Methods for routing a guidewire from a first vessel and through a second vessel in lower extremity vasculature

• US 10,543,308 B2
• Filed: 05/30/2019
• Issued: 01/28/2020
• Est. Priority Date: 04/10/2017
• Status: Active Grant

• Current Assignee: Inari Medical, Inc.
• Original Assignee: LimFlow GmbH
• Inventors: Lenihan, Timothy, Kum, Steven, Wenzel, Marcus, Humbert, Sophie, Deaton, David Hugo
• Primary Examiner(s): Deak, Leslie R
• Application Number:
  US16/426,375
• Publication Number:
  US 20190275293A1
• Time in Patent Office: 243 Days
• CPC Class Codes: A61B 17/00234 for minimally invasive surgery A61B17/0218, A61B17/0469, A61B17/12013, A61B17/1285, A61B17/29, A61B17/320016 take precedence
• CPC Class Codes: A61B 17/11 for performing anastomosis; Buttons for anastomosis
• CPC Class Codes: A61B 17/12036 partial occlusion
• CPC Class Codes: A61B 17/12045 double occlusion, e.g. during anastomosis
• CPC Class Codes: A61B 17/12109 in a blood vessel
• CPC Class Codes: A61B 17/12136 Balloons
• CPC Class Codes: A61B 17/12186 liquid materials adapted to be injected
• CPC Class Codes: A61B 17/320725 with radially expandable cutting or abrading elements A61B17/32075 takes precedence
• CPC Class Codes: A61B 17/3403 Needle locating or guiding means guides for suture needles A61B17/0482; guiding or tracking by nuclear magnetic resonance G01R33/285
• CPC Class Codes: A61B 2017/00106 ultrasonic
• CPC Class Codes: A61B 2017/00252 for by-pass connections, i.e. connections from heart chamber to blood vessel or from blood vessel to blood vessel
• CPC Class Codes: A61B 2017/00477 Coupling A61B2017/0046 takes precedence
• CPC Class Codes: A61B 2017/00783 Valvuloplasty
• CPC Class Codes: A61B 2017/00876 magnetic
• CPC Class Codes: A61B 2017/1107 for blood vessels
• CPC Class Codes: A61B 2017/1139 Side-to-side connections, e.g. shunt or X-connections
• CPC Class Codes: A61B 2017/1205 Introduction devices
• CPC Class Codes: A61B 2017/22035 for retrieving or repositioning foreign objects
• CPC Class Codes: A61B 2017/22049 Means for locking the guide wire in the catheter
• CPC Class Codes: A61B 2017/22067 Blocking; Occlusion A61B2017/22054 takes precedence
• CPC Class Codes: A61B 2017/22068 : Centering
• CPC Class Codes: A61B 2017/22071 : Steering
• CPC Class Codes: A61B 2017/22095 : accessing a blood vessel true lumen from the sub-intimal space
• CPC Class Codes: A61B 2017/22097 : Valve removal in veins
• CPC Class Codes: A61B 2017/2215 : having an open distal end
• CPC Class Codes: A61B 2017/3413 : guided by ultrasound
• CPC Class Codes: A61B 2034/2063 : Acoustic tracking systems, e.g. using ultrasound
• CPC Class Codes: A61B 2090/376 : using X-rays, e.g. fluoroscopy
• CPC Class Codes: A61B 2090/3782 : transmitter or receiver in catheter or minimal invasive instrument
• CPC Class Codes: A61B 2090/3786 : receiver only
• CPC Class Codes: A61B 2090/3788 : transmitter only
• CPC Class Codes: A61B 2090/3925 : ultrasonic
• CPC Class Codes: A61B 2090/3937 : Visible markers
• CPC Class Codes: A61B 2090/3966 : Radiopaque markers visible in an X-ray image
• CPC Class Codes: A61F 2/064 : with special features to facilitate anastomotic coupling anastomosis of natural blood vessels A61B17/11
• CPC Class Codes: A61F 2/07 : Stent-grafts
• CPC Class Codes: A61F 2/915 : with bands having a meander structure, adjacent bands being connected to each other
• CPC Class Codes: A61F 2/958 : Inflatable balloons for placing stents or stent-grafts
• CPC Class Codes: A61F 2/966 : with relative longitudinal movement between outer sleeve and prosthesis, e.g. using a push rod
• CPC Class Codes: A61F 2230/0091 : helically-coiled or spirally-coiled, i.e. having a 2-D spiral cross-section
• CPC Class Codes: A61F 2250/0015 : differing in density or specific weight
• CPC Class Codes: A61F 2250/0039 : differing in diameter
• CPC Class Codes: A61M 1/3655 : Arterio-venous shunts or fistulae
• CPC Class Codes: A61M 2025/0092 : Single injection needle protruding laterally from the distal tip
• CPC Class Codes: A61M 2025/0166 : Sensors, electrodes or the like for guiding the catheter to a target zone, e.g. image guided or magnetically guided
