DE19624642A1 - Clamping ring for retaining prosthesis in body passage, e.g. for repair of arterial aneurysms - Google Patents

Abstract

The clamping ring may be folded along a diametric axis for insertion into the body passage. The clamping ring is adapted to resiliently spring outwardly, once in position inside the body passage, and to be continually resiliently biassed against the interior surface of the body passage. One or more of the clamping rings may be attached to opposed ends of a tubular graft. The rings and connected graft may be positioned in the body passage using an applicator which selectively permits expansion and/or contraction of the annular ring in position within a body passage. Alternatively a retaining member may be used to retain the annular ring in a compressed condition until it is in a desired position within a body passage.

Description

The present invention relates to a vascular prosthesis and an associated application device, in particular for Elimination of arterial sacking (aneurysms) and for Bridging diseased sections of the vessel.

Diseased (arteriosclerotic) vascular sections who today mostly through a so-called "open" surgeon treated procedure. It gets through the diseased vessel a vascular prosthesis (woven, knitted or extruded Tube) bridged by connecting this tube before and after the diseased vascular region with the vascular ends is made by seam. This is an operational freile the vessel is necessary. For diseases of larger vessels such as the abdominal or breast artery (abdominal aorta, thoracala Aorta) is in most of the cases Aus sacs (aneurysms) that are of high mortality followed rupture are threatened (in Germany Approx. 220,000 patients are aneurysm carriers, of which approx. 45,000 immediately at risk of rupture). The elimination of this  Aneurysms by replacing the sac with one as above indicated tube is the therapy of choice today.

An aneurysm 10 is shown in FIG. 9a using the example of an abdominal aorta 1 . As shown, the aorta has an aneurysm 10 which is present between the right and left renal arteries 3 , 5 on the one hand and the right and left iliac arteries 7 , 9 . Furthermore, a proximal aneurysm neck 12 and a distal aneurysm neck 14 is shown schematically. Depending on the degree of the disease, the proximal and distal aneurysm neck are very short or may not even be present.

This operative deactivation is still predominantly carried out "open" today, ie the body cavity (abdomen or thorax) is opened, the artery is shown, this is clamped proximal and distal to the sac, the sac opens longitudinally, then proximally and distally a bridging tube 16 sewn in ( Fig. 9b). If the origin of the iliac arteries is also ill (aneurysmal Erwei tert) a so-called bifurcated prosthesis is a sewn 18, which connects the aorta having two iliac arteries (Iliacalar criteria) (Fig. 9c). This surgical therapy has the following dangers and also economic disadvantages.

The surgical procedure (opening of the large body height len) is a significant intervention in the physiological Normal condition of the patient due to the large wound inflicted with blood loss, hypothermia, reactive water and electr trolyte shifts between cell and vascular system.

To switch off the affected vessel section, d. H. to Interposition of artificial vascular replacement is one more or less long interruption of blood flow in the right constructing vessel necessary. Due to the increased river wi then there is a considerable mechanical load for the heart, which is now against this increased resistance  must pump. This results in an increased oxygen level need of the heart, which is due to increased blood circulation the coronary arteries is compensated. Because patients with one Disease of the vessels in the manner described above Underlying disease of vascular calcification (arteriosclerosis) lei their coronary arteries are also affected, so wuh rend or after the operation of the type described above Heart attacks are possible.

The patient's recovery after one as stated above open surgery is sometimes done directly after the operation in an intensive care unit until a stable physical safe state. Intensive care monitor treatment, artificial respiration and drug therapy experience has shown that a stable state is required expensive. Even after surviving this acute condition, it is necessary prolonged postoperative inpatient care. After this inpatient stay is an immediate reintegra tion into normal social and professional life not yet possible - rehabilitation measures longer Duration can follow after this major surgery.

