Device, system and method for interstitial transvascular intervention

• US 20040133225A1
• Filed: 08/14/2003
• Published: 07/08/2004
• Est. Priority Date: 10/13/1995
• Status: Active Grant

• Current Assignee: Medtronic Vascular, Inc. (Medtronic Plc)
• Original Assignee: TransVascular, Inc. (Medtronic Plc)
• Inventors: Makower, Joshua
• Granted Patent: US 7,407,506 B2
• Time in Patent Office: Days
• US Class Current: 606/167
• CPC Class Codes: A61B 1/3137 for examination of the interior of blood vessels
• 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 17/00491 Surgical glue applicators surgical adhesives A61L24/00; two-component delivery syringes A61M5/19
• 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 17/0643 with separate closing member, e.g. for interlocking with staple
• CPC Class Codes: A61B 17/11 for performing anastomosis; Buttons for anastomosis
• CPC Class Codes: A61B 17/12022 Occluding by internal devices, e.g. balloons or releasable wires plugging an opening in the wall of an organ A61B17/0057; occluders for the cervical canal A61F6/146; vas deferens occluders A61F6/20
• 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 17/12131 characterised by the type of occluding device
• CPC Class Codes: A61B 17/12136 Balloons
• CPC Class Codes: A61B 17/12181 formed by fluidized, gelatinous or cellular remodelable materials, e.g. embolic liquids, foams or extracellular matrices
• CPC Class Codes: A61B 17/1219 expandable in contact with liquids
• CPC Class Codes: A61B 17/320725 with radially expandable cutting or abrading elements A61B17/32075 takes precedence
• CPC Class Codes: A61B 17/3417 Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating syringe needles A61M5/32; dilators A61M29/00
• CPC Class Codes: A61B 17/3496 Protecting sleeves or inner probes; Retractable tips for protecting body piercing guide needles A61M25/0612
• CPC Class Codes: A61B 18/00 Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body eye surgery A61F9/007; ear surgery A61F11/00
• CPC Class Codes: A61B 18/1445 at the distal end of a shaft, e.g. forceps or scissors at the end of a rigid rod
• CPC Class Codes: A61B 18/1477 Needle-like probes
• CPC Class Codes: A61B 18/1492 having a flexible, catheter-like structure, e.g. for heart ablation A61B18/1477 takes precedence
• CPC Class Codes: A61B 18/24 : with a catheter A61B18/26, A61B18/28 take precedence
• CPC Class Codes: A61B 2017/00243 : cardiac
• CPC Class Codes: A61B 2017/00247 : Making holes in the wall of the heart, e.g. laser Myocardial revascularization
• 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 2017/003 : Steerable
• CPC Class Codes: A61B 2017/00504 : Tissue welding
• CPC Class Codes: A61B 2017/00641 : for closing fistulae, e.g. anorectal fistulae
• CPC Class Codes: A61B 2017/0641 : having at least three legs as part of one single body
• 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 2017/12127 : Double occlusion, e.g. for creating blood-free anastomosis site
• CPC Class Codes: A61B 2017/22038 : with a guide wire
• CPC Class Codes: A61B 2017/22077 : with a part piercing the tissue A61B2017/22044 takes precedence
• CPC Class Codes: A61B 2017/306 : holding by means of suction
• CPC Class Codes: A61B 2017/347 : Locking means, e.g. for locking instrument in cannula
• CPC Class Codes: A61B 2017/3488 : Fixation to inner organ or inner body tissue
• CPC Class Codes: A61B 2018/00392 : Transmyocardial revascularisation
• CPC Class Codes: A61B 2018/00869 : Phase
• CPC Class Codes: A61B 2018/1425 : Needle
• CPC Class Codes: A61B 2090/378 : using ultrasound
• CPC Class Codes: A61B 2090/3925 : ultrasonic
• CPC Class Codes: A61B 2090/3929 : Active markers
• CPC Class Codes: A61B 2090/3958 : emitting a signal
• CPC Class Codes: A61B 90/361 : Image-producing devices, e.g. surgical cameras
• CPC Class Codes: A61B 90/40 : Apparatus fixed or close to patients specially adapted for providing an aseptic surgical environment
• CPC Class Codes: A61F 2/07 : Stent-grafts
• CPC Class Codes: A61F 2/2493 : Transmyocardial revascularisation [TMR] devices
• 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 2002/30079 : magnetic
• CPC Class Codes: A61F 2002/8486 : provided on at least one of the ends
• CPC Class Codes: A61F 2210/009 : magnetic
• CPC Class Codes: A61M 2025/0076 : Unidirectional valves
• CPC Class Codes: A61M 2025/018 : Catheters having a lateral opening for guiding elongated means lateral to the catheter
• CPC Class Codes: A61M 2025/1052 : for temporarily occluding a vessel for isolating a sector

