JP5395486B2 - Tubular treatment device placement device - Google Patents

Description

  The present invention relates to a tubular treatment instrument placement device for placing a tubular treatment tool expandable in a radial direction in an affected area.

  FIG. 1 is a diagram for explaining the aorta. FIG. 1A is a diagram schematically showing blood vessels from the ascending aorta to the common iliac artery, and FIG. 1B is a diagram for explaining the thoracic aorta.

  As shown in FIG. 1 (a), the aorta is an artery that ascends from the left ventricle of the heart, bends in an arcuate shape, then descends and branches at the bifurcation of the abdominal aorta to reach the common iliac artery It is an artery that is the main source of blood circulation throughout the body.

  A state in which a part of the blood vessel wall constituting the aorta bulges is called “aortic aneurysm”. An aortic aneurysm can occur in various parts of the aorta and is a serious disease that can lead to death by rupture of the aneurysm if left untreated.

As a surgical treatment for an aortic aneurysm, the so-called “artificial blood vessel replacement” in which the blood vessel of the affected part where the aortic aneurysm has occurred is replaced with an artificial blood vessel is well known. The technique is drawing attention.
This method uses a stent-graft indwelling device having a stent graft with a reduced diameter inside the sheath. This is a method for preventing the rupture of the aortic aneurysm by exposing the stent graft and placing the stent graft in the affected area.
Stent graft endoscopy does not require thoracotomy or laparotomy, and is a useful treatment for patients who are physically difficult to perform normal thoracotomy or laparotomy.

  As a stent graft indwelling device that can be used for such stent graft insertion, for example, a stent graft indwelling device disclosed in Patent Document 1 or 2 is known.

JP 2000-350785 A International Publication No. 2005/99806 Pamphlet

  By the way, when an aortic aneurysm occurs in the ascending aorta or the proximal arch aorta (the part of the aortic arch that is close to the ascending aorta, see FIG. 1B), the conventional stent graft placement device has the following problems. It is done.

  That is, when a stent graft is to be placed in the affected area of the ascending aorta or proximal arch aorta via the groin using a conventional stent graft placement device, the proximal arch aorta or ascending aorta Since it is in an arcuately bent position or a deeper position, it is not easy to reach the stent graft (the distal end portion of the stent-graft placement device) to the affected area. If the stent-graft placement device is forcibly pushed forward to reach the affected area, the stent-graft placement device may contact the blood vessel wall and damage the blood vessel, or the stent-graft placement device may contact the blood vessel wall to cause a wall thrombus.・ The mural atheroma may be released. If the mural thrombus / mural atheroma is liberated, it may cause complications such as cerebral infarction.

  In other words, in the conventional stent graft placement device, when an aortic aneurysm occurs in the ascending aorta or proximal arch aorta, it is not necessary to place the stent graft without causing vascular damage or release of wall thrombus / wall atheroma. There is a problem that it is not easy.

  Such a problem is not limited to the stent graft indwelling device. For example, there is a problem that may also occur in a tubular treatment instrument placement device for placing a tubular treatment tool other than a stent graft, such as a stent placement device for placing a radially expandable stent in the affected part.

  Therefore, the present invention has been made to solve such problems, and even when an aortic aneurysm occurs in the ascending aorta or the proximal arch aorta, it is possible to place the tubular treatment device relatively easily. An object of the present invention is to provide a tubular therapeutic device indwelling device.

[1] The tubular treatment device placement device (1) of the present invention is a tubular treatment device placement device (1) for placing a tubular treatment device (SG) expandable in the radial direction in an affected area, and is flexible. The first sheath (10) having a tubular shape, and the first sheath (10) is flexible, and is configured to be able to advance and retreat along the axial direction of the first sheath (10). A tubular second sheath (60), and the tubular treatment instrument in a state of being reduced in diameter, configured to be able to advance and retreat inside the second sheath (60) along the axial direction of the second sheath (60). The rod member (50) for exposing the SG) from the tip of the second sheath (60) and the function of bending the tip of the first sheath (10) or a position near the tip to a predetermined curvature. The first bending mechanism (30) and the distal end portion of the second sheath (60) or a position near the distal end portion, And a second bending mechanism having a function of bending to the constant curvature of the (80), said rod member (50), the rod body portion (52), be a diameter smaller than the rod body (52), A holding portion (54) for holding the tubular treatment device (SG) in a reduced diameter state, and the tubular treatment device (SG) is not the first sheath (10) but the second sheath (60). ) And is held by the holding portion (54) when the tubular treatment device (SG) loaded in the tubular treatment device placement device (1) reaches the affected area. In this state, the second sheath (60) is advanced with respect to the first sheath (10), and after the tubular treatment device (SG) has reached the affected area, the rod member (50) ) With the position of the second sheath ( By retracting the 0), characterized that you have been configured to be placed the tubular treatment instrument of (SG) to the affected area.

According to the tubular treatment instrument indwelling device of the present invention, the first and second sheaths and the first and second bending mechanisms having a function of bending the distal end portion of each sheath or the position near the distal end portion to a predetermined curvature are provided. Therefore, the first advancing mechanism is advanced while the first sheath is bent from the descending aorta to the distal arch aorta, and from there (from the proximal arch aorta to the ascending aorta) the second bend By advancing the second sheath while bending the second sheath by the mechanism, the tubular treatment device is placed up to the position of the aortic aneurysm occurring in the proximal arch aorta or the ascending aorta without contacting the tubular treatment device placement device with the blood vessel wall. The tip of the device can be reached. As a result, the tubular treatment tool can be relatively easily placed in the affected part of the proximal arch aorta or the ascending aorta.
In addition, according to the tubular treatment instrument placement device of the present invention, the tubular treatment tool placement device is not forcibly advanced when placing the tubular treatment tool in the affected part of the proximal arch aorta or the ascending aorta. It becomes possible to suppress the occurrence of the problem of blood vessel damage and the problem of liberation of mural thrombus / mural atheroma.

  In this specification, the “tip portion of the sheath” means the tip of the sheath and its peripheral portion. Further, the “position near the distal end of the sheath” refers to a position from the distal end of the sheath to a position closer to the proximal end than the position where the tubular treatment device is loaded, excluding the distal end of the sheath. means.

