1. Field of the Invention
The invention relates to a device and method for determining a depth of an incision for deployment of a closure system for blood vessel punctures.
2. Brief Description of the Related Art
A large number of diagnostic and interventional procedures involve the percutaneous introduction of instrumentation into a vein or artery. For example, coronary angioplasty, angiography, atherectomy, stenting of arteries, and many other procedures often involve accessing the vasculature through a catheter placed in the femoral artery or other blood vessel. Once the procedure is completed and the catheter or other instrumentation is removed, bleeding from the punctured artery must be controlled.
Traditionally, external pressure is applied to the skin entry site to stem bleeding from a puncture wound in a blood vessel. Pressure is continued until hemostasis has occurred at the puncture site. In some instances, pressure must be applied for up to an hour or more during which time the patient is uncomfortably immobilized. In addition, a risk of hematoma exists since bleeding from the vessel may continue beneath the skin until sufficient clotting effects hemostasis. Further, external pressure to close the vascular puncture site works best when the vessel is close to the skin surface and may be unsuitable for patients with substantial amounts of subcutaneous adipose tissue since the skin surface may be a considerable distance from the vascular puncture site.
More recently, devices have been proposed to promote hemostasis directly at a site of a vascular puncture. One class of such puncture sealing devices features an intraluminal anchor which is placed within the blood vessel and seals against an inside surface of the vessel puncture. The intraluminal anchor may be used in combination with a sealing material positioned on the outside of the blood vessel, such as collagen. Sealing devices of this type are disclosed in U.S. Pat. Nos. 4,852,568; 4,890,612; 5,021,059; and 5,061,274.
Another approach to subcutaneous blood vessel puncture closure involves the delivery of non-absorbable tissue adhesives, such as cyanoacrylate, to the perforation site. Such a system is disclosed in U.S. Pat. No. 5,383,899.
The application of an absorbable material such as collagen or a non-absorbable tissue adhesive at the puncture site has several drawbacks including: 1) possible injection of the material into the blood vessel causing thrombosis; 2) a lack of pressure directly on the blood vessel puncture which may allow blood to escape beneath the material plug into the surrounding tissue; and 3) the inability to accurately place the absorbable material plug directly over the puncture site.
The use of an anchor and plug system addresses these problems to some extent but provides other problems including: 1) complex and difficult application; 2) partial occlusion of the blood vessel by the anchor when placed properly; and 3) complete blockage of the blood vessel or a branch of the blood vessel by the anchor if placed improperly. Another problem with the anchor and plug system involves reaccess. Reaccess of a particular blood vessel site sealed with an anchor and plug system is not possible until the anchor has been completely absorbed because the anchor could be dislodged into the blood stream by an attempt to reaccess.
Such puncture sealing devices are generally used in conjunction with a cannula or arterial dilator which dilates an access tract in the tissue before inserting the sealing device for placing the intraluminal or sealing plug. By using the cannula to dilate the access tract, the sealing device can be easily advanced into the tissue toward the vascular puncture. A conventional cannula C having a constant diameter lumen which is sized to closely accommodate a guidewire is shown in
Accordingly, it would be desirable to provide a device and method for accurately determining the depth of an incision by accurately locating the blood vessel wall for properly placing a hemostasis promoting plug over the puncture site.
The present invention relates to a device and method for accurately determining the depth of an incision that extends from the epidermal layer to the blood vessel wall for properly placing a hemostasis promoting plug over a puncture site.
In accordance with one aspect of the present invention, a device for determining a depth of an incision that extends from the epidermal layer to a blood vessel includes an elongated member including a distal end and a proximal end, the distal end having means for locating the blood vessel while impeding the distal end of the elongated member from entering the blood vessel.
In accordance with another aspect of the present invention, a device for determining a depth of an incision that extends from an epidermal layer to a blood vessel puncture site includes an elongated member having a distal end, a proximal end, and means at the distal end for locating the blood vessel puncture site by capturing an edge of the blood vessel puncture and a control member extending from the distal end of the elongated member and configured to be received in the puncture site.
