Intra-aortic renal delivery catheter

• US 20040059277A1
• Filed: 08/06/2003
• Published: 03/25/2004
• Est. Priority Date: 09/20/2002
• Status: Active Grant

• Current Assignee: AngioDynamics, Inc.
• Original Assignee: AngioDynamics, Inc.
• Inventors: Geoffrion, Richard, Maguire, Mark
• Granted Patent: US 7,563,247 B2
• Time in Patent Office: Days
• US Class Current: 604/6.16
• CPC Class Codes: A61M 2025/0057 Catheters delivering medicament other than through a conventional lumen, e.g. porous walls or hydrogel coatings
• CPC Class Codes: A61M 2025/0681 Systems with catheter and outer tubing, e.g. sheath, sleeve or guide tube
• CPC Class Codes: A61M 2025/105 having a balloon suitable for drug delivery, e.g. by using holes for delivery, drug coating or membranes
• CPC Class Codes: A61M 2025/1052 for temporarily occluding a vessel for isolating a sector
• CPC Class Codes: A61M 2025/1095 with perfusion means for enabling blood circulation while the balloon is in an inflated state or in a deflated state, e.g. permanent by-pass within catheter shaft
• CPC Class Codes: A61M 2029/025 characterised by the guiding element
• CPC Class Codes: A61M 2210/127 Aorta
• 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

Abstract

A renal flow system and method direct fluid into renal arteries from a location within the aorta. A renal flow assembly has a tapered tube that is adjustable between a radially collapsed condition for delivery to the location through a delivery sheath and a radially expanded condition that divides aortic flow into exterior and interior paths. The tube'"'"'s wall is made from a sheet of flexible material, such as PTFE or ePTFE. Two, nickel-titanium rings radially support the tube'"'"'s ends and are connected by a longitudinal spine support. A fluid delivery assembly injects drug to flow along the exterior flow path and the tubular wall directs the agent into the renal artery ostium. The tube'"'"'s taper has localized shape for circumferential agent mixing to infuse both kidneys'"'"' renals. The flow assembly allows an interventional device, e.g. delivery catheter, to advance across the location while directing blood into the renals and perfusing downstream circulation. The renal flow assembly and distal device are used within a common guide sheath through a single puncture wound. Vasodilators, antioxidants, or diuretics are delivered to the kidneys to treat/prevent RCN, CHF, or ARF.

Claims

1. A renal flow system, comprising:

a renal flow device with a renal flow assembly that is adapted to be positioned at a location within an aorta of a patient adjacent to at least one renal artery ostium and to locally direct a volume of fluid from the location and substantially into the at least one renal artery via its ostium while allowing a substantial volume of aortic blood to flow downstream across the location; and

a delivery catheter having an elongate tubular body with a proximal end portion, a distal end portion, and a delivery lumen extending between a proximal port along the proximal end portion and a distal port along the distal end portion;

wherein the renal flow device is adapted to allow the delivery catheter to be positioned across the location with the distal port positioned at an upstream location that is upstream from the location adjacent the renal ostium, and also with the proximal port on the proximal end portion located externally of the patient'"'"'s body, while the renal flow device is positioned at the location.

2. The system of claim 1, wherein

the renal flow device further comprises a delivery shaft with a proximal end portion and a distal end portion;

the renal flow assembly is located along the distal end portion and is adjustable between a first configuration and a second configuration;

in the first configuration the renal flow assembly is adapted to be delivered to the location through a delivery lumen of a delivery sheath;

the renal flow assembly is adapted to be adjusted to the second configuration at the location;

in the second configuration at the location the renal flow assembly is adapted to divide the aorta at the location into a first flow path and a second flow path;

in the second configuration at the location the renal flow assembly is further adapted to direct a first volume of aortic blood flowing along the first flow path to flow substantially into only the at least one renal artery via its ostium;

in the second configuration at the location the renal flow assembly is further adapted to allow a second volume of aortic blood flowing along the second flow path to flow substantially downstream across the location; and

wherein the renal flow assembly is further adapted to allow the delivery catheter to be positioned across the location within the second flow path.

3. The system of claim 2, wherein:

the renal flow assembly is adapted to allow the delivery catheter to be positioned across the location within the second flow path while allowing a substantial volume of blood to continue to flow downstream across the location through the second flow path sufficient to prevent substantial downstream ischemia.

4. The system of claim 3, further comprising:

a guide sheath with a guide lumen having an inner diameter that is greater than a first sum of an outer diameter of the proximal end portion of the delivery shaft of the renal flow device plus an outer diameter of the delivery catheter, but that is less than a second sum of an outer diameter of the renal flow assembly in the first configuration plus the outer diameter of the delivery catheter;

wherein the guide sheath is adapted to deliver the distal end portion of the renal flow device through the guide lumen with the renal flow assembly in the first configuration such that the renal flow assembly may be extended distally from the guide lumen at the location in the second configuration; and

wherein the guide sheath is adapted to deliver the delivery catheter through the guide lumen to the location while the renal flow assembly is in the second configuration distally from the guide lumen at the location.

