EP1448254A1 - Methode et appareil d'insertion d'instruments allonges dans une cavite corporelle - Google Patents

Methode et appareil d'insertion d'instruments allonges dans une cavite corporelle

Info

Publication number
EP1448254A1
EP1448254A1 EP01987155A EP01987155A EP1448254A1 EP 1448254 A1 EP1448254 A1 EP 1448254A1 EP 01987155 A EP01987155 A EP 01987155A EP 01987155 A EP01987155 A EP 01987155A EP 1448254 A1 EP1448254 A1 EP 1448254A1
Authority
EP
European Patent Office
Prior art keywords
sheath
moldability
shaping tool
body cavity
moldable
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Withdrawn
Application number
EP01987155A
Other languages
German (de)
English (en)
Other versions
EP1448254A4 (fr
Inventor
Paul Kurth
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Individual
Original Assignee
Individual
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Individual filed Critical Individual
Publication of EP1448254A1 publication Critical patent/EP1448254A1/fr
Publication of EP1448254A4 publication Critical patent/EP1448254A4/fr
Withdrawn legal-status Critical Current

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00—Catheters; Hollow probes
    • A61M25/01—Introducing, guiding, advancing, emplacing or holding catheters
    • A61M25/06—Body-piercing guide needles or the like
    • A61M25/0662—Guide tubes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00—Catheters; Hollow probes
    • A61M25/0021—Catheters; Hollow probes characterised by the form of the tubing
    • A61M25/0041—Catheters; Hollow probes characterised by the form of the tubing pre-formed, e.g. specially adapted to fit with the anatomy of body channels
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00—Catheters; Hollow probes
    • A61M25/01—Introducing, guiding, advancing, emplacing or holding catheters
    • A61M25/06—Body-piercing guide needles or the like
    • A61M25/0662—Guide tubes
    • A61M25/0668—Guide tubes splittable, tear apart

