Assembled aortic intraluminal stent and left subclavian artery in situ window system and method

Abstract

The present invention belongs to the technical field of medical devices, and specifically discloses an assembled aortic intraluminal stent and a left subclavian artery in situ window system, including an aortic intraluminal stent and a left subclavian artery stent, a traction structure is provided on the aortic intraluminal stent, the traction structure extends into the left subclavian artery, the traction structure is connected to a puncture structure that can be assembled and connected with the traction structure, a guide wire is provided in the puncture structure, and the guide wire guides an expansion balloon to enter the left subclavian artery. The present invention guides the puncture position of the puncture needle by arranging a traction ring and a traction line on the aortic intraluminal stent, and at the same time, according to the interaction force between the traction line and the puncture needle, the puncture needle can easily achieve the puncture action of the coating part on the aortic intraluminal stent.

Description

Technical Field

[0001] The present invention belongs to the technical field of medical devices, and specifically relates to an assembled aortic intraluminal stent and a left subclavian artery in situ fenestration system, and also relates to a method for the assembled aortic intraluminal stent and the left subclavian artery in situ fenestration system. Background Art

[0002] Aortic disease is extremely harmful. The lesions will accumulate in the three important branch vessels on the aortic arch. Most of the treatments for aortic disease are based on endovascular treatment. When the lesions completely cover the branch vessels, serious consequences will occur. Window treatment has become the mainstream method at present, and the left subclavian artery is the most troublesome and difficult blood vessel to be treated with window treatment. The reason is that the left subclavian artery is distorted and its position is unstable. At present, various in situ window needles cannot successfully complete the in situ window of the left subclavian artery, and the in situ window of the left subclavian artery is prone to serious complications, which leads to aggravation of arterial dissection or failure of arterial window treatment. Summary of the invention

[0003] In order to solve the problem that it is difficult to successfully open a window in situ for the left subclavian artery, the present invention provides an assembled intraluminal aortic stent and an in situ window opening system for the left subclavian artery, which reduce the difficulty of in situ window opening, increase the success rate of puncture, and can successfully open a window in situ for the left subclavian artery, and also provides a corresponding window opening method.

[0004] Based on the above purpose, the present invention is achieved through the following technical solutions:

[0005] The assembled aortic intraluminal stent and left subclavian artery in situ window system include an aortic intraluminal stent and a left subclavian artery stent. A traction structure is provided on the aortic intraluminal stent, the traction structure extends into the left subclavian artery, the traction structure is connected to a puncture structure that can be assembled with the traction structure, a guide wire is provided in the puncture structure, and the guide wire guides an expansion balloon into the left subclavian artery.

[0006] Preferably, the traction structure comprises a traction line, one end of which can be assembled and connected to the aortic intraluminal stent, and an intravascular catcher, and the intravascular catcher cooperates with the traction line.

[0007] Preferably, a traction catheter which is loosely matched with the traction wire is disposed on the traction wire outer sleeve.

[0008] Preferably, the puncture structure is a puncture needle, and the guide wire is arranged in the puncture needle.

[0009] Preferably, the aortic intraluminal stent is provided with a traction ring group cooperating with the left subclavian artery, and the length of the traction ring group is 25-45mm, 26mm, 27mm, 28mm, 29mm, 30mm, 31mm, 32mm, 33mm, 34mm, 35mm, 36mm, 37mm, 38mm, 39mm, 40mm, 41mm, 42mm, 43mm, 44mm.

[0010] Preferably, the traction ring group includes a traction ring that can be assembled and connected to the traction line, and the interval between two adjacent traction rings is 5-20mm, 6mm, 7mm, 8mm, 9mm, 10mm, 11mm, 12mm, 13mm, 14mm, 15mm, 16mm, 17mm, 18mm, 19mm.

[0011] Preferably, the puncture needle is a bendable puncture needle.