5. The system of claim 4, wherein the inner diameter of the guide lumen is between about 6 French and about 12 French.

6. The system of claim 3, wherein:

the outer diameter of the proximal end portion of the delivery shaft of the renal flow device is between about 1 French and about 4 French.

7. The system of claim 2, wherein:

the diameter of the second flow path of the renal flow assembly is at least about 2 cm.

8. The system of claim 2, wherein:

the delivery catheter has an outer diameter of at least about 4 French.

9. The method of claim 2, wherein:

the delivery catheter has an outer diameter of between about 6 French and about 12 French.

10. The system of claim 2, wherein

the delivery catheter comprises an angiographic catheter.

11. The system of claim 2, wherein

the delivery catheter comprises a coronary guiding catheter with a proximal end portion, a distal end portion, and a guide catheter lumen extending between a proximal port along the proximal end portion and a distal port along the distal end portion;

and

the distal end portion is adapted to be positioned upstream across the location with the distal port located within a coronary artery.

12. The system of claim 11, further comprising:

a coronary interventional catheter system that is adapted to be delivered through

13. The system of claim 1, wherein:

the renal flow assembly is adapted to substantially direct the volume of fluid to flow substantially into multiple renal arteries via their respective unique ostia.

14. The system of claim 13, wherein:

the renal flow assembly comprises an expandable tubular member with a tubular wall that extends between a first end portion and a second end portion, and also with an interior passageway that extends between a first open end along the first end portion and a second open end along the second end portion;

the expandable tubular member is adjustable between a radially collapsed condition and a radially expanded condition;

in the radially collapsed condition the expandable tubular member has a collapsed outer diameter that is adapted to be delivered to the location through a delivery lumen of a delivery sheath;

at the location the expandable tubular member is expandable to the radially expanded condition with an expanded outer diameter that is greater than the collapsed outer diameter, and also with the first end portion located downstream from the multiple renal artery ostia and the second end located upstream from the multiple renal artery ostia;

in the radially expanded condition the tubular wall is adapted to divide aortic blood flow at the location into an exterior flow path located within an exterior circumferential space between an outer circumferential surface of the tubular member and a wall of the aorta that includes the multiple renal artery ostia, and an interior flow path located within the interior passageway;

the tubular member directs the volume of fluid into the multiple renal arteries along the exterior flow path; and

the tubular member allows the substantial volume of aortic blood downstream across the location along the interior flow path within the interior passageway.

15. The system of claim 14, wherein:

the tubular member in the radially expanded condition further comprises a frustroconical shape with a tapering outer diameter that tapers between the first end portion having a first outer diameter and the second end portion having a second outer diameter that is less than the first outer diameter.

16. The system of claim 15, wherein:

the tubular member has a length between the first end portion and the second end portion, and the taper varies along the length.

17. The system of claim 15, wherein the expandable tubular member further comprises:

a first radial support member along the first and portion and that includes a first shape-retaining ring-shaped wire member that is collapsible in the radially collapsed condition and expandable to the ring-shape in the radially expanded condition at the location; and

a second radial support member along the second end portion and that includes a second shape-retaining ring-shaped wire member that is radially collapsed in the radially collapsed condition and radially expanded to the ring-shape in the radially expanded condition at the location;

in the radially expanded condition the first radial support member has a larger outer diameter than the second radial support member; and

a sheet of substantially flexible material that extends between the first and second radial support members and forms at least in part the tubular wall of the expandable tubular member.

18. The system of claim 17, wherein the first and second radial support members comprise a nickel-titanium metal alloy.

19. The system of claim 17, wherein the sheet of substantially flexible material comprises a fluoropolymer material.

20. The system of claim 19, wherein the fluoropolymer material comprises a polytetrafluoroethylene (PTFE) material.

21. The system of claim 17, wherein:

the distal end portion of the delivery shaft further comprises a spine member that extends between the first and second radial support members along the tubular wall.

22. The system of claim 21, wherein:

the spine member has a shape that provides a stand-off adapted to space the tapered tubular wall away from the wall of the aorta at the location.

23. The system of claim 1, further comprising:

a fluid agent delivery system cooperating with the renal flow assembly and that is adapted to deliver a volume of fluid agent at a location adapted to substantially mix with the volume of fluid being directed by the renal flow assembly into the at least one renal artery ostium.

98. A system as in any one of claims 1, 24, 44, 57, 65, or 73, further comprising:

a source of drug agent comprising at least one of a vasodilator, an antioxidant, or a diuretic agent, or a combination or blend thereof.

99. A system as in claim 98, wherein the drug agent comprises a vasodilator.

100. A system as in claim 99, wherein the vasodilator comprises at least one of papavarine, fenoldopam, calcium channel blockers, atrial natriuretic peptide (ANP), acetylcholine, nifedipine, nitroglycerine, nitroprusside, adenosine, dopamine, or theophylline, or combinations or blends thereof.