[2] In the tubular treatment instrument indwelling device (1) according to the above [1], the first bending mechanism (30) is formed on the first sheath (10) along the first sheath (10). A first wire (32) provided in the tube wall or on the tube wall surface and configured to be able to advance and retract along the axial direction of the first sheath (10), and a proximal end side of the first sheath (10) Of the first operating portion (34) when operating the first operating portion (34), and a first operating portion (34) for operating the bent state of the first sheath (10). A first motion conversion section (36) that converts the movement into a forward / backward movement of the first wire (32) to move the first wire (32) forward and backward, and the second bending mechanism (80) Provided in the tube wall of the second sheath (60) or on the tube wall surface along the second sheath (60), A second wire (82) configured to be movable back and forth along the axial direction of the two sheaths (60), and a bent end of the second sheath (60) provided on the proximal end side of the second sheath (60) The operation of the second operation unit (84) for operating the state and the operation of the second operation unit (84) when the second operation unit (84) is operated are the advance and retreat operations of the second wire (82). It is preferable to have a second motion converter (86) that converts and advances and retracts the second wire (84).

  By comprising in this way, it becomes possible to bend the 1st and 2nd sheath comparatively easily using a wire.

[3] In the tubular treatment instrument indwelling device (1) according to the above [2], the first and second operation portions (34, 84) of the first or second sheath (10, 60), respectively. A slide member configured to be slidable along the axial direction, and the first and second motion converters (36, 86) are each based on a slide amount when the slide member is slid. It is preferable that the first or second wire (32, 82) is configured to be able to advance and retract by a predetermined amount.

  With this configuration, it is possible to bend the distal end portion or the vicinity of the distal end portion of each sheath to a predetermined curvature by a simple operation of “sliding the slide member”.

[4] In the tubular treatment instrument indwelling device (2) according to the above [2], the first and second operation portions (234, 284) each have a shaft portion (244) and a fulcrum portion (246). And a lever member configured to be rotatable about the fulcrum part (246) as a rotation center, and the first and second motion conversion parts (236, 286) are respectively rotated when the lever member is rotated. It is preferable that the first or second wire (32, 82) can be advanced or retracted by a predetermined amount on the basis of the amount of rotation.

  With this configuration, it is possible to bend the distal end portion of each sheath or the vicinity of the distal end to a predetermined curvature by a simple operation of “turning (tilting) the lever member in either direction”. It becomes.

[5] In the tubular treatment instrument indwelling device (3) according to the above [2], each of the first and second operation portions (334, 384) is a button member configured to be depressible in a predetermined direction. The first and second motion converters (336, 386) advance or retract the first or second wire (32, 82) by a predetermined amount based on the pressing amount when the button member is pressed, respectively. It is preferable to be configured so that

  With this configuration, it is possible to bend the distal end portion or the vicinity of the distal end portion of each sheath to a predetermined curvature by a simple operation of “pressing the button member”.

[6] In the tubular treatment instrument indwelling device according to any one of [1] to [5], the first bending mechanism (30) maintains the bent state of the first sheath (10). It is preferable to further have a function and a function of releasing maintenance of the bent state of the first sheath (10).

  With this configuration, the second sheath can be advanced and retracted while the bent state of the first sheath is maintained.

[7] In the tubular treatment instrument placement device (1) according to any one of [1] to [6], the tubular treatment instrument is preferably a stent graft (SG).

  By configuring in this manner, the tubular treatment instrument placement device of the present invention is a stent graft placement device capable of relatively easily placing a stent graft in an aortic aneurysm generated in the ascending aorta or proximal arch aorta.

  In addition, the reference numerals added in parentheses below the wording of each member, etc. described in the claims and in this column (column of means for solving the problems) are the contents described in the claims and this column. It is used for facilitating understanding of the present invention, and does not limit the contents described in the claims and in this section.

The figure shown in order to demonstrate an aorta. The figure shown in order to demonstrate the tubular treatment tool placement apparatus 1 which concerns on Embodiment 1. FIG. The figure shown in order to demonstrate the tubular treatment tool placement apparatus 1 which concerns on Embodiment 1. FIG. The figure shown in order to demonstrate the 1st and 2nd sheaths 10 and 60 and the 1st and 2nd wires 32 and 82. FIG. The figure shown in order to demonstrate the tubular treatment tool placement apparatus 1 which concerns on Embodiment 1. FIG. The figure shown in order to demonstrate the tubular treatment tool placement apparatus 1a which concerns on a comparative example. The figure shown in order to demonstrate the tubular treatment tool placement apparatus 1 which concerns on Embodiment 1. FIG. The figure shown in order to demonstrate the tubular treatment tool placement apparatus 2 which concerns on Embodiment 2. FIG. The figure shown in order to demonstrate the tubular treatment tool placement apparatus 2 which concerns on Embodiment 2. FIG. The figure shown in order to demonstrate the tubular treatment tool placement apparatus 3 which concerns on Embodiment 3. FIG. The figure shown in order to demonstrate the tubular treatment tool placement apparatus 3 which concerns on Embodiment 3. FIG.

  Hereinafter, the tubular treatment instrument placement device of the present invention will be described based on the embodiment shown in the drawings.

[Embodiment 1]
First, the configuration of the tubular treatment instrument placement device 1 according to the first embodiment will be described in detail with reference to FIGS.

  FIG.2 and FIG.3 is a figure shown in order to demonstrate the tubular treatment tool placement apparatus 1 which concerns on Embodiment 1. FIG. FIG. 2 (a) is a view showing each member constituting the tubular treatment instrument placement device 1 and the stent graft SG, and FIG. 2 (b) is a view showing a state in which each member is assembled and the stent graft SG is further arranged. FIG. 2 (c) is an enlarged cross-sectional view showing the vicinity of the distal end portion of the tubular treatment instrument placement device 1 (the portion where the stent graft SG is disposed). In FIG. 2, in order to facilitate understanding of the invention, the size (length, diameter, etc.) and shape of each member constituting the tubular treatment instrument placement device 1 and the stent graft SG are schematically shown. It is shown.

  FIG. 4 is a view for explaining the first and second sheaths 10 and 60 and the first and second wires 32 and 82. FIG. 4A is a cross-sectional view of the first sheath 10 as viewed in a cross section orthogonal to the tube axis, and FIG. 4B is an enlarged view of the portion indicated by the symbol A in FIG. 4 (c) is a cross-sectional view of the second sheath 60 as viewed in a cross section orthogonal to the tube axis, and FIG. 4 (d) is an enlarged view of the portion indicated by the symbol B in FIG. 4 (c). FIG.

  FIG. 5 is a view for explaining the tubular treatment instrument placement device 1 according to the first embodiment. FIG. 5A is a perspective view schematically showing a peripheral portion of the first operating portion 34, and FIG. 5B is an enlarged sectional view showing the distal end portion of the first sheath 10, and FIG. FIG. 5C is a conceptual diagram showing the position of the first wire 32 when the first sheath 10 is not bent, and FIG. 5D is the first wire when the first sheath 10 is bent. It is a conceptual diagram which shows the position of 32. In order to facilitate understanding of the invention, in FIGS. 5B to 5D, the thickness of the tube wall of the first sheath 10 and the first wire with respect to the thickness of the first sheath 10 are used. The diameter dimension of the lumen 12 for use and the diameter dimension of the first wire 32 are exaggerated to some extent.

