor along line 8-8 of Figure 7. FIG. 9 is a perspective view of another embodiment of the femoral artery closure device according to the present invention. FIG. 10 is an exploded perspective view of another embodiment of the femoral artery closure device shown in FIG. FIG. 11 is a side view of the two halves of the retractors of FIGS. 9 and 10 with the dilator inserted slightly separated. FIG. 12 is a cross-sectional view of the distal end of the retractor through which the dilator and guide wire are inserted. FIG. 13 is a side view of the components of the femoral artery localized / closed assembly. FIG. 14 is a side view of two halves of a retractor with a surgical clip applicator that is slightly separated and has an applicator guide and a guide wire inserted. FIG. 15 is a top view of the surgical clip applicator guide of the present invention. FIG. 16 is a side view of the clip applicator guide through which the guide wire is inserted. FIG. 17 is an enlarged perspective view of an dilator with a removable double-sleeved balloon at the distal end. Figure 18 shows the balloon with the sleeve inflated. It is an enlarged perspective view of the dilator of FIG. FIG. 19 is an enlarged perspective view of the dilator of FIG. 18 having a retractor inserted between the sleeves of the balloon. FIG. 20 shows a tunnel formed by the retractor and the outer sleeve of the balloon, and is an enlarged perspective view of the dilator and the retractor in FIG. 19 with the dilator removed. FIG. 21 is a perspective view of another specific example of the retractor according to the present invention. FIG. 22 is an exploded perspective view of another specific example of the retractor shown in FIG. 21. FIG. 23 is a perspective view of another specific example of the dilator provided with the double-sleeved balloon and the distal balloon according to the present invention. FIG. 24 is a top view of another specific example of a balloon with a double sleeve showing an l-shaped inner sleeve. FIG. 25 is a perspective view of another specific example of the dilator of FIG. 23 showing an inflated balloon. FIG. 26 is a cross-sectional view of the dilator of the present invention showing various lumens in the dilator. FIG. 27 is a side view of the distal end of a surgical clip applicator with an indicator tube. FIG. 28 is a perspective view of another specific example of the retractor of the present invention shown in the closed position. FIG. 29 is a perspective view of another specific example of the retractor of the present invention shown in the open position. FIG. 30 is a side view of the double lumen indicator tube of the present invention having a guide wire inserted into the central lumen. FIG. 31 is a side view of the double lumen indicator tube of the present invention provided with a retractor. It is a top view of another specific example of a balloon with a balloon. FIG. 25 is a perspective view of another specific example of the dilator of FIG. 23 showing an inflated balloon. FIG. 26 is a cross-sectional view of the dilator of the present invention showing various lumens in the dilator. FIG. 27 is a side view of the distal end of a surgical clip applicator with an indicator tube. FIG. 28 is a perspective view of another specific example of the retractor of the present invention shown in the closed position. FIG. 29 is a perspective view of another specific example of the retractor of the present invention shown in the open position. FIG. 30 is a side view of the double lumen indicator tube of the present invention having a guide wire inserted into the central lumen. FIG. 31 is a side view of the double lumen indicator tube of the present invention provided with a retractor. It is a top view of another specific example of a balloon with a balloon. FIG. 25 is a perspective view of another specific example of the dilator of FIG. 23 showing an inflated balloon. FIG. 26 is a cross-sectional view of the dilator of the present invention showing various lumens in the dilator. FIG. 27 is a side view of the distal end of a surgical clip applicator with an indicator tube. FIG. 28 is a perspective view of another specific example of the retractor of the present invention shown in the closed position. FIG. 29 is a perspective view of another specific example of the retractor of the present invention shown in the open position. FIG. 30 is a side view of the double lumen indicator tube of the present invention having a guide wire inserted into the central lumen. FIG. 31 is a side view of the double lumen indicator tube of the present invention provided with a retractor.<u style="single">Detailed description of preferred embodiments</u><u style="single">Preface</u>Although the following description details the closure of puncture wounds in the femoral artery, the present invention is not limited to use only in the femoral artery. Rather, the description below is merely exemplary and one of ordinary skill in the art could readily modify the method described below to be used for other types of wounds to the vascular system. First, referring to FIG. 1, a side view of a part of the human body showing a portion 5 where the femoral artery 10 is typically approached and stabbed during angioplasty or angiography is shown. During these procedures, a hollow needle 15 is first inserted through the skin into the femoral artery 10. The guide wire 20 is then inserted into the artery 10 through the proximal end of the hollow needle 15 and the needle 15 is withdrawn from the patient, as shown in FIG. X-ray imaging is often used to advance the guidewire 20 through the patient's vascular structure to help direct the guidewire 20 to the desired position. When the guide wire 20 is in the desired position, the catheter is used. The proximal end of the guide wire 21 is inserted into the distal end of the catheter and the catheter is passed over the guide wire 20 and advanced to the desired position. For angioplasty, the catheter has an inflatable balloon attached to the distal end. When in place within the stenosis, the balloon is repeatedly inflated and stenotic to widen the narrowed blood vessels. In the case of angiography, a catheter is passed along the guide wire 20 into the blood vessel to be examined, as described immediately above. A contrast medium is then injected and a rapid radiograph is taken so that the blood flow along the affected blood vessels can be examined. After completing any of these procedures, the catheter and guidewire 20 are removed from the blood vessel and the patient. The puncture wound 25 of the femoral artery 10 caused by the insertion of the hollow needle 15, the guide wire 20 and the catheter must be closed to stop bleeding through the puncture site 25 of the artery 10.<u style="single">Retractor configuration</u>A retractor 30 is used to facilitate closing of the wound 25 of the femoral artery 10. The retractor 30 includes a body portion 35 and a cap 40, as shown in FIGS. 2 and 3. The body 35 of the retractor 30 has a narrow tapered distal end 37 and a wide circular proximal end 41. The device 30 has two handles 43, 45 positioned on the body 35, one for each half body 35a, 35b. The handles 43 and 45 are positioned approximately one-third from the proximal end 41 of the retractor 30 and extend laterally from the body of the retractor 35. These handles 43, 45 help the user handle the device 30. The retractor 30 also has a circular cap 40 with a hole 47 at the proximal end 41. This hole 47 extends into channel 50, which extends over the entire length of device 30. As shown in FIG. 3, the cap 40 and the body 35 of the retractor 30 consist of three separable pieces, the cap part 40 and the two halves 35a and 35b of the body part. The removable cap 40 has a female screw 55. The proximal ends 39 of the two halves 35a and 35b of the body are male threads 60 that allow the cap 40 to be removed and accepted. Each half of the body of the retractor, 35a, 35b, has a semi-circular groove 65 on its flat inner surface 67. When the cap 40 is screwed firmly into both halves 35a and 35b of the body as shown in FIG. 2, the three pieces are joined together and the semicircular groove 65 forms a channel 50 extending through the interior of the device 30. However, this channel 50 begins at the hole in the cap 47 at the proximal end 41 and continues through the body 35, at the distal end 37 of the retractor 30 where both halves 35a, 35b of the body meet. It ends with a small hole 49. When the cap 40 is removed from the body 35, both halves 35a and 35b of the body can be moved in directions away from each other as shown in FIG.