101. A system as in claim 98, wherein the drug agent comprises an antioxidant.

102. A system as in claim 101, wherein the antioxidant comprises acetylcysteine.

103. A system as in claim 98, wherein the drug agent comprises a diuretic agent.

104. A system as in claim 103, wherein the diuretic agent comprises at least one of mannitol, or furosemide, or combinations or blends thereof.

24. A flow isolation assembly for dividing and substantially isolating first and second paths of blood flowing within a blood vessel in a patient, comprising:

a delivery shaft with a proximal end portion and a distal end portion;

a tubular member having a tubular wall formed by a sheet of substantially flexible material that is substantially impermeable to blood, and having an outer surface with an outer diameter, and also having an inner surface that defines an interior passageway that extends along an axis between first and second openings along first and second end portions, respectively, of the tubular member; and

at least one radial support member that is secured to the distal end portion of the delivery shaft, and having a ring-shaped support wire with a circumference, and that is adjustable between a radially collapsed condition and a radially expanded condition relative to the axis;

wherein the tubular member along one end portion is secured substantially along the circumference of the ring-shaped support wire such that the tubular member extends along the axis from the one end portion corresponding to the radial support member to the other end portion;

wherein in the radially collapsed condition the radial support member is relatively radially collapsed with respect to the axis such that the tubular member has collapsed outer and inner diameters that are sufficiently small so that the tubular member may be delivered to the location within the blood vessel through a radially confining delivery lumen of a delivery sheath with the first and second open end portions having respective downstream and upstream positions relative to blood flowing along the blood vessel;

wherein in the radially expanded condition at the location the radial support member is radially expanded relative to the axis such that the tubular member has expanded outer and inner diameters that are substantially larger than the collapsed outer and inner diameters, respectively, but wherein the outer diameter of the tubular member at least along the upstream end portion of the tubular member is less than an inner diameter of the blood vessel wall; and

wherein the tubular member in the radially expanded condition is adapted to substantially prevent fluid communication through the tubular wall between an interior flow path along the interior passageway and an exterior flow path along a circumferential region of the blood vessel surrounding the outer surface of the tubular member and located between the outer surface of the tubular wall and the blood vessel wall at least along the upstream end portion of the tubular member.

25. The system of claim 24, wherein:

the radial support member is located along the respective downstream end portion of the tubular member.

26. The system of claim 24, wherein:

the radial support member is located along the respective upstream end portion of the tubular member.

27. The system of claim 24, further comprising:

first and second said radial support members;

wherein the tubular member along the first end portion is secured substantially along a first circumference to the first radial support member;

wherein the tubular member along the second end portion is secured substantially along a second circumference to the second radial support member; and

wherein in the radially expanded condition the tubular wall is supported by the first and second radial support members at the first and second end portions, respectively, to thereby form the tubular member with a shape that provides a first flow path through the interior passageway between the first and second open end portions and across the location, and also that provides a second flow path that is substantially isolated from the first flow path in the exterior circumferential space surrounding the outer surface of the tubular member and between the outer surface and the body space wall.

28. The fluid isolation assembly of claim 24, wherein:

the at least one adjustable ring-shaped support wire comprises a nickel-titanium alloy.

29. The fluid isolation assembly of claim 24, wherein:

the at least one adjustable ring-shaped support wire comprises a shape-retaining material.

30. The fluid isolation assembly of claim 24, further comprising:

a fluid agent delivery assembly cooperating with the tubular member;

wherein the fluid agent delivery assembly is adapted to deliver a volume of fluid agent primarily into the exterior flow path; and

wherein the tubular member in the radially expanded condition at the location is adapted to substantially prevent fluid communication with respect to the volume of fluid agent through the tubular wail and from the exterior flow path and into the interior flow path.

31. The fluid isolation assembly of claim 30, wherein the fluid agent delivery assembly further comprises:

a delivery passageway extending between a proximal port located externally of the body of the patient and a distal port that is adapted to be positioned at an injection location within the blood vessel;

wherein the proximal port is adapted to couple to a source of fluid agent;

wherein the delivery passageway is adapted to deliver the volume of fluid agent from the fluid agent source and through the distal port into the injection location within the blood vessel; and

wherein the injection location is positioned to allow the volume of fluid agent to flow substantially along the exterior flow path and without substantial mixing of the fluid agent into the interior passageway of the tubular member along the location.

32. The fluid isolation assembly of claim 31, wherein:

the tubular wall further comprises a bladder along the upstream end portion that is defined at least in part by overlapping portions of the sheet of material;

the bladder defines a reservoir that is in fluid communication with and forms a portion of the delivery passageway;

the distal port of the delivery passageway comprises an outer surface along the bladder that is permeable to the fluid agent and that is positioned to allow the fluid agent to flow from within the reservoir of the bladder, through the surface, and principally into the exterior flow path.