[0012] The method for simulating the human body's aortic endovascular stent and left subclavian artery in situ fenestration according to the above fenestration system comprises the following steps:

[0013] Step 1: Measure the position of the left subclavian artery to determine the corresponding traction ring on the aortic stent, thread the traction wire through the corresponding traction ring, retract the aortic stent into the stent release system and deliver it through the femoral artery;

[0014] Step 2: implant a traction catheter through the left subclavian artery to a suitable position such as the corresponding abdominal aorta, iliac aorta or femoral aorta, where the appropriate position enables the intravascular capture device to capture the traction line after extending the traction catheter, thereby preventing damage to the blood vessel. The traction line is captured by the intravascular capture device through the traction catheter and pulled out through the traction catheter;

[0015] Step 3: implanting the aortic intraluminal stent to a predetermined position, wherein the corresponding traction ring is close to the connection between the left subclavian artery and the aorta, and during the implantation process, the connection a between the aortic intraluminal stent and the traction line is exposed, and the connection a is close to the opening of the left subclavian artery;

[0016] Step 4: releasing the aortic stent, releasing the coated part and the bare stent part of the aortic stent at one time;

[0017] Step 5: The puncture needle passes through the traction catheter along the traction line to reach the connection point a of the stent in the aortic cavity;

[0018] Step 6: Using the interaction force between the traction wire and the puncture needle, the puncture needle punctures the membrane of the stent in the aortic cavity;

[0019] Step 7: After the puncture is completed, the guide wire is sent into the aorta through the cavity in the puncture needle, the track is established, and the puncture needle and traction wire are withdrawn;

[0020] Step 8: Deliver the dilatation balloon to the designated position of the left subclavian artery via the guide wire and implant the left subclavian artery stent.

[0021] The method for simulating human body's aortic endovascular stent and left subclavian artery in situ fenestration according to the above fenestration system comprises the following steps:

[0022] Step 1: Measure the position of the left subclavian artery to determine the corresponding traction ring on the aortic stent, thread the traction wire through the corresponding traction ring, retract the aortic stent into the stent release system and deliver it through the femoral artery;

[0023] Step 2: implant a traction catheter through the left subclavian artery to a suitable position such as the corresponding abdominal aorta, iliac aorta or femoral aorta, where the appropriate position enables the intravascular capture device to capture the traction line after extending the traction catheter, thereby preventing damage to the blood vessel. The traction line is captured by the intravascular capture device through the traction catheter and pulled out through the traction catheter;

[0024] Step 3: implanting the aortic intraluminal stent to a predetermined position, wherein the corresponding traction ring is close to the connection between the left subclavian artery and the aorta, and during the implantation process, the connection a between the aortic intraluminal stent and the traction line is exposed, and the connection a is close to the opening of the left subclavian artery;

[0025] Step 4: Release the aortic stent. First release the coated part of the aortic stent. After the window is successfully opened, release the bare stent part of the aortic stent.

[0026] Step 5: The puncture needle passes through the traction catheter along the traction line to reach the connection point a of the stent in the aorta;

[0027] Step 6: Using the interaction force between the traction wire and the puncture needle, the puncture needle punctures the membrane of the aortic stent;

[0028] Step 7: After the puncture is completed, the guide wire is sent into the aorta through the cavity in the puncture needle, the track is established, and the puncture needle and traction wire are withdrawn;

[0029] Step 8: Deliver the dilatation balloon to the designated position of the left subclavian artery via the guide wire and implant the left subclavian artery stent.

[0030] Preferably, in step 4, the aortic intraluminal stent is released according to the FAN classification positioning method.

[0031] Compared with the prior art, the present invention has the following beneficial effects:

[0032] (1) The present invention provides a traction structure on the aortic stent to cooperate with the puncture structure to perform an in situ fenestration of the left subclavian artery. When the traction structure is used, the traction line is connected to the corresponding traction ring according to the measurement data of the left subclavian artery, so as to guide the puncture needle of the puncture structure and assist the puncture action, thereby achieving the purpose of accurately puncturing the coated part of the aortic stent by the puncture needle, thereby increasing the puncture success rate, reducing the serious complications caused by the puncture, reducing the difficulty of in situ fenestration, and improving the success rate of in situ fenestration.

