阅读说明：本技术 用于血管外科手术的支架和支架输送 (Stent and stent delivery for vascular surgery ) 是由 S·马诺利迪斯 于 2020-01-28 设计创作，主要内容包括：一种用于在外科手术应用中使用的支架装置,具有带有近端和远端的中空管状分段。该支架装置还可以具有多个呈放射状地延伸的锚点,该锚点位于该近端和远端。该可以被压缩的支架也可以包括特定材料构成的护套,该材料可以被拉离,以将其从该支架移除以及展开该支架装置和多个呈放射状地延伸的锚点。(A stent device for use in surgical applications has a hollow tubular section with a proximal end and a distal end. The stent device may also have a plurality of radially extending anchor points located at the proximal and distal ends. The compressible stent may also include a sheath of a material that can be pulled away to remove it from the stent and deploy the stent device and the plurality of radially extending anchor points.)

1. A stent device for use in surgery, comprising:

(a) a hollow tubular section having a proximal end and a distal end;

(b) a plurality of radial anchor points centrally located between the proximal and distal ends;

(c) a compression device for compressing the stent device, and

wherein the compression means comprises a material that can be pulled apart to remove it from the stent device and to deploy the stent device and the plurality of radial anchor points.

2. The bracket device for surgical operation according to claim 1, further comprising:

(d) at least one set of atraumatic anchors located at the proximal end or the distal end.

3. The stent device of claim 1, wherein the hollow tubular section comprises a lattice of nodes and interconnecting elements, wherein the interconnecting elements have an expansion memory.

4. The stent device of claim 1, wherein the hollow tubular section is printable.

5. A stent device according to claim 3, wherein the interconnecting elements of the hollow tubular sections are cylindrical.

6. A stent device for surgical procedures as claimed in claim 1, wherein the plurality of radial anchor points are generally atraumatic.

7. The stent device of claim 1, the plurality of radial anchor points comprising: means for securing a blood vessel to the stent device.

8. The stent device of claim 1, wherein the plurality of radial anchor points are deflected from a first orientation by the compression means, wherein the first orientation is flat against the stent device.

9. The stent device of claim 1, wherein the plurality of radial anchor points are deflected from a first orientation by the compression means, wherein the first orientation is contracted against the stent device.

10. The bracket device for surgical operation according to claim 1, wherein the bracket device further comprises: at least one compressible fixation anchor located at the proximal and distal ends of the hollow tubular section, the compressible fixation anchor piercing the luminal surface of the human blood vessel.

11. The stent device for surgical procedures of claim 1, wherein the proximal end of the hollow tubular section further comprises: a distal section for engaging a blood vessel of a human body; an attachment end section; a proximal section connected to the hollow tubular section.

12. The stent device for surgical procedures of claim 11, wherein the distal section further comprises: the at least one anchor point.

13. The stent device for surgical procedures of claim 11, wherein the attachment end section further comprises: the at least one anchor point.

14. The stent device for surgical procedures of claim 11, wherein the proximal section further comprises: the at least one anchor point.

15. The stent device for surgical procedures of claim 1, wherein the distal end of the hollow tubular section further comprises: a distal section for engaging a blood vessel of a human body; an attachment end section; a proximal section connected to the hollow tubular section.

16. The stent device for surgical procedures of claim 11, wherein the distal section further comprises: the at least one anchor point.

17. The stent device for surgical procedures of claim 11, wherein the attachment end section further comprises: the at least one anchor point.

18. The stent device for surgical procedures of claim 11, wherein the proximal section further comprises: the at least one anchor point.

19. A stent device for surgical procedures as claimed in claim 1, wherein the at least one anchor point is non-traumatic to a human blood vessel.

20. A stent device for surgical procedures as claimed in claim 1, wherein the at least one anchor point is positioned in a radial manner around the circumference of the hollow tubular section.

21. A stent device for surgical procedures as claimed in claim 1, wherein the at least one anchor point is positioned in a linear manner along the length of the hollow tubular section.

Technical Field

The present invention relates to a stent and delivery of the stent. More particularly, but not by way of limitation, the present invention relates to a device, method or system for a stent and stent delivery.

Background

Hospitals around the world perform many different types of surgery each day, one of which is free flap reconstruction. Free flap reconstructions are a mature method of repairing soft tissue and bone defects or composite defects and can be used in a variety of procedures. The free skin flap is applied to head and neck reconstruction, breast reconstruction, orthopedic surgery and various other specialized departments in sequence. Severe applications of head and neck surgery, especially free flap reconstructions. This is due to the complexity of the defect in the critical area where, in addition to cosmetic, the recovery of functions such as swallowing, vocalization and chewing is of great importance.

Free flap reconstruction involves the transfer of tissue from the distal end of the body to the area to be reconstructed. The principle of operation behind this concept is that tissue in the body is provided with segmental functions. That is, a length of subcutaneous tissue, fascia, muscle, bone, or any combination of these tissues may be harvested based on the particular location. Tissue transfer is accomplished when the free flap vessels (arteries and veins) are connected to the donor vessel and the flap is then placed in the defect.

The donor vessel is selected from among suitable vessels to match the diameter of the recipient vessel (free flap vessel). In the neck, these vessels are usually branches of the external carotid artery and one of the multiple head and neck veins, or the jugular vein itself. Each donor vessel is dissected from the surrounding tissue and prepared with its margins for anastomosis. In free flap reconstructions, the vessels are elevated in situ and the supply vessels are traumatically and carefully dissected out. The supply vessel is then severed, preferably at a length suitable for anastomosis without tension. This is not always possible because different free flaps have different lengths of vessels depending on their location of acquisition. For example, the free rectus vascular pedicle may have a maximum length of 8 centimeters, while the radial vascular pedicle of the forearm may have a maximum length of 15 to 20 centimeters.

Once the vessel is removed from the proper location, margin preparation begins. The vessel preparation procedure may take about an hour and is performed under optimal conditions using a surgical microscope and/or a magnifying glass. This requires considerable skill from long surgical training. Each anastomosis (coaptation) of the vascular anastomosis itself takes about 20 minutes. The venous connector reduces the time required for a venous anastomosis. However, these venous couplers still require suturing for each venous anastomosis, which takes considerable time and increases the anesthesia time for the patient. There are two general types of anastomosis: end-to-end and end-to-side. End-to-end anastomosis is preferred because it proceeds rapidly without additional problems, and because the vascular dynamics are linear flow, end-to-end anastomosis presents a lower complication rate. End-to-end anastomosis accounts for a large portion of the vessel anastomosis. However, these procedures and/or attachments still currently require significant suturing time, which may lead to other complications.