33. The fluid isolation assembly of claim 32, wherein:

the outer surface includes at least one aperture formed therethrough and through which the fluid agent is allowed to pass into the exterior flow path.

34. The fluid isolation assembly of claim 32, wherein:

the sheet of material along the outer surface of the bladder is sufficiently porous with respect to the fluid agent to allow flow therethrough into the exterior flow path.

35. The fluid isolation assembly of claim 32, wherein:

the bladder is located around a circumference of the upstream end portion of the tubular member; and

the radial support member is located within the reservoir formed by the bladder.

36. The fluid isolation assembly of claim 35, wherein:

the bladder is permeable to the fluid agent substantially around the circumference.

37. The fluid isolation assembly of claim 36, wherein:

the bladder is permeable to the fluid agent continuously around the circumference.

38. The fluid isolation assembly of claim 36, wherein:

the bladder is permeable to the fluid agent at multiple discrete locations around the circumference.

39. The fluid isolation assembly of claim 24, wherein:

the sheet of material comprises a fluoropolymer material.

40. The fluid isolation assembly of claim 39, wherein:

the fluoropolymer material comprises a polytetrafluoroethylene material.

41. The fluid isolation assembly of claim 24, wherein:

the first end portion of the tubular member corresponding to the downstream position has a first outer diameter in the radially expanded condition;

the second end portion of the tubular member corresponding to the upstream position has a second outer diameter in the radially expanded condition that is substantially less than the first outer diameter and that is less than the inner diameter of the blood vessel at the upstream position; and

the tubular member has a tapered shape with a reducing outer diameter from the first outer diameter to the second outer diameter.

42. The fluid isolation assembly of claim 41, wherein:

the first outer diameter of the first end portion of the tubular member is sufficient to substantially circumferentially engage the blood vessel wall of the blood vessel at the downstream position.

43. The fluid isolation assembly of claim 41, wherein:

the first and second end portions of the tubular member corresponding to the respective downstream and upstream positions within the blood vessel are located proximally and distally, respectively, with respect to each other along the distal end portion of the delivery shaft.

44. A medical device system, comprising:

a delivery shaft with a proximal end portion and a distal end portion having a longitudinal axis;

a tubular member secured to the distal end portion of the delivery shaft and having a proximal end portion, a distal end portion, and a tubular wall comprising a sheet of material formed into a tubular shape with an outer surface and an inner surface that defines an interior passageway extending along the axis between a proximal open end along the proximal end portion of the tubular member and a distal open end along the distal end portion of the tubular member;

a proximal radial support member secured to the distal end portion of the delivery shaft and comprising a ring-shaped support wire also secured substantially along a circumference of the proximal end portion of the tubular member; and

a distal radial support member comprising a ring-shaped support wire secured substantially along a circumference of the distal end portion of the tubular member;

wherein the tubular member has a distally tapered shape that tapers from a proximal outer diameter along the proximal end portion where secured to the proximal radial support member to a distal outer diameter that is less than the proximal outer diameter along the distal end portion of the tubular member where secured to the distal radial support member.

45. The system of claim 44, wherein:

the distal radial support member is also secured to the distal end portion of the delivery shaft distally to the proximal radial support member.

46. The system of claim 44, further comprising:

a longitudinal support member extending along the axis and secured to the proximal and distal radial support members, respectively, and that is adapted to hold the respective radial support members at relatively fixed longitudinal positions relative to each other with respect to the longitudinal axis.

47. The system of claim 46, wherein:

the longitudinal support member comprises a region of the distal end portion of the delivery shaft.

48. The system of claim 46, wherein:

the longitudinal support member is the sole longitudinal support member secured to the tubular member and extends along the tubular wall of the tubular member relative to the longitudinal axis; and

the tubular member does not include other longitudinal or radial support members than the proximal and distal radial support members and the longitudinal support member.

49. The system of claim 44, wherein:

each of the ring-shaped support wires of the proximal and distal radial support members, respectively, comprises a shape-retaining material.

50. The system of claim 49, wherein:

each of the ring-shaped support wires of the proximal and distal radial support members, respectively, comprises a nickel-titanium metal alloy material.

51. The system of claim 49, wherein:

each of the ring-shaped support wires comprises an elongated wire having a length between two opposite ends;

wherein the elongated wire has an intermediate portion between the opposite ends that is ring-shaped such that the two ends are positioned closely adjacent to each other; and

wherein the two adjacently positioned ends are secured to a longitudinal support member extending between the proximal and distal radial support members.

52. The system of claim 44, wherein:

the sheet of material comprises a fluoropolymer material.

53. The system of claim 52, wherein:

the fluoropolymer material comprises a polytetrafluoroethylene (PTFE) material.