  The tubular treatment device placement apparatus 1 according to Embodiment 1 is a stent graft placement device for placing a stent graft SG (tubular treatment device) expandable in the radial direction in an affected area, as shown in FIGS. A tubular first sheath 10; a tubular second sheath 60 configured to be able to advance and retreat inside the first sheath 10 along the axial direction of the first sheath 10 (longitudinal direction of the first sheath 10); The rod member 50 configured to be able to advance and retreat inside the sheath 60 along the axial direction of the second sheath 60 (longitudinal direction of the second sheath 60), and the position in the vicinity of the distal end portion of the first sheath 10 have a predetermined curvature. A first bending mechanism 30 having a function of bending and a second bending mechanism 80 having a function of bending a position in the vicinity of the distal end portion of the second sheath to a predetermined curvature are provided.

  Both the first and second sheaths 10 and 60 are made of a flexible material. Examples of flexible materials include biocompatible synthetic resins (elastomers) selected from fluororesins, polyamide resins, polyethylene resins, polyvinyl chloride resins, and other materials mixed with these resins. It is possible to preferably use a resin compound prepared, a multilayer structure in which these synthetic resins are composed of multiple layers, or a composite of these synthetic resins and metal wires.

  In the tube walls of the first and second sheaths 10 and 60, as shown in FIG. 4, as the first or second wire lumens 12 and 62, the diameter dimensions of the first wire 32 or the second wire 82 described later are used. A cavity with an elliptical cross section having a larger minor axis is provided. Each lumen 12, 62 is provided along the longitudinal direction of the first or second sheath 10, 60, and the first or second wire 32, 82 is disposed in each lumen 12, 62 (see FIG. 2 (c), FIG. 4 and FIG. 5 (b)).

Although the details will be described later, the first sheath 10 when the first wire 32 is not disposed in the first wire lumen 12 is shaped in advance so as to have a bent shape as shown in FIG. As shown in FIG. 5 (c), the first sheath 10 is straightened by advancing the first wire 32 to the tip of the first wire lumen 12. The first sheath 10 when the first wire 32 is not disposed in the first wire lumen 12 is configured to have a curvature radius of 60 mm, for example. In addition, the said curvature radius is not limited to 60 mm, About 20 mm-100 mm may be sufficient.
The second sheath 60 is configured similarly to the first sheath 10.

  The inner diameter D1 of the first sheath 10 is configured to be equal to or larger than the outer diameter D2 of the second sheath 60 (see FIGS. 4A and 4C). Thereby, the second sheath 60 can be disposed inside the first sheath 10.

  As shown in FIG. 2A, a first sheath base portion 20 is provided on the proximal end portion side of the first sheath 10 (the end portion side opposite to the side where the stent graft SG is disposed). As shown in FIG. 5A, the first sheath base portion 20 is provided with a long hole 22 for operating a first operation portion 34 described later along the axial direction of the first sheath base portion 20. .

Similar to the first sheath 10, a second sheath base 70 is also provided on the base end side of the second sheath 60 (see FIG. 2A). Moreover, although explanation by illustration is abbreviate | omitted, the 2nd sheath base part 20 is also provided with the long hole which becomes the shape similar to the long hole 22 of the 1st sheath base part 20. FIG.
Although not shown in the sheath bases 20 and 70 shown in FIGS. 2 and 5, a liquid filling port for filling the first sheath 10 (second sheath 60) with a liquid is provided for each sheath base. 20 and 70 may be provided. In addition, a cap with a valve (not shown) is attached to the base end side of each sheath base 20, 70, such as blood when the second sheath 60 or the rod member 50 is inserted into each sheath 10, 60. It is configured not to leak.

  As shown in FIGS. 2 and 3, the rod member 50 includes a rod body 52, a holding portion 54 that holds the stent graft SG in a reduced diameter state, and a distal tip disposed at the distal end of the rod member 50. 56. The holding part 54 has a smaller diameter than the rod main body part 52 (see FIG. 2A).

  As a material constituting the rod main body 52 and the holding portion 54, various materials having appropriate hardness and flexibility such as resin (plastic, elastomer) or metal can be preferably used.

  As a material constituting the tip chip 56, for example, various materials having appropriate hardness and flexibility such as a synthetic resin (elastomer) made of polyamide resin, polyurethane resin, polyvinyl chloride resin, or the like are used. It can be preferably used.

  In addition, although description by illustration is abbreviate | omitted, in the rod main-body part 52, the holding | maintenance part 54, and the front-end | tip tip 56, the lumen for guide wires for inserting a guide wire or the stent graft SG of a reduced diameter state is expanded in an affected part, for example. A trigger wire lumen for inserting a trigger wire is formed along the axial direction of the rod member 50 (longitudinal direction of the rod member 50).

  Although not described in detail, the distal tip 56 is provided with a locking groove (not shown) for locking the trigger wire. As a method (mechanism) for expanding the stent graft SG in a reduced diameter state using the trigger wire and the distal tip at the affected part, for example, a known method described in Patent Document 1 or 2 can be used.

  As shown in FIG. 3, the first bending mechanism 30 is provided in the tube wall of the first sheath 10 along the first sheath 10, and extends along the axial direction of the first sheath 10 (FIG. 5B). A first wire 32 configured to be movable back and forth (in the direction of the arrow R1 or R2 shown in FIG. 1) and a first wire for operating the bent state of the first sheath 10 provided on the proximal end side of the first sheath 10. An operation unit 34 and a first motion conversion unit 36 are provided.

  Further, the first bending mechanism 30 has a function of bending the vicinity of the distal end portion of the first sheath 10 to a predetermined curvature (bending function), and a function of maintaining the bent state of the first sheath 10 (bending state maintaining function). And at least a function of releasing the maintenance of the bent state of the first sheath 10 (bending state releasing function).

  As the material of the first wire 32, for example, various materials having appropriate hardness and flexibility such as resin (plastic, elastomer) or metal can be preferably used. Examples of the resin include a fluororesin, and examples of the metal include stainless steel (SUS316 and the like), Ni—Ti alloy, Co—Cr alloy, and the like. In addition, although description by a part of illustration is abbreviate | omitted, the one end of the 1st wire 32 is connected to the mechanism which comprises the 1st motion conversion part 36, and the other end is not fixed.

  As shown in FIG. 5A, the first operation unit 34 is a slide member configured to be slidable (movable) in the P1 direction or the P2 direction within the long hole 22 along the axial direction of the first sheath 10. is there.