EP-A-0 461 791 proposes a system for the to avoid operational exposure. By one of the lesion more distant from the vessel, from the outside by puncture accessible vessel (e.g. in the groin) is through this Ge the artificial tube to be used for replacement is the one above introduced specified type. To insert this vessel sentence is a tube (catheter) is used, the through knife is far smaller than the diameter of the over bridging portion of the diseased vessel. A radial com pression of the vascular replacement to be inserted in the catheter therefore necessary. The catheter with the one contained in it Pipe is pushed into the region to be bridged, the Tube held in the catheter with an arrangement and the Catheter withdrawn over the vascular replacement. This will the vascular replacement is released in the vessel. After or during the  Release of the two ends of the vascular replacement from the Ka These ends are connected to the vessel wall through a tube shaped expandable clamping device (stent) by radi pressure generated by a balloon from in jammed. During this process is the blood flow completely blocked. For vascular diseases where no jamming of the vascular replacement possible at the lower end is a connection of the pipe at the bottom with smaller vessels branching off the vessel (at the belly artery with the 2 pelvic vessels). Also in this case, both tube "tube" and Ge "Leg" barrel replacement with its connections to the vessels connected (blood-tight), d. H. inside with a stent ver get stuck.

EP-A-0 539 237 describes a further possibility for Attachment of a vascular replacement. There is a clamp direction from a circular inside a hose arranged zigzag wire. This one has Self elasticity, so that the whole system after application radially from the catheter and the clamp device by this radial force against the hose Vessel wall jammed blood-tight.

With a short neck, i.e. H. Distance from the beginning of the Aneurysms from the lower edge of the exits of the renal vessels can both when introducing a pipe replacement, as even if a replacement with two legs is inserted (Bifur cation prosthesis) the following problems occur.

The length of the vessel section to be replaced is before Introduction of the vascular replacement by X-ray (angio graphics, computed tomography) tries to determine. Experience According to the determined geometric sizes with has a significant error. Especially length measurements show a high variation due to meandering of the vessels width when measured by various independent sub  viewfinder. Either there is an eco in the clinic nomically unacceptable number of different lengths Ge or individually tailored to each patient tenes system necessary.

Systems with elastic clamping devices open up Spring force immediately after ejection from the catheter with which it be placed - the result is an extensive blockage the current path and, under certain circumstances, runoff, d. H. Dislo cation of the prosthesis distally, creating an accurate placenta tion, which is particularly necessary for a short neck, cannot be reached. Furthermore, a correction of the Position of the proximal end after leaving the vascular replacement no longer possible from the catheter.

When using a tube replacement in the breast artery With these systems, there is even more of a runoff because there the blood flow is very high - when used in the tho The sacral aorta must therefore artificially reduce blood flow (by lowering it blood pressure) can be reduced, with possible negative effects Effects on heart function.

All previously known systems have in particular technical ones Problems when the neck of the aneurysm is short.

A secure seal on the neck of the aneurysm can only be sufficient if the length or mesh height H _{M of} the holding device used is smaller than the neck length L _P or L _D. ( Fig. 10). With short neck lengths and thus necessary shortening of the stitch height, an increase in the number of stitches is necessary in order to achieve a sufficient diameter of the holding device (which must always be somewhat larger than the diameter of the neck).

However, as the number of these stitches increases, the number decreases the radial force due to Hooke's law since it in principle here around elastic Fe arranged in series  who acts. This causes a thickening constructively of the material (enlargement of the wire diameter). Thereby but also increases the diameter of the compressed Systems in the catheter, making thicker catheters necessary the more difficult through the peripheral vessel into the Abdominal aorta are to be spent.

If the aneurysm neck is only a few mm long, the systems currently used can no longer be used, since there is a risk that the renal artery outlets will be covered by the system and thus closed. At present, only those aneurysms can be treated with the method given above, whose neck is a length L _P or L _D of at least 15-20 mm.

The shorter the neck, the more precise the placement follow which are only checked from the outside by X-ray that can. Once the system is out of the catheter, no correction is possible.

During the application, the current path is occluded, it therefore exists particularly in the thoracic aorta with its high blood flow the risk of washing away distally.

The invention has for its object a vascular prosthesis and to provide an associated application device, where the holding device has a sufficient radial force generated and the blood tightness between the vessel wall and the textile prosthesis and slipping of the Pro thesis distally prevented by the flow resistance.

The problem is solved by using a vascular prosthesis Features of claim 1 and a device for Einbrin system from the catheter into the current path with the Features of claim 19.  

The vascular prosthesis according to the invention has a hose cut open at one or both ends with a elastically deformable ring is connected. With the help of elastically deformable ring is the hose section on pressed the inner wall of a vessel. The radial resilience a circular ring guarantees blood tightness between the vessel wall and the tube section and prevented a sliding of the prosthesis distally through the flow resistance. The ring offers high stability with low dimensions use of materials. The vascular prosthesis according to the invention is in particular especially suitable for aneurysms with a very short aneurysm neck.