• CPC Class Codes: A61M 2025/0197 : for creating an artificial passage within the body, e.g. in order to go around occlusions
• CPC Class Codes: A61M 2025/0293 : Catheter, guide wire or the like with means for holding, centering, anchoring or frictionally engaging the device within an artificial lumen, e.g. tube natural lumen, e.g. vessels A61M25/04
• CPC Class Codes: A61M 2025/1047 : having centering means, e.g. balloons having an appropriate shape
• CPC Class Codes: A61M 2025/1052 : for temporarily occluding a vessel for isolating a sector
• CPC Class Codes: A61M 2025/1072 : having balloons with two or more compartments
• CPC Class Codes: A61M 25/0082 : Catheter tip comprising a tool
• CPC Class Codes: A61M 25/0084 : being one or more injection needles
• CPC Class Codes: A61M 25/0105 : Steering means as part of the catheter or advancing means; Markers for positioning systems for detection of markers A61B
• CPC Class Codes: A61M 25/0108 : using radio-opaque or ultrasound markers
• CPC Class Codes: A61M 25/0127 : Magnetic means; Magnetic markers
• CPC Class Codes: A61M 25/0158 : with magnetic or electrical means, e.g. by using piezo materials, electroactive polymers, magnetic materials or by heating of shape memory materials
• CPC Class Codes: A61M 25/04 : in the body, e.g. expansible A61M25/10, A61M16/0488 take precedence
• CPC Class Codes: A61M 25/10 : Balloon catheters A61M25/0125 takes precedence; embolectomy A61B17/22032; retractors A61B17/02; inflatable balloons for placing stents or stent-grafts A61F2/958 ; stomach balloons for treatment of obesity A61F5/0003; oesophagal tubes A61J15/00
• CPC Class Codes: A61M 25/1002 : characterised by balloon shape A61M25/1006, A61M25/1009 take precedence
• CPC Class Codes: A61M 25/1011 : Multiple balloon catheters
• CPC Class Codes: A61M 25/104 : used for angioplasty
• CPC Class Codes: A61M 27/002 : Implant devices for drainage of body fluids from one part of the body to another intraocular A61F9/00781; middle ear A61F11/202
• CPC Class Codes: A61M 29/02 : Dilators made of swellable material balloon catheters for angioplasty A61M25/104
• CPC Class Codes: A61M 31/005 : for contrast media
• CPC Class Codes: G02F 1/133345 : Insulating layers G02F1/1335, G02F1/1337, G02F1/135, G02F1/136 take precedence
• CPC Class Codes: G02F 1/1368 : in which the switching element is a three-electrode device G02F1/136277 takes precedence
• CPC Class Codes: H01L 21/02565 : Oxide semiconducting materials not being Group 12/16 materials, e.g. ternary compounds
• CPC Class Codes: H01L 21/02664 : Aftertreatments planarisation in general H01L21/304
• CPC Class Codes: H01L 21/477 : Thermal treatment for modifying the properties of semiconductor bodies, e.g. annealing, sintering H01L21/38 - H01L21/449 and H01L21/461 - H01L21/475 take precedence
• CPC Class Codes: H01L 27/1225 : with semiconductor materials not belonging to the group IV of the periodic table, e.g. InGaZnO
• CPC Class Codes: H01L 27/1248 : with a particular composition or shape of the interlayer dielectric specially adapted to the circuit arrangement
• CPC Class Codes: H01L 27/1251 : comprising TFTs having a different architecture, e.g. top- and bottom gate TFTs
• CPC Class Codes: H01L 27/1259 : Multistep manufacturing methods
• CPC Class Codes: H01L 29/66969 : of devices having semiconductor bodies not comprising group 14 or group 13/15 materials comprising selenium or tellurium in uncombined form other than as impurities in semiconductor bodies of other materials, comprising cuprous oxide or cuprous iodide H01L21/02365
• CPC Class Codes: H01L 29/7869 : having a semiconductor body comprising an oxide semiconductor material, e.g. zinc oxide, copper aluminium oxide, cadmium stannate
• CPC Class Codes: H01L 29/78696 : characterised by the structure of the channel, e.g. multichannel, transverse or longitudinal shape, length or width, doping structure, or the overlap or alignment between the channel and the gate, the source or the drain, or the contacting structure of the channel H01L29/78612 takes precedence; transistors having a drain offset region or a lightly doped drain [LDD] H01L29/78621