  In addition, although description by illustration is abbreviate | omitted, the 1st operation part 34 is comprised so that the position in the long hole 22 can be temporarily fixed and cancelled | released. Thereby, the bending state maintenance function and bending state cancellation | release function of the 1st bending mechanism 30 mentioned above are realizable.

  The first motion conversion unit 36 converts the operation of the first operation unit 34 when the first operation unit 34 is operated into the advance / retreat operation of the first wire 32 and moves the first wire 32 forward / backward (operation conversion / advance / retreat). Function) and a function of adjusting the advance / retreat amount of the first wire 32 based on the slide amount when the first operation unit 34 is slid (advance / retreat amount adjustment function).

  The above-described advance / retreat amount adjustment function refers to the first operation unit 34 with respect to the slide amount so that a value that is several times or a fraction of the slide amount of the first operation unit 34 becomes the advance / retreat amount of the first wire 32. This is a function for adjusting the advance / retreat amount of one wire 32. For example, when the first operation unit 34 is configured so that a value twice the slide amount of the first operation unit 34 becomes the advance / retreat amount of the first wire 32, the first operation unit 34 is slid 10 mm within the long hole 22. The first wire 32 advances and retracts 20 mm along the axial direction of the first sheath 10. In addition, when it is configured so that the half of the slide amount of the first operation portion 34 becomes the advance / retreat amount of the first wire 32, the first operation portion 34 is slid 10 mm within the long hole 22. As a result, the first wire 32 moves forward and backward along the axial direction of the first sheath 10 by 5 mm. The ratio of the advance / retreat amount of the first wire 32 with respect to the slide amount of the first operation unit 34 is not limited to the above-described specific numerical values, and can be set as appropriate. Further, the sliding amount of the first operation unit 34 and the advance / retreat amount of the first wire 32 do not necessarily have a proportional relationship.

  In addition, although description is abbreviate | omitted about the concrete structure (mechanical structure and electrical structure) of the 1st operation part 34 and the 1st motion conversion part 36, both functions of the above-mentioned operation | movement conversion / advance / retreat function and advance / retreat amount adjustment function As long as the configuration can be realized, known means (for example, a gear mechanism, a rack and pinion mechanism, etc.) may be used.

  Here, based on the relationship between the position of the first wire 32 when the first sheath 10 is not bent and the position of the first wire 32 when the first sheath 10 is bent, The bending function of the first bending mechanism 30 will be described.

When the first sheath 10 is not bent, that is, when the first sheath 10 is straight, as shown in FIG. 5C, the first wire extends to the distal end portion of the first wire lumen 12. 32 is moved. In order to move the first wire 32 to the distal end portion of the first wire lumen 12 (in the R1 direction shown in FIG. 5B), the first operating portion 34 is moved in the P1 direction shown in FIG. 5A. Move to.
On the other hand, when the first sheath 10 is bent, the first wire 32 is moved to a predetermined retracted position in the first wire lumen 12. In order to move the first wire 32 to a predetermined retraction position in the first wire lumen 12 (move in the direction R2 shown in FIG. 5B), the first operating portion 34 is moved to FIG. What is necessary is just to move to the P2 direction shown.
That is, by moving the first operation unit 34 in the P2 direction shown in FIG. 5A, the position near the distal end of the first sheath 10 can be bent to a predetermined curvature, and the first operation unit 34 is illustrated in FIG. The first sheath 10 can be straightened by moving it in the P1 direction shown in FIG.

  The second bending mechanism 80 is provided in the tube wall of the second sheath 60 along the second sheath 60, and is configured to advance and retract along the axial direction of the second sheath 60. The second sheath 60 is provided on the base end side, and has a second operation portion 84 for manipulating the bent state of the second sheath 60, and a second motion conversion portion 86. Further, the second bending mechanism 80 has at least a function (bending function) for bending the position in the vicinity of the distal end portion of the second sheath 60 to a predetermined curvature. The bending function of the second bending mechanism 80 is the same as the bending function of the first bending mechanism 30, and thus the description thereof is omitted.

  As the material of the second wire 82, the same material as that of the first wire 32 described above can be used. In addition, although description by illustration is abbreviate | omitted, the one end of the 2nd wire 82 is connected to the mechanism which comprises the 2nd motion conversion part 86, and the other end is not fixed.

  The second operation unit 84 is a slide member configured to be slidable along the axial direction of the second sheath 60. Similar to the first operation unit 34 described above, the second operation unit 84 is configured to be movable within a long hole (not shown) provided in the second sheath base 70.

  The second motion conversion unit 86 converts the operation of the second operation unit 84 when the second operation unit 84 is operated into the advance / retreat operation of the second wire 82 and moves the second wire 82 forward / backward (operation conversion / advance / retreat). Function) and a function of adjusting the advance / retreat amount of the second wire 82 based on the slide amount when the second operation portion 84 is slid (advance / retreat amount adjustment function). The advance / retreat amount adjustment function of the second motion converter 86 is the same as that described in the case of the first motion converter 36.

  In addition, although description is abbreviate | omitted about the concrete structure (mechanical structure and electrical structure) of the 2nd operation part 84 and the 2nd motion conversion part 86, both functions of the above-mentioned motion conversion / advance / retreat function and advance / retreat amount adjustment function As long as the configuration can be realized, known means (for example, a gear mechanism, a rack and pinion mechanism, etc.) may be used.

  The stent graft SG as a tubular treatment device loaded in the tubular treatment device placement apparatus 1 is not illustrated, but a self-expanding stent portion in which a thin metal wire is folded back in a zigzag shape and formed into a substantially cylindrical shape, And a graft portion which is sutured and fixed so as to cover the stent portion from the outer periphery. As a material of the metal fine wire constituting the stent portion, for example, a known metal or metal alloy represented by stainless steel, Ni—Ti alloy, titanium alloy, or the like can be preferably used. As a material constituting the graft portion, for example, a fluororesin such as PTFE (polytetrafluoroethylene) or a polyester resin such as polyethylene terephthalate can be preferably used. Graft parts made of these resin materials have relatively high biocompatibility and durability, and are chemically stable.

  In addition, the stent graft which can be used for the tubular treatment instrument placement device 1 according to the first embodiment (the tubular treatment tool placement device of the present invention) is not limited to the stent having the above-described configuration and material, and is described above. You may use the well-known stent graft which consists of a structure and material different from.

  Next, the tubular treatment instrument placement device 1 according to the first embodiment will be described in more detail based on the tubular treatment tool placement device 1a according to the comparative example.