The size of the clamp ring becomes relative to the size of the vessel chosen so that it is full on the inner wall of the vessel constantly pending.

The diameter of the clamping ring is preferably so large that this nestles against the inner wall of the vessel and min at least there is an arc that is essentially extends parallel to the axis of the clamping ring. This has the Advantage that with an increase in the diameter of the neck and with the pulsation of the vessel or with a possible give way later the vessel expansion of the clamping ring can, d. H. can increase its effective diameter. Be the clamping ring particularly nestles in each case two opposite arches on the inside of the vessel. The clamping ring points in relation to the flow direction of the blood two proximal arches and two distal arches. This Ge Barrel prosthesis can be used particularly advantageously with egg abdominal aorta aneurysm with very short proximal Aneurysm neck. The vascular prosthesis is used that the distal arches in the area of the left or right The renal artery rests against the aneurysm neck and the proximal Arches extend into the area of the aorta, with and the exits of the renal arteries remain free.  

The clamping ring preferably has a plurality of rings or windings on a highly elastic wire. Depending on the ge desired clamping force and the elastic deformability of the Material has the clamping ring at least 2 and at most 100 Turns up. A diameter of is also preferred Individual wires in the range from 0.05 to 0.2 mm. The clamping ring consists of an elastic material such as metal or Plastic, particularly preferably a memory alloy like nitinol. Nitinol is 10 times higher than steel Flexibility. The minimum bend diameter before one plastic deformation of the wire is about 10 times higher than the diameter of the wire. A clamping ring with egg A wire diameter of 0.1 mm can be reduced to a diameter of approximately 1 mm.

On the other hand, the clamping force is greater when the wire passes through knife is larger. For certain applications where a high clamping force is required, a wire would be knife of approx. 1.5 mm necessary. Such a clamping ring would leave compress to a diameter of 15 mm without one to achieve permanent plastic deformation, which is a would prevent elastic expansion. An equally high Clamping force can be achieved in that a clamping ring several parallel turns of a thin highly elastic Has wire, such a clamping ring accordingly can be compressed more radially. For example such a vascular prosthesis is used by means of a catheter that has a small diameter, d. H. one Inner diameter of, for example, 4 to 6 mm.

According to a development of the invention, the clamping ring the vascular prosthesis on one or more holding sections, which are preferably arranged in the area of the proximal arches are. The holding section consists of, for example narrow strips of rigid plastic or sheet metal. These holding sections are used to deploy the vascular pro  thesis from the catheter by means of a written application device.

One or more are preferably on the holding sections outward check marks arranged, preferably on the Tip of the proximal end of the holding section. This Wi derhaken by the clamping force of the clamping ring against the Inner wall of the vessel pressed and cause an increased Friction or anchoring, causing a washing away of the Prevent vascular prosthesis by distal blood flow can be changed.

A holding device is preferably on the holding section device in the form of a longitudinal hole or a tab hen, preferably at the distal end of the holding section. In these protrude retaining wires of those described in more detail below Application device into it.

The hose section preferably consists of a flexible material and is for example a woven or knitted textile tube made of Dakron, Teflon or one their body-compatible material. It is an advantage if the tube section is essentially unchangeable Has circumferential length, this to the size of a he setting vessel is adapted.

The clamping ring is preferably at the edge of the hose cut, for example, by a seam or glue the. It is advantageous if the clamping ring on the inside the hose section is arranged and thus the Section of hose between the clamping ring and the inside of the vessel wall is lying.

The diameter of the clamping ring is preferably larger than the diameter of the hose section. This results in advantageously the training described above  of two proximal and two distal arches when using the Vascular prosthesis in a vessel.

The vascular prosthesis can be called a bifurcation prosthesis with a proximal tube section and two ver bound distal tube sections. There at is at least at the proximal end of the proximal Hose section arranged a clamping ring. Preferably are at the ends of the distal tubing sections, respectively another clamping ring arranged.

An application device for inserting a vascular pro This by means of a catheter has at least one stop wire that is releasably connectable to the vascular prosthesis and at least one holding device for holding the Clamping rings in a bent position. Preferably, the or the holding wires can be connected to the clamping ring, specifically each with a holding device on the clamping ring arranged holding section. For example, the holding wire in a longitudinal bore formed as a holding device or Inserted tab and in it by positive locking and / or Friction held. Each tether is preferred surrounded by a hose that is sufficiently rigid has. This has the advantage that after inserting the Vascular prosthesis of the holding wire from the holding section on Clamping ring can be removed and at the same time Support section on the hose can support.