Definitions

  • the present invention is directed to the field relating to apparatus and methods used to insert of medical devices in a human or animal body, and in particular apparatus and methods used to insert medical devices into a vascular system or other anatomical cavities.
  • the introducer With the medical instrument correctly positioned, the introducer is then removed leaving the medical instrument in position.
  • the positioning of the medical instrument can be very delicate. Any force or displacement imparted to the medical instrument by withdrawal of the introducer can potentially dislodge the medical instrument from its intended position, which in turn can be reachieved only with additional procedures of varying difficulty, if at all.
  • U.S. Pat. No. 4,467,817 to Harris discloses a small diameter pacing lead of carbon filaments surrounded by a stiffening sheath.
  • the tip of the pacing lead extends beyond the stiffening sheath whereby the stiffening sheath is positioned behind the tip of the pacing lead to assist guiding the pacing lead into the desired organ.
  • U.S. Pat. No. 5,639,276 to Weinstoc et.al. describes a cardiac introducer which as a gradient of stiffness along its length so that it is sufficiently soft or flowable at its distal end so that it can pass through the tricuspid valve without causing trauma and is proximally sufficiently stiff so that it can be forced through a tortuous venous path into the apex of the right ventricle of the heart.
  • Weinstock or Harris regarding the moldability of the introducer which would allow a reliable lead placement or reliable introducer withdrawal.
  • a single preshaped guide is frequently inadequate to reach a desired location due to large anatomical variations within the body.
  • the illustrated embodiment of the invention shows a guiding sheath made of a moldable material which is not resilient, or at least has a limited resiliency returning it to its original shape once deformed from that original shape.
  • the sheath does not necessarily retain its original shape, but tends to assume and keep the new shape which has been later imparted to it. This is referred to as moldability.
  • the material from which the sheath is made and/or its construction renders the sheath more moldable in that it is able to retain a new shape when or after being placed in the body, typically without the on-going aid of shape retaining devices such as obturators, guidewires, steering devices, stylets and the like.
  • the sheath may be molded by the clinician before being placed in the body, or it may change its resiliency or moldability just before or after being placed in the body when it is exposed to water, temperature, light or any combination of such exposures.
  • the material comprising the sheath becomes moldable and retains its new shape either by being placed within the body, or otherwise changes its moldability by means of a treatment of the material of the sheath just prior to being implanted or from being implanted in the body.
  • the guiding sheath may have any number of different physical forms, such as a moldable elongate tube with braided reinforcement at selected sections of its length, reinforcing fibers disposed on the sheath for improved kink resistance and to aid in the maintenance of a new shape, or it may have a moldable sheath body which is splittable, peelable, tearable by tearing along least one score line or by virtue of the nature of the material itself. It is also contemplated that the guiding sheath may not be peelable or separable, but may need to be cut with a cutting tool. It may be preshaped or straight when first introduced. It may be made of the same material along its entire length or made of moldable material of various stiffness at various sections along its length.
  • stiffness of a moldable section can be altered by varying its thickness, disposing tubes within tubes, layering it or bonding different layers of different stiffness together.
  • the guiding sheath may contain at least one segment of variable length made of a material which is not moldable.
  • the material which is used that is not moldable may similarly be of various stiffness by altering its thickness, diameter or its chemical makeup and may have varying resiliency.
  • a nonmoldable section may be made of materials of various stiffness and resiliency which are bonded together or have their stiffness and resiliency altered by layering of materials each with a different stiffness or resiliency, by positioning tubes of variable diameters inside of each other, or by use of variable thickness materials to alter the stiffness and resiliency of the section.
  • the sheath may contain wires for deflection and positioning, but which are not used to retain the shape of the catheter.
  • the guiding sheath may contain at least one electrode for sensing or delivering energy, or may contain at least one fiber optic wire.
  • the sheath may also be provided with at least one distal balloon. The balloon disposed on the sheath may be separable from sheath along score lines or may be cut off or otherwise removable from sheath.
  • the guiding sheath may contain at least one lumen and at least one vent.
  • the guiding sheath may contain a proximal sealing valve with or without a side port, and a sealing valve which may be separable, tearable or not separable.
  • the sealing valve may be attachable or detachable to the sheath.
  • Use of the guiding sheath may require a steering or shaping tool for molding or guiding of sheath.
  • the shaping tool may contain a handle and at least one wire for deflection or steering of the tip of the tool.
  • the shaping tool may be preshaped and may or may not contain a mechanical steering mechanism.
  • the shaping tool may also have a soft tip and may contain at least one lumen with at least one vent.
  • the lumen of shaping tool may be used for infusion of a liquid and or for passage of a guide wire.
  • the shaping tool may contain at least one balloon, and at least one electrode for sensing or delivering energy.
  • the sheath may be nonmoldable, but flexible so that it can be steered or guided using a steering or guiding tool to a physician selected site, and then after implantation of a medical instrument through the sheath, peeled away from the medical instrument.