54. The system of claim 44, wherein:

the tubular member is adjustable between a radially collapsed condition and a radially expanded condition;

in the radially collapsed condition the tubular member has a respective collapsed outer diameter that is adapted to be delivered to a location within an aorta adjacent to at least one renal artery ostium in a patient with the proximal end portion of the tubular member positioned downstream from the ostium and the distal end portion of the tubular member positioned upstream from the tubular member; and

the tubular member is adjustable at the location to the radially expanded condition with a radially expanded outer diameter that is larger than the collapsed outer diameter, and such that tubular wall divides aortic flow along the location into exterior and interior blood streams that are substantially isolated from each other by the tubular wall along the location;

wherein the tubular wall in the radially expanded condition at the location directs the exterior blood stream along an exterior flow path within a circumferential area surrounding the tubular member and between the outer surface of the tubular member and the aortic wall into the renal artery ostium, and

wherein the tubular wall in the radially expanded condition at the location allows the interior blood stream to flow along an interior flow path corresponding to the interior passageway and that perfuses downstream across the location.

55. The system of claim 54, further comprising:

a fluid agent delivery assembly cooperating with the tubular member;

wherein the fluid agent delivery assembly is adapted to deliver a volume of fluid agent primarily into the exterior flow path; and

wherein the tubular member in the radially expanded condition at the location is adapted to substantially prevent fluid communication with respect to the volume of fluid agent through the tubular wall and from the exterior circumferential area and into the interior passageway.

56. The system of claim 55, wherein the fluid agent delivery assembly further comprises:

a delivery passageway extending between a proximal port located externally of the body of the patient and a distal port that is adapted to be positioned at an injection location within the blood vessel;

wherein the proximal port is adapted to couple to a source of fluid agent;

wherein the delivery passageway is adapted to deliver the volume of fluid agent from the fluid agent source and through the distal port into the injection location within the blood vessel; and

wherein the injection location is positioned to allow the volume of fluid agent to flow substantially along the exterior flow path and without substantial mixing of the fluid agent into the interior passageway of the tubular member along the location.

64. The system of claim 54, wherein:

the tubular member is adjustable between a radially collapsed condition and a radially expanded condition;

in the radially collapsed condition the tubular member has a respective collapsed outer diameter that is adapted to be delivered to a location within an aorta adjacent to at least one renal artery ostium in a patient with the proximal end portion of the tubular member positioned downstream from the ostium and the distal end portion of the tubular member positioned upstream from the tubular member; and

the tubular member is adjustable at the location to the radially expanded condition with a radially expanded outer diameter that is larger than the collapsed outer diameter, and such that tubular wall divides aortic flow along the location into first and second blood streams that are substantially isolated from each other by the tubular wall along the location;

wherein the tubular wall in the radially expanded condition at the location directs the first blood stream along an exterior flow path within the exterior circumferential area surrounding the tubular member and between the outer surface of the tubular member and the aortic wall, which exterior flow path is directed to flow primarily into the at least one renal artery ostium, and

wherein the tubular wall in the radially expanded condition at the location allows the second blood stream to flow along an interior flow path corresponding to the interior passageway and that perfuses downstream across the location.

57. A system for locally delivering a volume of a fluid agent to a desired location within a patient, comprising:

a delivery shaft having a proximal end portion and a distal end portion, a tubular member secured to the distal end portion of the delivery shaft and having a proximal end portion, a distal end portion, and a tubular wall comprising a sheet of material formed into a tubular shape with an outer surface and an inner surface that defines an interior passageway extending between a proximal open end along the proximal end portion of the tubular member and a distal open end along the distal end portion of the tubular member;

a bladder located along the distal end portion of the tubular wall and that defines a reservoir; and

a fluid delivery passageway that is fluidly coupled to the reservoir and also to a proximal port located along the proximal end portion of the delivery shaft;

wherein the proximal port is adapted to couple to a source of a fluid agent; and

wherein the bladder further comprises an outer wall that is permeable to the fluid agent and that is positioned to allow the fluid agent to flow from within the reservoir of the bladder, through the outer wall, and principally into an exterior circumferential area surrounding the outer surface of the tubular member.

58. The system of claim 57, wherein:

the bladder comprises overlapping portions of the sheet of material that forms the tubular wall of the tubular member.

59. The system of claim 57, wherein:

the outer wall comprises at least one aperture formed therethrough and through which the fluid agent is allowed to pass into the exterior circumferential area.

60. The system of claim 57, wherein:

the sheet of material along the outer wall of the bladder is sufficiently porous with respect to the fluid agent to allow flow therethrough into the exterior circumferential area.

61. The system of claim 57, wherein:

the bladder is located around a circumference of the distal end portion of the tubular member; and

a radial support member is located within the circumferential bladder.

62. The system of claim 61, wherein:

the bladder is permeable to the fluid agent at multiple locations around the circumference.

63. The system of claim 61, wherein:

the bladder is permeable to the fluid agent continuously around the circumference.