In accordance with an additional aspect of the present invention, a method for determining a depth of an incision that extends from the epidermal layer to a puncture in a blood vessel includes the steps of introducing an elongated member through the incision, the elongated member having a proximal end, and a distal end configured for locating a blood vessel while preventing the distal end of the elongated member from entering the blood vessel, locating the blood vessel by receiving a portion of a wall of the blood vessel with the distal end, and setting a depth indicating member to mark a depth of the puncture in the blood vessel.
In accordance with a further aspect of the invention, a method for determining a depth of an incision that extends from an epidermal layer to a puncture in a blood vessel includes the steps of introducing an elongated member through the incision and providing visual feedback of a general location of the blood vessel puncture by venting blood through the elongated member and providing specific tactile feedback of a specific location of the blood vessel puncture by contact between the elongated member and an exterior of the blood vessel puncture.
The present invention provides a device and method which accurately determines the location of the blood vessel for properly placing a hemostasis over a puncture site.
The invention will now be described in greater detail with reference to the preferred embodiments illustrated in the accompanying drawings, in which like elements bear like reference numerals, and wherein:
The device and method for determining a depth of an incision according to the present invention is used in connection with a delivery system for delivery of a bio-compatible sponge in a hydrated condition to a blood vessel puncture site to achieve hemostasis. In kit form, as shown in
Prior to discussing the present invention in further detail, the following terms are defined:
“Pledget” means a piece of sponge formed into a generally elongated shape having a size which allows delivery in a hydrated state through a delivery cannula or introducer to a site of a puncture in a blood vessel.
“Sponge” means a biocompatible material which is capable of being hydrated and is resiliently compressible in a hydrated state. Preferably, the sponge is non-immunogenic and may be absorbable or non-absorbable.
“Absorbable sponge” means sponge which when implanted within a human or other mammalian body is absorbed by the body.
“Hydrate” means to partially or fully saturate with a fluid, such as, saline, water, contrast agent, thrombin, therapeutic agents, or the like.
“Kneading” of the absorbable sponge material means both dry and wet manipulation of sponge material which compresses, enlarges, or changes the shape of the sponge material causing the sponge material to have improved expansion response.
The tract dilator 10, as illustrated in
The stem-portion 32 of the tract dilator 10 may have a constant outer diameter d3 or may taper slightly to a smaller outer diameter at the distal end 20. The outer diameter d3 of the tract dilator distal end 20 is configured so that the tip of the tract dilator will not pass into the blood vessel 66 but will stop and provide tactile feedback when it reaches the external wall of the blood vessel. The distal end 20 can be provided with rounded edges 28 to prevent catching on subcutaneous tissue 68 as the tract dilator 10 is inserted through the epidermal outer layer 70 and subcutaneous tissue 68 to the blood vessel puncture site 64.
An internal tapering surface 18 is provided at the distal end 20 of the tract dilator 10. The tapered surface 18 extends from the lumen 24 having a diameter d1 to the distal end 20 which has an internal larger diameter d2. As shown most clearly in
A depth indicator 30 is positioned around the stem portion 32 of the tract dilator 10 and is movable in an axial direction. Once the tract dilator 10 has been inserted until the distal end 20 abuts the external wall of the blood vessel 66, as shown in
The elongated member 32 is made of a material with a hardness not lower than 50 D durometer. In addition, a portion of the elongated member 32 is provided with a friction reducing material resulting in the outer surface of the elongated member having a low friction resistance.
The sponge pledget 40 is formed from a sheet of sponge material which has been cut into a rectangular shape and rolled to form a compact, substantially cylindrical, elongated pledget. The pledget 40 is sized to be received within the staging chamber 34 of the introducer 12 in a dry rolled state.