Accordingly, it would be advantageous to have an apparatus and system for a stent and stent delivery system for vascular surgery that overcomes the disadvantages of the prior art. The present invention provides such an apparatus and system.

Disclosure of Invention

The present disclosure relates to a stent, and delivery of the stent during open surgery. Thus, in one aspect, the invention relates to a stent that may be self-correcting or self-expanding during or upon delivery.

In another aspect, the present disclosure is directed to a stent that can be delivered with an outer sheath or protective layer. In yet another aspect, the invention relates to a stent that can be delivered by a syringe or push-release mechanism.

Accordingly, in one aspect, the present disclosure is directed to an improved self-expanding stent that may be used for anastomosis with a novel carrier for endoluminal application of the stent. The stent may have anchor points (anchors) or non-traumatic points.

Accordingly, in one aspect, the present disclosure relates to rapidly performing an anastomosis without the need for vascular preparation or suturing. In another aspect, the present invention relates to lengthening a vessel pedicle during implantation and/or dilating the lumen of a vessel during stenting surgery.

Drawings

The novel features believed characteristic of the disclosure are set forth in the appended claims. The disclosure itself, however, as well as a preferred mode of use, further objectives and advantages thereof, will best be understood by reference to the following detailed description of an illustrative embodiment when read in conjunction with the accompanying drawings.

FIG. 1A is a schematic front view of a coil form stent;

FIG. 1B is a schematic side view of a coil form carrier;

FIG. 2A is a schematic side view of a stent;

FIG. 2B is a front view of a stent;

FIG. 3A is a schematic side view of a compressed expandable stent;

FIG. 3B is a schematic side view of an uncompressed expandable stent;

FIG. 4A is a schematic side view of a compressed expandable stent;

FIG. 4B is a schematic side view of an uncompressed expandable stent;

FIG. 5A is a schematic diagram of a non-invasive node;

FIG. 5B is a schematic view of a barbed node;

FIG. 6 is a schematic view of an expandable stent structure;

FIG. 7A is a schematic side view of an expandable stent structure;

FIG. 7B is a schematic front view of an expandable stent structure;

FIG. 8A is a schematic view of a modifiable support in an unmodified state;

FIG. 8B is a schematic view of a modifiable support in a modified state;

FIG. 8C is a schematic view of a modifiable support in an unmodified state;

FIG. 8D is a schematic view of a modifiable support in a modified state;

FIG. 9A is a schematic view of an expandable stent in an unexpanded state;

FIG. 9B is a schematic view of an expandable stent in a partially expanded state;

FIG. 10A is a schematic view of an expandable barbed stent with a sheath;

FIG. 10B is a schematic view of a barbed expandable stent attached to a donor vessel;

FIG. 10C is a schematic view of a barbed expandable stent attached to a donor vessel and a recipient vessel;

FIG. 10D is a schematic view of a barbed expandable stent attached to a donor vessel and a recipient vessel and in a partially expanded state;

FIG. 10E is a schematic view of a barbed expandable stent attached to a donor vessel and a recipient vessel and in an expanded state with the sheath removed;

FIG. 11A is a schematic view of an expandable stent with barbs and donor and recipient vascular anchors (anchors) in an unexpanded state;

FIG. 11B is a schematic view of an expandable stent with barbs and donor and recipient vascular anchors in a partially expanded state;

FIG. 11C is a schematic view of an expandable stent with barbs and donor and recipient vascular anchors in a partially expanded state;

FIG. 11D is a schematic view of an expandable stent with barbs and with donor and recipient vascular anchors in an expanded state;

FIG. 12A is a schematic view of an expandable stent for use in an end-to-side anastomosis;

FIG. 12B is a schematic view of an expandable stent for end-to-side anastomosis in a locked state;

FIG. 12C is a schematic view of an expandable stent for end-to-side anastomosis in an expanded state;

FIG. 13A is a schematic view of a stent with at least one traumatic radial anchor, at least one atraumatic anchor, and at least one atraumatic anchor;

FIG. 13B is a schematic view of a stent with at least one traumatic radial anchor, at least one atraumatic anchor, and at least one atraumatic anchor;

FIG. 13C is a schematic view of a stent with at least one traumatic radial anchor, at least one atraumatic anchor, and at least one atraumatic anchor;

FIG. 14A is a schematic representation of an expandable stent with both traumatic and non-traumatic anchors in an unexpanded state;

FIG. 14B is a schematic representation of an expandable stent with both traumatic and non-traumatic anchors in an expanded state;

FIG. 15 is a schematic view of an expandable stent with traumatic and non-traumatic anchors attached to donor and recipient blood vessels;

FIG. 16 is a schematic view of an expandable stent with a plurality of atraumatic anchors;

FIG. 17 is a schematic view of an expandable stent with multiple atraumatic anchors.

Detailed Description

An embodiment of the present disclosure will now be described. It should be noted that although vascular, and/or microvascular surgery and/or surgical methods will be described herein, the present disclosure may also be applied to a number of procedures, including but not limited to, procedures for the head, neck, sinuses, nasal cavity, ears, heart, lung, artery, vein, brain, nerve, organ, blood vessel, and/or any other human or animal procedure. It is to be understood that although the present description will refer to human surgery, those skilled in the veterinary art will also benefit from the present disclosure. Some examples of the disclosure may also benefit plumbing, electrical, or other fields.

The description herein will be made with respect to a gravitational frame of reference, but such description should not be considered limiting. It will be understood that, unless otherwise indicated, reference frames to the left or right of an object may be mirrored or reversed; similarly, unless otherwise indicated, reference to upper or lower frames may be mirrored or reversed. The stents and/or stent delivery mechanisms disclosed herein may be produced, manufactured and/or formed from a number of materials, including but not limited to: wood, plastic, silicon material, metal alloy, composite material, polymer, resorbable polymer, Teflon (Teflon), Mylar (Mylar), carbon fiber, other similar materials, or combinations thereof.

Fig. 1A is a front view of a coil stent a 100. The coiled stent 100A and/or the stent body 102 may be manufactured or produced in at least one variation from expandable or modifiable materials, such as, but not limited to: elastomeric polymers, elastomeric alloys, metals, plastics, composite materials, and/or combinations thereof. In some variations, the stent body 102 is a hollow cylinder or hollow tubular body having an inner diameter and a corresponding inner circumference, and an outer diameter and a corresponding outer circumference.

