Medical grafting methods and apparatus

• US 20020022857A1
• Filed: 09/17/2001
• Published: 02/21/2002
• Est. Priority Date: 11/07/1996
• Status: Abandoned Application

• Current Assignee: St Jude Medical ATG Incorporated (Abbott Laboratories Incorporated)
• Original Assignee: St Jude Medical Cardiovascular Group Incorporated
• Inventors: Sullivan, Daniel J., Mazzocchi, Rudy, Bachinski, Thomas J., Goldsteen, David S.
• Application Number:
  US09/955,244
• Publication Number:
  US 20020022857A1
• Time in Patent Office: Days
• US Class Current: 606/185
• CPC Class Codes: A61B 1/0058 using shape-memory elements
• CPC Class Codes: A61B 17/0057 Implements for plugging an opening in the wall of a hollow or tubular organ, e.g. for sealing a vessel puncture or closing a cardiac septal defect sutures A61B17/04; closing rectum or urethra near body surface A61F2/0009
• CPC Class Codes: A61B 17/11 for performing anastomosis; Buttons for anastomosis
• CPC Class Codes: A61B 17/1114 of the digestive tract, e.g. bowels or oesophagus
• CPC Class Codes: A61B 17/221 Gripping devices in the form of loops or baskets for gripping calculi or similar types of obstructions surgical snare instruments A61B17/32056
• CPC Class Codes: A61B 17/32056 Surgical snare instruments for removing or smashing calculi A61B2017/2212; tonsillotomes A61B17/26
• CPC Class Codes: A61B 2017/003 Steerable
• CPC Class Codes: A61B 2017/1107 for blood vessels
• CPC Class Codes: A61B 2017/1135 End-to-side connections, e.g. T- or Y-connections Y-shaped blood vessel prostheses A61F2002/065
• CPC Class Codes: A61B 2017/1139 Side-to-side connections, e.g. shunt or X-connections
• CPC Class Codes: A61B 2017/2212 having a closed distal end, e.g. a loop
• CPC Class Codes: A61B 2017/2939 Details of linkages or pivot points
• CPC Class Codes: A61B 2090/306 using optical fibres
• CPC Class Codes: A61B 2090/3614 using optical fibre
• CPC Class Codes: A61F 2/06 Blood vessels
• 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 2/90 characterised by a net-like or mesh-like structure
• CPC Class Codes: A61F 2/95 Instruments specially adapted for placement or removal of stents or stent-grafts
• CPC Class Codes: A61F 2/954 for placing stents or stent-grafts in a bifurcation
• CPC Class Codes: A61F 2/958 : Inflatable balloons for placing stents or stent-grafts
• CPC Class Codes: A61F 2002/061 : provided with means for allowing access to secondary lumens
• CPC Class Codes: A61F 2002/065 : Y-shaped blood vessels
• CPC Class Codes: A61F 2002/3008 : radio-opaque, e.g. radio-opaque markers
• CPC Class Codes: A61F 2002/30092 : using shape memory or superelastic materials, e.g. nitinol
• CPC Class Codes: A61F 2002/826 : more than one stent being applied sequentially
• CPC Class Codes: A61F 2002/8486 : provided on at least one of the ends
• CPC Class Codes: A61F 2210/0014 : using shape memory or superelastic materials, e.g. nitinol
• CPC Class Codes: A61F 2240/001 : Designing or manufacturing processes
• CPC Class Codes: A61F 2250/0098 : radio-opaque, e.g. radio-opaque markers
• 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 2025/1052 : for temporarily occluding a vessel for isolating a sector
• CPC Class Codes: A61M 25/0041 : pre-formed, e.g. specially adapted to fit with the anatomy of body channels urethral catheters A61F2/04
• CPC Class Codes: A61M 25/0108 : using radio-opaque or ultrasound markers
• CPC Class Codes: A61M 25/0133 : Tip steering devices
• CPC Class Codes: A61M 25/0147 : with movable mechanical means, e.g. pull wires
• CPC Class Codes: A61M 25/0152 : with pre-shaped mechanisms, e.g. pre-shaped stylets or pre-shaped outer tubes
• CPC Class Codes: A61M 25/04 : in the body, e.g. expansible A61M25/10, A61M16/0488 take precedence
• CPC Class Codes: A61M 25/09025 : with sliding mandrils
• CPC Class Codes: Y10S 623/903 : Blood vessel

Abstract

Methods and apparatus for delivering and installing a new length of tubing between two sections of a patient'"'"'s existing body organ tubing and at least partly outside of that existing structure. For example, the new length of tubing may be for the purpose of providing the patient with a coronary bypass. The new tubing may be an artificial graft, a natural graft (harvested elsewhere from the patient), or both. The new tubing is delivered to and installed at the operative site primarily by working through the patient'"'"'s existing tubular body organ structure. This avoids the need for any significant surgery on the patient. The artificial grafts may have shapes other than tubular. Certain procedural and apparatus aspects of the invention have uses other than in connection with grafting in general or tubular grafting in particular.