<u style="single">Another example of a retractor</u>Other suitable examples of the present invention are shown in FIGS. 9 and 10. In this embodiment, the retractor 100 has a retracting mechanism that allows the two halves 102a and 102b of the retractor body 102 to move away from each other by a desired distance while maintaining their alignment. it can. The retractor also includes a body portion 102 and an annular cap 104. Both halves 102a and 102b of the body are initially held together by a female thread 105 cap 104. The cap 104 is screwed on and removed from the male threaded halves 102a and 102b of the retractor body. The outer surface of the cap 106 is configured to facilitate manual tightening and loosening of the cap 104. As shown in FIG. 10, each half body 102a, 102b of the retractor body has a semicircular groove 128 extending downward in the length direction from the center of its flat inner surface 128. When the cap 104 is firmly screwed onto both halves 102a, 102b of the retractor body so that the inner surfaces 128 abut against each other, the semicircular groove 126 forms the channel 108. The cap 104 is open at both ends through its center so that it can approach channel 108. In addition, the retractor 100 has a collar 110 positioned on the retractor body 102 away from the male thread proximal end 103 and two parallels mounted on a handle 116c with a right angle at one end, as shown in FIGS. 9 and 10. It includes a pin assembly 116 consisting of pins 116a and 116b, and two set screws 120a and 120b. As shown in FIG. 10, the pins 116a, 116b are one half of the retractor body so that one half 102b of the retractor body can slide along the pins 116a, 116b in a direction away from each other. It crosses the guide passages 118a, 118b provided through the color region 110b of the body 102b and is placed in the color region 110a of the other half of the retractor body 102a and inserted into the holes 124a, 124b. Color 1 The 10b has female screw holes 122a and 122b that are designed to accept male screw type presser screws 120a and 120b. The countersunk screws 120a and 120b tighten the pins 116a and 160b when they are advanced, and thus the collar is perpendicular to the pin guide passages 118a and 118b so as to fix the distance between both halves 102a and 102b of the retractor body. Enter region 110a.<u style="single">A second alternative embodiment of the retractor</u>Yet another embodiment of the retractor of the present invention is shown in FIGS. 28 and 29. The retractor 300 includes a distal body portion 302 and a proximal handle portion 304. The distal body portion 302 of the retractor 300 is formed in two parts, the hemi-body 302a and 302b. At the distal end 306 of the body portion 302, the retracted portion 308 extends at an angle to the body portion 302 in a direction away from the body portion 302. Preferably, the retracted portion 308 extends substantially at right angles to the body portion 302. The retracted portion 308 is formed in two separable portions, halves 308a and 308b. Each of these portions 308a, 308b may be semi-circular in shape, or may have a semi-circular groove 312 (FIG. 29) on its flat integral surface. The outer surface is preferably rounded and tapered towards the distal end 310. When the two portions 308a, 308b are aligned so that they abut against each other, as can be seen in FIG. 28, a channel 314 is formed through the interior of the retracted portion 308 of the retractor 300. Handles 316a and 361b are positioned at the proximal end 304 of the retractor 300. The handles 316a and 316b are preferably elongated and sized enough to be manipulated by hand. The handles 316a and 316b are firmly connected to the body portion 302 of the retractor 300. The handles 316a and 316b are used to control the movement of the retracted portion 308 of the retractor 300. Figures 28 and 29 also show loop 320 extending from one of the handles 316a in the direction of the other handle 316b. The other handle, 316b, has a screw 322 inserted through it. The loop 320 surrounds the screw 322 so that when the screw 322 is tightened, the loop 320 is firmly held between the screw 322 and the lower surface. This mechanism controls the distance between the handles 316a and 316b, thereby acting to control the distance between the two halves of the retracted portions 308a and 308b. Grab The hands 316a, 316b and the corresponding retracted portions 308a, 308b lock in any position by sliding the loop 320 along the screw 322 and then tightening the screw 322 to secure the loop 320 in the desired position. Can be done. Of course, the positioning of the retractor 300 can also be controlled using other locking mechanisms well known to those of skill in the art. The retractor of the present invention is preferably formed of one of many strong biocompatible engineering polymers. Plastics such as polypropylene, polyethylene or polyterephthalate are suitable. Elastomers such as silastic or silicone can also be used. Most preferably, the retractor is formed using stainless steel or a surgical hole or a metal such as titanium.<u style="single">Expander configuration</u>As shown in FIGS. 11-13, the retractor 100 is preferably used in conjunction with the dilator 150. As is known to those skilled in the art, the hollow dilator 150 preferably has a standard male connector, such as a luer connector, at its proximal end, the distal end 151 of which is narrowly tapered. The inner diameter of the dilator 160 is large enough to accommodate the guide wire, so that the dilator 15 can be fed along the guide wire 144 into the lumen of the femoral artery. Dilators are commonly used in procedures such as angioplasty and angiography to enlarge the puncture site and improve access to the femoral artery. In one embodiment of the invention, the dilator preferably has a notch 152 formed near its distal end 151 over its entire circumference. The notch 152 tapers both halves 102a, 102b of the retractor body so that when the retractor 100 is closed over the dilator 150, the sharp distal tip of the retractor body 112 is buried in the dilator notch 152. It forms a seat for the tip of the position. This forms a smooth transition between the dilator 150 and the retractor 100 (Fig. 12). As will be fully described below, when the guide wire 144 is inserted through the expander 150 and then the expander 150 is inserted through the retractor 100 (FIGS. 12 and 13), the expander 150 is the length of the retractor body 102. It is firmly located within the circular internal channel 108 (Fig. 9) that extends over. Also, the dilator 150 preferably has at least one indicator hole 154. The dilators 150 shown in FIGS. 11 to 13 face each other directly and have two indicator holes 154 positioned a few millimeters away from the notch 152. The distance X between the hole 154 and the notch 153 is preferably just slightly greater than the wall thickness of the femoral artery. As an example of modification, a pressure monitoring catheter with a tip converter provided on the outside of the dilator 150 may be used in cooperation with the dilator 150 and the indicator hole 154. Indicator hole 154 and pressure<u style="single">Expander / retractor assembly</u>Another embodiment of the present invention comprises a total femoral artery localized / closed assembly as shown in FIG. The guide wire 144 that emerges from the original puncture wound is fed through the dilator 150, and then the dilator 150 is inserted through the retractor 100. Advance the retractor 100 along the dilator 150 until the distal end 112 of the retractor 100 stops within the notch 152 of the dilator 150. Preferably, a male joint 149 at the proximal end of the dilator 150 is connected to one port of a commercially available three-way Y connector 156. A syringe 158 or other means of applying negative pressure is connected to one of the other ports of the Y connector 156, and the proximal end of the guide wire 144 goes through the remaining ports to the proximal end of the Y connector 156. I'm out of the club. Therefore, the Y connector 156 acts as a seal on the proximal ends of the dilator 150 and the guide wire 144.