FIG. 6 is a view for explaining the tubular treatment instrument placement device 1a according to the comparative example. FIG. 6A to FIG. 6E are conceptual diagrams showing in stages the progress of the tubular treatment instrument placement device 1a toward the affected part in the aorta. Note that “●” shown in FIGS. 6A to 6E indicates a bendable portion of the sheath 10a.
FIG. 7 is a view for explaining the tubular treatment instrument placement device 1 according to the first embodiment. FIG. 7A to FIG. 7F are conceptual diagrams showing in stages the manner in which the stent-graft SG is placed by advancing the tubular treatment device placement device 1 toward the affected part in the aorta. In FIG. 6 and FIG. 7, illustration of the guide wire disposed in the aorta is omitted.

  As described above, the tubular treatment instrument indwelling apparatus 1 according to Embodiment 1 includes two sheaths (first and second sheaths 10 and 60) as sheaths, and positions near the distal ends of the sheaths 10 and 60. Are provided with first and second bending mechanisms 30 and 80 that respectively bend to a predetermined curvature, the tubular treatment instrument placement device 1a according to the comparative example has a sheath 1 as shown in FIG. Only one sheath 10a is provided, and a bending mechanism (not shown) for bending the position near the distal end of the sheath 10a to a predetermined curvature is provided.

  For this reason, when trying to place a stent graft in the affected part of the ascending aorta or the proximal arch aorta via the groin using the tubular treatment instrument placement device 1a according to the comparative example, FIG. 6 (a) to FIG. 6 ( As can be seen from d), the tubular treatment instrument placement device 1a can be advanced to the distal arch aorta, but from there on the proximal arch aorta and the ascending aorta, the tubular treatment instrument placement device The tip of 1a cannot be reached. When the tubular treatment instrument placement device 1a is forcibly pushed to reach the position of the affected part of the proximal arch aorta or the ascending aorta, as shown in FIG. 6 (e), the tubular treatment is performed. The indwelling device 1a comes into contact with the blood vessel wall. As a result, the above-mentioned problem of vascular damage and the problem of liberation of mural thrombus / mural atheroma occur.

  On the other hand, according to the tubular treatment instrument indwelling apparatus 1 according to the first embodiment, the first and second sheaths 10 and 60 and the first and second sheaths 10 and 60 have a function of bending the positions in the vicinity of the distal ends to a predetermined curvature. Since the first and second bending mechanisms 30 and 80 are provided, the first sheath 10 is advanced from the descending aorta to the distal arch aorta while being bent by the first bending mechanism 30 (FIG. 7 ( a) and FIG. 7 (b).) From there, the tip (from the proximal arch aorta to the ascending aorta) is advanced while the second sheath 60 is bent by the second bending mechanism 80, so that the tubular treatment is performed. The distal end portion of the tubular treatment device placement device 1 can reach the position of the aortic aneurysm that has occurred in the proximal arch aorta or ascending aorta without bringing the device placement device 1 into contact with the blood vessel wall (FIG. 7 (c)). reference.). After reaching the affected part, the second sheath 60 is pulled out with the position of the rod member 50 fixed to expose the stent graft SG from the second sheath 60 (see FIG. 7D), and the first sheath 10 is further removed. Is pulled out to completely expose the stent graft SG (see FIG. 7E). Thereafter, the distal end portion of the stent graft SG is expanded by pulling a trigger wire (not shown), and the tubular treatment device indwelling device 1 is extracted together with the rod member 50, whereby the placement of the stent graft SG is completed (see FIG. 7 (f)).

As described above, the tubular treatment device placement apparatus 1 according to the first embodiment is a tubular treatment device placement that can place the stent graft relatively easily even if an aortic aneurysm occurs in the ascending aorta or the proximal arch aorta. Device (stent graft placement device).
Moreover, according to the tubular treatment instrument placement device 1 according to the first embodiment, the tubular treatment tool placement device 1 is not forced to be pushed forward when placing the stent graft SG in the affected part of the proximal arch aorta or the ascending aorta. It is possible to suppress the occurrence of the above-described problems of vascular damage and the problem of free of wall thrombus / wall atheroma.

  In the tubular treatment instrument placement device 1 according to the first embodiment, as described above, the first and second bending mechanisms 30 and 80 include the first or second wires 32 and 82 and the first or second operation unit 34. , 84 and the first or second motion converters 36, 86, the first and second sheaths 10, 60 can be bent relatively easily using the first and second wires 32, 82. Is possible.

  In the tubular treatment instrument placement device 1 according to the first embodiment, as described above, the first and second operation portions 34 and 84 are slidable along the axial direction of the first or second sheath 10 or 60, respectively. The first and second motion conversion units 36 and 86 are configured to move the wires 32 and 82 forward and backward by a predetermined amount based on the slide amounts when the operation units 34 and 84 are slid, respectively. It is configured to be able to. As a result, the position in the vicinity of the distal end of each sheath 10, 60 can be bent to a predetermined curvature by a simple operation of “sliding the first or second operation portion 34, 84”.

  In the tubular treatment instrument indwelling apparatus 1 according to the first embodiment, as described above, the first bending mechanism 30 has the bent state maintaining function and the bent state releasing function, so that the bent state of the first sheath 10 is maintained. Thus, the second sheath 60 can be advanced and retracted.

  In the tubular treatment instrument placement device 1 according to the first embodiment, the tubular treatment tool is a stent graft SG. That is, the tubular treatment instrument placement device 1 according to the first embodiment is a stent graft placement device capable of relatively easily placing the stent graft SG in an aortic aneurysm generated in the ascending aorta or the proximal arch aorta.

[Embodiment 2]
FIG.8 and FIG.9 is a figure shown in order to demonstrate the tubular treatment tool placement apparatus 2 which concerns on Embodiment 2. FIG. FIG. 8 (a) is a view showing each member and stent graft SG constituting the tubular treatment instrument placement device 2, and FIG. 8 (b) is a view showing a state in which each member is assembled and the stent graft SG is further arranged. FIG. 8C is a perspective view schematically showing a peripheral portion of the first operation unit 234. 8 and 9, the same members as those in FIGS. 2 and 3 are denoted by the same reference numerals, and detailed description thereof is omitted.

  The tubular treatment instrument placement device 2 according to the second embodiment basically has a configuration similar to that of the tubular treatment tool placement device 1 according to the first embodiment, but the configuration of the operation unit and the function of the motion conversion unit are embodiments. 1 is different from the tubular treatment instrument placement device 1 according to FIG.

  That is, in the tubular treatment instrument indwelling device 2 according to the second embodiment, as shown in FIGS. 8 and 9, as the operation unit, the first and second operation units for operating the bending state of each sheath 10, 60. 234, 284.