Once the pledget 40 has been inserted into the staging chamber 34 of the introducer 12, a conventional syringe 50 containing a hydrating fluid, such as saline, is connected to the luer fitting 42, as shown in
As shown in
The introducer 12 also includes a depth indicator 52 which is an axially movable member used to indicate the depth to which the introducer should be inserted into the patient to achieve the proper positioning of the pledget 40 at the puncture site 64. The depth indicator 52 of the introducer 12 is aligned with the depth indicator 30 on the tract dilator 10 to achieve proper pledget positioning.
The introducer 12 may be formed in any known manner such as by injection molding from a plastic material. Preferably, the introducer 12 is transparent so that the pledget 40 can be viewed through the introducer and the user can visually confirm the pledget position. The introducer lumen may be provided with a friction reducing coating for improved pledget delivery. The delivery fluid also reduces friction for improved delivery by wetting the exterior surface of the pledget.
The pusher 14, as illustrated in
The pusher 14 also may include a male luer fitting 58 for connecting the proximal end of the pusher to the proximal end of the introducer 12 after pledget delivery. The male luer fitting 58 acts as a stop to limit the motion of the pusher 14 with respect to the introducer 12. When the pusher 14 is locked to the introducer 12, the two may be used together to apply localized compression to the puncture site 100. A female luer fitting 60 may also be included at the proximal end of the pusher 14 for connection of a syringe to the pusher for injection of a beneficial agent through the pusher.
One method of delivering an absorbable sponge pledget 40 to facilitate hemostasis of a blood vessel puncture wound 64 will now be described with respect to the steps illustrated in
As discussed above, the tract dilator 10 is threaded over the guidewire 26 and advanced down into the incision through the subcutaneous tissue 68 to an exterior wall of the blood vessel 66. Resistance is felt when the tract dilator distal end 20 contacts the exterior wall of the blood vessel 66 since the tract dilator 10 is configured to resist passing through the blood vessel puncture 64 and into the blood vessel. The tract dilator distal end 20 receives the raised anterior proximal lip 62 of the blood vessel 66 (shown in
The outside surface of the stem-portion 32 of the tract dilator 10 is preferably provided with a friction reducing overlay to facilitate advancing the tract dilator through the subcutaneous tissue 68. By reducing the amount of force necessary to advance the tract dilator 10 through tissue layers, the user can more easily distinguish when the tract dilator is passing through subcutaneous tissue as compared to contacting the exterior of the blood vessel. The friction reducing overlay is selected such that the coefficient of friction between the outside surface of the stem portion 32 and subcutaneous tissue 68 is reduced by about 10%, preferably by about 20%, more preferably by 30%, yet more preferably by about 40%, and more preferably by about 50%, and yet more preferably by more than 50%. The friction reducing overlay may also be provided on the walls of the lumen 24 to facilitate introducing the tract dilator 10 over the guidewire 26.
The depth indicator 30 on the tract dilator 10 is moved to abut the epidermal layer 70, thereby indicating a distance from the outer skin surface to the blood vessel puncture site 64. The tract dilator 10 is then removed over the guidewire 26 and the introducer depth indicator 52 is aligned with the tract dilator depth indicator 30.
A sheet of sponge material is cut into a rectangle, is rolled tightly to form a pledget 40, and is placed into the staging chamber 34 of the introducer 12. The steps of cutting and rolling the pledget 40 and placing the dry pledget in the introducer staging chamber 34 may be performed before or after the intravascular procedure. Alternatively, the introducer 12 may be provided preloaded with a prepared pledget 40. With the pledget 40 placed in the introducer, the syringe 50 is filled with a hydrating fluid such as saline, thrombin, contrast agent, other therapeutic agent, or the like and attached to the introducer 12, as illustrated in
As shown in
As shown in
After feeding the guidewire 26 through the introducer 12, the guidewire 26 is fed through the pusher 14 and the pusher is advanced into the introducer until the distal end 56 of the pusher is in contact with the pledget 40. The introducer 12 and pusher 14 are then advanced together down though the epidermal layer 70 and the subcutaneous tissue 68 until the depth indicator 52 on the exterior of the introducer is at the skin level.