<u style="single">Another embodiment of the dilator</u>Other embodiments of the invention use the modified expander 150. As shown in FIG. 17, a double-sleeved balloon 170 is detachably attached to the dilator 150 near the distal end 151 proximal to a single indicator hole 154. Preferably, the balloon 170 is approximately the width of the arterial wall, eg, about 1. It is installed at a distance from the indicator hole 154, which is 5 mm. The inflatable double-sleeved balloon 170 is tilted at its distal end 172 to fit well into the femoral artery 10. The balloon 170 has an inflating means that inflates and narrows it from the proximal end of the extension 150. The use of the double-sleeved balloon 170 and the cylindrical retractor 100 will be described in detail below. In yet another embodiment shown in FIGS. 23-25, the dilator 220 has both a double-sleeved balloon 222 and a second inflatable balloon 224 located at its distal end 226. Have. The double-sleeved balloon 222 is detachably attached to the dilator 220 in a single indicator hole 228 proximally near its distal end 226. A second inflatable balloon 224 is provided on the dilator 220 distally to the indicator hole 228. This second balloon 224, when inflated, helps to secure the dilator 220 in place on the femoral artery 10 and prevent the dilator 220 from being pushed out of the artery 10 during the procedure. Thus, the second balloon 224 is positioned within the artery 10 with the indicator hole 228, while the proximal double-sleeved balloon 222 of the indicator hole 228 remains outside the artery 10 as shown in FIG. The balloons 222, 224 assist in the proper positioning of the dilator 220 and, once the dilator 220 is properly positioned, help to secure the dilator 220 as described in detail below. The inner sleeve 230 of the double-sleeved balloon 222 is preferably molded to facilitate insertion of the retractor 200 between the two sleeves 229, 230 as described in more detail below. As shown in FIG. 24, the inner sleeve 230 is in the shape of an "l", thus providing additional space between the inner surface of the outer sleeve 229 and the outer surface of the inner sleeve 230. As a result, the two halves of the retractor bodies 202a and 202b The body can be more easily inserted between the two sleeves. The two sleeves of the balloons 229, 230 can be molded into any form that helps facilitate the insertion of the retractor 220. A dilator 200 with a double-sleeved balloon 222 and a second distal balloon 224 is further shown in FIG. As can be seen from the drawing, the dilator 200 has four different lumens 232, 234, 236, 238 extending from its proximal end 225 to its distal end 226. A guide wire 240 is inserted through one of the lumens, 236. The other one lumen is used to inflate the double-sleeved balloon 222, and the third lumen is used to inflate the second balloon 224 at the distal end of the dilator 226. The fourth lumen 234 is used to aspirate blood through the indicator hole 228 at the distal end of the dilator 226. Syringes are preferably used to supply suction and inflating pressure through these lumens 232, 234, 236, 238. The proximal end of the dilator 225 is preferably designed to provide fluid communication between the syringe and the various lumens 232, 234, 236, 238 in the dilator. Of course, other means of sucking and inflating the balloon may be used, and a connector specifically adapted for these devices is provided at the proximal end of the expander 225 to accommodate the chosen means. Can be installed. The third lumen is used to inflate the second balloon 224 at the distal end of the dilator 226. The fourth lumen 234 is used to aspirate blood through the indicator hole 228 at the distal end of the dilator 226. Syringes are preferably used to supply suction and inflating pressure through these lumens 232, 234, 236, 238. The proximal end of the dilator 225 is preferably designed to provide fluid communication between the syringe and the various lumens 232, 234, 236, 238 in the dilator. Of course, other means of sucking and inflating the balloon may be used, and a connector specifically adapted for these devices is provided at the proximal end of the expander 225 to accommodate the chosen means. Can be installed. The third lumen is used to inflate the second balloon 224 at the distal end of the dilator 226. The fourth lumen 234 is used to aspirate blood through the indicator hole 228 at the distal end of the dilator 226. Syringes are preferably used to supply suction and inflating pressure through these lumens 232, 234, 236, 238. The proximal end of the dilator 225 is preferably designed to provide fluid communication between the syringe and the various lumens 232, 234, 236, 238 in the dilator. Of course, other means of sucking and inflating the balloon may be used, and a connector specifically adapted for these devices is provided at the proximal end of the expander 225 to accommodate the chosen means. Can be installed.<u style="single">Double lumen catheter</u>In yet another embodiment of the invention, a double lumen catheter is used to locate the exact location of the puncture wound. As shown in FIGS. 30 and 31, catheter 340 has an medial lumen 342 extending all the way from the proximal end of catheter 344 to the distal end of catheter 346. This medial lumen 342 is adapted to accept the medial catheter 360 or guidewire 350 as described in more detail below. The lateral lumen of the dual lumen catheter 340 surrounds the medial lumen 342 and extends from the proximal end to the distal end 346 of the catheter 344. Near the distal end of catheter 346, at least one indicator hole 352 is positioned on the outer wall of catheter 340. The indicator hole 352 provides fluid communication between the outer region of the catheter 340 and the outer lumen. The outer surface 354 of the retractor 340 surrounding the indicator hole 352 preferably acts as an elevated stopper. Preferably, the distance between the indicator hole 352 and the proximal end of the ascending surface 354 of the retractor 340 is approximately the same as the wall thickness of the femoral artery. As will be described later, the retractor 300 is first provided at the distal end of the catheter where the distal tip of the retracted portion 310 stops in the immediate vicinity of the ascending surface 354, ie, proximal to the indicator hole 352 up to about 0.5 mm. So that it is positioned. This allows the distal tip of the retracted portion 310 to be properly positioned inside the patient's body at the site of the injury in the artery. At the proximal end of catheter 344, the proximal end 358 of the lateral lumen is preferably a lure-type connector that is adapted to accept syringe 360 or other negative pressure sources as described in more detail below. It is joined to a connector 364 such as.<u style="single">Surgical clip applicator</u>The retractors of the present invention are used to facilitate closure of wounds in a patient's vascular structure using surgical clips, staples and sewing threads. Therefore, one feature of the present invention includes the use of the surgical clip applicator 70. The surgical clip applicator 70 used with the retractor 30 of the present invention is shown in FIG. As shown in this figure, two protruding blades 77a and 77b are attached to the distal end of the clip applicator 75, and these blades are lateral to the side of the distal end 75 of the clip applicator 70. It extends in the direction. These blades 77a, 77b are configured to fit into a groove 65 positioned on the inner surface of the two halves 35a, 35b of the body of the retractor 30, as best seen in FIG. With the blades 77a, 77b of the clip applicator 70 in the grooves 65 of the two halves 35a, 35b of the body of the retractor 30, the clip applicator 70 is suitable within the patient's body as described in more detail below. You will be guided to the position. Also, the surgical clip applicator 70 preferably has a guide 80 attached to its distal end 75. The guide 80 preferably extends laterally from the side surface of the clip applicator 70, and its proximal and distal ends are open so that the guide wire 20 can be routed through it. This guide 80 is used in combination with the guide wire 20 to accurately guide the clip applicator 70 to the location of the vascular puncture hole 25 as described below. Also, the surgical clip applicator 70 preferably has a stopper 85 positioned near the distal end 75 at the end of the proximal ends of its blades 77a, 77b. As described below, the stopper 80 helps to properly position the clip applicator 70 at the vessel puncture hole 25 and prevents the clip applicator 70 from being deeply inserted into the patient's body.