Abstract

A catheter system can include a tubular body, and at least one of a targeting system coupled to the tubular body, an expandable member, or a fluid injection port. A method of identifying a bifurcation can include inserting a catheter system into a first vessel, positioning the catheter system at a first location, expanding an expandable member to occlude the first vessel, delivering contrast material so the contrast material pooling proximate to the expandable member, and reviewing a shape of the contrast material in the first vessel under fluoroscopy.

Claims

1. A method of routing a guidewire, the method comprising:

inserting a first catheter in a first vessel, the first catheter comprising an expandable element;

inserting a second catheter in a second vessel, the second catheter comprising a needle;

expanding the expandable element to an expanded state in the first vessel;

extending the needle from the second catheter, wherein extending the needle comprises;

exiting the second vessel,

traversing through interstitial tissue between the second vessel and the first vessel,

entering the first vessel, and

extending at least a portion of the needle through the expandable element between a proximal end of the expandable element and a distal end of the expandable element;

extending a guidewire from the second catheter, wherein extending the guidewire comprises;

exiting the second vessel through the needle, and

entering into the expandable element;

collapsing the expandable element towards a collapsed state, wherein collapsing the expandable element comprises snaring the guidewire;

proximally retracting the expandable element through the first vessel, wherein proximally retracting the expandable element comprises routing the guidewire through and out of the first vessel such that at least a distal portion of the guidewire is removed from the first vessel; and

deploying a prosthesis at least partially between the first vessel and the second vessel, wherein deploying the prosthesis comprises tracking the prosthesis over the guidewire, and wherein after deploying the prosthesis, blood is diverted from the second vessel to the first vessel through the prosthesis.

2. The method of claim 1, wherein collapsing the expandable element comprises twisting the expandable element.

3. The method of claim 1, wherein expanding the expandable element comprises expanding the first vessel.

4. The method of claim 1, wherein the expandable element comprises radiopaque material visible under fluoroscopy, and wherein the method comprises targeting the expandable element under fluoroscopy.

5. The method of claim 4, wherein the radiopaque material is located between the proximal end of the expandable element and the distal end of the expandable element.

6. The method of claim 1, further comprising determining a bifurcation in the first vessel, wherein determining the bifurcation comprises injecting a contrast material in the first vessel.

7. The method of claim 6, wherein determining the bifurcation further comprises:

identifying a location of the bifurcation, and

adjusting a position of the first catheter in the first vessel such that the expandable member is not proximate to the bifurcation, wherein determining the bifurcation is before extending the needle.

8. The method of claim 1, wherein the expandable member comprises radiopaque material visible under fluoroscopy, and wherein the method further comprises:

targeting the expandable element under fluoroscopy; and

making valves in the first vessel incompetent, wherein making the valves in the first vessel incompetent comprises;

tracking a stent-graft over the guidewire,

positioning the stent-graft in the first vessel, and

covering the valves of the first vessel,

wherein making the valves in the first vessel incompetent is after deploying the prosthesis.