In the step illustrated in
The guidewire 26 is then completely removed from the introducer 12 and the pusher 14. The introducer 12 is withdrawn the remaining approximately 25% by engaging the fitting 58 of the pusher with the female luer fitting 42 of the introducer to completely discharge the pledget 40 into the subcutaneous tissue 68 above the puncture site 64. A slight forward pressure can then be maintained by the operator on the introducer 12 and pusher 14 for approximately 1 minute before the introducer and pusher are removed from the tissue tract, as shown in
One type of absorbable sponge material which is acceptable for use in the present invention is Gelfoam™, manufactured by the Pharmacia & Upjohn Company. Gelfoam™ is a porous, pliable, cross-linked gelatin material and is available commercially in sheet form as pre-compressed or non-compressed sponge. The material may be provided preformed as a pledget 40 or may be cut with a punch, or a stencil, or template and knife and rolled to form a pledget as described above. Once hydrated, the pledget 40 can be easily compressed to fit into a lumen having a smaller cross sectional area than the original cross sectional area of the pledget. Additionally, the kneading of the hydrated pledget 40 during delivery encourages air trapped within the Gelfoam™ to be expelled and replaced with fluid, allowing rapid expansion upon delivery. When a pledget 40 of a pre-compressed Gelfoam™ is hydrated and kneaded (expelling air) during delivery, the pledget will have the absorption capacity to rapidly expand to many times (e.g., 3 or more times) its original dry volume upon delivery. When a pledget 40 of the non-compressed Gelfoam™ is hydrated and kneaded (expelling air) during delivery, the pledget will have the absorption capacity to rapidly expand to its original dry volume upon delivery. These properties make the Gelfoam™ sponge material particularly useful for facilitating hemostasis of blood vessel punctures.
Abrupt lumen diameter changes within the introducer 12, such as at the tapered section 38, will improve “kneading” of the absorbable sponge material passing through the introducer. Manipulation of the dry absorbable sponge material, such as the rolling of the pledget 40, also provides kneading. Kneading improves hydration of the sponge material thereby improving the expansion properties of the hydrated delivered absorbable sponge.
As illustrated in
A further embodiment of a tract dilator 210 is substantially similar to the embodiment of
In the embodiment of
Another alternative embodiment of a tract dilator 410 is illustrated in
As shown in
The blood 482 exits the lumen 424 in the tract dilator 410 at the proximal end 422, as illustrated in
The exterior surface of extending control member 472 further provides the benefit of limiting or preventing fluid from exiting out of the puncture site 464 since the extending member will substantially occlude said puncture 464. Thus, the extending member 472 prevents fluid from exiting the blood vessel through the puncture site and into the surrounding tissue and controls the puncture site. Alternatively, by partially occluding the puncture site 464, the extending control member 472 allows the physician to prevent fluid from exiting the blood vessel through said puncture and into the surrounding tissue by applying pressure. Typically, pressure is applied at the epidermal surface at a position directly over or proximal to the puncture site 464. It is understood that the extended member can be provided without a vent 480 if controlling the amount of fluid from exiting the blood vessel through the puncture site is the only additional benefit desired.
Although the use of a tract dilator 10 has been described above, the introducer 12 can be used in place of the tract dilator, and the depth determining step can be performed while inserting the introducer, particularly where a plastic sheathed guidewire, other friction reducing guidewire, or other friction reducing feature is used. The use of the introducer 12 as the dilator eliminates errors which may occur in accurately setting the depth indicator 52 on the introducer.