[0033] (2) The present invention guides the puncture position of the puncture needle by arranging a traction ring and a traction wire on the aortic stent. At the same time, according to the interaction force between the traction wire and the puncture needle, the puncture needle can easily puncture the coated part of the aortic stent. The traction wire provided by the present invention can not only guide the puncture position of the puncture needle, but also assist the puncture needle in puncturing the coated part of the aortic stent. The traction ring with an interval design can solve the problem of large differences in the position of the left subclavian artery between individuals, so that the present invention can be suitable for more patients. BRIEF DESCRIPTION OF THE DRAWINGS

[0034] Figure 1 It is a schematic diagram of the structure of the present invention in Example 1;

[0035] Figure 2 In Example 1 Figure 1 A schematic diagram of the structure of part A;

[0036] Figure 3 In Example 1 Figure 2 Schematic diagram of the structure at the traction ring;

[0037] Figure 4 is a schematic structural diagram of the puncture needle in Example 1;

[0038] Figure 5 is a schematic diagram of the structure of the puncture needle in Example 3;

[0039] Figure 6 is a schematic structural diagram of the puncture needle in Example 4;

[0040] Figure 7 is a schematic structural diagram of the puncture needle in Example 5;

[0041] Figure 8 is a schematic structural diagram of the puncture needle in Example 6;

[0042] Fig. 9 It is a schematic diagram of the structure of the puncture needle in Example 7.

[0043] In the figure, 1. intraluminal aortic stent; 2. traction wire; 3. traction catheter; 4. puncture needle; 5. traction ring; 6. connection a; 7. conical head end; 8. circular opening; 9. assemblable sleeve; 10. adjustment ring; 11. circular head end; 12. conical opening; 13. pointed head end; 14. arc-shaped head end. DETAILED DESCRIPTION

[0044] The present invention is further described in detail below through specific examples, but the scope of the present invention is not limited thereto.

[0045] Example 1

[0046] The structure of the assembled aortic endovascular stent and left subclavian artery in situ fenestration system is as follows: Figure 1-Figure 4 As shown, Figure 3 The traction catheter 3 and puncture needle 4 are not shown, including an aortic intraluminal stent 1 and a left subclavian artery stent. The aortic intraluminal stent 1 is provided with a traction structure, which extends into the left subclavian artery. The traction structure is connected to a puncture structure that can be assembled with the traction structure. A guide wire is provided in the puncture structure, which guides the expansion balloon into the left subclavian artery.

[0047] The traction structure includes a traction wire 2, one end of which can be assembled and connected to the aortic intraluminal stent 1, and an intravascular catcher, which cooperates with the traction wire 2. The traction wire 2 is provided with a traction catheter 3 that is gap-matched with the traction wire 2. The puncture structure is a puncture needle 4, and the guide wire is arranged in the puncture needle 4. The puncture needle 4 is a bendable puncture needle.

[0048] The aortic endoluminal stent 1 is provided with a traction ring group matching with the left subclavian artery, the length of the traction ring group is 25-45 mm, and the traction ring group includes a traction ring 5 that can be assembled and connected with the traction line 2, and the interval between two adjacent traction rings 5 ​​is 5-20 mm.

[0049] The head end of the puncture needle 4 can be set to a conical head end 7, and the conical head end 7 is provided with a circular opening 8; the head end of the puncture needle 4 can be set to a circular head end 11, and the conical head end 7 is provided with a conical opening 12; the head end of the puncture needle 4 can be set to a pointed head end 13, and the conical head end 7 is provided with a circular opening 8; the head end of the puncture needle 4 can be set to an arc-shaped head end 14, and the conical head end 7 is provided with a conical opening 12; the above-mentioned head end shapes of the puncture needle 4 and the opening methods can all achieve puncture of the coated part of the aortic intraluminal stent 1.

[0050] The method for simulating human body's aortic endovascular stent and left subclavian artery in situ fenestration according to the above fenestration system comprises the following steps:

[0051] Step 1: Measure the position of the left subclavian artery to determine the corresponding traction ring 5 on the aortic intraluminal stent 1, pass the traction wire 2 through the corresponding traction ring 5, retract the aortic intraluminal stent 1 into the stent release system and deliver it through the femoral artery;

[0052] Step 2: implant the traction catheter 3 into a suitable position such as the abdominal aorta, the iliac aorta or the femoral aorta via the left subclavian artery, grab the traction wire 2 with an intravascular catcher via the traction catheter 3, and pull the traction wire 2 out via the traction catheter 3;

[0053] Step 3: implanting the aortic intraluminal stent 1 to a predetermined position, and during the implantation process, exposing the connection a 6 between the aortic intraluminal stent 1 and the traction wire 2, so that the connection a 6 is close to the opening of the left subclavian artery;

[0054] Step 4: releasing the aortic intraluminal stent 1, and releasing the coated part and the bare stent part of the aortic intraluminal stent 1 at one time;