<u style="single">Another surgical clip applicator assembly</u>With reference to FIGS. 14-16, another suitable embodiment of the surgical clip applicator 130 is shown. The clip applicator 130 incorporates a standard commercial surgical clip applicator 132. According to the present invention, the applicator is modified to have a removablely tied guide assembly 134 near its distal end. The guide assembly includes a bladed guide plate 138 that is detachably attached to the body 140. In the embodiments shown in FIGS. 14 to 16, allen screws 142 are used to mount the guide plate 138, but other well-known mounting means can also be used. The distal end of the surgical clip applicator 132 slides in channel 148 (FIG. 15) formed when the bladed guide plate 138 is tied to the guide body 140. A guide tube 136 is attached to the guide body 140 so as to receive the guide wire 144. A preferred embodiment of the guide tube 136 has a mechanism for closing the guide tube 136 when the guide wire 144 is inserted. Such a mechanism may include a second partially open tube that fits within the guide tube 136. Rotate this second pipe within the guide pipe 136 to close the guide pipe 136 when opening the guide pipe 136 when aligning the openings of both pipes or shifting the openings of both pipes. Can be made to. To facilitate this opening and closing, the inner tube preferably has a handle through the slot of the outer guide tube 136. This mechanism can be spring-loaded like a closed structure commonly used in jewelry. The surgical clip applicator guide assembly 134, along with the retractor 100 and the guide wire 144, is designed to accurately guide the clip applicator 132 to the puncture hole in the femoral artery, as detailed below. As mentioned above, the lateral edge of the bladed guide plate 138 fits into the groove 126 (Fig. 10) positioned on the inner surface of each half of the retractor body 102a, 102b. It is configured like this. The surgical clip applicator 132 follows the guide wire 144 through the guide tube 136 at its distal end and is guided between the retracted halves 102a, 102b of the retractor body.<u style="single">Second separate surgical clip applicator assembly</u>Another embodiment of the surgical clip applicator assembly 250 is shown in FIG. The clip applicator assembly 250 incorporates a standard commercial surgical clip applicator 252. The applicator 252 has been modified to have a guide assembly 254 reversibly fastened near the distal end 256. The guide assembly 254 is designed to accept the indicator tube 260. The indicator tube 260 is a hollow tube having an indicator hole 264 near the distal end 262. The indicator tube 260 receives a guide wire 240 through it and is connected to a negative pressure source at the proximal end. This negative pressure source, such as a syringe, is used to perform suction through indicator hole 264. When properly positioned on the clip applicator 252, the distal end of the indicator tube 262 and the indicator hole 264 extend beyond the distal end of the clip applicator 256. Preferably, the distance between the indicator hole 264 and the distal tip of the clip applicator 256 is approximately equal to the width of the arterial wall, eg, about 1.5 mm.<u style="single">how to use</u>First, with reference to FIGS. 4-8, a first method of using the retractor 30 in collaboration with the surgical clip applicator 70 to close the wound 25 in the femoral artery 10 is described below. As described above, during angioplasty or angiography, a hollow needle 15 is first pierced into the femoral artery 10 and a guide wire 20 is inserted through it (Fig. 4). The proximal portion of the guide wire 21 remains outside the patient's body. After the distal end 23 of the guide wire is in place within the femoral artery 10, the hollow needle 15 is removed. A catheter (not shown) is then passed along the guide wire 20 and inserted into the patient's body. In a preferred embodiment, a specially designed guidewire 20 with an inflatable balloon 24 positioned near the distal end 23 is used for diagnostic or therapeutic procedures. The guide wire 20 is inserted into the patient's vascular structure through the hollow needle 15. As a modification, for example, in the case of balloon angioplasty procedures, standard guide wires well known to those of skill in the art can be used in conjunction with balloon catheters. Instead of the balloon 24 positioned on the guide wire 20, a balloon at the distal end of the catheter can be used. Following the completion of the treatment or diagnostic procedure, remove the catheter used during the procedure. The guide wire 20 stays in place in the patient's vascular structure. (In addition, when a balloon catheter is used instead of the guide wire having a balloon at the distal end, the catheter is left inside the patient, and the use of the balloon is the same as the use of the balloon 24 of the guide wire 20 described later. ). If the doctor wants to close the wound 25 in the femoral artery 10, the doctor first says that the guide wire 20 and / or the distal end 23 of the catheter is close to the puncture site 25 of the femoral artery 10 Withdraw the guidewire 20 and / or catheter through the patient's vascular structure using a guidewire 20 and / or part of the catheter that remains outside the patient's body 21 until inside. The balloon 24 at the guide wire 20 or the distal end 23 of the catheter is then inflated and the doctor Pull out the guide wire 20 or catheter further until the teacher feels some resistance. This indicates that the balloon 24 is inside the femoral artery 10 and at the site of the puncture wound. The physician then inserts the proximal end of the guide wire 21 into the hole 49 positioned at the distal end 37 of the fully assembled retractor 30 (Figs. 2, 3 and 6). Guide wire 20 into channel 50 formed in the body of retractor 35 until the proximal end of guide wire 21 exits through hole 47 in cap 40 at proximal end 41 of the retractor (Figure 6). Pass through. The retractor 30 is then slowly advanced along the guide wire 20 into the patient's body until resistance is felt. Resistance indicates that the distal end 37 of the retractor is in contact with the inflated balloon 24 within the femoral artery 10. Therefore, the distal end 37 of the retractor is properly positioned at the puncture site in the femoral artery 25, as shown in FIG. In a preferred embodiment, the guide wire 20 used in conjunction with the femoral artery closure retractor 30 has a mark 27 to help indicate that the retractor 30 has been properly positioned (Fig. 6). ). The marking 27 preferably consists of a small bead or colored line of the guide wire 20. The marking 27 on the guide wire is located proximal to the proximal end 26 of the balloon. The length of the retractor 30 is measured and the marking 27 is measured from the proximal end of the balloon 26 and is formed at least the same length in the proximal direction of the guide wire 20. Thus, when the retractor 30 was advanced along the guidewire 20 and felt resistance, the doctor asked whether the marking 27 on the guidewire exited through the proximal end 41 of the retractor, as shown in FIG. Check to see. If the mark 27 is not yet visible, the physician must advance the retractor 30 further so that it contacts the puncture site 25 of the femoral artery. Once the retractor 30 is properly positioned within the patient's body, the surgical clip applicator 70 or other method of closing the puncture wound 25 use. First, the cap 40 of the retractor 30 is removed from the body by loosening the screw. The proximal end 21 of the guide wire exiting the proximal end of the retractor is passed through a guide 80 positioned on the outer surface of the applicator 70 as shown in FIG. By aligning the blades 77a, 77b of the surgical clip applicator with the applicator 30 with the groove 65 positioned on the inner surface of the retractor body half bodies 35a, 35b, these blades 77a, 77b are close to the retractor body. Insert into the hole 90 formed in the position end 39 (Figs. 7 and 8). The blades 77a and 77b of the clip applicator are sized to fit within the groove 65 of the retractor 30 as best shown in FIG. The clip applicator 70 is then advanced, thereby separating both halves 35a and 35b of the retractor body as shown in FIG. When the two halves 35a, 35b are separated, the patient's tissue is laterally displaced to allow good access to the puncture site 25 in the femoral artery 10 below the upper tissue. Advance the clip applicator 70 through the retractor 30 until the stopper 85 of the clip applicator 70 