The diameter of the retaining wire is equal to the diameter of the Longitudinal bore or the size of the tab on the holding section fit. The diameter of the retaining wire is preferably between 0.3 and 1 mm.

According to a preferred embodiment, the holding is direction a resizable loop around the ra dial compressed ring is placed. This has the advantage that by changing the size of the loop the effective one  Check the diameter of the clamping ring in the bent position can be enlarged and reduced. Preferably the loop consists of a wire loop that is at the free End of the loop by means of a releasable blocking device is noticeable. According to an advantageous embodiment the blocking device has an eyelet through which the End of the wire loop is insertable and one through the Wire loop inserted locking wire prevents this Pull the loop back. In one example, both are Compression loop and blocking wire wires from surrounded by a Bowden cable sheath, and at the free end of the Bowden the sheath is arranged.

The application device according to the invention has the front part that after the deployment of the vascular prosthesis from the Ka exact positioning of the vascular prosthesis and a subsequent correction of the position of the vascular prosthesis possible is. In particular, the holding device enables one radial compression of the clamping ring, which creates the clamping fit of the clamping ring on the inner wall of the vessel can be and the holding wires allow moving and rotating the vascular prosthesis in the vessel.

The invention is illustrated below by means of examples and Drawing explained in more detail. Show it.

FIGS. 1a and 1b is a schematic view of a erfindungsge MAESSEN clamping ring before or after insertion into a tube (artery),

FIG. 2a is a schematic representation of an OF INVENTION to the invention the vascular prosthesis prior to insertion into a vessel,

Fig. 2b is a front view of the vascular prosthesis of FIG. 2a, after introduction into the abdominal aorta

Fig. 2c is a side view of the arrangement of FIG. 2b,

Figure 3 is a schematic view of direction. A vascular prosthesis having an inventive Applikationsein,

Fig. 4 is a schematic enlarged side view of the arrangement of Fig. 3,

Fig. 5 is a sectional view of the arrangement of Fig. 4,

FIG. 6a is a schematic view of a vascular prosthesis with a holding device,

Fig. 6b shows an enlarged view of the Halteeinrich tung,

Fig. 7 is a schematic view of a vascular graft with two vascular prostheses,

Fig 8 consisting synthesis. A schematic view of a vascular graft of a tubular Gefäßpro and a bifurcated prosthesis,

Figs. 9a, 9b and 9c is a schematic view of an aneurysm in the abdominal aorta without and with a tubular prosthesis or bifurcated prosthesis and

Fig. 10 is a schematic view of a conventional vascular prosthesis having a zigzag stent.

In Fig. 1a, a circular clamping ring 30 is shown schematically, which consists of a highly elastic material and has a diameter D _K. Fig. 1a also shows a tube or an artery 1 with a diameter D _R , where D _R is ner D _K. In Fig. 1b, the clamping ring 30 is arranged in the tube 1 . The opposing points in Fig. 1 A, A, in FIG. 1b in the axial direction of the tube upwardly and in Fig. 1a opposing points B, B, which are offset from the points A, A by 90 °, have in Fig. 1b down. Two proximal arches A, A and two distal arches B, B are formed and the clamping ring hugs the circumference of the tube completely. The height H shown in FIG. 1b is a first approximation of a quadratic function of the radial compression. The bending diameter D _B is also shown in FIG. 1b. When inserting a vascular prosthesis, the clamping ring 30 is compressed even more radially according to the inner diameter of a catheter. The permissible smallest bending diameter D _B depends on the material and the thickness of the clamping ring or the individual wires that make up the clamping ring.

In the example, the clamping ring consists of several parallel turns of a thin, approximately 0.1 mm thick, highly elastic wire (preferably Nitinol) (not shown). Because of Hooke's law, these windings can be seen as parallel-connected springs, the spring characteristics of which add up, the individual low radial clamping force adds up to a large total clamping force, which is only dependent on the number of turns. At the same time, it applies to each individual turn of the thin material that this single turn has a bend diameter when the overall structure is compressed, which corresponds approximately to the minimum bend diameter D _{B of} the single turn, ie a bend diameter of approximately 1 mm for 0.1 mm wire . It can thus form such a clamping ring with a high clamping force for the reasons given above to form a small compressed structure which, after being discharged from the catheter, also returns to the old shape and presses the prosthesis against the vessel wall with sufficient clamping force.