[0055] Step 5: The puncture needle 4 passes through the traction catheter 3 along the traction line 2 to reach the connection point a 6 of the aortic intraluminal stent 1;

[0056] Step 6: The puncture needle 4 punctures the membrane of the aortic stent 1 by using the interaction force between the traction wire 2 and the puncture needle 4;

[0057] Step 7: After the puncture is completed, the guide wire is sent into the aorta through the cavity in the puncture needle 4, the track is established, and the puncture needle 4 and the traction wire 2 are withdrawn;

[0058] Step 8: Deliver the dilatation balloon to the designated position of the left subclavian artery via the guide wire and implant the left subclavian artery stent.

[0059] The method for simulating human body's aortic endovascular stent and left subclavian artery in situ fenestration according to the above fenestration system comprises the following steps:

[0060] Step 1: Measure the position of the left subclavian artery to determine the corresponding traction ring 5 on the aortic intraluminal stent 1, pass the traction wire 2 through the corresponding traction ring 5, retract the aortic intraluminal stent 1 into the stent release system and deliver it through the femoral artery;

[0061] Step 2: implant the traction catheter 3 into a suitable position such as the abdominal aorta, the iliac aorta or the femoral aorta via the left subclavian artery, grab the traction wire 2 with an intravascular catcher via the traction catheter 3, and pull the traction wire 2 out via the traction catheter 3;

[0062] Step 3: implanting the aortic intraluminal stent 1 to a predetermined position, and during the implantation process, exposing the connection a 6 between the aortic intraluminal stent 1 and the traction wire 2, so that the connection a 6 is close to the opening of the left subclavian artery;

[0063] Step 4: releasing the aortic intraluminal stent 1, first releasing the coated part of the aortic intraluminal stent 1, and then releasing the bare stent part after the window is successfully opened;

[0064] Step 5: The puncture needle 4 passes through the traction catheter 3 along the traction line 2 to reach the connection point a 6 of the aortic intraluminal stent 1;

[0065] Step 6: The puncture needle 4 punctures the membrane of the aortic stent 1 by using the interaction force between the traction wire 2 and the puncture needle 4;

[0066] Step 7: After the puncture is completed, the guide wire is sent into the aorta through the cavity in the puncture needle 4, the track is established, and the puncture needle 4 and the traction wire 2 are withdrawn;

[0067] Step 8: Deliver the dilatation balloon to the designated position of the left subclavian artery via the guide wire and implant the left subclavian artery stent.

[0068] In step 4, the aortic intraluminal stent 1 is released according to the FAN classification and positioning method.

[0069] Example 2

[0070] The assembled aortic intraluminal stent and left subclavian artery in situ fenestration system are different from Example 1 in that the length of the puncture needle 4 is ≥ the length of the traction catheter 3 , and the length of the traction wire 2 is ≥ the length of the traction catheter 3 .

[0071] Example 3

[0072] The structure of the assembled aortic endovascular stent and left subclavian artery in situ fenestration system is as follows: Figure 5 As shown, the difference from Example 1 is that the tip of the puncture needle 4 is a conical tip 7 , and the conical tip 7 is provided with a circular opening 8 connected to the inner cavity of the puncture needle 4 .

[0073] Example 4

[0074] The structure of the assembled aortic endovascular stent and left subclavian artery in situ fenestration system is as follows: Figure 6 As shown, the difference from Example 1 is that: the traction structure is provided with an assemblable connecting structure that cooperates with the guide wire track structure, and the assemblable connecting structure includes an assemblable sleeve 9 that is sleeved on the puncture needle 4, and the assemblable sleeve 9 is provided with an adjustment ring 10 that cooperates with the traction line 2.

[0075] Example 5

[0076] The structure of the assembled aortic endovascular stent and left subclavian artery in situ fenestration system is as follows: Figure 7As shown, the difference from Example 1 is that the tip of the puncture needle 4 is a circular tip 11 , and the circular tip 11 is provided with a conical opening 12 which is connected to the inner cavity of the puncture needle 4 .

[0077] Example 6

[0078] The structure of the assembled aortic endovascular stent and left subclavian artery in situ fenestration system is as follows: Figure 8 As shown, the difference from the embodiment 1 is that the tip end of the puncture needle 4 is a sharp tip end 13 , and the sharp tip end 13 is provided with a circular opening 8 which is connected with the inner cavity of the puncture needle 4 .