contacts the proximal end 39 of the retractor. At this time, the guide wire or the balloon 24 of the catheter is deflated, and then the catheter and / or the guide wire 20 is removed from the patient. A surgical clip located at the distal end of the clip applicator is attached to the puncture wound 25 using a method well known to those skilled in the art. After closing the femoral artery puncture wound 25, the clip applicator 70 and retractor 30 are removed from the patient. These blades 77a, 77b are inserted into the holes 90 formed in the proximal end 39 of the body of the retractor (Figs. 7 and 8). The blades 77a and 77b of the clip applicator are sized to fit within the groove 65 of the retractor 30 as best shown in FIG. The clip applicator 70 is then advanced, thereby separating both halves 35a and 35b of the retractor body as shown in FIG. When the two halves 35a, 35b are separated, the patient's tissue is laterally displaced to allow good access to the puncture site 25 in the femoral artery 10 below the upper tissue. Advance the clip applicator 70 through the retractor 30 until the stopper 85 of the clip applicator 70 contacts the proximal end 39 of the retractor. At this time, the guide wire or the balloon 24 of the catheter is deflated, and then the catheter and / or the guide wire 20 is removed from the patient. A surgical clip positioned at the distal end of the clip applicator is applied to the puncture wound 25 using a method well known to those skilled in the art. After closing the femoral artery puncture wound 25, the clip applicator 70 and retractor 30 are removed from the patient. These blades 77a, 77b are inserted into the holes 90 formed in the proximal end 39 of the body of the retractor (Figs. 7 and 8). The blades 77a and 77b of the clip applicator are sized to fit within the groove 65 of the retractor 30 as best shown in FIG. The clip applicator 70 is then advanced, thereby separating both halves 35a and 35b of the retractor body as shown in FIG. When the two halves 35a, 35b are separated, the patient's tissue is laterally displaced to allow good access to the puncture site 25 in the femoral artery 10 below the upper tissue. Advance the clip applicator 70 through the retractor 30 until the stopper 85 of the clip applicator 70 contacts the proximal end 39 of the retractor. At this time, the guide wire or the balloon 24 of the catheter is deflated, and then the catheter and / or the guide wire 20 is removed from the patient. A surgical clip positioned at the distal end of the clip applicator is applied to the puncture wound 25 using a method well known to those skilled in the art. After closing the femoral artery puncture wound 25, the clip applicator 70 and retractor 30 are removed from the patient. 4 wither and then remove the catheter and / or guide wire 20 from the patient. A surgical clip positioned at the distal end of the clip applicator is applied to the puncture wound 25 using a method well known to those skilled in the art. After closing the femoral artery puncture wound 25, the clip applicator 70 and retractor 30 are removed from the patient. 4 wither and then remove the catheter and / or guide wire 20 from the patient. A surgical clip positioned at the distal end of the clip applicator is applied to the puncture wound 25 using a method well known to those skilled in the art. After closing the femoral artery puncture wound 25, the clip applicator 70 and retractor 30 are removed from the patient.<u style="single">First alternative</u>Localizing a femoral artery puncture wound using another embodiment of the retractor 100 in collaboration with the dilator 150 and the surgical clip applicator assembly 130, with reference to FIGS. 9-16. The closing method is explained below. As mentioned above, following the completion of angioplasty or angiography, the catheter used during the procedure is removed from the patient's body, leaving only the guidewire inserted into the femoral artery. If desired, prior to using the retractor / dilator assembly 101 (Fig. 13), a standard dilator with a diameter smaller than the dilator 150 incorporated into the retractor / dilator assembly 101 at the proximal end of the guide wire. Can be fed to and advanced down the guide wire into the artery. This preliminary step expands the upper tissue, if necessary, to facilitate the subsequent passage of the larger retractor / expander assembly 101 through the surrounding tissue. After expanding the tissue as described above, first remove the standard dilator with a smaller pore size. First, the proximal end 144 of the guide wire is inserted into the distal channel 160 (Figure 11) of the dilator 150. The dilator 150 is pre-inserted into the internal channel of the retractor 100, and the retractor 100 advances along the dilator 150 until the distal tip 112 rests in the notch 152 at the distal tip of the dilator 150. Being touched. The Y connector 156 is then attached to the proximal end of the dilator 150 and the syringe 158 is attached to one of the ports on the connector 156. The retractor / dilator assembly 101 is then advanced along the guide wire into the patient's body. While advancing the retractor / dilator assembly 101 into the patient's body, suction is continuously applied to the dilator 150 via syringe 158 or other negative pressure source (FIG. 13). When the indicator hole 154 enters the lumen of the femoral artery, blood is sucked into the syringe 158, indicating that the dilator 150 has been inserted into the femoral artery through the puncture site. Thus, the distal tip 112 of the retractor, still buried in the notch 152 of the dilator 150, is in the immediate vicinity of the arterial wall at the site of the puncture, i.e. Positioned on the outside, the indicator hole 154 of the dilator 150 is positioned far from the arterial lumen, i.e., inside. As a modification, the dilator 150 has a pressure sensor (not shown), such as a fiber optic pressure sensor, near its distal tip. This sensor is preferably mounted on the outer wall of the dilator 150. In a preferred embodiment, a pressure monitoring catheter with a tip converter, such as a Camino catheter commercially available from Camino Laboratories (San Diego, CA), is used. A pressure sensor provided on the outside of the dilator 150 is inserted into the femoral artery along the guide wire. When inserted into the femoral artery, the pressure sensor works with a pressure monitor to indicate an increase in pressure. At this point, the retractor 100 is stopped advancing and the distal tip 112 of the retractor is positioned near the arterial wall at the site of the puncture wound. This allows the physician to properly locate the puncture wound in the patient's femoral artery. Once the dilator 150 and retractor 100 are in the proper position, remove the cap 104 from the retractor 100, loosen the set screws 120a and 120b, and slide the two half bodies 120a and 120b of the retractor laterally away from each other. This slightly separates the two halves 102a and 102b of the retractor body (Fig. 10). As a result, the distal tips 112 of the two halves 102a and 102b emerge from the notch 152 of the dilator 150 (Fig. 11) and straddle the puncture site. Then, the set screws 120a and 120b are tightened to hold the two halves 102a and 102b of the retractor 100 in the separated positions. While pushing down the retractor 100 against the outer wall of the femoral artery, the dilator 150 is removed, leaving only the retractor 100 and the guide wire 144 in place at the site of the puncture wound in the artery. To close the wound, the retractor 100 must be retracted far enough to bring the surgical clip applicator assembly 130 close to the puncture site. When the presser screws 120a and 120b are loosened, the pin handle of the retractor 11 The two halves 102a and 102b of the retractor are further separated by applying pressure to 6c (Figs. 9 and 10). When the retractor is fully retracted, tighten the set screws 120a and 120b of the retractor assembly 100 to maintain an appropriate distance between the retractor halves. If necessary, a thickness suitable for sliding in the grooves 126 of each half of the retractor body 102a, 102b and a width equal to the width of the bladed guide plate 138 (FIG. 14) of the surgical clip applicator guide assembly 134. A separate retractor with the can be used to open the retractor body to an appropriate distance.