Along the outer perimeter of the stent body 102, there may be a stent body anchor 104. The stent body anchor may be one or more such that there is at least one stent body anchor 104 along the outer circumference of the stent body 102. The stent body anchor 104 may be, but is not limited to: anchors, barbs, atraumatic anchors, prongs, points, staples, and/or any combination of the foregoing. In at least one embodiment, an atraumatic anchor may assist in securing a blood vessel to the stent. The stent body anchor 104 may be used to secure a donor vessel and/or a recipient vessel to the coiled stent 100A. The stent body 102 may also have at least one stent end anchor 106. The stent end anchor 106 may be, but is not limited to: barbs, atraumatic anchors, prongs, points, staples, and/or any combination of the foregoing.

The aperture 108 may be formed by the stent body 102. The aperture may be defined by the stent body 102, and more specifically, by the inner diameter and/or inner circumference of the stent body 102. It is understood that the apertures 108 may have any number of cross-sections and/or profiles such as, but not limited to, circles, ellipses, squares, rectangles, polygons, cones, pyramids, other shapes or profiles, and/or combinations thereof.

Fig. 1B is a side view of a coil form support 100B. The stent body 102 may comprise many different shapes, cross-sections, and/or contours. In one example, the stent body 102 may have a top and a bottom in parallel planes with each other and a first end 103 and a second end 105, the second end 105 being distal to the first end 103. In other examples, the top and bottom of the stent body 102 may not be in parallel planes. For example, a blood vessel (not shown) may have a narrowed or narrowed section, which requires that one end of the stent body be smaller and the other end be larger. Creating the situation where the top may be in a plane that converges to a plane parallel to the bottom of the stent body 102.

The stent body 102 may have at least one anchor along the outer circumference and/or ends of the stent body. The stent body anchor 104, or at least one stent body anchor, may be disposed at a central location and/or at different locations along the outer circumference of the stent body 102. The anchor may be non-invasive or non-penetrating, or in the form of a penetrating or traumatic anchor. For example, in low pressure or slow blood flow vessels, non-invasive anchors may be used to avoid damage to the vessels flowing through the low blood flow. In another example, the coil stent 100B may also be used in high pressure or fast blood flow vessels, with the anchor 104/106 securing the coil stent 100B in place by using a piercing anchor and/or a combination of a piercing anchor and a non-traumatic anchor.

In a surgical procedure involving end-to-end anastomosis, a donor vessel (not shown) and a recipient vessel (not shown) may be secured to the coiled stent 100B by the stent body anchors 104 and/or the stent end anchors 104. The vessel need not be prepared in a conventional manner because the anchor 104/106 allows for fixation of the donor vessel and/or recipient vessel without suturing the vessel. The time required to prepare the vessel end is also reduced. The stent body anchor 104 may be manufactured to have a length sufficient to pierce the lumen or wall of a donor or recipient vessel. The stent end anchor 106 may be manufactured to have a length sufficient to pierce the lumen or wall of a donor or recipient vessel.

Fig. 2A is a side view of a stent 200A. The stent body 202 of the stent 200A may comprise a plurality of sections, such as, but not limited to, a first stent body section 210A, a second stent body section 210B, and/or a third stent body section 210C. The stent body segments may be constructed, formed, or manufactured from plastic, silicon materials, metals, metal alloys, composite materials, polymers, absorbable polymers, Teflon (Teflon), Mylar (Mylar), carbon fiber, other similar materials, or combinations thereof. In addition, in at least one variation, each stent body section may be constructed of a different material. For expandable or modifiable stents, different materials may allow for different expansion and deformation rates for each stent body segment. The stent body section may also be a first stent end section (proximal section), an intermediate stent section (attachment section) and a second stent end section (distal section). It will be appreciated that in some examples, the proximal and distal sections may also be reversed. Each end section may also have their own proximal section, attachment section and/or distal section.

The radial anchors 212 or radial anchor points may be radially disposed along the stent body 202. In one example, at the second stent body section 210B or the middle stent section, a radial anchor 212 may be centrally disposed between each end of the stent body 202. In another example, the radial anchor 212 may include more than one radial anchor, or at least one radial anchor, and/or be disposed along the first stent body 210A, the second stent body 210B, and the third stent body 210C.

Fig. 2B is a front view of a cradle 200B. The support body 202 may include an aperture 208. The aperture 208 may define the lumen of the stent 200B alone or in combination with the stent body 202. The hole 208 and the lumen may also vary with the expansion and revision of the stent 200B. The material from which the stent 200 is formed, constructed, or manufactured may have a particular force on them for expansion and/or revision, such that in one example, the stent 200B may expand from a first diameter to a second diameter that is approximately double or double the first diameter. It will be appreciated that the expansion rate may be 1 to 100 times the original size of the stent or the size of the other expandable section.

The bore 208 and/or the stent body 202 may have radial anchors 212 along the outer or inner circumference of the stent body 202. In at least one example, the radial anchors 212 may be equally spaced apart. In other examples, the radial anchors 212 may not be equally spaced along the circumference of the stent body 202. Expansion and modification of the stent 200B may allow at least one radial anchor to secure the donor and/or recipient vessel.

FIG. 3A is a side view of a compressed expandable stent 300A. The compressed expandable stent 300A may have an unexpanded stent body 302A with at least one radial anchor 312. The compression of the uncompressed expandable stent 300A may result from the materials used to form, construct and/or manufacture the stent. The material may have elastic or tensile strength based on the modular structure, segmented structure, and/or geometry selected for the particular stent. The unexpanded stent body 302A may have an atraumatic anchor 314A and/or a traumatic anchor 316A that may be in a compressed state. A traumatic anchor refers to an anchor that can pierce or invade the wall or lumen of a vessel, but which is at an acceptable level of injury and/or minimally invasive to secure the stent in place in the donor and/or recipient vessel. Atraumatic anchor 314A and/or traumatic anchor 316A may be in a compressed or unexpanded state prior to or during initial delivery or installation of the stent. A device may be used to deliver the stent to the donor and/or recipient vessel and initiate decompression, expansion and/or revision of the properties of the stent, the unexpanded stent body 302A and/or the anchors 314A/316A.

Fig. 3B is a side view of an uncompressed expandable stent 300B. The uncompressed expandable stent 300B may have an expanded stent body 302B. The expanded stent body 302B may have at least one radial anchor 312 coupled along the circumference of the stent body 302. The compression of the uncompressed expandable stent 300A may result from the materials used to form, construct and/or manufacture the stent. The material may have elastic or tensile strength based on the modular structure, segmented structure, and/or geometry selected for the particular stent.