[0079] Example 7

[0080] The structure of the assembled aortic endovascular stent and left subclavian artery in situ fenestration system is as follows: Fig. 9 As shown, the difference from Example 1 is that the tip of the puncture needle 4 is an arc-shaped tip 14 , and the arc-shaped tip 14 is provided with a conical opening 12 connected to the inner cavity of the puncture needle 4 .

[0081] Example 8

[0082] The assembled aortic intraluminal stent and left subclavian artery in situ fenestration system is different from that of Example 1 in that the length of the traction ring group is 26 mm.

[0083] Example 9

[0084] The assembled aortic endoluminal stent and left subclavian artery in situ fenestration system is different from that of Example 1 in that the length of the traction ring group is 27 mm.

[0085] Example 10

[0086] The assembled aortic intraluminal stent and left subclavian artery in situ fenestration system is different from that of Example 1 in that the length of the traction ring group is 28 mm.

[0087] Embodiment 11

[0088] The assembled aortic intraluminal stent and left subclavian artery in situ fenestration system is different from that of Example 1 in that the length of the traction ring group is 29 mm.

[0089] Example 12

[0090] The assembled aortic intraluminal stent and left subclavian artery in situ fenestration system is different from that of Example 1 in that the length of the traction ring group is 30 mm.

[0091] Embodiment 13

[0092] The assembled aortic intraluminal stent and left subclavian artery in situ fenestration system is different from that of Example 1 in that the length of the traction ring group is 31 mm.

[0093] Embodiment 14

[0094] The assembled aortic endoluminal stent and left subclavian artery in situ fenestration system is different from that of Example 1 in that the length of the traction ring group is 32 mm.

[0095] Embodiment 15

[0096] The assembled aortic intraluminal stent and left subclavian artery in situ fenestration system is different from that of Example 1 in that the length of the traction ring group is 33 mm.

[0097] Example 16

[0098] The assembled aortic intraluminal stent and left subclavian artery in situ fenestration system is different from that of Example 1 in that the length of the traction ring group is 34 mm.

[0099] Embodiment 17

[0100] The assembled aortic intraluminal stent and left subclavian artery in situ fenestration system is different from that of Example 1 in that the length of the traction ring group is 35 mm.

[0101] Embodiment 18

[0102] The assembled aortic intraluminal stent and left subclavian artery in situ fenestration system is different from that of Example 1 in that the length of the traction ring group is 36 mm.

[0103] Embodiment 19

[0104] The assembled aortic endoluminal stent and left subclavian artery in situ fenestration system is different from that of Example 1 in that the length of the traction ring group is 37 mm.

[0105] Embodiment 20

[0106] The assembled aortic intraluminal stent and left subclavian artery in situ fenestration system is different from that of Example 1 in that the length of the traction ring group is 38 mm.

[0107] Embodiment 21

[0108] The assembled aortic intraluminal stent and left subclavian artery in situ fenestration system is different from that of Example 1 in that the length of the traction ring group is 39 mm.

[0109] Embodiment 22

[0110] The assembled aortic intraluminal stent and left subclavian artery in situ fenestration system is different from that of Example 1 in that the length of the traction ring group is 40 mm.

[0111] Embodiment 23

[0112] The assembled aortic intraluminal stent and left subclavian artery in situ fenestration system is different from that of Example 1 in that the length of the traction ring group is 41 mm.

[0113] Embodiment 24

[0114] The assembled aortic intraluminal stent and left subclavian artery in situ fenestration system is different from that of Example 1 in that the length of the traction ring group is 42 mm.

[0115] Embodiment 25

[0116] The assembled aortic intraluminal stent and left subclavian artery in situ fenestration system is different from that of Example 1 in that the length of the traction ring group is 43 mm.

[0117] Embodiment 26

[0118] The assembled aortic intraluminal stent and left subclavian artery in situ fenestration system is different from that of Example 1 in that the length of the traction ring group is 44 mm.

[0119] Embodiment 27

[0120] The assembled aortic endoluminal stent and left subclavian artery in situ fenestration system is different from that of Example 1 in that the interval between two adjacent traction rings 5 ​​is 6 mm.