<u style="single">Second alternative</u>Another embodiment shown in FIG. 17 uses a modified dilator 150 having an inflatable balloon 170 with a double sleeve detachably attached to the distal end 151 of the dilator in the immediate vicinity of the indicator hole 154. To do. The balloon dilator device 175 is inserted into the patient's body along the guide wire 144. As mentioned above, advancing the balloon dilator device 175 applies negative pressure to the device via a syringe or other source. When blood is inhaled, the balloon dilator device 175 stops advancing. The double-sleeved balloon 170 is then inflated to form a tunnel 176 between the puncture wound of the femoral artery and the surface of the patient's body as shown in FIG. The double-sleeved balloon 170 advantageously prevents the femoral artery closure retractor 100 from entering the femoral artery 10 and damaging this artery. Should the narrowed balloon 170 be advanced into the femoral artery 10, the process of inflating the balloon 170 pulls the balloon 170 out of the artery 10 and thereby the tunnel 176 used to approach the artery 10. To form safely. The balloon 170 is preferably tilted at its distal end so that the balloon 170 fits snugly against the femoral artery 10, as shown in FIGS. 17-19. When the balloon 170 is inflated (Fig. 18), the retractor 100 is advanced between the two sleeves of the balloon 170 until the distal tip of the retractor 100 reaches the distal end of the double-sleeved balloon 170. When the retractor 100 is positioned between the two sleeves of the balloon 170, the retractor halves 102a and 102b are moved away from each other. The inner sleeve 178 and dilator 150 are removed from the patient, leaving the separated retractor 100 and the outer sleeve 180 of the balloon 170 to the patient. The dilator 150 and inner sleeve 178 are removed from the patient along the guide wire 144. The retractor 100 and the outer sleeve 180 of the balloon approach between the puncture wound of the femoral artery and the surface of the patient's body as shown in FIG. Form 182. The tunnel 182 allows the introduction of a wound closure device to seal a puncture wound in the femoral artery. At this point, with the retractor close to the femoral artery, the proximal end of the guide wire 144 is inserted into the guide tube 136 of the surgical clip applicator assembly 130 and the blades of the guide plate are opened to the retractor body 102. Fit into the groove 126 (Figs. 14-16). At this time, the clip applicator assembly 130 is guided by the guide wire 144 passing through the guide tube 136 at the distal tip of the surgical clip applicator assembly 130 and slides in the groove 126 of the retractor body 102. Then you can move forward towards the puncture wound. When the distal tip of the surgical clip applicator 130 reaches the outer wall of the femoral artery 10 at the site of the puncture, the surgeon removes the guide wire 144 from the patient's body and immediately places the surgical clip. The second clip can then be placed 1 or 2 mm away from the first clip to close the wound. In a preferred embodiment, immediately prior to closure of the puncture site, the flexible guidewire 144 used during the main procedure should be of commercially available variable stiffness, which should be rigid at the distal end forming the hook. Replace with a guide wire. The hooked distal end can be pulled back to hook a puncture wound in an artery. Further pulling back on the guidewire stretches the puncture wound into a linear slit, making it easier to close with a surgical clip. Guided by the guide wire 144, it can slide in the groove 126 of the retractor body 102 and move forward toward the puncture wound. When the distal tip of the surgical clip applicator 130 reaches the outer wall of the femoral artery 10 at the site of the puncture, the surgeon removes the guide wire 144 from the patient's body and immediately places the surgical clip. The second clip can then be placed 1 or 2 mm away from the first clip to close the wound. In a preferred embodiment, immediately prior to closure of the puncture site, the flexible guidewire 144 used during the main procedure should be of commercially available variable stiffness, which should be rigid at the distal end forming the hook. Replace with a guide wire. The hooked distal end can be pulled back to hook a puncture wound in an artery. Further pulling back on the guidewire stretches the puncture wound into a linear slit, making it easier to close with a surgical clip. Guided by the guide wire 144, it can slide in the groove 126 of the retractor body 102 and move forward toward the puncture wound. When the distal tip of the surgical clip applicator 130 reaches the outer wall of the femoral artery 10 at the site of the puncture, the surgeon removes the guide wire 144 from the patient's body and immediately places the surgical clip. The second clip can then be placed 1 or 2 mm away from the first clip to close the wound. In a preferred embodiment, immediately prior to closure of the puncture site, the flexible guidewire 144 used during the main procedure should be of commercially available variable stiffness, which should be rigid at the distal end forming the hook. Replace with a guide wire. The hooked distal end can be pulled back to hook a puncture wound in an artery. Further pulling back on the guidewire stretches the puncture wound into a linear slit, making it easier to close with a surgical clip.<u style="single">Third alternative</u>A method of locating and closing a puncture wound in the femoral artery using another example of a retractor with a dilator 220 and a surgical clip applicator assembly 250, with reference to FIGS. 21-27. Will be described below. As mentioned above, after the completion of angioplasty or angiography, the catheter used during the procedure is removed from the patient's body and close to the guidewire 240, leaving only the guidewire 240 inserted into the femoral artery 10. The position end is first inserted into the distal lumen 236 (Fig. 26) of the dilator 220. Advance the dilator 220 along the guide wire 240 into the patient's body. As described above, advancing the balloon dilator device 250 applies negative pressure to the device via a syringe or other source coupled at the proximal end of the dilator 225. As soon as blood is aspirated through the indicator hole 228 to indicate that the distal end of the dilator 226 is positioned within the femoral artery 10, the dilator 220 stops advancing. The distal balloon 224 and the double-sleeved balloon 222 are then inflated to secure the dilator 220 in place and form a tunnel between the thigh puncture wound and the surface of the patient's body. Inflating the balloons 222 and 224 advances the retractor 200 between the two sleeves 229 and 230 of the double-sleeved balloon 222. As shown in FIG. 24, the inner sleeve 230 of the double-sleeved balloon 222 is an "l" shape that provides more space between the two sleeves for inserting the two halves 202a, 202b of the retractor 200. Is good. Advance the retractor 200 until the distal end 204 of the retractor is positioned just proximal to the puncture wound in the femoral artery 10. When the retractor 200 is positioned between the two sleeves of the balloons 229 and 230, the two halves 202a and 202b of the retractor are laterally moved away from each other. This loosens the presser screws 214a, 214b and slides one half 202b of the retractor body along the pins 212a, 212b away from the other half 202a. It is done by moving. The inner sleeve 230 and dilator 220 of the double-sleeved balloon 222 are removed from the patient along the guide wire 240, leaving the separated retractor 200 and the outer sleeve 229 of the balloon 222 to the patient. The retractor 200 and the outer sleeve 229 of the balloon form an approach tunnel between the femoral artery puncture wound and the surface of the patient's body. This tunnel allows the introduction of a wound closure device to seal a puncture wound in the femoral artery. At this point, with the retractor 200 and the outer sleeve 229 of the balloon close to the femoral artery 10, the proximal end of the guide wire 240 is the distal end of the indicator tube 260 provided on the surgical clip applicator 252. Insert in 262. As described above, the distal end 262 of the indicator tube 260 having the indicator hole 264 is positioned so that the indicator hole 264 extends beyond the distal end 256 of the clip applicator 252. Advancing the clip applicator 252 along the indicator tube 260 guide wire 240 while applying suction pressure to the proximal end of the indicator