65. A renal flow system, comprising:

a renal flow device having a delivery shaft with a proximal end portion and a distal end portion, and also having a renal flow assembly on the distal end portion with an expandable tubular member; and

a fluid agent delivery system cooperating with the renal flow assembly of the renal flow device;

wherein the tubular member is secured to the distal end portion of the delivery shaft and has a proximal end portion, a distal end portion, and a tubular body with an outer surface and an inner surface that defines an interior passageway extending between respective proximal and distal open ends located along the proximal and distal end portions of the tubular member, respectively;

wherein the tubular member is adjustable between a radially collapsed condition and a radially expanded condition;

wherein in the radially collapsed condition the tubular member is adapted to be positioned at a location within an aorta of a patient adjacent to at least one renal artery ostium along the aorta and with the proximal end portion of the tubular member located downstream from the ostium and the distal end portion of the tubular member located upstream from the ostium;

wherein in the radially expanded condition at the location the tubular member is adapted to substantially divide aortic blood flow between an interior flow path within the interior passageway and an exterior flow path located within a exterior circumferential area surrounding the outer surface of the tubular member and between the outer surface and the wall of the aorta at the location;

wherein in the radially expanded condition the tubular member is further adapted to direct the exterior flow path substantially into the renal artery via its ostium, and to allow the aortic blood in the interior flow path to flow downstream past the location;

wherein the fluid agent delivery system is adapted to locally deliver a volume of fluid agent into the exterior flow path at a localized circumferential region around the circumference of the tubular member; and

wherein the tubular member has a localized shape corresponding with at least the localized circumferential region around the tubular member and that forms a mixing region that is adapted to promote substantial mixing of the fluid agent delivered into the localized circumferential region with blood flowing along other circumferential regions of the exterior flow path.

66. The system of claim 65, wherein:

the tubular member in the radially expanded condition has a tapered tubular shape with a distally reducing tapered outer diameter from a first outer diameter along the proximal end portion to a second outer diameter along the distal end portion and that is less than the first outer diameter;

the localized shape of the tubular member comprises a localized region of relatively increased taper pitch corresponding to a more drastic reduction in the outer diameter of the tubular member over the length of the localized region; and

the more drastically increased taper pitch further corresponds to an increased exterior space between the tubular member and the aortic wall along and distal to the localized region that thereby allows for more efficient mixing of the fluid agent with blood flow within the exterior flow path around the tubular member.

67. The system of claim 66, wherein:

the tapered shape along the localized region has a stepped increase in taper pitch going from the proximal end portion to the distal end portion of the tubular member.

68. The system of claim 67, wherein:

the tapered shape along the localized region has a stepped increase in taper pitch followed by a stepped decrease in taper pitch, both going from the proximal end portion to the distal end portion of the tubular member.

69. The system of claim 66, further comprising:

a longitudinal support member extending along and secured relative to the tubular wall of the tubular member along the localized circumferential region; and

wherein the localized mixing region is formed at least in part by a corresponding localized shape of the longitudinal support member.

70. The system of claim 69, wherein:

the longitudinal support member further comprises an elongated tubular member with a distal fluid delivery lumen that communicates externally from the elongated tubular member through a distal port located along the localized circumferential region; and

the distal fluid delivery lumen is further adapted to fluidly couple to a proximal port located externally of the body of the patient;

the proximal port is adapted to couple to the source of fluid agent; and

such that the longitudinal support member forms a distal portion of the fluid agent delivery assembly and is adapted to deliver the volume of fluid agent into the exterior flow path through the distal port.

71. The system of claim 70, wherein:

the longitudinal support member is in fluid communication with a proximal fluid delivery lumen extending proximally along the proximal end portion of the delivery shaft and communicating with the proximal port on the proximal end portion of the delivery shaft externally of the patient.

72. The system of claim 65, wherein:

the tubular member is adapted to direct the exterior flow path into multiple renal arteries via multiple respective ostia along the aorta wall, wherein each kidney is fed by at least one of the multiple renal arteries.

73. A renal flow system, comprising:

a renal flow device having a delivery shaft with a proximal end portion and a distal end portion, and also having a renal flow assembly located along the distal end portion;

means for dividing a cross-section of aortic blood flow at a location within an aorta adjacent to at least one renal artery ostium into an interior flow path flowing downstream across the location and an exterior flow path that substantially circumferentially surrounds the interior flow path;

means for substantially directing the blood in the exterior flow path to flow substantially into the at least one renal artery ostium along the aorta at the location;

means for allowing the blood in the interior flow path to flow substantially downstream from the location;

means for substantially isolating the exterior and interior flow paths from each other along the location;

means for locally delivering a volume of fluid agent substantially into a localized circumferential portion of the exterior flow path along the distal end portion of the tubular member; and

means for mixing the volume of fluid agent that is delivered into the localized circumferential portion of the exterior flow path across a substantial circumferential portion of the exterior flow path circumferentially around the tubular member such that a substantial portion of the agent is delivered via the second flow path into each of the plurality of renal artery ostia.