9. A method of routing a guidewire, the method comprising:

inserting a first catheter in a first vessel, the first catheter comprising;

a capture element being configured to expand, and

a tubular element,

wherein the capture element is configured to extend outward of the tubular element;

inserting a second catheter in a second vessel, the second catheter comprising a needle;

expanding the capture element in the first vessel;

extending the needle from the second catheter, wherein extending the needle comprises;

exiting the second vessel,

traversing through interstitial tissue between the second vessel and the first vessel, and

entering the first vessel;

extending a guidewire from the second catheter, wherein extending the guidewire from the second catheter comprises;

exiting the second vessel through the needle,

traversing through interstitial tissue between the second vessel and the first vessel through the needle,

entering into the first vessel, and

entering the capture element in an expanded state;

extending the guidewire through the first vessel;

removing the first catheter from the first vessel, wherein removing the first catheter comprises removing at least a distal portion of the guidewire from the first vessel; and

making valves in the first vessel incompetent, wherein making the valves in the first vessel incompetent comprises tracking a stent-graft over the guidewire.

10. The method of claim 9, further comprising monitoring a position of the capture element in the first vessel.

11. The method of claim 9, wherein the first catheter further comprises an inflation lumen, and wherein expanding the capture element comprises inflating a balloon through the inflation lumen.

12. The method of claim 9, wherein expanding the capture element comprises apposing the capture element against a sidewall of the first vessel.

13. The method of claim 9, further comprising determining a bifurcation in the first vessel, wherein determining the bifurcation comprises injecting a contrast material in the first vessel.

14. The method of claim 13, wherein determining the bifurcation further comprises:

identifying a location of the bifurcation, and

adjusting a position of the first catheter in the first vessel such that the expandable member is not proximate to the bifurcation,

wherein determining the bifurcation is before extending the needle.

15. The method of claim 9, wherein the first catheter further comprises an inflation lumen, wherein expanding the capture element comprises inflating a balloon through the inflation lumen, and wherein the method further comprises:

monitoring a position of the capture element in the first vessel; and

deploying a prosthesis at least partially between the first vessel and the second vessel, wherein deploying the prosthesis comprises tracking the prosthesis over the guidewire, and wherein after deploying the prosthesis, blood is diverted from the second vessel to the first vessel through the prosthesis,

wherein making valves in the first vessel incompetent further comprises;

positioning the stent-graft in the first vessel, and

covering the valves of the first vessel,

wherein making valves in the first vessel incompetent is after deploying the prosthesis.

16. A method of routing a guidewire, the method comprising:

expanding an expandable element of a first catheter in a first vessel;

extending a needle from a second catheter in a second vessel into the first vessel;

extending a guidewire from the second catheter, wherein extending the guidewire comprises;

exiting the second vessel through the needle, and

entering into the first vessel, and

entering the expandable element; and

collapsing the expandable element towards a collapsed state, wherein collapsing the expandable element comprises snaring the guidewire; and

proximally retracting the expandable element through the first vessel, wherein proximally retracting the expandable element comprises routing the guidewire through and out of the first vessel such that at least a distal portion of the guidewire is removed from the first vessel.

17. The method of claim 16, further comprising monitoring a position of the expandable element in the first vessel.

18. The method of claim 16, further comprising determining a bifurcation in the first vessel, wherein determining the bifurcation comprises injecting a contrast material in the first vessel.

19. The method of claim 18, wherein determining the bifurcation further comprises:

identifying a location of the bifurcation, and

adjusting a position of the first catheter in the first vessel such that the expandable member is not proximate to the bifurcation,

wherein determining the bifurcation is before extending the needle.

20. The method of claim 16, wherein the first catheter further comprises an inflation lumen, wherein expanding the expandable element comprises inflating a balloon through the inflation lumen, and wherein the method further comprises:

monitoring a position of the expandable element in the first vessel;

deploying a prosthesis at least partially between the first vessel and the second vessel, wherein deploying the prosthesis comprises tracking the prosthesis over the guidewire, and wherein after deploying the prosthesis, blood is diverted from the second vessel to the first vessel through the prosthesis; and

making valves in the first vessel incompetent, wherein making the valves in the first vessel incompetent comprises;

tracking a stent-graft over the guidewire,

positioning the stent-graft in the first vessel, and

covering the valves of the first vessel,

wherein making the valves in the first vessel incompetent is after deploying the prosthesis.