tube 260. As soon as blood is sucked through the indicator hole 264, the indicator tube 260 and the clip applicator 256 stop advancing. At this point, the distal end of the surgical clip applicator 256 is positioned at the site of the puncture wound in the femoral artery 10. A surgical clip is then attached to seal the wound. Preferably, the distal end of the indicator tube 262 is curved or hooked. Hook-bent distal ends are used to hook-bend arterial puncture wounds and bridge the edges of the wounds to facilitate clipping. The hook-bent distal end 262 of the indicator tube 260 is used to straighten the puncture wound into a linear slit for easier closure with a surgical clip. Leave the outer sleeve 229 of the rune 222 to the patient. The retractor 200 and the outer sleeve 229 of the balloon form an approach tunnel between the femoral artery puncture wound and the surface of the patient's body. This tunnel allows the introduction of a wound closure device to seal a puncture wound in the femoral artery. At this point, with the retractor 200 and the outer sleeve 229 of the balloon close to the femoral artery 10, the proximal end of the guide wire 240 is the distal end of the indicator tube 260 provided on the surgical clip applicator 252. Insert in 262. As described above, the distal end 262 of the indicator tube 260 having the indicator hole 264 is positioned so that the indicator hole 264 extends beyond the distal end 256 of the clip applicator 252. Advancing the clip applicator 252 along the indicator tube 260 guide wire 240 while applying suction pressure to the proximal end of the indicator tube 260. As soon as blood is sucked through the indicator hole 264, the indicator tube 260 and the clip applicator 256 stop advancing. At this point, the distal end of the surgical clip applicator 256 is positioned at the site of the puncture wound in the femoral artery 10. A surgical clip is then attached to seal the wound. Preferably, the distal end of the indicator tube 262 is curved or hooked. Hook-bent distal ends are used to hook-bend arterial puncture wounds and bridge the edges of the wounds to facilitate clipping. The hook-bent distal end 262 of the indicator tube 260 is used to straighten the puncture wound into a linear slit for easier closure with a surgical clip. Leave the outer sleeve 229 of the rune 222 to the patient. The retractor 200 and the outer sleeve 229 of the balloon form an approach tunnel between the femoral artery puncture wound and the surface of the patient's body. This tunnel allows the introduction of a wound closure device to seal a puncture wound in the femoral artery. At this point, with the retractor 200 and the outer sleeve 229 of the balloon close to the femoral artery 10, the proximal end of the guide wire 240 is the distal end of the indicator tube 260 provided on the surgical clip applicator 252. Insert in 262. As described above, the distal end 262 of the indicator tube 260 having the indicator hole 264 is positioned so that the indicator hole 264 extends beyond the distal end 256 of the clip applicator 252. Advancing the clip applicator 252 along the indicator tube 260 guide wire 240 while applying suction pressure to the proximal end of the indicator tube 260. As soon as blood is sucked through the indicator hole 264, the indicator tube 260 and the clip applicator 256 stop advancing. At this point, the distal end of the surgical clip applicator 256 is positioned at the site of the puncture wound in the femoral artery 10. A surgical clip is then attached to seal the wound. Preferably, the distal end of the indicator tube 262 is curved or hooked. Hook-bent distal ends are used to hook-bend arterial puncture wounds and bridge the edges of the wounds to facilitate clipping. The hook-bent distal end 262 of the indicator tube 260 is used to straighten the puncture wound into a linear slit for easier closure with a surgical clip. In the state, the proximal end of the guide wire 240 is inserted into the distal end 262 of the indicator tube 260 provided on the surgical clip applicator 252. As described above, the distal end 262 of the indicator tube 260 having the indicator hole 264 is positioned so that the indicator hole 264 extends beyond the distal end 256 of the clip applicator 252. Advancing the clip applicator 252 along the indicator tube 260 guide wire 240 while applying suction pressure to the proximal end of the indicator tube 260. As soon as blood is sucked through the indicator hole 264, the indicator tube 260 and the clip applicator 256 stop advancing. At this point, the distal end of the surgical clip applicator 256 is positioned at the site of the puncture wound in the femoral artery 10. A surgical clip is then attached to seal the wound. Preferably, the distal end of the indicator tube 262 is curved or hooked. Hook-bent distal ends are used to hook-bend arterial puncture wounds and bridge the edges of the wounds to facilitate clipping. The hook-bent distal end 262 of the indicator tube 260 is used to straighten the puncture wound into a linear slit for easier closure with a surgical clip. In the state, the proximal end of the guide wire 240 is inserted into the distal end 262 of the indicator tube 260 provided on the surgical clip applicator 252. As described above, the distal end 262 of the indicator tube 260 having the indicator hole 264 is positioned so that the indicator hole 264 extends beyond the distal end 256 of the clip applicator 252. Advancing the clip applicator 252 along the indicator tube 260 guide wire 240 while applying suction pressure to the proximal end of the indicator tube 260. As soon as blood is sucked through the indicator hole 264, the indicator tube 260 and the clip applicator 256 stop advancing. At this point, the distal end of the surgical clip applicator 256 is positioned at the site of the puncture wound in the femoral artery 10. A surgical clip is then attached to seal the wound. Preferably, the distal end of the indicator tube 262 is curved or hooked. Hook-bent distal ends are used to hook-bend arterial puncture wounds and bridge the edges of the wounds to facilitate clipping. The hook-bent distal end 262 of the indicator tube 260 is used to straighten the puncture wound into a linear slit for easier closure with a surgical clip. Attach and seal the scratches. Preferably, the distal end of the indicator tube 262 is curved or hooked. Hook-bent distal ends are used to hook-bend arterial puncture wounds and bridge the edges of the wounds to facilitate clipping. The hook-bent distal end 262 of the indicator tube 260 is used to straighten the puncture wound into a linear slit for easier closure with a surgical clip. Attach and seal the scratches. Preferably, the distal end of the indicator tube 262 is curved or hooked. Hook-bent distal ends are used to hook-bend arterial puncture wounds and bridge the edges of the wounds to facilitate clipping. The hook-bent distal end 262 of the indicator tube 260 is used to straighten the puncture wound into a linear slit for easier closure with a surgical clip.<u style="single">Fourth alternative</u>Yet another method of closing a wound in a patient's femoral artery is described with reference to FIGS. 26-31. First, a hollow needle is inserted into the femoral artery, and the guide wire 350 is inserted there. The proximal portion 351 of the guide wire remains outside the patient's body. After the distal portion 353 of the guide wire is in place in the femoral artery, the hollow needle is removed. The diagnostic and / or treatment procedure is then performed using a guide wire 350 that guides the insertion of other medical devices into the patient's vascular structure. After completing the treatment or diagnostic procedure, remove the device used during the procedure. The guide wire 350 stays in place in the patient's vascular structure. If you want to close a doctor's artery wound, first attach the dilator 300 to the distal end of the dual catheter 340. This is done by loosening the screw 322 on one of the handles 316b and moving the handles 316a, 316b away from each other to separate the two halves of the retracted portion 308, the two portions of the retracted portion 308a, Position 308b around the double lumen catheter 340. The double lumen catheter 340 fits into a semi-circular channel or groove 312 formed on the inner surface of the retractor 308 of the retractor 300. Using handles 316a, 316b, align the two halves 308a, 308b of the retracted part with each other so as to surround the