A preferred embodiment of a vascular prosthesis is shown in Fig. 2a. This has a hose section 20 made of a textile fabric and a clamping ring 30 arranged at one end. The hose section has a diameter D _P that is smaller than the diameter D _{K of} the clamping ring. Due to the connection of the clamping ring to the end of the hose section, there is a diameter D _KP at the connection point between the clamping ring and hose section. The clamping ring stretches the end of the hose section as far as possible. By a corresponding shaping of the end edge of the hose section and due to mesh shifts in the fabric, the clamping ring can expand accordingly.

The arrangement of this vascular prosthesis in the aorta 1 is shown in FIGS. 2b and 2c. The clamping ring 30 lies against the aorta in such a way that the distal arches in the area of the left and right renal arteries 3 , 5 rest against the proximal aneurysm neck 12 . The proximal arches of the clamping ring 30 extend into the area of the aorta 1 , which is offset by 90 ° relative to the branches of the renal artery 3 , 5 . In the side view of Fig. 2c it can be clearly seen that the exit of the renal artery 5 is free. The vascular prosthesis thus lies in a blood-tight manner on the inner wall of the aorta 1 and the tube section 20 projects into the area of the aneurysm 10 in the direction of flow of the blood.

An advantage of this geometric design is that can also be treated with aneurysms, the neck of which is very is short, in theory the neck length could be extreme be equal to the thickness of the clamping ring. Through the double sheet shaped configuration is achieved that the prosthesis to Part above the renal artery can be fixed due to the arched design both renal arteries remain free. An additional advantage of the design of the Clamping ring is that this is also irregularly configu cross sections of the aneurysm neck (not circular mig) through the flexibility of the individual turns.

In Fig. 3, a vascular prosthesis is shown in which two retaining sections 40 in the form of narrow strips are arranged on the two proximal arches in the clamping ring 30 . These holding sections 40 are each shown in FIGS. 4 and 5 enlarged in the side view and in section. In the example shown, the fastening of the holding section 40 to the clamping ring 30 takes place with the aid of a tab 42 which is present somewhat above the middle. A longitudinal bore 44 is provided in the holding section and extends from the distal end to approximately the height of the fastening tab 42 . At the proximal end, a total of four barbs 46 are arranged. These barbs are wires in the example shown, which are inserted in oblique holes in the holding section.

The longitudinal bore 44 in each holding section 40 serves to receive a holding wire 52 which is surrounded by a rigid hose 54 .

The vascular prosthesis is pushed out of the catheter 50 with the holding wires. The retaining wires run inside the vascular prosthesis and inside the catheter and emerge from the catheter outside of the patient.

When inserting the prosthesis with the clamping ring, which is mounted in the catheter, the catheter is first placed, at the end of the catheter, which is located outside the body, the retaining wires are gripped and the catheter is now pushed back so that the position the arrangement of the clamping ring and prosthesis is not changed after delivery from the catheter. After expansion of the clamping ring and fixation on the artery wall, the retaining wires can be removed by pulling out of the hole or the tab of the longitudinal strips. For a safe and frictionless removal of the holding wires 52 , the rigid thin-walled hose 54 is used over the holding wires. This thin-walled hose is held outside the body and the retaining wires are retracted, so that the pulling forces when pulling out the retaining wires are caught by friction in the longitudinal bore of the rigid tube in order to prevent a change in the position (FIGS . 4 and 5) .

After positioning, the barbs are removed from the holder cut through the tension of the clamping ring against the species rienwand pressed and thus increase the friction to a Ab wash the arrangement distally through the blood flow prevent.  

A suitable material for the holding sections is more rigid Plastic or nitinol sheet.

Other ways of attaching the retaining wires to the hal Teg section in the form of a tab are possible Lich.

In Fig. 6a and 6b is shown apparatus, a further portion of the application with which the clamping ring in the vessel is radially compressible when Einbrin 30 gene. The device Halteinrich 60 has a wire loop 62 in the example shown, which is placed around the clamping ring. In the area of the center of the clamping ring bent in this way, holding loops 32 are provided, through which the wire loop is pulled. This has the advantage that slipping of the two wires of the compression loop 62 of the clamping ring 30 is avoided. The two wires of the compression loop are surrounded by a Bowden cable sheath 70 , at the end of which an eyelet 66 is provided. Through this eyelet 66 , the smart end 64 is pushed through at the beginning and secured with a blocking wire 68 , which is also passed through the Bowden cable casing, against being pulled out.