  • Figs. 1a - 1d are side elevational views of the sheath in which the sheath is composed of a moldable material showing how a series of bends of differing nature can be molded into the compound shape of the sheath.
  • Fig. 2 is a side elevational view of the sheath in which a portion has been reinforced by a woven or braided reinforcement or braiding to help retain the new shape and to make the sheath axially more rigid.
  • Fig. 3 is a side elevational view of the sheath in which a portion has been reinforced by fiber to add axial strength and to help retain molded shape.
  • Fig. 4 is a side elevational view of the sheath in which a portion of the sheath is stiffened by layering concentric material around the exterior of the sheath.
  • Fig. 5 is a side elevational view of the sheath in which at least one conductor or wire is disposed along its length and coupled to a diagnostic or therapeutic device such as an ultrasound imager.
  • Fig. 6 is a side elevational view of the sheath in which a lumen is defined longitudinally through the sheath and communicated to a balloon disposed on the sheath.
  • Fig. 7 is a side elevational view of the sheath in which a proximal sealing valve and side arm port is provided.
  • Fig. 8 is a side elevational view of a steerable shaping tool which is telescopically
  • a prebiased introducer or sheath can be steered or manipulated by a number of means to a designated site within a body cavity, such as the coronary sinus in the heart.
  • a body cavity such as the coronary sinus in the heart.
  • exact placement of an introducer in the coronary sinus even with a prebiased introducer is frequently not possible and if placed, its retention therein for delivery of a medical instrument is often not reliable.
  • patients with cardiomyopathy typically have a heart one-and-a-half to two times the normal size.
  • conventional fixed, preshaped introducers must often be forcibly deformed by considerable amounts in order to be properly placed.
  • an introducer which can be custom-shaped as it is being implanted into each patient so as to accommodate each individual's anatomy and then once appropriate placement is achieved, then remain in position with the custom shape imparted to it without torque or shearing forces being present until the medical instrument, or in this example, the pacemaker lead, is safely delivered to the coronary sinus.
  • the illustrated embodiment is sometimes characterized as a cardiac application using the sheath of the invention or in particular an implantation into the coronary sinus, it is expressly understood that the medical applications to which the sheath may be put is entirely general and not limited to even cardiac applications.
  • the guiding sheath may be used to deploy permanent pacemaker leads into various areas of the heart such as the right atrial appendage, the intra atrial septum, the lateral atrial wall, the right ventricle, the intra ventricular septum ,as well as the right ventricular outflow tract.
  • Other areas of the heart can be accessed such as the left atrium either through an intra atrial puncture or retrograde through the left ventricle. Equipped with an ultrasound probe the walls of the heart can be imaged and more precise placement of an ablating probe can be accomplished. Having a moldable coronary angioplasty guide for delivery of coronary and venous graft devices would also be of benefit.
  • a moldable catheter would be of significant value
  • brain where deployment of stents, coils or other diagnostic and therapeutic devices would be of value.
  • a moldable guide for delivery of renal stents, arterial devices such as aortic stents and peripheral arterial devices and stents would be of value.
  • Moldable catheters for use as nephrostomy drainage catheters, gall bladder drainage catheters, liver drainage catheters would be useful.
  • Fig. 1a is a diagrammatic perspective view showing an introducer or sheath 10 of the invention which has been initially provided in a straight form.
  • sheath 10 is shown as a hollow cylinder in which a central main lumen is defined.
  • sheath 10 should be understood to also include an elongate member which may be solid or have only minor lumens defined therein, like a catheter.
  • the shaping tool used with sheath 10 will then be an elongate tube which is telescopically disposed over sheath 10 instead of being an elongate cylinder disposed in the central lumen of sheath 10.
  • sheath 10 is composed of a single kind of biocompatible material which is moldable.
  • resiliency what is meant is the tendency of material to return to its original shape like a spring.
  • the stiffness of a material is independent of its resiliency and refers to the force required to deform an object.
  • an object may be stiff, while not being resilient like common iron, or may not be stiff and also not resilient like malleable lead wire.
  • a weak coil spring would thus not be stiff, but would be resilient, while a strong coil spring would be both stiff and resilient.
  • the stiffness of the material is the resistance the material to a change in its shape, which stiffness is independent of its resiliency. Materials may be very stiff, but when once deformed do not return to their original undeformed shape. It is also possible to have a material which has a low stiffness, i.e. can be easily deformed, and have a high or low resiliency tending to return them to their original shape or not respectively.
  • the stiffness and moldability of the material of the preferred embodiment is such that it can easily be deformed by hand by the physician prior to implantation, by means of a guiding or shaping tool such as a steerable or shaped dilator, stylet and/or guide wire during placement within the body, or by molding wires embedded in the sheath.
  • a guiding or shaping tool such as a steerable or shaped dilator, stylet and/or guide wire during placement within the body, or by molding wires embedded in the sheath.
  • sheath 10 is initially implanted into the vascular system with the aid of a dilator as is conventional in the art, which dilator is used to open the vascular puncture to allow sheath 10 to be telescopically disposed over the dilator and smoothly accepted into the punctured vessel while maintaining good blockage against blood loss.