The at least one radial anchor 312 may be used to secure a donor vessel and/or a recipient vessel (not shown). The expanded stent body 302B may have an atraumatic anchor 314B and or a traumatic anchor 316B in an uncompressed state. In a compressed state or first orientation, as shown in FIG. 3A, the anchor may be flat or collapsed against the stent body, and/or may not extend from a section or region of the stent body that is protected. In an uncompressed state or second orientation, the anchor may be released to a designed structure, place or location based on the self-expanding and/or self-modifying configuration of the stent. When in an uncompressed state, the anchors 314B/316B can be secured against a lumen or wall of a donor and/or recipient vessel. In one example the radial anchor 312 may be compressible, while in other examples the radial anchor 312 may be in a fixed position.

FIG. 4A is a schematic side view of a compressed expandable stent 400A. The compressed stent body 402A may include: radial anchor 412, compressed expandable structure 413A, compressed atraumatic anchor 414A, structural node 415, and/or compressed traumatic anchor 416A. The compressed stent body 402A may be in a compressed state because the compressed structure surrounds and contains the compressed stent body 402A in the compressed state, and/or the nature of the material used to form, construct and/or manufacture the compressed expandable stent 400A. In one example, the radial anchors 412 can be in a fixed position, the radial anchors 412 radiating outward from the compressed stent body 402 and/or the outer circumference of the compressed stent body 402. In another example, the radial anchors 412 may be collapsible and may change to a fixed position during expansion or when the compressed stent body 402A decompresses.

The compressed expandable structure 413A may be made of a material such as plastic, silicon material, metal alloy, composite material, polymer, resorbable polymer, Teflon (Teflon), Mylar (Mylar), carbon fiber, other similar materials, or combinations thereof. The material should be compressible to allow the compressed expandable structure 413A to be about half its normal size, one-fourth its normal size, or any other proportion of the entire portion of the expandable structure 413A. The compressed expanded structure 413A may also be formed, constructed and/or fabricated from materials that may have a memory effect or memory of expansion, such as flexible plastic or silicon materials, although other materials such as plastic, silicon materials, metals, metal alloys, composite materials, polymers, absorbable polymers, Teflon (Teflon), polyester film (Mylar), carbon fiber, other similar materials, or combinations thereof, may also be used. Memory effect or expanded memory shape a material can be manipulated from a first position to a second position and then returned to the first position when released from the second position.

The structural node 415 may provide a connection point for the expandable structure 413A. In at least one example, the structural nodes 415 can be used with the expandable structure 413 to form a node mesh. Structural node 413 may be constructed, formed, or fabricated from materials such as, but not limited to: plastic, silicon material, metal alloy, composite material, polymer, absorbable polymer, Teflon (Teflon), Mylar (Mylar), carbon fiber, other similar materials, or combinations thereof. In at least one example, the structural node 415 may be constructed, formed and/or fabricated from an expandable structure 413A. In other examples, the structural node 415 may be connected or secured to the expandable structure 413A by an adhesive, fastener, glue, connector, cement, epoxy, adhesive.

Fig. 4B is a side view of an uncompressed expandable stent 400B. The uncompressed stent body 402B may include radial anchors 412, an uncompressed expandable structure 413B, uncompressed atraumatic anchors 414B, structural nodes 415, and/or uncompressed traumatic anchors 416B. For example, a compressed stent body, radial anchor, compressed expandable structure, compressed atraumatic anchor, structural node, and/or compressed traumatic anchor may be decompressed and/or expanded by external or internal forces.

When the compressed stent body decompresses or expands, the anchors along the stent body may decompress or expand radially from the stent body to secure the stent to the donor or recipient vessel. In other variations, the anchors may extend linearly or outwardly. In one example, the radial anchor 412 may be in a fixed position that does not allow for compression and expansion. Alternatively, the radial anchor 412 may be compressed along the stent body. In at least one variation, the uncompressed non-traumatic anchor 414B and/or the uncompressed traumatic anchor 416B may expand outward and/or radially from an axis extending longitudinally through the uncompressed stent body 402B.

In at least one example, expansion and/or decompression of the stent body and/or anchor can occur in response to blood flow through the interior of the stent body. In other examples, expansion and/or decompression of the stent body and/or anchor may occur in response to external or internal forces, such as, but not limited to: a deployment or delivery device, a syringe, a surgical instrument or tool, an electro-mechanical force, an electrical signal, an electromagnetic force, or a magnetic force.

Fig. 5A is a schematic diagram of a non-invasive node 530. The vessel lumen 518 may be connected, coupled, and/or secured by atraumatic nodes 520. Atraumatic nodes 520 may have a smooth or textured outer surface 521. In other variations, atraumatic node 520 may also be an atraumatic anchor.

FIG. 5B is a schematic view of a traumatic node 522. The vessel lumen 518 may be connected, coupled, and/or secured by the traumatic node 522. The surface of the traumatic node 522 may be textured and/or covered with barbs, dots, spikes, or other sharp objects that may secure or fasten the traumatic node 522. The fastening may be accomplished by fasteners such as bolts, nails, screws, tongues and grooves, dovetails, grooves and poles, or other attachment methods. In addition, adhesives such as, but not limited to: adhesives, bonding agents, and other materials that can form an adhesive connection. Combinations of fasteners and adhesives may also be used. In other variations, traumatic node 522 may also be a traumatic anchor.

FIG. 6 is a schematic view of an expandable stent structure. The expandable structure may include an expandable member or structural element 624, and/or expandable connection nodes 626. In at least one example, expandable member 624 and/or expandable connection node 626 can be manufactured to have magnetic and/or shape memory properties. In at least one example, the connecting node 626 can interact with other connecting nodes to effect conversion or modification of the expandable or structural member 624.

FIG. 7A is a side view schematic illustration of an expandable stent structure. The expandable stent may have expandable structural elements 724. Connecting node 726 may connect and/or couple expandable structural element 724 with non-expandable structural element 728. The expandable structural element 724 may be formed, constructed and/or manufactured from materials such as, but not limited to: plastic, silicon material, metal alloy, composite material, polymer, absorbable polymer, Teflon (Teflon), Mylar (Mylar), carbon fiber, other similar materials, or combinations thereof. Additionally, in one example, expandable structural element 724 may have a memory property that allows expandable structural element 724 to be compressed or expanded from a first position to a second position, and then to return to the first position when released from the second position.