To ensure exact positioning and ver prevent blood flow when deploying the assembly interrupted (the part of the prosthesis with the clamping ring would already be open, but the dependent prosthesis is still com primed in the catheter) it is beneficial to arrange the whole after complete delivery from the catheter To keep part of the clamping ring compressed and only after ge precise position control to open the clamping ring in a controlled manner. It is also advantageous if an inadequate position tion has been reached to be able to undo this nen, d. H. to compress the clamping ring again, a better one Location by rotation and by longitudinal displacement and then open the clamp ring again. This will fol achieved in the following way:  

The clamping ring is kept compressed in the compressed state by the highly flexible wire loop (Nitinol). The wire loop is continued in the Bowden cable casing (diameter approx. 1 mm). The two wires belonging to the loop run through the entire length of the Bowden cable, the entire length of the Bowden cable runs through the entire insertion catheter to the outside. The loop encircles the entire circumference of the clamping ring, the tip of the loop protrudes into the eyelet at the tip of the Bowden cable sleeve in the direction of the lumen of the Bowden cable sleeve. The blocking wire, which is also in the Bowden cable sheath and is also accessible outside the patient (inside the catheter) runs through the tip of the loop and initially blocks the loop tip in the eye. The clamping ring can be compressed and relieved by pulling with relief on the two highly flexible thin loop wires. Once the definitive position of the clamping ring has been found, the blocking wire, which runs through the loop tip, is removed from the outside, then the loop wires can be pulled back into the Bowden cable cover by pulling from the outside, then the Bowden cable cover removed by pulling back. The retaining wires held during this procedure prevent the clamping ring prosthesis from slipping off. The retaining wires can also serve as a guide rail for the insertion kit (catheter) for a second tube (telescope) in order to extend the stent-prosthesis construction distally. It then jams the second vascular prosthesis 20 ', 30 ' in the first. At the end, the retaining wires are removed in the manner indicated above ( Fig. 7).

First of all, a first vascular prosthesis 20 , 30 is arranged in the region of the proximal aneurysm neck. At closing a second vascular prosthesis 20 ', 30 ' is inserted into the free end of the first vascular prosthesis, the clamping ring 30 'of the second vascular prosthesis nestling against the inner wall of the first tube section 20 . The free end of the tube section 20 'has a further clamping ring 35 ', with which the second vascular prosthesis is clamped to the distal neck of the aneurysm.

The procedure given above corresponds to the procedure for the endovascular insertion of a bifurcation prosthesis. First, as shown in Fig. 8, a proximal vascular prosthesis 20 , 30 is introduced, this is then extended with a two-part vascular prosthesis 20 ', 30 ' so that the two distal openings come to lie near the outlets of the iliac arteries, then in Both "pants legs" from the same and the contralateral side short vascular prostheses 20 '', 30 '' and 20 ''', 30 ''' introduced, which have a smaller diameter, the construction of which is identical to the construction specified above.

At the other ends of the short vascular prosthesis, a clamping ring 35 '' and 35 '''is arranged. These are used in the area of the branches of the iliac arteries.

In the example shown, rings 37 ', 38 ' are arranged on the distal end of the legs of the second vascular prosthesis. These rings preferably consist of several turns z. B. of very thin nitinol wire. The ends are preferably cut obliquely, thereby preventing the legs from kinking. In addition, both legs are made by a seam 39 'or gluing the tube 30 in the longitudinal direction.

Both with a replacement by tube, as well as with an Er through a bifurcation, the system is a modular Er sentence system, d. H. the affected vascular section will not replaced by a geometrically rigid prefabricated system, but through "modules", d. H. single prosthesis that in the vessel to be replaced or bridged (flanged) without the Blood flow is interrupted. There is also a position correction  the vascular replacement is still possible after it has been removed from the catheter Lich.