[0121] Embodiment 28

[0122] The assembled aortic endoluminal stent and left subclavian artery in situ fenestration system is different from that of Example 1 in that the interval between two adjacent traction rings 5 ​​is 7 mm.

[0123] Embodiment 29

[0124] The assembled aortic endoluminal stent and left subclavian artery in situ fenestration system is different from that of Example 1 in that the interval between two adjacent traction rings 5 ​​is 8 mm.

[0125] Embodiment 30

[0126] The assembled aortic endoluminal stent and left subclavian artery in situ fenestration system is different from that of Example 1 in that the interval between two adjacent traction rings 5 ​​is 9 mm.

[0127] Embodiment 31

[0128] The assembled aortic endoluminal stent and left subclavian artery in situ fenestration system is different from that of Example 1 in that the interval between two adjacent traction rings 5 ​​is 10 mm.

[0129] Embodiment 32

[0130] The assembled aortic endoluminal stent and left subclavian artery in situ fenestration system is different from that of Example 1 in that the interval between two adjacent traction rings 5 ​​is 11 mm.

[0131] Embodiment 33

[0132] The assembled aortic endoluminal stent and left subclavian artery in situ fenestration system is different from that of Example 1 in that the interval between two adjacent traction rings 5 ​​is 12 mm.

[0133] Embodiment 34

[0134] The assembled aortic endoluminal stent and left subclavian artery in situ fenestration system is different from that of Example 1 in that the interval between two adjacent traction rings 5 ​​is 13 mm.

[0135] Embodiment 35

[0136] The assembled aortic endoluminal stent and left subclavian artery in situ fenestration system is different from that of Example 1 in that the interval between two adjacent traction rings 5 ​​is 14 mm.

[0137] Embodiment 36

[0138] The assembled aortic endoluminal stent and left subclavian artery in situ fenestration system is different from that of Example 1 in that the interval between two adjacent traction rings 5 ​​is 15 mm.

[0139] Embodiment 37

[0140] The assembled aortic endoluminal stent and left subclavian artery in situ fenestration system is different from that of Example 1 in that the interval between two adjacent traction rings 5 ​​is 16 mm.

[0141] Embodiment 38

[0142] The assembled aortic endoluminal stent and left subclavian artery in situ fenestration system is different from that of Example 1 in that the interval between two adjacent traction rings 5 ​​is 17 mm.

[0143] Embodiment 39

[0144] The assembled aortic endoluminal stent and left subclavian artery in situ fenestration system is different from that of Example 1 in that the interval between two adjacent traction rings 5 ​​is 18 mm.

[0145] Embodiment 40

[0146] The assembled aortic endoluminal stent and left subclavian artery in situ fenestration system is different from that of Example 1 in that the interval between two adjacent traction rings 5 ​​is 19 mm.

[0147] The above description is only a preferred embodiment of the present invention, but is not limited to the above examples. Any modifications, equivalent substitutions and improvements made within the spirit and principles of the present invention should be included in the protection scope of the present invention.

Claims

1. Assembled aortic endovascular stent and left subclavian artery in situ fenestration system, It is characterized in that It includes an aortic intraluminal stent and a left subclavian artery stent. The aortic intraluminal stent is provided with a traction structure, which extends into the left subclavian artery. The traction structure is connected to a puncture structure that can be assembled with the traction structure. The puncture structure is provided with a guide wire, which guides an expansion balloon into the left subclavian artery. The traction structure includes a traction line with one end that can be assembled and connected to the aortic intraluminal stent and an intravascular capturer, which cooperates with the traction line. The aortic intraluminal stent is provided with a traction ring group that cooperates with the left subclavian artery, and the length of the traction ring group is 25-45mm. The traction ring group includes a traction ring that can be assembled with the traction line, and the interval between two adjacent traction rings is 5-20mm.

2. The assembled aortic endovascular stent and left subclavian artery in situ fenestration system according to claim 1, It is characterized in that The outer sleeve of the traction wire is provided with a traction catheter which is gap-matched with the traction wire.

3. The assembled aortic endovascular stent and left subclavian artery in situ fenestration system according to claim 2, It is characterized in that The puncture structure is a puncture needle, and the guide wire is arranged in the puncture needle.

4. The assembled aortic endovascular stent and left subclavian artery in situ fenestration system according to claim 3, It is characterized in that The puncture needle is a bendable puncture needle.

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