Claims

1. An instrument for creating an aperture through a side wall of a patient'"'"'s tubular body organ structure at a point along that structure which is remote from the location at which the instrument is inserted into said tubular structure and from which the instrument is controlled comprising:

an elongated guide structure longitudinally insertable into said tubular structure at said location and extendable along the interior of said tubular structure to said point; and

a longitudinal structure substantially aligned with and guided by said guide structure and longitudinally movable relative thereto, a distal portion of said longitudinal structure being adapted to penetrate said side wall when forced against said side wall by a sufficient amount of distal motion of said longitudinal structure relative to said guide structure.

2. The apparatus defined in claim 1 wherein said guide structure includes an expandable structure for stabilizing said guide structure in said tubular structure.

3. The apparatus defined in claim 2 wherein said expandable structure comprises an inflatable balloon.

4. The apparatus defined in claim 3 wherein said balloon is a perfusion balloon.

5. The apparatus defined in claim 1 wherein said guide structure has a distal portion adapted to deflect said distal portion of said longitudinal structure laterally toward said side wall.

6. The apparatus defined in claim 1 wherein said guide structure has a distal portion which includes a laterally expandable structure for urging said distal portion of said guide structure into contact with said side wall.

7. The apparatus defined in claim 6 wherein said laterally expandable structure comprises an inflatable balloon.

8. The apparatus defined in claim 7 wherein said balloon is a perfusion balloon.

9. The apparatus defined in claim 6 wherein said laterally expandable structure is disposed on a first lateral side of said distal portion of said guide structure, and wherein said distal portion of said guide structure is adapted to deflect said distal portion of said longitudinal structure laterally toward a second lateral side of said disal portion which faces away from said first lateral side.

10. The apparatus defined in claim 1 wherein said guide structure comprises:

a radiologic marker on a distal portion of said guide structure.

11. The apparatus defined in claim 1 wherein said guide structure comprises a tube through which said longitudinal structure extends longitudinally.

12. The apparatus defined in claim 1 further comprising:

a tube longitudinally insertable into said tubular structure at said location and extendable along the interior of said tubular structure to an intermediate location which is between said location and said point, said guide structure being longitudinally insertable through said tube.

13. The apparatus defined in claim 1 wherein said distal portion of said longitudinal structure, is sharpened to facilitate penetration of said side wall.

14. The apparatus defined in claim 1 wherein said distal portion of said longitudinal structure is externally threaded to facilitate penetration of said side wall when said distal portion of said longitudinal structure is rotated about its longitudinal axis.

15. The apparatus defined in claim 1 wherein said distal portion of said longitudinal structure is resiliently biased to deflect laterally toward said side wall when released from guidance by said guide structure.

16. The apparatus defined in claim 1 wherein said distal portion of said longitudinal structure comprises:

a substantially central longitudinal member having a distal portion which is adapted to make an initial penetration of said side wall; and

a tubular member disposed substantially concentrically about said central member and longitudinally movable relative thereto for circumferentially enlarging said initial penetration when forced through said side wall after said central longitudinal member has made said initial penetration.

17. The apparatus defined in claim 16 wherein said tubular member is externally threaded to facilitate passage of said tubular member through said side wall when said tubular member is rotated about its longitudinal axis.

18. The apparatus defined in claim 1 wherein said distal portion of said longitudinal structure comprises:

a tubular member insertable through said aperture, said tubular member having a selectively enlargeable structure disposed on its exterior at a predetermined distance proximally from its distal end for selectively preventing more than the portion of said tubular member which is distal of said enlargeable structure form passing out of said tubular structure via said aperture.

19. The apparatus defined in claim 18 wherein said enlargeable structure comprises an inflatable balloon.

20. The apparatus defined in claim 19 wherein said balloon extends annularly around the exterior of said tubular member and projects radially outwardly from said tubular member in all radially outward directions when inflated.

21. The apparatus defined in claim 1 wherein said distal portion of said longitudinal structure comprises:

a tubular member insertable through said aperture, said tubular member having a selectively enlargeable structure disposed on its exterior at a predetermined distance proximally from its distal end for selectively preventing the portion of said tubular member which is distal of said enlargeable structure from moving proximally back though said aperture.

22. The apparatus defined in claim 21 wherein said enlargeable structure comprises an inflatable balloon.

23. The apparatus defined in claim 22 wherein said balloon extends annularly around the exterior of said tubular member and projects radially outwardly from said tubular member in all radially outward directions when inflated.

24. The apparatus defined in claim 1 wherein said distal portion of said longitudinal structure comprises:

a tubular member insertable through said aperture, said tubular member having first and second selectively inflatable balloons disposed on the exterior thereof, said balloons being spaced from one another along the longitudinal axis of said tubular member, and each of said balloons extending annularly around said tubular member so that each of said balloons forms an enlarged ring around the outside of said tubular member when inflated, the spacing between said balloons being such that said first and second balloons can be located adjacent respective interior and exterior surfaces of said side wall when said tubular member is inserted through said apertures.

25. The apparatus defined in claim 24 wherein said spacing between said balloons is further such that said balloons resiliently compress said side wall between them when inflated.

26. The apparatus defined in claim 24 wherein said balloons substantially prevent longitudinal motion of said tubular member through said aperture when inflated.

27. The apparatus defined in claim 24 wherein said balloons help to prevent fluid leakage through said aperture around said tubular member when inflated.