74. The system of claim 73, wherein the means for dividing the aortic blood flow comprises:

a tubular member that is adapted to be positioned within the aorta at the location.

75. The system of claim 73, wherein the means for substantially directing the blood comprises:

a tubular member with a tubular wall having an outer surface;

wherein the tubular member is adapted to be positioned within the aorta at the location with a shape;

wherein the shape is adapted such that the exterior flow path is located between the outer surface of the tubular wall and a region of the aortic wall including the renal artery ostium at the location; and

wherein the shape is adapted such that the tubular wall substantially isolated blood in the exterior flow path from flowing across the location and escaping into downstream circulation from the location, and further such that blood in the exterior flow path flows principally into the at least one renal artery via its ostium located along the exterior flow path.

76. The system of claim 73, wherein the means for allowing the blood in the interior flow path to flow substantially downstream from the location comprises:

a tubular member having first and second end portions and an interior passageway extending between a first open end along the first end portion of the tubular member and a second open end along the second end portion of the tubular member;

wherein the tubular member is adapted to be positioned within the aorta at the location with the first and second end portions on upstream and downstream sides of the at least one ostium, respectively; and

wherein an inner flow component of aortic blood flowing into the location from an upstream location is allowed to enter the interior passageway through the first open end and is thereafter allowed to flow downstream across the location through the interior passageway.

77. The system of claim 73, wherein the means for substantially isolating the interior and exterior flow paths respectively from each other along the location further comprises:

a tubular wall of a tubular member that is adapted to be positioned within the aorta at the location and that is substantially impermeable to blood;

wherein the exterior flow path is located within an exterior circumferential space surrounding the tubular member and between an outer surface of the tubular wall and the aortic wall; and

wherein the interior flow path is located within an interior passageway defined at least in part by an inner surface of the tubular wall.

78. The system of claim 73, wherein the means for locally delivering a volume of fluid agent substantially into a localized circumferential portion of the exterior flow path along the distal end portion of the tubular member further comprises:

a fluid delivery assembly having a fluid passageway extending between a proximal port and a distal port;

wherein the distal port is adapted to be positioned within the aorta along the localized circumferential portion of the exterior flow path and with the proximal port located externally of the body of the patient; and

wherein the proximal port is adapted to couple to a source of the fluid agent, such that the volume of fluid agent is delivered into the localized circumferential portion of the exterior flow path through the distal port via the fluid passageway and proximal port coupled to the source.

79. The system of claim 73, wherein the means for mixing the volume of fluid agent across a substantial circumferential portion of the exterior flow path circumferentially around the tubular member further comprises:

a tubular member that is adapted to be positioned at the location with a proximal end portion of the tubular member located downstream from the ostia and a distal portion of the tubular member located upstream from the ostia;

wherein the tubular member is shaped such that the exterior flow path flows externally around the tubular member and between an outer surface of a tubular wall of the tubular member and the aortic wall; and

wherien the tubular member further has a localized shape corresponding with the localized circumferential portion of the exterior flow path that forms a localized mixing region of locally increased space between the tubular wall and the aortic wall; and

wherein the locally increased space is adapted to increase mixing of the fluid agent with blood flowing substantially around the tubular member in the exterior flow path.

80. A method for providing localized medical care to a renal system in a patient, comprising:

positioning a distal end portion of a catheter at a location within the patient'"'"'s aorta that is adjacent to an ostium of at least one renal artery extending from the aorta;

using the distal end portion of the catheter from within the aorta at the location, directing a volume of fluid within the aorta to be locally delivered primarily into the at least one renal artery via its ostium;

while locally delivering the volume of fluid into the at least one renal artery, allowing a substantial volume of aortic blood to flow downstream past the location and into the patient'"'"'s downstream circulation downstream from the renal artery ostium;

substantially isolating the volume of fluid being directed into the at least one renal artery from mixing with the substantial volume of aortic blood flowing downstream from the location; and

conducting an interventional medical procedure at least in part at an upstream location upstream from the location while locally directing the volume of fluid into the at least one renal artery, and while allowing the substantial volume of aortic blood to flow downstream from the ostium, and also while substantially isolating the volume of fluid from mixing with the substantial volume of aortic blood flowing downstream.

81. The method of claim 80, wherein the volume of fluid comprises an outer blood flow component of aortic blood, and further comprising:

passively directing the outer blood flow component into the at least one renal artery at an increased pressure at the respective ostium that is artificially elevated by the catheter to be greater than a normal physiologic pressure at the ostium for that patient.

82. The method of claim 80, further comprising:

preventing a portion of the aortic blood from passively flowing downstream across the location and past the renal artery ostium; and

passively redirecting the portion of aortic blood toward the at least one renal artery ostium using the distal end portion of the catheter.