The connection node 726 may be formed, constructed and/or fabricated from materials such as, but not limited to: plastic, silicon material, metal alloy, composite material, polymer, absorbable polymer, Teflon (Teflon), Mylar (Mylar), carbon fiber, other similar materials, or combinations thereof. In at least one example, the connecting nodes 726 can be formed, constructed and/or manufactured from the same or similar materials as the expandable structural elements 724. In other examples, the connection nodes 726 may be formed, composed, and/or manufactured from a different material than the expandable structural element 724. Non-expandable element 728 may be formed, composed, and/or fabricated from materials such as, but not limited to: plastic, silicon material, metal alloy, composite material, polymer, absorbable polymer, Teflon (Teflon), Mylar (Mylar), carbon fiber, other similar materials, or combinations thereof. In at least one example, fig. 7A may also represent a section of a stent device, or a first or second end of a stent device, having a proximal section 701A, an attachment end section 701B, and a distal section 701C, which may be coupled to a hollow tubular section or structure of the stent device. The expansion may include linear expansion 720 or radial expansion 732.

FIG. 7B is a schematic front view of an expandable stent structure. The holes 708 may be defined by the expandable stent structure and allow fluid to flow through the expandable stent structure. The expandable stent structure may include: expandable structural element 724, connecting node 726, and/or non-expandable structural element 728. Expandable structural element 724 can allow the expandable stent structure to expand based on a variety of conditions. For example, the expandable stent structure may be maintained in a contracted, unexpanded, or unmodified state with a covering or sheath prior to insertion into or use on a patient. The covering or sheath may then be removed to allow the expandable stent to expand or self-correct to an expanded or corrected state.

FIG. 8A is a schematic view of a modifiable support in an unmodified state 834A. FIG. 8B is a schematic view of a modifiable support in a modified state 834B. Referring to fig. 8A and 8B, the modifiable stent can be modified with an expandable stent element 824 and a connection node 826. For example, the stent may be in an unmodified state 834A prior to use in a patient, allowing the modifiable stent to be relatively easily placed into a patient, and allowing the modifiable stent to be sized to fit any number of blood vessels. The cover or sheath encasing the modifiable stent can remain in an unmodified state 834A or the characteristics of the stent element can be modified to produce a memory effect. The stent elements may be interconnected elements or interconnected elements. These characteristics may include, but are not limited to: chemical structure, magnetic structure, and/or electrically conductive structure of the stent elements. These characteristics can be modified to change the geometry of the modifiable support to a modified state 834B. For example, the transition from the uncorrected state 834A to the corrected state 834B can allow the modifiable stent to expand to secure it to the lumen or wall of a certain vessel or group of vessels.

Fig. 8C is a schematic view of a modifiable support in an unmodified state 836A. Fig. 8D is a schematic view of a modifiable support in a modified state 836B. Referring to fig. 8C and 8D, the modifiable stent can be modified with an expandable stent element 824 and a connection node 826. For example, the stent may be in an unmodified state 836A prior to use in a patient, allowing the modifiable stent to be relatively easily placed into the patient, and allowing the modifiable stent to be sized to fit any number of blood vessels. The inserter or sheath encasing the modifiable stent can remain in an unmodified state 836A or the characteristics of the stent elements can be modified to produce a memory effect. These characteristics may include, but are not limited to: chemical structure, magnetic structure, and/or electrically conductive structure of the stent elements. These characteristics can be modified to change the geometry of the modifiable stent to a modified state 836B. For example, the transition from unmodified state 836A to modified state 836B may allow the modifiable stent to deform to secure it to the lumen or wall of a vessel or group of vessels.

FIG. 9A is a schematic view of an expandable stent in an unexpanded state 938. The expandable stent may include: an expandable structural element 924, a connection node 926, and/or a non-expandable structural element 928. For example, if constructed of a shape memory alloy, the expandable structural element 924 may be expanded by an external force or based on an internal structural force. In at least one example, the expandable structural element 924 can be received by a sheath, covering, or delivery device (not shown), which maintains the expandable structural element 924 in an unexpanded or contracted state until the sheath, covering, or delivery device is removed. In at least one example, the expandable structural elements 924 can be used to form the circumference of the expanded stent (or expandable rings 925 along the length of the expandable stent), while the non-expandable structure 928 can be used to longitudinally connect the expandable rings via the connection nodes 926.

FIG. 9B is a schematic view of an expandable stent 940 in a partially expanded state. The expandable stent includes: an expandable structural element 924, a connection node 926, and/or a non-expandable structural element 928. The expandable structural element 924 may be fabricated and/or formed from a shape memory alloy or other material that allows for an elastic and/or expandable structure. The connection nodes 926 may be formed from a shape memory alloy, or other material that allows for a resilient and/or expandable structure, or materials such as, but not limited to: plastic, silicon material, metal, composite material, and/or other materials approved for use in the human or animal body. Non-expandable structural element 928 may be fabricated and/or formed from materials including, but not limited to: plastic, silicon material, metal, composite material, and/or other material approved for use in the human or animal body.

The expandable stent may be expanded and/or modified when the sheath, covering, and/or delivery device (not shown) are removed, thereby allowing the expandable structural elements 924 to expand to their fullest extent. For example, the unexpanded section 924A can be contained within a sheath, covering, and/or delivery device (not shown) that maintains the expandable structural element 924 in an unexpanded or contracted state. In another example, the partially expanded portion 924B may be between the unexpanded state 938 and the fully expanded state. The portion expansion portion 924B may be the portion of the sheath, covering, and/or delivery device (not shown) that has just been removed. After the sheath, covering, and/or delivery device (not shown) are removed, the expandable structural element 924 begins to expand or decompress to an expanded or decompressed state. In one example, the expandable structural element 924 can return to an original shape or state based on the memory of the material used to fabricate the expandable element 924. As another example, an expandable portion 944 is shown that allows the expandable structural element 924 to fully expand or decompress.

Figure 10A is a schematic view of a barbed expandable stent 1000 with a sheath 1043. The sheath 1043 covers and/or houses the barbed expandable stent 1000 and/or stent body 1002 in an unexpanded or contracted state. The sheath 1043 can help to cover and/or house the atraumatic anchor 1014A and/or traumatic anchor 1016A coupled to the stent body 1002. Anchors 1014A and/or 1016A may be used on one or more ends of barbed expandable stent 1000. In at least one example, the anchors 1014A and/or 1016A can be in an unexpanded or contracted state, but the anchors 1014A and/or 1016A can interact with a vessel or other body part when the anchors 1014A and/or 1016A are allowed to expand or transition. The anchors 1014A and/or 1016A can be coupled to the stent body 1002 via the expandable structural element 1024 and/or the connecting node 1026. In at least one variation, the stent body 1002 includes an expandable structural element 1024 and a connecting node 1026. The stent body 1002 may also include radial anchors 1012 that extend radially outward from the stent body 1002. In at least one variation, the radial anchors 1012 may be collapsed and/or contained within a sheath, covering, or delivery device 1043. In other variations, the radial anchors 1012 are fixed at a particular angle relative to the stent body 1002, which may range from 15 degrees relative to the stent body 1002 to 165 degrees relative to the stent body 1002. The sheath, covering, or delivery device 1043 may include at least one perforation 1044 and/or a needle (needle) 1046. The at least one perforation 1044 allows the sheath, covering, or delivery device 1043 to be detached from around the anchors 1014A, 1016A, and/or 1012. The needle 1046 may allow the sheath, covering, or delivery device 1043 to be removed through the lumen of a blood vessel or other tissue.