Claims (25)

1. vascular prosthesis with at least one hose section ( 20 ) and at least one at one end of the hose section arranged clamping device, characterized in that the clamping device has an elastically deformable clamping ring ( 30 ) which is not deformed substantially circular. 2. Vascular prosthesis according to claim 1, wherein the clamping ring ( 30 ) is deformable in such a way that it has at least one arc which extends essentially parallel to an axis of the ring. 3. A vascular prosthesis according to claim 2, wherein the clamping ring ( 30 ) is deformable in such a way that it has two proximal arches that extend in a first direction and two distal arches that extend in the direction opposite to the first direction. 4. Vascular prosthesis according to one of claims 1 to 3, wherein the clamping ring ( 30 ) has at least two turns of a highly elastic wire. 5. Vascular prosthesis according to one of claims 1 to 4, wherein the clamping ring ( 30 ) has at most 100 turns of a highly elastic wire. 6. Vascular prosthesis according to one of claims 1 to 5, wherein the wire has a diameter in the range of 0.05 to 0.2 mm, particularly preferably from about 0.1 mm points. 7. Vascular prosthesis according to one of claims 1 to 6, wherein the clamping ring ( 30 ) consists of an elastic material such as metal or plastic, particularly preferably a Ge memory alloy such as Nitinol. 8. Vascular prosthesis according to one of claims 1 to 7, wherein the clamping ring ( 30 ) has at least one holding section ( 40 ), which is preferably arranged on one of the proximal arches. 9. Vascular prosthesis according to claim 8, wherein the holding section ( 40 ) has a narrow strip, preferably made of rigid plastic or sheet metal. 10. Vascular prosthesis according to claim 8 or 9, wherein the Halteab section ( 40 ) has at least one outwardly directed hook ( 46 ) preferably made of wire, which is preferably arranged at the tip of the proximal end of the holding section. 11. Vascular prosthesis according to one of claims 8 to 10, wherein on the holding section ( 40 ) preferably a longitudinal bore ( 44 ) or tab is provided, which is preferably arranged at the di stalen end of the holding section. 12. Vascular prosthesis according to one of claims 1 to 11, wherein the tube section ( 20 ) consists of a flexible material, preferably a woven or knitted textile tube made of DACRON, Teflon or another body-compatible material. 13. Vascular prosthesis according to one of claims 1 to 12, wherein the hose section ( 20 ) has a substantially unchangeable circumferential length, which is preferably adapted to the size of a vessel to be replaced. 14. Vascular prosthesis according to one of claims 1 to 13, wherein the edge of the end of the tube section ( 20 ) follows the clamping ring ( 30 ). 15. Vascular prosthesis according to one of claims 1 to 14, wherein the clamping ring ( 30 ) on the inside of the tube section ( 20 ) is arranged. 16. Vascular prosthesis according to one of claims 1 to 15, wherein the clamping ring ( 30 ) with the edge of the tube section ( 20 ), preferably by a seam or adhesive verbun the. 17. Vascular prosthesis according to one of claims 1 to 16, wherein the diameter of the clamping ring ( 30 ) is larger than the diameter of the tube section ( 20 ). 18. Vascular prosthesis according to one of the sections 1 to 17, with a proximal hose section ( 20 ) and two distal hose sections connected thereto, the diameter of the distal hose sections being smaller than the diameter of the proximal hose section. 19. Application device, in particular for a Gefäßpro thesis according to one of claims 1 to 18, with at least one holding wire ( 52 ) which can be detachably connected to the vascular prosthesis preferably on the clamping ring ( 30 ) and at least one holding device ( 60 ) for holding the clamping ring ( 30 ) in a bent position. 20. Application device according to claim 19, wherein the Hal ted wire ( 52 ) is surrounded by a hose ( 54 ) which is preferably rigid. 21. Application device according to claim 19 or 20, wherein the diameter of the holding wire ( 52 ) is approximately 0.3 to 1 mm. 22. Application device according to one of claims 19 to 21, wherein the holding device ( 60 ) has a resizable loop ( 62 ) for controlled holding of the clamping ring ( 30 ) in the bent position. 23. Application device according to claim 22, wherein the loop ( 62 ) is formed from a wire loop which can be fixed at the free end of the loop ( 64 ) by means of a releasable blocking device ( 66 , 68 ). 24. Application device according to claim 23, wherein the blocking device has an eyelet ( 66 ) through which the end of the wire loop ( 64 ) can be inserted and a displaceable blocking wire ( 68 ) prevents the loop from being pulled back. 25. Application device according to claim 24, wherein the wires of the loop ( 62 ) and the blocking wire ( 68 ) are surrounded by a Bowden cable sheath ( 70 ), at the free end of which the eyelet ( 66 ) is arranged.