catheter 340. The retracted portion 308 is positioned immediately proximal to the elevated portion of the catheter 354 and the distal tip 310 of the retracted portion is positioned immediately proximal to the indicator hole 352. Preferably, the distal tip of the retracted portion 308 is approximately 0. Behind the indicator hole 352. It will be at 5 mm (see Fig. 31). Once in place, the screw 322 is tightened onto the loop 320 to lock the two recessed parts 308a, 308b into place on the catheter 340. When the retractor 300 is properly positioned on the dual lumen catheter 340, the physician inserts the proximal end 351 of the guide wire 350 into the distal end of the medial lumen 342 of the dual lumen catheter 340. The double lumen catheter 340 and retractor 300 are advanced into the patient along the guide wire 350. When the catheter 340 and retractor 300 are advanced, for example, a syringe 360 attached to the proximal end of the lateral lumen 358 is used to apply negative pressure to the lateral lumen of the catheter. When the indicator hole 352 is advanced to a position inside the artery, blood is drawn through the indicator hole 352 and this blood becomes visible in the lateral lumen of the catheter 340 and in the syringe. At this point, when the catheter 340 and retractor 300 are properly positioned with the patient, the catheter 340 and retractor 300 stop advancing. Once properly positioned at the site of the puncture wound, use handles 316a, 316b at the proximal end 304 of the retractor 300 to slightly separate both halves 308a, 308b of the retracted area. To release the retracted portions 308a and 308b, loosen the screw 322 and operate the handles 316a and 316b to the desired positions. The screw 322 is then tightened onto the loop 320 to prevent further movement of the handles 316a, 316b and the corresponding retracted portions 308a, 308b. At this point, the surrounding tissue is displaced to form an approach path to the puncture wound, and the puncture wound is visible. The double lumen catheter 340 is removed from the patient by pulling it along the guide wire 350. The guide wire 350 is left in place and a wound closure device, such as a clip applicator, is inserted along the guide wire 350 to the site of the wound. After removing the guide wire, attach a clip, such as one made of titanium or a biodegradable material, to the wound. necessary During the closure of the stab wound, the artery is compressed to stop the outflow of blood from the stab wound. When the doctor is confident that the wound will be closed, the closing device is removed and the retractor 300 is removed from the patient. As a modification, a separate medial catheter 360 is used for the device of the invention. In this embodiment, when the retractor 300 and the double lumen catheter 340 are in place and the retracted portion 308 is in the open position, the double lumen catheter 340 is left in place and the guidewire 350 is passed through the medial lumen 342. Extract from the patient. An medial catheter 360 with an inflatable balloon at the distal end is inserted into the patient through the medial lumen 342. When the distal balloon 362 advances beyond the distal tip 346 of the dual lumen catheter 340, it inflates the balloon 362. Remove the double lumen catheter 340 from the patient and leave the medial catheter 360 in place. In order to properly position the balloon inside the patient's artery, it is best to measure the distance from the distal tip of the double lumen catheter 346 to just outside the patient's body when the catheter 340 is properly positioned. Good. The doctor then inserts the medial catheter 360 a distance just slightly shorter than the above distance so that the distal balloon 362 is in the artery. The doctor then pulls the medial catheter proximally until resistance is felt. As a result, the balloon 362 is placed at the site of the puncture wound. Properly position the balloon 362 just inside the patient's artery. Balloon 362 stops the outflow of blood from the puncture wound. The medial catheter 360 is used as a guide for clip applicators or other closing devices used to close wounds. Advance the closure device until it contacts the inflated balloon 362. If the wound is closer, slowly squeeze the balloon 362 and remove the medial catheter 360 from the patient. Finally, when the doctor is convinced that the wound has closed, the retractor is removed from the patient. The present invention can also be used in the case of surgical staples or sewing threads. Insert the retractor into the patient's body as described above and stab After positioning at the site, the two halves of the retractor are separated and pierced with tissue to laterally displace the tissue surrounding the site. The retractor acts like a dilator that gradually increases the displacement of the underlying tissue until the puncture wound is visible to the doctor. The wound is then closed using any acceptable means for wound closure, including surgical staples and sewing threads. Although the invention has been shown and described using some examples and examples, the scope of the invention is not limited to the examples described herein. The scope of the present invention is defined by the following claims.
Every citation, both ways
| Document | Relation | Office |
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| US05580344A | Cites | United States of America |
| JP58160014U | Cites | Japan |
| JP56091744A | Cites | Japan |
| DE09202738B | Cites | Germany |
| US05360397A | Cites | United States of America |
| US05292332A | Cites | United States of America |
34 members in 9 offices
Priority claims19
| Document | Office | Kind | Date |
|---|---|---|---|
| 08764611 | United States of America | – | |
| 76461196 | United States of America | A | |
| 76461196 | United States of America | A | |
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| 94336997 | United States of America | A | |
| 94336997 | United States of America | A | |
| 08984757 | United States of America | – | |
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| 98475797 | United States of America | A | |
| 9723133 | United States of America | W | |
| 9723133 | United States of America | W | |
| 1996764611 | – | – | – |
| 1997943369 | – | – | – |
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| US19960764611 | – | – | – |
| US19970943369 | – | – | – |
| US19970984757 | – | – | – |
| WO1997US23133 | – | – | – |
Members34
| Document | Office | Kind | |
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| WO9720505A1 | World Intellectual Property Organization (WIPO) | A1 | |
| CA2274066A1 | Canada | A1 | |
| WO9824374A1 | World Intellectual Property Organization (WIPO) | A1 | |
| AU7621998A | Australia | A | |
| EP0874591A1 | European Patent Office (EPO) | A1 | |
| EP0955900A1 | European Patent Office (EPO) | A1 | |
| CA2334226A1 | Canada | A1 | |
| WO9962405A1 | World Intellectual Property Organization (WIPO) | A1 | |
| AU4546599A | Australia | A | |
| US6004341A | United States of America | A | |
| WO9962405A9 | World Intellectual Property Organization (WIPO) | A9 | |
| EP1083827A1 | European Patent Office (EPO) | A1 | |
| US6287322B1 | United States of America | B1 | |
| CN1314795A | China | A | |
| US2001053922A1 | United States of America | A1 | |
| JP2001527431A | Japan | A | |
| JP2002513303A | Japan | A | |
| US6425901B1 | United States of America | B1 | |
| US6524326B1 | United States of America | B1 | |
| CA2334226C | Canada | C | |
| EP0955900B1 | European Patent Office (EPO) | B1 | |
| AT300242T | Austria | T | |
| ATE300242T1 | Austria | T1 | |
| DE69733835D1 | Germany | D1 | |
| US6964675B2 | United States of America | B2 | |
| CA2274066C | Canada | C | |
| US2006064124A1 | United States of America | A1 | |
| DE69733835T2 | Germany | T2 | |
| EP0874591A4 | European Patent Office (EPO) | A4 | |
| JP4023830B2This record | Japan | B2 | |
| JP4185165B2 | Japan | B2 | |
| CN100525717C | China | C | |
| EP0874591B1 | European Patent Office (EPO) | B1 | |
| DE69638352D1 | Germany | D1 |
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Numbers
- Publication
- 4023830
- Publication, DOCDB
- 4023830
- Publication, EPODOC
- JP4023830B
- Application
- 52591398
- Application, DOCDB
- 52591398
- Application, EPODOC
- JP19980525913
Titles2
- Japanese
- 血管創傷閉鎖装置
- English
- Vascular wound closure device
Classification
- CPC, 4
- A61B17/0057
- A61B17/0206
- A61B17/128
- B29K2067/003
- IPC, 5
- A61B17 00
- A61B17 02
- A61B17 08
- A61B17 12
- A61B17 128