As shown in
As shown in
A further embodiment of an introducer/pusher system may be used for dilation in which the pusher or obturator used during dilation and depth determination is different from the pusher which is used for delivery of the pledget. The pusher for use during dilation preferably has a luer lock at a proximal end which locks to the proximal end of the introducer and has a length such that the distal ends of the pusher and introducer are aligned. As in the previous discussion, the introducer has a tapering interior surface at the distal end which receives a portion of the blood vessel and impedes the distal end from entering said blood vessel. Alternatively, the pusher may have the interior tapering surface. After setting of the depth indicator on the introducer with the dilation pusher in place, the system is then removed from the tissue tract and the dilation pusher is removed from the introducer. The introducer is then prepared for delivery of the pledget by hydrating and staging the pledget within the introducer and the delivery pusher is inserted in the introducer. The introducer is then reintroduced over the guidewire and advanced into the tissue tract to the depth indicated by the depth indicator. In this manner, reliable, accurate, and repeatable placement of the pledget is performed without the use of a separate tract dilator.
According to yet another use, the introducer is inserted to the pledget delivery site through a sheath. In this method, the sheath with a removable dilator positioned inside the sheath is advanced over the guidewire into a tissue tract to establish the location of an arterial puncture site. The removable dilator includes a tapering surface at a distal end for receiving a portion of the blood vessel and impeding the dilator from entering the blood vessel. Once the exterior wall of the vessel has been located by tactile feedback, the dilator is withdrawn leaving the sheath in place. The introducer with prepared pledget and pusher are then inserted into the sheath over the guidewire. The introducer may be locked to the sheath, such as by a luer lock. This will position the distal end of the introducer at the distal end of the sheath in preparation for pledget delivery. The combined sheath and introducer system is used to deposit the pledget in the manner described above.
Among other advantages, the absorbable sponge delivery system permits the delivery of more absorbable sponge material down a smaller tract by hydrating and compressing the absorbable sponge material. The over the wire delivery method ensures that the absorbable sponge pledget is delivered directly over the puncture site and remains in the proper position while hemostasis is achieved. The vessel depth indicator system ensures that the absorbable sponge material is positioned adjacent the exterior of the blood vessel and does not extend into the blood vessel to possibly induce thrombosis.
The absorbable sponge material can be absorbed by the body in a period of time between several days and several months depending on the absorbable sponge material used. However, the pledget material may be engineered to provide different rates of absorption. Preferably, the pledget 40 is designed to be absorbed in less than one month.
Although the tract dilator and introducer are primarily intended for delivery of absorbable sponge, non-absorbable sponge may also be delivered with the devices, systems, and methods. A non-absorbable sponge may be desirable where it will be necessary to locate the blood vessel puncture after the procedure.
While an amorphous or discontinuous sponge structure may be used in the present invention, a continuous structure of the delivered absorbable sponge pledget 40 provides more secure and reliable placement of a plug of material against the blood vessel puncture than a paste or liquid. The continuous sponge structure can even facilitate partial withdrawal, removal, or movement of the ejected pledget.
The absorbable sponge material can be hydrated with a clotting agent such as thrombin, a contrast agent, another beneficial agent, a combination of agents, or the like. Alternatively, the pledget material itself may contain an agent such as a clotting agent, a contrast agent, another beneficial agent, a combination of agents, or the like.
The absorbable sponge pledget may be presoaked with a beneficial agent such as thrombin for delivery of the beneficial agent to the punctured blood vessel. Alternatively, the pledget may be hydrated with a beneficial liquid agent used as the hydrating fluid within the syringe 50. Further, the beneficial agent may be delivered to the pledget after the pledget is ejected at the blood vessel puncture site through the lumen of the pusher 14 or through the introducer 12.