  • Shape memory is defined within this specification as the tendency of a material to retain a new shape once molded to the new shape or configuration. Shape memory is thus a characteristic which is distinguished from stiffness. An object can lack resiliency without having high shape memory. For example, a soft, completely limp catheter tip, has no substantial resiliency and may not have any substantial shape memory either. By the same token a different type of soft catheter tip may be fabricated according to the invention to have high shape memory and hence would also not have any substantial resiliency.
  • a sheath fabricated according to the invention would have a suppleness such that it may be molded by its disposition within the body cavity without trauma to the tissues. Yet, it has sufficient shape memory such that it retains a shape which has been imparted to it by a shaping tool when in the body, even when left unsupported or unconfined in a body cavity or subject to normal bodily fluid, blood or air flow.
  • a material would have "moldability" or be “moldable” in the context of this specification, if its shape could be changed without difficulty before or during a medical procedure, and if it had sufficient shape memory to hold its new shape in such circumstances.
  • sheath 10 will tend to stay in its molded shape in a heart chamber without generating a resilient force or displacement which returns it to its original shape.
  • a catheter or other elongate medical instrument (not shown) can then be telescopically disposed through sheath 10 and thus correctly delivered within the body according to the molded shape imparted to sheath 10 by a shaping tool 42. Further, the removal of sheath 10 similarly will not dislodge the medical instrument from its implanted position by the application of resilient forces or displacement arising from the movement of sheath 10 relative the medical instrument during the removal of the sheath.
  • Fig. 1a depicts sheath 10 as originally manufactured so as to be straight and to be provided with a proximal nonsealing hub or sealing hemostatic valve 36.
  • Fig. 1b is a side elevational view of sheath 10 of Fig. 1a in which an acute bend 46 has been molded into sheath 10 near distal tip 48. Bend 46 can be formed outside the body or within the body by any of the means disclosed in this specification and means equivalent thereto. In the preferred embodiment, an approximate shape is formed by hand by the attending physician when sheath 10 is outside the body and then it is fine tuned to the final shape using a shaping tool after being implanted in the body or heart.
  • Fig. 1c is a side elevational view of sheath 10 of Fig.
  • a slightly less acute bend 50 has been molded into sheath 10 at a more proximal position than bend 46.
  • an approximate shape is formed by hand by the attending physician when sheath 10 is outside the body and then it is fine tuned to the final shape or bend 50 using a shaping tool after being implanted in the body, or body cavity such as the heart.
  • Fig. 1d is a side elevational view of sheath 10 of Fig. 1c in which an even less acute bend 52 has been molded into sheath 10 at a more proximal position than bend 50.
  • TPU thermoplastic urethane
  • TPU thermoplastic urethane
  • Such TPU materials include, but are not limited to, families of aliphatic polyether based thermoplastic urethane resins, which can be formulated to absorb water, aromatic polyether based thermoplastic urethanes, and aliphatic polycarbonate based thermoplastic urethanes, all of which are available with a wide range of durometers, colors and radiopacifiers. These resins are easy to process and do not yellow upon aging. Solution grade versions are candidates for replacement of latex.
  • sheath 10 when made from these temperature, moisture or light sensitive materials, may remain stiffer and more resilient than the distal portions which have been implanted into the body and exposed to a higher temperature and/or moisture.
  • the change in stiffness and resilience, or the change in moldability is not instantaneous, but occurs over a period of time during the medical procedure. Therefore, sheath 10 remains nonmoldable and stiff enough to be steerable or guideable during the placement procedure. After being implanted it becomes moldable and with the use of a guiding tool it can be guided to its target location. The medical device can then be disposed through sheath 10. Even in cases where the change in moldability is fast, any conventional shaping and/or guiding tool, well known to the art, can be used to support sheath 10 during its implantation and used to impart a specific shape to it in preparation for its use to deliver a medical instrument.
  • sheath 10 when sheath 10 is to be removed, it has had sufficient time to respond to the elevated temperature, moisture or previous exposure to light to increase its moldability. Sheath 10 may then be slid off the medical instrument without then imparting a disturbing force to the medical instrument that would cause it to be dislodged from the target site.
  • sheath 10 of Fig. 1 in addition to being composed of homogeneous material or of temperature, light or moisture sensitive material, may be comprised of a plurality of different materials or composition of the same or different materials in different physical forms.
  • one or more sections 12 of sheath 10 may include reinforced or braided fibers which will give sheath 10 a selective stiffness or resilience along its length as shown in diagrammatic view in Fig. 2.
  • reinforcing fibers 16 may be provided on a section 14 of sheath 10 to provide kink resistance. Both means of reinforcement also assist in retaining new shapes.
  • sheath 10 may also be provided with different moldability by being made out of different materials which are bonded or layered together, by telescopically positioning tubes of different diameters inside each other, or by using sections or layers of variable thickness.
  • sheath 10 may be itself manufactured with a varying integral wall thickness.
  • Fig. 4 is a side cross sectional view in enlarged scale and which shows a section 24 of sheath 10 which is comprised of three telescopically disposed layers 18, 20 and 22 to provide a thickened and therefore stiffer section 24 then could be realized than using a single layer 18.