Fig. 10B is a schematic view of a barbed expandable stent 1000 attached to a donor vessel 1048. In at least one example, when the barbed expandable stent 1000 is attached to the donor vessel 1048 by the radial anchors 1012. The radial anchors 1012 may be in an uncompressed state or in a fixed position, allowing the anchors to pierce through tissue to secure the barbed expandable stent 1000 and/or stent body 1002. Blood flow 1050 through the barbed expandable stent 1012 and/or stent body 1002 may facilitate the healing process of the donor vessel 1048 or the recipient vessel.

Fig. 10C is a schematic illustration of a barbed expandable stent 1000 attached to a donor vessel 1048 and a recipient vessel 1052. In at least one example, the donor vessel 1048 and the recipient vessel 1052 can overlap. This overlap may occur near the radial anchor 1012. In at least one example, the donor vessel 1048 receives the barbed expandable stent 1000 and/or the stent body 1002 within an inner diameter of the donor vessel 1048, with a lumen of the vessel placed over the radial anchor 1012. In other examples, the donor vessel 1048 is placed over the radial anchor 1012, and the radial anchor 1012 pierces the lumen and wall of the vessel and allows the recipient vessel 1052 to also be placed over the radial anchor 1012. In at least one variation, the donor vessel 1048 and/or the recipient vessel 1052 are placed over a sheath 1043 that covers the stent body 1002.

Fig. 10D is a schematic view of a barbed expandable stent 1000 attached to a donor vessel 1048 and a recipient vessel 1052, and in a partially expanded state. In at least one example, the anchors 1061B expand 1056 in a partially expanded state, allowing them to secure the barbed expandable stent 1000 and/or stent body 1002 to the donor vessel 1048. The radial anchors 1054 may also expand 1054 to couple the barbed expandable stent 1000 and/or the stent body 1002 to the donor vessel 1048 and/or the recipient vessel 1052. The anchor 1014A remains in a contracted or unexpanded state until the sheath, covering, and/or delivery device 1043 is completely removed.

Fig. 10E is a schematic view of a barbed expandable stent 1000 attached to a donor vessel and a recipient vessel 1048 and in an expanded state with the sheath 1043 removed. When the sheath, covering, and/or delivery device 1043 is removed from the barbed expandable stent 1000, it may be segmented into one or more segments 1060 along pre-cut or pre-designed perforations in the sheath or covering material 1043. This expanded state allows the anchors 1014B/1016B to engage or interconnect with a corresponding vessel or tissue. When expanded 1058, the anchors 1014B/1016B may allow the barbed expandable stent 1000 and/or stent body 1002 to be coupled and/or secured to a vessel or other tissue.

FIG. 11A is a schematic view of an expandable stent 1100 with barbs and with donor and recipient vascular anchors 1114A/1116B in an unexpanded state. The radial anchors 1112 allow the donor vessel 1148 and/or recipient vessel to be coupled to the barbed expandable stent 1100 and/or stent body 1102. The stent body 1102 can also include anchors 1114A and/or 1116A. In other variations of the barbed expandable stent 1100, the anchors 1112/1114a/1116A may be retractable or compressible. The stent body 1002 and/or the anchors 1112/1114a/1116A may be compressed or held in an unexpanded state by the sheath, covering 1162, or delivery device. In one variation, the sheath, covering or delivery device 1162 may be a wire (wire) or other object that can conform or be in a contracted or unexpanded state with the barbed expandable stent 1000 and/or stent body 1102. The sheath, cover, or delivery device 1162 may include a needle attached to one end of the cover, which may allow the sheath, cover, or delivery device 1162 to be removed through a blood vessel or other tissue.

Fig. 11B is a schematic view of an expandable stent 1100 with barbs and with donor and recipient vascular anchors 1114/1116 in a partially expanded state. The anchor 1116 expands or decompresses with the removal of the cover 1162, allowing the anchor 1116 to engage the vessel and/or tissue. In some variations, the anchor 1116 may be a traumatic anchor, where the traumatic anchor may pierce or invade the vessel or tissue, but this is an acceptable level of injury and/or minimal invasion to secure the stent in place in the vessel or tissue. In other variations, anchor 1116 may be a non-invasive anchor that may engage a blood vessel or tissue without causing injury or invasion. When the cover 1162 is removed, the radial anchors 1112 may also expand or decompress as the barbed expandable stent 1100 and/or stent body 1102 expands. Recipient vessel 1152 may receive barbed expandable stent 1100 and/or stent body 1102 with a portion of the vessel or tissue engaged with radial anchor 1112. When the barbed expandable stent 1100 and/or stent body 1102 has been completely surrounded by a vessel and tissue, the needle 1146 may be used to remove the cover 1162 through the vessel or tissue. In at least one example, when the recipient vessel 1152 receives the stent body 1102, the needle 1146 pierces a lumen or wall of the recipient vessel 1152 to provide an exit path for the cover 1162 of the barbed expandable stent 1100.

Fig. 11C is a schematic view of an expandable stent 1000 with barbs and with donor and recipient vascular anchors 1114/1116 in a partially expanded state. As the cover 1165 is further removed, the barbed expandable stent 1100 continues to expand. In one variation, the barbed expandable stent 1100 is engaged with a low blood flow rate or low pressure vessel. In low pressure vessels, non-invasive anchors may be used to reduce the invasiveness of the stent and/or the procedure. In other variations, the barbed expandable stent 1100 is engaged with a high blood flow rate or high pressure vessel. High pressure vessels may require the use of invasive anchors to ensure that the stent does not move after placement.