The treatment of a blood vessel puncture with a hydrated and injected pledget 40 of absorbable sponge to facilitate hemostasis provides substantial advantages in comfort over external pressure methods. In addition, the present invention also provides advantages over the insertion of an absorbable sponge material in a dry state or injection of a liquid or paste. In particular, the hydration and manipulation or “kneading” of the hydrated Gelfoam™ pledget 40 as it is passed through the introducer 12 improves the expansion and absorption characteristics of the Gelfoam™. The injected Gelfoam™ conforms in shape quickly to the shape of the puncture site and immediately begins blocking blood flow through the puncture site and providing local compression. In contrast, a dry piece of sponge material does not swell until the blood has sufficiently saturated the sponge material, which can take up to hours. The hydrated and kneaded sponge material will expand to a larger size much more quickly when wetted than a piece of dry sponge material when wetted.
Because the amount of subcutaneous fat and tissue between the epidermal layer 106 and the blood vessel 102 varies between patients from approximately 0.5 cm to 15 cm or more, the system may be provided in different lengths for use in different patients. The pledget 40 size and shape may also be varied for different patients. The absorbable sponge material should form a complete plug over the puncture site without expanding into the blood vessel or exiting the skin of the patient. In some instances where the amount of subcutaneous tissue is great it may be desirable to deliver multiple pledgets 40 in spaced apart positions along the tract leading to the puncture site.
The particular size and shape of the tract dilator 10 may vary depending on the size of the access site, amount of subcutaneous tissue, and the size of pledget 40 to be delivered. The particular length of the tract dilator 10 depends on the subcutaneous tissue depth of the patient.
The invention also includes several embodiments of methods of using a device for determining the depth of an incision that extends from the epidermal layer to a blood vessel. The method as illustrated in
In another embodiment of the method, the elongated member 32 is introduced over a guidewire 26 into a tissue tract. The guidewire 26 has a preselected stiffness to raise a portion of an anterior proximal lip 62 of a blood vessel 66 adjacent to a blood vessel puncture 64. The elongated member 32 is introduced until an elastic recoil is introduced on the blood vessel 66. The elastic recoil is felt by the operator of the elongated member 32 as the distal end 20 catches the anterior proximal lip 62 of the puncture site 64.
The guidewire 26 directs the wall of the blood vessel 66 to be received by the elongated member 32. The diameter of the elongated member 32 is larger than the diameter of the puncture of the blood vessel 66. The guidewire 26 pushes the anterior proximal lip 62 into the interior surface of the elongated member 32. The force vector generated by the anterior proximal lip 62 on the elongated member 32 represents the elastic recoil used to identify the location of the artery and puncture site 64.
In another embodiment, the elongated member 32 can be introduced to determine a depth of the incision before the placement of a procedural sheath and before an intervascular procedure has been performed. Alternatively, the elongated member 32 can be introduced after the placement of a procedural sheath and after a procedure has been completed, or after removal of the procedural sheath.
In another embodiment, the depth of the incision can be determined by inserting a portion of an extending control member 472 into the blood vessel, wherein the extending control member at least partially occludes the puncture in the blood vessel wall. Fluid from the blood vessel will enter the extending control member 472, and the fluid from the blood vessel becomes visible to communicate with the operator by providing visual feedback to the operator.
While the invention has been described in detail with reference to the preferred embodiments thereof, it will be apparent to one skilled in the art that various changes and modifications can be made and equivalents employed, without departing from the present invention.