Abstract

Method and apparatus for utilizing the vascular system as a conduit to reach other vascular and extravascular locations within the body. Included are methods for revascularization wherein the extravascular passageways are formed to permit blood flow between vascular locations. Also included are methods for performing transvascular interstitial surgery (TVIS) wherein extravascular passageways are formed from a blood vessel to another vascular or non-vascular intracorporeal location. Also disclosed are devices usable for forming extravascular passageways in accordance with the invention, or for modifying, valving, maintaining or closing such passageways.

Claims

1. A method for effecting revascularization of a diseased artery comprising:

a) forming a first opening in a vein proximate to the diseased artery;

b) forming a second opening in the diseased artery in a location proximate to the first opening; and

c) providing a passage for the flow of blood between the first and second openings.

2. A method for effecting revascularization of a diseased artery in the heart comprising:

a) forming a first opening in a blood vessel at a point within the circulatory system of the heart;

b) forming a second opening in a blood vessel at another position within the circulatory system of the heart; and

c) providing for the passage of blood between the first and second openings.

3. A device for effecting tissues beyond the lumen of a blood vessel comprising:

a) a catheter with proximal and distal ends, the distal end being adapted to pass into the vascular system to a desired surgical location, and the proximal end being adapted to remain outside of the body to allow for control by an operator;

b) orientation means provided on the distal portion of the catheter for allowing the operator to determine the axial rotational position of the catheter within the lumen; and

c) penetrating access means, provided on the distal portion of the catheter, for creating an opening and extending into the space beyond the lumen.

4. A device for routing blood from one blood vessel segment, through a tissue channel to second blood vessel segment comprising:

a) a tubular member having a proximal portion, a midsection portion and a distal portion;

b) the proximal portion capable of assuming the diameter of the first vessel;

c) the midsection portion capable of assuming the diameter of the tissue channel; and

d) the distal portion capable of assuming the diameter of the second blood vessel.

5. A method of dilating a tissue channel formed between two blood vessels comprising:

a) passing a guidewire through the tissue channel;

b) advancing a balloon with proximal and distal portions over the guidewire;

c) locating the balloon so that the proximal and distal portions extend into the lumens of both blood vessels; and

d) inflating of the balloon.

6. A device for creating a widened space from a first blood vessel segment, through a tissue channel, into a second blood vessel segment comprising:

a) a catheter with a proximal end and a distal end for insertion into the vascular system; and

b) an energy guide whose exit is located at the distal end of the catheter and is capable of delivering energy into tissue to form a tissue channel from a portion of the vascular system.

7. A device to permit the attachment of a first opening in a first blood vessel to a second opening in a second blood vessel comprising:

a) a first shaft with a proximal end and distal end;

b) a first expandable portion located on the first shaft, capable of being expanded within the first blood vessel;

c) a second shaft with a proximal and distal end;

d) a second expandable portion on the second shaft capable of being expanded within the second vessel;

e) means for bringing the two expanded portions towards each other to create first and second openings opposed to one another to permit flow between the first and second blood vessels.

8. A device for providing a one-way valve within a vessel comprising:

a) a stent with a tubular shape and a proximal end and a distal end; and

b) a membrane provided within the stent capable of collapsing upon itself at the distal end of the stent while remaining the diameter of the stent at the proximal end.

9. A port for the purpose of providing transvascular interstitial access comprising:

a) a catheter with a proximal end and a distal end and at least one lumen;

b) the proximal portion of the catheter and having a housing to permit the introduction of various instruments into the catheter; and

c) the distal portion of the catheter adapted to be introduced through a blood vessel, through an opening in the wall of the blood vessel and into the interstitial space beyond the lumen of the blood vessel.

10. A device for enlarging a channel between a first opening in a first blood vessel and a second opening in a second blood vessel comprising:

a) a first and second shafts with proximal and distal portions;

b) a cylindrical blade located on the first shaft for cutting out a segment of tissue;

c) a receptacle for the cylindrical blade located on the second shaft; and

d) a means for bringing the cylindrical blade into contact with the receptacle.