Fig. 11D is a schematic view of an expandable stent 1100 with barbs and with donor and recipient vascular anchors 1114/1116 in an expanded state. When the covering 1162 is removed, the anchors 1114 expand or decompress, thereby allowing them to engage the vessel or tissue. In some variations, anchor 1114 may be a traumatic anchor, where the traumatic anchor may pierce or invade a vessel or tissue, where the vessel is a human vessel or a mammalian vessel, but this is an acceptable level of injury and/or minimal invasion to fix the stent in place in the vessel or tissue. In other variations, anchor 1114 may be a non-invasive anchor that may engage a vessel or tissue without causing injury or invasion. When the cover 1162 is removed, the radial anchors 1112 may also expand or decompress as the barbed expandable stent 1100 and/or stent body 1102 expands. Recipient vessel 1152 may receive barbed expandable stent 1100 and/or stent body 1102 with a portion of the vessel or tissue engaged with radial anchor 1112. The cover 1162 can include a plurality of ends and/or sections 1163, which can be removed with the cover 1162 and/or the needle 1164. The plurality of ends and/or sections may be created by perforated or pre-perforated sections of the sheath, covering, or delivery device.

Fig. 12A is a schematic view of an expandable stent 1200 for use in an end-to-side anastomosis. The expandable stent 1200 includes a stent body 1202, an anchor 1216/1264/1268. In at least one variation, the stent 1200 also includes a sheath, covering, or delivery device 1262. The sheath, covering, or delivery device 1243 may be coupled with the needle 1246 to assist in removal of the sheath, covering, or delivery device 1243 after the expandable stent body 1200 is placed in place. In one example, the needle 1246 removes the sheath, covering, or delivery device 1243 from the proximal end 1203 of the stent body 1202. Donor vessel 1248 and/or recipient vessel 1270 may receive expandable stent 1200.

In at least one variation, the expandable stent 1200 is received by a recipient vessel 1270 through an opening 1266. In one example, the distal end 1205 of the stent body 1202 includes at least one locking anchor and at least one fixation anchor 1268. In at least one variation, the at least one locking anchor 1264 allows the locking anchor 1264 to flex when the expandable stent 1200 is received by the recipient vessel 1270. After the lock anchor 1264 has passed through the opening 1266, a spring-like or expansive force will cause the lock anchor 1264 to extend beyond the edge of the opening 1266. When the lock anchors 1264 extend past the edges of the openings 1266, a locking effect is created that prevents removal of the expandable stent 1200.

The at least one anchor 1268 can be received and/or compressed by a sheath, covering, or delivery device 1243. In at least one variation, the anchor 1268 extends through the donor vessel opening 1296 and the locking anchor 1264 passes through the lumen or wall of the donor vessel 1248.

Fig. 12B is a schematic view of an expandable stent 1200 in a locked state for end-to-side anastomosis. A locked state is created when locking anchor 1264 has passed through opening 1266 and engages lumen or wall 1267 of recipient vessel 1270. In at least one example, the locked state provides resistance through the lock anchor 1264 that can be used during removal of the sheath, covering, or delivery device 1243. Applying an amount of force on the needle 1246 and/or sheath, covering, or delivery device 1243, the needle 1246 and/or sheath, covering, or delivery device 1243 can be removed from the expandable stent 1200 and/or stent body 1202, which can create a resistance or reaction force when the lock anchor 1264 engages the lumen of the recipient vessel 1270. The reaction force may allow the sheath, covering, or delivery device 1243 to detach from any point of contact of the expandable stent 1200, such as anchors 1216, 1264, and/or 1268.

The anchor 1268 can remain housed, collapsed, and/or in an unexpanded state before the sheath, covering, or delivery device 1243 is removed from the expanded stent 1200. While the anchor 1268 may remain lodged, contracted, and/or in an unexpanded state, a portion of the donor vessel 1248 is within the recipient vessel 1270. In at least one example, the portion of the donor vessel 1248 within the recipient vessel 1270 can be the portion of the donor vessel 1248 between the locking anchor 1264 and the distal end 1205 of the expandable stent 1200 and/or stent body 1202.

Fig. 12C is a schematic view of an expandable stent 1200 in an expanded state for end-to-side anastomosis. The expandable stent 1200 may be expanded when the sheath, covering, or delivery device 1243 is removed. The expandable stent 1200 and/or stent body 1202 may include expandable structures or structural elements that may be modified or expanded to match and/or conform to the shape of the donor vessel 1248 and/or recipient vessel 1270. In at least one example, the expandable stent 1200 and/or stent body 1202 expands the donor vessel 1248 and/or recipient vessel 1270 beyond the corresponding vessel size to allow increased blood flow through the expandable stent 1200 and/or stent body 1202 and/or one or both vessels 1248/1270.

This expansion may also trigger expansion or a change in state of the anchor 1268. The expanded fixation anchor 1268B secures a portion of the donor vessel 1248 between the distal end 1205 of the expandable stent 1200 and the location of the inner and/or outer lumens of the donor vessel 1248 that the lock anchor 1264 has pierced or punctured. Portions of the donor vessel 1248 can be folded over, secured against and/or over the lock anchor 1264, and/or engaged with portions of the donor vessel 1248. Securing and/or engaging portions of donor vessel 1248 against and/or over lock anchors 1264 creates a covering that resembles a suture, butterfly, and/or band-aid effect to prevent blood loss through the opening and/or along the edges of opening 1266, the edges of opening 1266 having an engagement interface between donor vessel 1248 and recipient vessel 1270.

The securing and/or engagement of portions of donor vessel 1248 is aided by the engagement and/or connection of either anchor 1268B or at least one end of anchor 1268B with lumen 1267 of recipient vessel 1270. The anchor 1268B and/or at least one end of anchor 1268B may create a sealing and/or sealing effect via engagement 1269 with a lumen or wall 1267 of recipient vessel 1270. The sealing and/or sealing effect can also be assisted by portions of the donor vessel 1248 that are folded over, secured and/or engaged by the fixation anchors 1268 against and/or on the locking anchors 1264. In at least one variation, the anchor 1268B is a traumatic anchor. In other variations, the fixation anchor 1268B is a traumatic anchor or a combination of a non-traumatic and a traumatic anchor.

Fig. 13A, 13B, 13C are schematic illustrations of a stent 1300A, 1300B, and/or 1300C with at least one traumatic radial anchor 1312, at least one non-traumatic anchor 1314, and at least one non-traumatic anchor 1316, respectively. In one example, stent 1300 may be an expandable stent. The expandable stent may be expanded in an accordion-like fold (flexion), twist, and/or rotational motion. In other examples, the at least one atraumatic anchor 1314/1316 may be flexible and/or elastic, allowing one or both ends of the stent 1300 to be placed into a vessel (not shown) without the need for a dilation and/or delivery tool.