Filing Document | Filing Date | Country | Kind | 371c Date |
---|---|---|---|---|
PCT/US00/26367 | 9/25/2000 | WO | 00 | 12/16/2002 |
Publishing Document | Publishing Date | Country | Kind |
---|---|---|---|
WO01/21058 | 3/29/2001 | WO | A |
Number | Name | Date | Kind |
---|---|---|---|
581235 | Kenyon | Apr 1897 | A |
1578517 | Hein | Mar 1926 | A |
2086580 | Shirley | Jul 1937 | A |
2465357 | Correll | Mar 1949 | A |
2492458 | Bering, Jr. | Dec 1949 | A |
2507244 | Correll | May 1950 | A |
2558395 | Studer | Jun 1951 | A |
2597011 | MacMasters et al. | May 1952 | A |
2680442 | Linzmayer | Jun 1954 | A |
2761446 | Reed | Sep 1956 | A |
2814294 | Figge | Nov 1957 | A |
2824092 | Thompson | Feb 1958 | A |
2899362 | Sieger, Jr. et al. | Aug 1959 | A |
3157524 | Artandi | Nov 1964 | A |
3724465 | Duchane | Apr 1973 | A |
4000741 | Binard et al. | Jan 1977 | A |
4211323 | Olsen | Jul 1980 | A |
4218155 | Weidner | Aug 1980 | A |
4238480 | Sawyer | Dec 1980 | A |
4292972 | Pawelchak | Oct 1981 | A |
4323072 | Rosenbluth et al. | Apr 1982 | A |
4340066 | Shah | Jul 1982 | A |
4390018 | Zuloowski | Jun 1983 | A |
4404970 | Sawyer | Sep 1983 | A |
4515637 | Cioca | May 1985 | A |
4573576 | Krol | Mar 1986 | A |
4587969 | Gillis | May 1986 | A |
4588395 | Lemelson | May 1986 | A |
4619261 | Guerriero | Oct 1986 | A |
4619913 | Luck et al. | Oct 1986 | A |
4645488 | Matukas | Feb 1987 | A |
4708718 | Daniels | Nov 1987 | A |
4744364 | Kensey | May 1988 | A |
4790819 | Li et al. | Dec 1988 | A |
4829994 | Kurth | May 1989 | A |
4850960 | Grayzel | Jul 1989 | A |
4852568 | Kensey | Aug 1989 | A |
4869143 | Merrick | Sep 1989 | A |
4890612 | Kensey | Jan 1990 | A |
4900303 | Lemelson | Feb 1990 | A |
4929246 | Sinofsky | May 1990 | A |
4936835 | Haaga | Jun 1990 | A |
4950234 | Fujioka et al. | Aug 1990 | A |
5007895 | Burnett | Apr 1991 | A |
5021059 | Kensey et al. | Jun 1991 | A |
5053046 | Janese | Oct 1991 | A |
5061274 | Kensey | Oct 1991 | A |
5080655 | Haaga | Jan 1992 | A |
5108421 | Fowler | Apr 1992 | A |
5163904 | Lampropoulos et al. | Nov 1992 | A |
5167624 | Butler et al. | Dec 1992 | A |
5192300 | Fowler | Mar 1993 | A |
5192301 | Kamiya et al. | Mar 1993 | A |
5195988 | Haaga | Mar 1993 | A |
5220926 | Jones | Jun 1993 | A |
5221259 | Weldon et al. | Jun 1993 | A |
5242683 | Klaveness | Sep 1993 | A |
5275616 | Fowler | Jan 1994 | A |
5282827 | Kensey et al. | Feb 1994 | A |
5310407 | Casale | May 1994 | A |
5322515 | Karas et al. | Jun 1994 | A |
5325857 | Nabai et al. | Jul 1994 | A |
5334216 | Vidal et al. | Aug 1994 | A |
5366480 | Corriveau et al. | Nov 1994 | A |
5370656 | Shevel | Dec 1994 | A |
5383896 | Gershony et al. | Jan 1995 | A |
5383899 | Hammerslag | Jan 1995 | A |
5385550 | Su et al. | Jan 1995 | A |
5388588 | Nabai et al. | Feb 1995 | A |