  • sheath 10 may be provided with a moldable or nonmoldable section of arbitrary length which may have variable stiffness.
  • sheath 10 may be comprised of preshaped nonmoldable sections and moldable sections according to the application in question.
  • Sheath 10 may be supplied in an originally straight shape or may be preshaped during original manufacture.
  • sheath 10 may also be altered not only by building up a composite thickness such as shown in section 24 of Fig. 4, but also by chemically altering the composition of a section, such a section 26 of sheath 10.
  • sheath 10 may have a section 26 which is chemically treated or exposed to radiation to change its moldability or to prevent it from becoming moldable. The change may be such as to either increase or decrease these characteristics.
  • Sheath 10 may be splittable, peelable, or tearable. It may be comprised material which naturally tears along the preferred line, namely the longitudinal direction of sheath 10, or sheath 10 may be scored so that it preferentially tears along score line as is well- known in the art.
  • sheath 10 may be peeled away or otherwise removed from the medical instrument after its implantation without the need for sliding sheath 10 over the proximal end of the medical instrument.
  • the possibility that sheath 10 may be peeled away does not exclude, of course, the option that sheath 10 may be cut away by a scalpel or a sheath splitter well-known to the art. In such a latter case, sheath 10 may be integral and not peelable or separable from the medical instrument other than by sliding it over the proximal end of the instrument or by cutting it away. It is also to be expressly understood that sheath 10 may include many additional structures used for deflection, steering and guiding.
  • sheath 10 may contain wires for deflection and positioning which are not used to retain the shape of the catheter which is inserted into it, such as shown by Savage et.al., "Steerable Catheter," U. S. Patent 5,507,725 (1996), incorporated herein by reference.
  • the wire or wires included within sheath 10 may be used to provide a conducting part a circuit, alone or in combination with being used for deflection and positioning.
  • the tip of sheath 10 may also include a plurality of active diagnostic or therapeutic devices such as an ultrasound imaging tip as diagrammatically depicted in Fig. 5.
  • Ultrasound imaging device 28 is mounted on or near distal tip of 30 of sheath 10 and is connected to the proximal end of sheath 10 by means of a conductor or wire 32 imbedded within the wall of sheath 10.
  • sheath 10 may be provided with one or more optical fibers for use with a photonic device mounted at or near the distal tip of sheath 10.
  • Sheath 10 may be provided not only with distal electrical devices but also with actuatable mechanical structures or devices, such as an inflatable distal balloon 34 as diagrammatically shown in Fig. 6. Balloon 34 may be mounted at any point on sheath 10, beginning at the distal tip rearwards.
  • Balloon 34 is then communicated with a lumen defined within sheath 10 to provide for its inflation and deflation.
  • Balloon 34 may be separable from sheath 10 by also being splittable along score lines defined in sheath 10 along its longitudinal axis, or may be cut off by use a scalpel or other cutting tool. Balloon 34 may be removed from sheath 10 by any means now known or later devised.
  • the same lumen used to inflate or deflate balloon 34 may also be used as a lumen for delivery or removal of fluids through sheath 10.
  • One or more vents may then be provided or defined through sheath 10 as exit and/or entry orifices for such a lumen.
  • the proximal end 40 of sheath 10 of may also be provided with a sealing valve 36 with or without the provision of a side port 38 through which fluids may be provided to and from the lumens defined within sheath 10.
  • Sealing valve 36 may or may not be separable, splittable, or tearable from sheath 10.
  • sheath 10 may we require a shaping tool to assist in its implantation within the body.
  • the shaping tool generally denoted by reference numeral
  • shaping tool 42 may contain a handle 44 and at least one or more wires to deflect at least the distal tip portion of the shaping tool, such as shown in diagrammatic view in Fig. 8. While tool 42 is shown in Fig. 8 as not having a prebiased shape and as being mechanically steerable, it is also within the scope of the invention that such shaping tool 42 may be manufactured with a predetermined shape or biased and may not have a mechanical steering mechanism. As with sheath 10, shaping tool 42 may be provided with a soft or completely pliable or moldable tip and may incorporate one or more lumens with corresponding vents within the elongate tool body. Just as for sheath 10, any lumens provided in shaping tool 42 may be used for infusion of a liquid or for passage of a guide wire there through. So too may shaping tool 42 contain at least one inflatable balloon at or near its distal tip and at least one electrode for sensing signals along the length of shaping tool 42 or for delivery of energy through a distal electrode.
  • a peel-away, flexible and nonmoldable sheath may be used in combination with a steering and/or guiding tool.
  • a peel-away sheath 10 would be flexible enough so that it could be practically guided to a target site selected by the physician by an obturator, guidewire, steering device, stylet 42 or the like, namely selectively shaped or guided to a selected site like the coronary sinus.
  • Sheath 10 need not be moldable and would normally be provided in an initially straight shape or form. Its shape would then be determined or changed according to the application to which it is applied by means of steering and guiding tool 42.
  • Sheath 10 could then be separated from tool 42 by being peeled off along a longitudinal score line, or by tearing along a preferred direction of tear characteristic of the material of which sheath 10 is composed.
  • sheath 10 may be used with or without a proximal sealing valve, distal balloons, and distal therapeutic or diagnostic devices. In the case where a distal balloon is used, it is splittable with sheath 10.