  The first operation portion 234 is a lever member having a shaft portion 244 and a fulcrum portion 246 as shown in FIG. The first operation portion 234 is configured to be rotatable about the fulcrum portion 246 as a rotation center in the S1 direction or the S2 direction (along the axial direction of the first sheath base portion 20).

  The first motion conversion unit 236 converts the operation of the first operation unit 234 when the first operation unit 234 is operated into the advance / retreat operation of the first wire 32 to advance / retreat the first wire 32 (operation conversion / advance / retreat). Function) and a function (advance / retreat amount adjustment function) of adjusting the advance / retreat amount of the first wire 32 based on the rotation amount (rotation angle) when the first operation unit 234 is rotated.

  The above-described advance / retreat amount adjustment function is a first function with respect to the rotation amount of the first operation unit 234 such that a value corresponding to the rotation amount (rotation angle) of the first operation unit 234 becomes the advance / retreat amount of the first wire 32. This is a function for adjusting the amount of advancement / retraction of the wire 32. For example, in the case where the first wire 32 is configured to move forward and backward by 1 mm when the first operation unit 234 is rotated once, when the first operation unit 234 is rotated 10 degrees, the first wire 32 is It moves forward and backward by 10 mm along the axial direction of the first sheath 10. In addition, the ratio of the advance / retreat amount of the first wire 32 with respect to the rotation amount of the first operation unit 234 is not limited to the above specific numerical values, and can be set as appropriate. Further, the rotation amount of the first operation unit 234 and the advance / retreat amount of the first wire 32 do not necessarily have a proportional relationship.

  Since the second operation unit 284 and the second motion conversion unit 286 have the same configuration as the first operation unit 234 and the first motion conversion unit 236, detailed description thereof is omitted.

  Further, the description of the specific configuration (mechanical configuration and electrical configuration) of each operation unit 234, 284 and each motion conversion unit 236, 286 is omitted, but the above-described motion conversion / advance / retreat function and advance / retreat amount adjustment function As long as both functions can be realized, known means (for example, a gear mechanism, a rack and pinion mechanism, etc.) may be used.

  In the tubular treatment instrument indwelling apparatus 2, the position near the distal end portion of the first sheath 10 is bent to a predetermined curvature by rotating (tilting) the first operation unit 234 in the S2 direction shown in FIG. 8C. The first sheath 10 can be straightened by rotating (tilting) the first operating portion 234 in the S1 direction shown in FIG. 8C. The same applies to the second sheath 60 and the second operation unit 284.

  As described above, the tubular treatment instrument placement device 2 according to the second embodiment is different from the tubular treatment tool placement device 1 according to the first embodiment in the configuration of the operation unit and the function of the motion conversion unit, but the first and second sheaths. 10 and 60 and the first and second bending mechanisms 230 and 280 having a function of bending the vicinity of the distal end portion of each sheath 10 and 60 to a predetermined curvature, the tubular treatment instrument placement according to the first embodiment Similar to the case of the device 1, even if an aortic aneurysm occurs in the ascending aorta or the proximal arch aorta, the tubular treatment device placement device (stent graft placement device) can place the stent graft relatively easily.

  In the tubular treatment instrument placement device 2 according to the second embodiment, as described above, the first and second operation units 234 and 284 are lever members, and the first and second motion conversion units 236 and 286 are respectively The wires 32 and 82 can be moved forward and backward by a predetermined amount based on the amount of rotation when the operation units 234 and 284 are rotated. As a result, the position in the vicinity of the distal end of each sheath 10, 60 is bent to a predetermined curvature by a simple operation of “turning (tilting) the first or second operation portion 234, 284 in either direction”. It becomes possible.

  The tubular treatment instrument placement device 2 according to the second embodiment has the same configuration as the tubular treatment tool placement device 1 according to the first embodiment except that the configuration of the operation unit and the function of the motion conversion unit are different. 1 has the corresponding effect as it is among the effects of the tubular treatment instrument placement device 1 according to 1.

[Embodiment 3]
FIGS. 10 and 11 are views for explaining the tubular treatment instrument placement device 3 according to the third embodiment. FIG. 10A is a diagram showing each member and stent graft SG constituting the tubular treatment instrument placement device 3, and FIG. FIG. 10C is a perspective view schematically showing a peripheral portion of the first operation unit 334. 10 and 11, the same members as those in FIGS. 2 and 3 are denoted by the same reference numerals, and detailed description thereof is omitted.

  The tubular treatment instrument placement device 3 according to the third embodiment basically has a configuration similar to the tubular treatment tool placement device 1 according to the first embodiment, but the configuration of the operation unit and the function of the motion conversion unit are embodiments. 1 is different from the tubular treatment instrument placement device 1 according to FIG.

  That is, in the tubular treatment instrument indwelling apparatus 3 according to Embodiment 3, as shown in FIGS. 10 and 11, the first and second operation parts for operating the bending state of the sheaths 10 and 60 as the operation parts. 334, 384.

  The first operation unit 334 is a button member configured to be able to be pressed toward the inside of the first sheath base 20.

  The first motion conversion unit 336 converts the operation of the first operation unit 334 when the first operation unit 334 is operated into the advance / retreat operation of the first wire 32 and moves the first wire 32 forward / backward (operation conversion / advancement / retraction). Function) and a function of adjusting the advance / retreat amount of the first wire 32 based on the depression amount when the first operation unit 334 is depressed (advance / retreat amount adjustment function).

  The advance / retreat amount adjustment function described above is the advance / retreat amount of the first wire 32 with respect to the press amount of the first operation unit 334 so that the value according to the press amount of the first operation unit 334 becomes the advance / retreat amount of the first wire 32. It is a function to adjust. For example, in a case where the first wire 32 is configured to move forward and backward by 10 mm when the first operating portion 334 is pressed down by 1 mm, when the first operating portion 334 is pressed down by 5 mm, the first wire 32 is moved to the axis of the first sheath 10. It will advance and retreat by 50 mm along the direction. The ratio of the advance / retreat amount of the first wire 32 with respect to the press amount of the first operation unit 334 is not limited to the above specific numerical values, and can be set as appropriate. Further, the pressing amount of the first operation unit 334 and the advance / retreat amount of the first wire 32 do not necessarily have a proportional relationship.

  Note that the second operation unit 384 and the second motion conversion unit 386 have the same configurations as the first operation unit 334 and the first motion conversion unit 336, and thus detailed description thereof is omitted.

  Further, the description of the specific configuration (mechanical configuration and electrical configuration) of each operation unit 334, 384 and each motion conversion unit 336, 386 is omitted, but the above-described operation conversion / advance / retreat function and advance / retreat amount adjustment function As long as both functions can be realized, known means (for example, a gear mechanism, a rack and pinion mechanism, etc.) may be used.