FIG. 14A is a schematic representation of an expandable stent 1400A in an unexpanded state with both traumatic and non-traumatic anchors. The expandable stent includes at least one traumatic anchor 1416 and/or at least one atraumatic anchor 1414. In other examples, the anchor 1414/1416 may both be a traumatic or non-traumatic anchor. In at least one variation, the anchor 1414/1416 is expandable, allowing for a change from an unexpanded state to an expanded or stretched state. In one example, the expansion may be from the material used to fabricate the expandable stent 1400A and/or the anchors 1414/1416. In other examples, the expansion may be a result of elasticity or external forces on the anchor 1414/1416. In at least one variation, the anchor 1414/1416 can be received and/or retracted by a sheath, covering, or delivery device (not shown). In other variations, the anchors 1414/1416 may expand or change state based on the expansion of the expandable stent 1400A. For example, the anchor 1414/1416 may transition based on a pulling or tightening effect triggered by the expansion of the expandable stent 1400A. The pulling or tightening effect may cause the anchor 1414/1416 to expand or transition outwardly from a position parallel to the support body 1402 or a plane parallel to the support body 1402 to a position or expanded state oblique or perpendicular to the support body 1402 and/or a plane parallel to the support body 1402. The expandable stent 1400A may also include at least one radial anchor 1412 extending radially from the expandable stent 1400A and/or the stent body 1402. In at least one variation, the radial anchor 1412 is expandable and/or contractible.

FIG. 14B is a schematic representation of an expandable stent 1400B in an expanded state with both traumatic and non-traumatic anchors. The expandable stent 1400B may transition from the unexpanded state to the expanded state in a radial (out along the circumference of the stent body 1402) and/or linear (out from the proximal end 1403 and/or the distal end 1405 of the expandable stent 1400B). During expansion in a radial manner, the anchors 1414/1416 may extend and/or decompress based on the tension and repulsion forces that cause the anchors 1414/1416 to extend in an upward and/or outward manner from the expandable stent 1400A and/or stent body 1402. During expansion in a linear manner, the tension and repulsion forces cause the anchors 1414/1416 to extend in an upward and/or outward manner from the expandable stent 1400A and/or stent body 1402. This linear and/or radial expansion may allow the anchor 1412/1414/1416 to connect and/or engage with a vessel and/or tissue.

Fig. 15 is a schematic representation of an expandable stent 1500 with traumatic and non-traumatic anchors attached to donor and recipient vessels. The expandable stent 1500 may include at least one atraumatic anchor 1514 and at least one traumatic anchor 1516. The anchors 1514/1516 can expand and/or compress, allowing them to expand and/or compress with the expandable stent 1500.

In at least one variation, the expandable stent 1500 is made of a reactive material. The reactive material, in response to the blood flow 1550, may initiate expansion of the stent 1500. In other variations, the reactive material, which may be responsive to a magnetic or electric field or code, may trigger expansion.

The expandable stent 1500 may be placed in a high pressure vessel having a blood flow rate 1550, the blood flow rate 1550 may result in stent displacement if the stent is not fixed. In at least one variation, the expandable stent 1500 is secured by a traumatic anchor 1516 and/or an atraumatic anchor 1514. For example, the traumatic anchor 1516 may be used in high pressure or high blood flow rate vessels. In other examples, the atraumatic anchor 1514 may be used, for example, in low pressure or low blood flow rate vessels. In still other examples, a combination of traumatic or non-traumatic anchors may be used to allow use of a traumatic anchor in a vessel that transports and/or transmits blood flow (e.g., donor vessel 1548) and a non-traumatic anchor in a vessel that receives blood flow (e.g., recipient vessel 1552).

FIG. 16 is a schematic view of an expandable stent 1600 with multiple atraumatic anchors 1672A/1672B/1672C/1672D/1672E (collectively 1672). In at least one variation of the expandable stent 1600, the stent body 1602 may include a plurality of atraumatic anchors 1672 along the circumference of the expandable stent. In other variations, anchor 1672 may be a traumatic anchor. In at least one example, the anchor 1672 is collapsible and/or compressible. The expandable stent 1600 may be covered and/or protected by a sheath, covering, delivery, and/or delivery device (not shown). The sheath, covering, delivery, and/or delivery device (not shown) may provide a force to contain, retract, and/or compress the anchor 1672.

Fig. 17 is a schematic view of the expandable stent 1700 described above. The stent 1700 can include a plurality of anchor points 1772A, 1772B, 1772C, 1772D, and/or 1772E. In at least one example, the anchor points 1172 (uniform markers) may be atraumatic anchor points. The stent body 1702 may also be expandable and/or contractible. In at least one embodiment, the atraumatic anchor may allow the stent 1700 to be secured in low flow and/or low pressure vessels. In at least one example, the anchor point may allow for fixation of a blood vessel to the stent device and may be compressible.

While the invention has been particularly shown and described with reference to a preferred embodiment, it will be understood by those skilled in the art that various changes in form and detail may be made therein without departing from the spirit and scope of the invention. The inventors expect skilled artisans to employ such variations as appropriate, and the inventors intend for the invention to be practiced otherwise than as specifically described herein. Accordingly, this invention includes all modifications and equivalents of the subject matter recited in the claims appended hereto as permitted by applicable law. Moreover, any combination of the above-described elements in all possible variations thereof is encompassed by the invention unless otherwise indicated herein or otherwise clearly contradicted by context.

While various embodiments in accordance with the principles disclosed herein have been described above, it is to be understood that their presentation is by way of example and not of limitation. Thus, the breadth and scope of the present disclosure should not be limited by any of the above-described exemplary embodiments, but should be defined only in accordance with the claims and their equivalents issuing from the present disclosure. Moreover, the above-described advantages and features have been provided in the described embodiments, but should not limit the application of the issued claims to methods and structures that achieve any or all of the above advantages.

Further, the section headings herein are provided to comply with the Federal regulations compilation 37, section 1.77, or to otherwise provide organizational cues. These headings should not be used to limit or characterize the invention as set forth in any claims that may issue from this disclosure. In particular, although the headings refer to a "technical field," by way of example, the claims should not be limited by the language chosen under this heading to describe the so-called field. In addition, the description of technology as background information should not be construed as an admission that certain technology is prior art to any embodiment in this disclosure. "summary of the invention" should not be considered a characterization of the embodiments set forth in the issued claims. Furthermore, any reference in this disclosure to "invention" in the singular should not be used to demonstrate that there is only a single point of novelty in this disclosure. Embodiments may be set forth according to the limitations of the claims issuing from this disclosure, and these claims accordingly define the embodiments protected thereby and their equivalents. In all cases, the scope of these claims should be considered in light of the spirit of the disclosure and should not be limited to the headings set forth herein.