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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Biophysics (AREA)
  • Pulmonology (AREA)
  • Engineering & Computer Science (AREA)
  • Anesthesiology (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Hematology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Media Introduction/Drainage Providing Device (AREA)

Abstract

L'invention concerne une gaine (10) constituée d'une matière biocompatible dont la rigidité et l'aptitude au moulage permettent de la déformer manuellement ou au moyen d'un outil de guidage ou de façonnage. Sa souplesse lui permet d'être moulée selon sa disposition à l'intérieur de la cavité corporelle sans provoquer de trauma aux tissus. La rigidité et l'aptitude au moulage de ladite gaine sont suffisantes pour garder une forme imposée par un outil de façonnage lorsqu'elle se trouve dans la cavité corporelle. Lorsque l'outil de façonnage a été retiré, ladite gaine a tendance à garder sa forme moulée dans la cavité corporelle sans générer de force résiliente ou de déplacement qui lui redonnerait sa forme initiale. La disposition télescopique d'un instrument médical à travers la gaine permet de l'amener correctement à l'intérieur de la cavité corporelle selon la forme donnée à la gaine par l'outil de façonnage.
EP01987155A 2001-11-30 2001-11-30 Methode et appareil d'insertion d'instruments allonges dans une cavite corporelle Withdrawn EP1448254A4 (fr)

Applications Claiming Priority (1)

Application Number Priority Date Filing Date Title
PCT/US2001/045028 WO2003047662A1 (fr) 2001-11-30 2001-11-30 Methode et appareil d'insertion d'instruments allonges dans une cavite corporelle

Publications (2)

Publication Number Publication Date
EP1448254A1 true EP1448254A1 (fr) 2004-08-25
EP1448254A4 EP1448254A4 (fr) 2009-01-07

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EP01987155A Withdrawn EP1448254A4 (fr) 2001-11-30 2001-11-30 Methode et appareil d'insertion d'instruments allonges dans une cavite corporelle

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WO (1) WO2003047662A1 (fr)

Families Citing this family (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP2014519907A (ja) * 2011-05-25 2014-08-21 アクセス サイエンティフィック， エルエルシー アクセスデバイス

Family Cites Families (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5190540A (en) * 1990-06-08 1993-03-02 Cardiovascular & Interventional Research Consultants, Inc. Thermal balloon angioplasty
US6090072A (en) * 1992-10-15 2000-07-18 Scimed Life Systems, Inc. Expandable introducer sheath
US5944691A (en) * 1996-11-04 1999-08-31 Cordis Corporation Catheter having an expandable shaft
US6245052B1 (en) * 1998-07-08 2001-06-12 Innerdyne, Inc. Methods, systems, and kits for implanting articles

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WO2003047662A1 (fr) 2003-06-12
EP1448254A4 (fr) 2009-01-07

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