  In the tubular treatment instrument indwelling device 3, the position near the distal end portion of the first sheath 10 can be bent to a predetermined curvature by pushing the first operation portion 334. Further, the tubular treatment instrument placement device 3 is configured such that when the finger pushing the first operation unit 334 is released, the button returns naturally, so that the first sheath 10 is released by releasing the finger from the first operation unit 334. Can be straightened. The same applies to the second sheath 60 and the second operation unit 384.

  As described above, the tubular treatment instrument placement device 3 according to the third embodiment is different from the tubular treatment tool placement device 1 according to the first embodiment in the configuration of the operation unit and the function of the motion conversion unit, but the first and second sheaths. 10 and 60 and the first and second bending mechanisms 330 and 380 having a function of bending the vicinity of the distal end portion of each sheath 10 and 60 to a predetermined curvature, the tubular treatment instrument placement according to Embodiment 1 is provided. As in the case of the device 1, even if an aortic aneurysm occurs in the ascending aorta or the proximal arch aorta, the tubular treatment device placement device (stent graft placement device) can place the stent graft relatively easily.

  In the tubular treatment instrument indwelling device 3 according to the third embodiment, as described above, the first and second operation portions 334 and 384 are configured to be able to be pressed toward the inner direction of the sheath base portions 20 and 70, respectively. It is a button member, and the first and second motion conversion units 336 and 386 can advance and retract the wires 32 and 82 by a predetermined amount based on the pressing amount when the operation units 334 and 384 are pressed, respectively. It is configured. Accordingly, it is possible to bend the positions near the distal end portions of the sheaths 10 and 60 to a predetermined curvature by a simple operation of “pressing the first or second operation portions 334 and 384”.

  The tubular treatment instrument placement device 3 according to the third embodiment has the same configuration as that of the tubular treatment tool placement device 1 according to the first embodiment except that the configuration of the operation unit and the function of the motion conversion unit are different. 1 has the corresponding effect as it is among the effects of the tubular treatment instrument placement device 1 according to 1.

  As mentioned above, although the tubular treatment instrument placement device of the present invention was explained based on each above-mentioned embodiment, the present invention is not limited to each above-mentioned embodiment, and in various modes in the range which does not deviate from the gist. For example, the following modifications are possible.

(1) In each of the above embodiments, the case where the first and second wires 32 and 82 are arranged in the tube wall of the first or second sheath 10 or 60 has been described as an example. It is not limited to this. If the first and second wires are configured so as not to cause problems due to contact between other members or blood vessel walls, for example, the first or second wire is disposed on the inner or outer surface of each sheath. May be.

(2) In each of the above embodiments, the case where the cross-sectional shapes of the first and second wire lumens 12 and 62 are elliptical has been exemplified, but the present invention is not limited to this. Other cross-sectional shapes (for example, circular shapes) may be used. Moreover, you may use the 1st and 2nd wire which consists of cross-sectional shapes other than circular cross-sectional shape according to the cross-sectional shape of the lumen | lumen for 1st and 2nd wires.

(3) In each of the above embodiments, if the first or second wire 32, 82 is not disposed in the first or second wire lumen 12, 62, the sheath 10, 60 is bent, Each sheath 10, 60 and each wire 32, 82 are configured so that each sheath 10, 60 is straight when the first or second wire 32, 82 is disposed within the second wire lumen 12, 62. However, the present invention is not limited to this. For example, each sheath and each wire so that each sheath is bent when each wire is disposed in each wire lumen, and each sheath is straight when each wire is not disposed within each wire lumen. May be configured. In short, each sheath, each wire, and other members are configured so that each sheath can change from a bent state to a non-bent state (straight state) or from a non-bent state to a bent state. Just do it.

(4) In the first embodiment, the first and second operation portions 34 and 84 are directed in the P1 direction or the P2 direction shown in FIG. 5A (in the axial direction of the first or second sheath 10 or 60). Although the case where it is configured to be slidable has been described as an example, the present invention is not limited to this. For example, the circumferential direction of the first or second sheath 10 or 60 (the circle of the sheath cross section) The first and second operating portions may be configured to be slidable along the direction along the circumference.
In the second embodiment, the first and second operation portions 234 and 284 are directed in the S1 direction or S2 direction shown in FIG. 8C (along the axial direction of the first or second sheath 10 or 60). However, the present invention is not limited to this. For example, the circumferential direction of the first or second sheath 10 or 60 (the circle in the sheath cross section) is described. The first and second operating portions may be configured to be rotatable along a direction along the circumference.

(5) In the first embodiment, a rod-shaped slide member is illustrated as each operation portion 34, 84. In the second embodiment, a rod-shaped lever member is illustrated as each operation portion 234, 284. In the third embodiment, the operation members 334 and 384 have been described by exemplifying button members having an elliptical shape in plan view. However, the present invention is not limited to this, and has a shape different from the above shape. It may be a slide member, a lever member, or a button member.

(6) In the first embodiment, the operation portions 34 and 84 can move along the axial direction of the sheaths 10 and 60, and the circumferential direction of the sheaths 10 and 60 (along the circumference of the sheath cross section). However, the present invention is not limited to this. For example, apart from the fact that each operation unit can move along the axial direction of each sheath 10, 60, the position of each operation unit can be moved along the circumferential direction of each sheath 10, 60. May be. The same can be said for the lever member in the second embodiment.

(7) In each of the above embodiments, the case where the first and second operation portions for operating the bent state of each sheath 10, 60 are configured by a slide member, a lever member, or a button member is exemplified. Although described, this invention is not limited to this, You may comprise the operation part in this invention using another operation means.

(8) In each of the above embodiments, the case where the first and second operation units are configured as separate bodies has been described as an example, but the present invention is not limited to this. For example, the first operation unit and the second operation unit may be integrated as long as a switching unit capable of switching between a function performed by the first operation unit and a function performed by the second operation unit is provided.

(9) In the first embodiment, the case where each of the motion conversion units 36 and 86 has an advance / retreat amount adjustment function has been described as an example. However, the present invention is not limited to this and the advance / retreat amount adjustment is performed. You may use the motion conversion part which is not equipped with a function. In this case, the amount by which each operation unit is slid is directly used as the advance / retreat amount of each wire.

(10) In each of the above embodiments, the case where two sheaths (first and second sheaths 10, 60) are provided as examples of the sheath has been described, but the present invention is not limited to this. Three or more sheaths may be provided, and a bending mechanism for bending the distal end portion of each of these sheaths or a position near the distal end portion to a predetermined curvature may be provided. However, when three or more sheaths are provided, it should be noted that the overall diameter of the tubular treatment device placement apparatus may be increased.