5391183 | Janzen et al. | Feb 1995 | A |
5395353 | Scribner | Mar 1995 | A |
5417699 | Klein | May 1995 | A |
5419765 | Weldon et al. | May 1995 | A |
5431639 | Shaw | Jul 1995 | A |
5437292 | Kipshidze | Aug 1995 | A |
5437631 | Janzen | Aug 1995 | A |
5443481 | Lee | Aug 1995 | A |
5467780 | Nabai et al. | Nov 1995 | A |
5478352 | Fowler | Dec 1995 | A |
5479936 | Nabai et al. | Jan 1996 | A |
5486195 | Myers et al. | Jan 1996 | A |
5490736 | Haber | Feb 1996 | A |
5507279 | Fortune | Apr 1996 | A |
5522840 | Krajicek | Jun 1996 | A |
5522850 | Yomtov et al. | Jun 1996 | A |
5526822 | Burbank et al. | Jun 1996 | A |
5527332 | Clement | Jun 1996 | A |
5529577 | Hammerslag | Jun 1996 | A |
5540715 | Katsaros et al. | Jul 1996 | A |
5542914 | Van Iten | Aug 1996 | A |
5545178 | Kensey et al. | Aug 1996 | A |
5558853 | Quay | Sep 1996 | A |
5591204 | Janzen et al. | Jan 1997 | A |
5591205 | Fowler | Jan 1997 | A |
5601602 | Fowler | Feb 1997 | A |
5601603 | Illi | Feb 1997 | A |
5645566 | Brenneman et al. | Jul 1997 | A |
5649547 | Ritchart et al. | Jul 1997 | A |
5653730 | Hammerslag | Aug 1997 | A |
5665107 | Hammerslag | Sep 1997 | A |
5676689 | Kensey et al. | Oct 1997 | A |
5681279 | Roper et al. | Oct 1997 | A |
5716375 | Fowler | Feb 1998 | A |
5725498 | Janzen et al. | Mar 1998 | A |
5741223 | Janzen et al. | Apr 1998 | A |
5769086 | Ritchart et al. | Jun 1998 | A |
5775333 | Burbank et al. | Jul 1998 | A |
5782861 | Cragg et al. | Jul 1998 | A |
5800389 | Burney et al. | Sep 1998 | A |
5810806 | Ritchart et al. | Sep 1998 | A |
5830130 | Janzen et al. | Nov 1998 | A |
5858008 | Capaccio | Jan 1999 | A |
5868762 | Cragg et al. | Feb 1999 | A |
5902310 | Foerster et al. | May 1999 | A |
5984950 | Cragg et al. | Nov 1999 | A |
6007563 | Nash et al. | Dec 1999 | A |
6027471 | Fallon et al. | Feb 2000 | A |
6027482 | Imbert | Feb 2000 | A |
6063085 | Tay et al. | May 2000 | A |
6071300 | Brenneman et al. | Jun 2000 | A |
6071301 | Cragg et al. | Jun 2000 | A |
6086607 | Cragg et al. | Jul 2000 | A |
6161034 | Burbank et al. | Dec 2000 | A |
6162192 | Cragg et al. | Dec 2000 | A |
6183497 | Sing et al. | Feb 2001 | B1 |
6200328 | Cragg et al. | Mar 2001 | B1 |
6315753 | Cragg et al. | Nov 2001 | B1 |
Number | Date | Country |
---|---|---|
032826 | Jul 1981 | EP |
476178 | Mar 1992 | EP |
482350 | Apr 1992 | EP |
0557963 | Feb 1993 | EP |
0637431 | Nov 1994 | EP |
2 641 692 | Jul 1990 | FR |
1509023 | Apr 1978 | GB |
1569660 | Jun 1980 | GB |
782814 | Nov 1980 | RU |
1088709 | Apr 1984 | RU |
WO 9112847 | Sep 1991 | WO |
WO 9402072 | Feb 1994 | WO |
WO 9428800 | Dec 1994 | WO |
WO 9528124 | Oct 1995 | WO |
WO 9532669 | Dec 1995 | WO |
WO 9532671 | Dec 1995 | WO |
WO 9608208 | Mar 1996 | WO |
WO 9624290 | Aug 1996 | WO |
WO 9806346 | Feb 1998 | WO |
WO 9966834 | Dec 1999 | WO |