83. The method of claim 80, wherein the volume of fluid comprises a fluid agent, and further comprising:

providing a proximal port at the proximal end portion of the catheter in fluid communication with a source of the fluid agent externally of the patient while the distal end portion of the catheter is positioned at the location;

delivering a volume of the fluid agent through the catheter to the location within the aorta; and

directing the volume of fluid agent to flow from the location within the aorta and principally into the at least one renal artery via its ostium.

84. The method of claim 80, wherein the interventional medical procedure further comprises:

injecting a radiopaque contrast agent into the patient'"'"'s arterial system at a location that is upstream from the renal ostium.

85. The method of claim 84, further comprising:

providing the volume of fluid being directed into the renal artery with an agent that is adapted to treat or protect the patient s renal system with respect to the radiopaque contrast agent being injected at the upstream location.

86. The method of claim 80, further comprising:

providing the volume of fluid being locally directed into the least one renal artery with an agent that comprises at least one of a vasodilator, an antioxidants, or a diuretic.

87. The method of claim 80, wherein the interventional medical procedure further comprises:

positioning a delivery device at least in part within the patient'"'"'s aorta at an upstream location that is upstream from the renal artery ostium.

88. The method of claim 87, wherein the delivery device comprises an angiographic catheter.

89. The method of claim 87, wherein the delivery device comprises a guiding catheter.

90. The method of claim 87, wherein:

the delivery device is positioned at least in part within a coronary artery ostium.

91. The method of claim 87, wherein:

the delivery device is positioned at least in part within a carotid artery ostium.

92. The method of claim 80, further comprising:

locally directing the volume of fluid into multiple renal arteries via multiple respective ostia that are located at unique, relatively spaced positions along the aorta, and wherein each kidney is perfused by at least a respective one of the multiple renal arteries.

93. The method of claim 92, wherein the volume of fluid comprises a fluid agent, and further comprising:

mixing the volume of fluid agent in an outer, circumferential region of the aortic blood flowing along the location adjacent the wall of the aorta and while substantially isolating the volume of agent from mixing with an inner region of aortic blood flowing downstream past the location and that is substantially surrounded by the outer, circumferential region; and

directing the aortic blood and mixed agent in the outer, circumferential region to principally flow into the multiple renal arteries via their respective ostia.

94. The method of claim 93, further comprising:

positioning a tubular member with a distal end portion of the tubular member located upstream from the location of the ostia and a proximal end portion of the tubular member located downstream from the location;

with the proximal and distal end portions at the downstream and upstream locations, respectively, providing the tubular member with a distally reducing tapered shape such that the proximal end portion has a first outer diameter that is sufficient to substantially circumferentially engage the aorta wall at the downstream location, and further such that the distal end portion has a second outer diameter that is sufficiently less than the inner diameter of the aorta wall at the upstream location; and

wherein the outer, circumferential region of aortic blood is located between an outer surface of the tubular member and the aortic wall between the distal tip of the distal end portion and the ostia.

95. The method of claim 94, further comprising:

delivering the volume of fluid agent into the outer, circumferential region of blood flow at a first isolated radial position; and

providing the shape of the tubular member with a mixing region having a different taper than other regions of the tubular member and that is associated with the first isolated circumferential position;

wherein the mixing region is adapted to enhance the mixing of the agent with blood circumferentially around the tubular member to thereby more evenly distribute the agent to renal arteries having respective ostia at respectively unique circumferential locations around the aorta at the location.

96. The method of claim 80, wherein the volume of aortic blood is allowed to flow passively downstream across the location during the delivery of the agent into the at least one renal artery.

105. A method as in either of claims 80 or 97, further comprising:

locally delivering at least one of a vasodilator, antioxidant, or diuretic agent substantially into a renal artery from the location within the aorta.

106. The method of claim 105, further comprising locally delivering a vasodilator into the at least one renal artery.

107. The method of claim 106, further comprising locally delivering at least one of

papavarine, fenoldopam, calcium channel blockers, atrial natriuretic peptide (ANP), acetylcholine, nifedipine, nitroglycerine, nitroprusside, adenosine, dopamine, or theophylline, or combinations or blends thereof, into the at least one renal artery.

108. The method of claim 105, further comprising locally delivering an antioxidant into the at least one renal artery.

109. The method of claim 108, further comprising delivering acetylcysteine into the at least one renal artery.

110. The method of claim 105, further comprising delivering a diuretic agent into the at least one renal artery ostium.

111. The method of claim 110, further comprising delivering at least one of mannitol, or furosemide, or combinations or blends thereof, into the at least one renal artery.

97. A method for directing fluid to a renal system in a patient, comprising:

locally delivering a volume of fluid to at least one renal artery in the patient; and

while locally delivering the volume of fluid to the at least one renal artery, positioning a medical device within an aorta of the patient upstream from an ostium of the at least one renal artery along the aorta of the patient.