(11) In each of the above embodiments, the bending mechanism including the wire, the operation unit, and the motion conversion unit has been described as an example of the bending mechanism for bending each sheath. However, the present invention is limited to this. It is not a thing. For example, a coil made of a shape memory alloy capable of generating an axial stress based on a temperature change is wound around the sheath distal end portion or a position near the distal end portion, and the temperature of the coil is increased or decreased by a predetermined operation. You may use the bending mechanism which bends. Alternatively, a bending mechanism that bends each sheath by using a sheath configured such that a portion of the sheath contracts or expands based on a temperature change, and increases or decreases the temperature of the predetermined portion of the sheath by a predetermined operation. May be used.

(12) In each of the above embodiments, the stent graft indwelling device for indwelling the stent graft to the affected part has been described as an example, but the present invention is not limited to this. The present invention can also be applied to a tubular treatment device indwelling device (for example, a stent indwelling device for placing a stent in an affected part) for placing a tubular treatment tool other than a stent graft in the affected part.

(13) The tubular treatment device indwelling device of the present invention can of course relatively easily place a tubular treatment device against an aortic aneurysm generated in the ascending aorta or proximal arch aorta, Needless to say, it is possible to relatively easily place the tubular treatment device for an aortic aneurysm that has occurred in other parts (distal arch aorta, descending aorta, etc.). In the tubular treatment instrument placement device of the present invention, the bending direction of the first sheath and the bending direction of the second sheath are opposite to each other (for example, the first sheath is bent inward and the second sheath is bent). If it is configured to be bent outward), for example, the tubular treatment tool can be placed relatively easily even at a portion beyond the position bent in an S shape.

1, 1a, 2, 3 Tubular treatment device placement apparatus 10, 10a First sheath 12 First wire lumen 20 First sheath base 22 Long holes 30, 230, 330 First bending mechanism 32 First wires 34, 234, 334 1st operation part 36,236,336 1st motion conversion part 50 Rod member 52 Rod main-body part 54 Holding | maintenance part 56 End tip 60 2nd sheath 62 2nd lumen | rumen 70 2nd sheath base part 80,280,380 2nd bending Mechanism 82 Second wire 84, 284, 384 Second operation portion 86, 286, 386 Second motion conversion portion 244 Shaft portion 246 Support point portion D1 Inner diameter D2 of second sheath SG stent graft

Claims (7)

A tubular treatment device placement device (1) for placing a radially expandable tubular treatment device (SG) in an affected area,
A flexible, tubular first sheath (10);
A tubular second sheath (60) having flexibility and configured to be able to advance and retract along the axial direction of the first sheath (10) inside the first sheath (10);
The tubular treatment device (SG) in a state in which the inner diameter of the second sheath (60) is advanced and retracted along the axial direction of the second sheath (60) and the diameter thereof is reduced is the second sheath (60). A rod member (50) for exposure from the tip of
A first bending mechanism (30) having a function of bending the distal end portion or the vicinity of the distal end portion of the first sheath (10) to a predetermined curvature;
A second bending mechanism (80) having a function of bending the distal end portion of the second sheath (60) or the vicinity of the distal end portion to a predetermined curvature ;
The rod member (50)
A rod body (52);
A holding part (54) that holds the tubular treatment device (SG) in a state of being smaller than the rod main body part (52) and having a reduced diameter;
The tubular treatment device (SG) is configured to be loaded inside the second sheath (60) instead of the first sheath (10),
When the tubular treatment device (SG) loaded in the tubular treatment device indwelling device (1) reaches the affected area, the tubular treatment device (SG) is held by the holding portion (54) and is attached to the first sheath (10). The second sheath (60) is configured to advance, and after the tubular treatment device (SG) reaches the affected area, the position of the rod member (50) is fixed and the second sheath (60) is fixed. ) by retracting the tubular treatment instrument indwelling device (1, characterized that you have been configured to be placed the tubular treatment instrument of (SG) to the affected area).
The tubular treatment instrument placement device according to claim 1,
The first bending mechanism (30)
A first sheath (10) is provided in the tube wall or on the surface of the tube wall along the first sheath (10), and is configured to advance and retract along the axial direction of the first sheath (10). 1 wire (32);
A first operating portion (34) provided on a proximal end side of the first sheath (10) for operating a bent state of the first sheath (10);
A first operation for moving the first wire (32) by converting the operation of the first operation unit (34) when the first operation unit (34) is operated into the advance / retreat operation of the first wire (32). A motion conversion unit (36),
The second bending mechanism (80)
A second sheath (60) is provided in the tube wall or on the surface of the tube wall along the second sheath (60), and is configured to advance and retreat along the axial direction of the second sheath (60). Two wires (82);
A second operating portion (84) provided on the proximal end side of the second sheath (60) for operating the bent state of the second sheath (60);
A second operation for converting the operation of the second operation portion (84) when the second operation portion (84) is operated into an advance / retreat operation of the second wire (82) to advance and retract the second wire (84). A tubular therapeutic instrument indwelling device (1) characterized by having a motion converter (86). The tubular treatment instrument placement device according to claim 2,
The first and second operation units (34, 84) are respectively
A slide member configured to be slidable along the axial direction of the first or second sheath (10, 60);
The first and second motion converters (36, 86) are respectively
A tubular treatment instrument placement characterized in that the first or second wire (32, 82) can be advanced or retracted by a predetermined amount based on the sliding amount when the sliding member is slid. Device (1). The tubular treatment instrument placement device according to claim 2,
The first and second operation units (234, 284) are respectively
A lever member having a shaft portion (244) and a fulcrum portion (246) and configured to be rotatable around the fulcrum portion (246);
The first and second motion converters (236, 286) are respectively
A tubular treatment instrument configured to be able to advance and retract the first or second wire (32, 82) by a predetermined amount based on a rotation amount when the lever member is rotated. Indwelling device (2). The tubular treatment instrument placement device according to claim 2,
The first and second operation units (334, 384) are respectively
A button member configured to be pressed in a predetermined direction;
The first and second motion converters (336, 386) are respectively
A tubular treatment instrument placement device characterized in that the first or second wire (32, 82) can be advanced or retracted by a predetermined amount based on the amount of pressing when the button member is pressed. (3). In the tubular treatment instrument indwelling device according to any one of claims 1 to 5,
The first bending mechanism (30) further has a function of maintaining the bent state of the first sheath (10) and a function of releasing the maintenance of the bent state of the first sheath (10). Tubular treatment device indwelling device (1). In the tubular treatment instrument indwelling device according to any one of claims 1 to 6,
The tubular treatment device placement device (1), wherein the tubular treatment device is a stent graft (SG).

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