METHODS AND DEVICES FOR PERCUTANEOUS AND SURGICAL INTERVENTIONS

• US 20110245751A1
• Filed: 03/03/2011
• Published: 10/06/2011
• Est. Priority Date: 01/24/2002
• Status: Active Grant

• Current Assignee: Johns Hopkins University
• Original Assignee: Johns Hopkins University
• Inventors: Hofmann, Lawrence
• Granted Patent: US 8,979,793 B2
• Time in Patent Office: Days
• US Class Current: 604/7
• CPC Class Codes: A61B 17/22 Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for dilators A61M29/00
• CPC Class Codes: A61B 2017/22069 Immobilising; Stabilising
• CPC Class Codes: A61B 2017/3488 Fixation to inner organ or inner body tissue
• CPC Class Codes: A61B 2217/005 with suction drainage system
• CPC Class Codes: A61M 25/0017 specially adapted for long-term hygiene care, e.g. urethral or indwelling catheters to prevent infections
• CPC Class Codes: A61M 39/06 Haemostasis valves, i.e. gaskets sealing around a needle, catheter or the like, closing on removal thereof

Abstract

Methods and devices for performing percutaneous and surgical interventions. The devices comprising a tubular portion and retractable mechanism at the distal end of the tubular portion. The retractable mechanism prevents the device from pulling out of an anatomical structure during complex interventions, for example, when switching from an antegrade to a retrograde approach within a blood vessel, enables the use of a single sheath when declotting AV hemodialysis fistulas and can provide occlusion of blood flow during interventions and means of removal of debris or clot from the blood vessel.

Claims

1-71. -71. (canceled)

72. A method for performing a vascular percutaneous intervention comprising the steps of:

(a) providing a device comprising;

a tubular portion, having a proximal end and a distal end, and a lumen extending from the proximal end to the distal end;

a retractable mechanism near the distal end of the tubular portion, the mechanism providing an increased cross section of the tubular portion when deployed and substantially no increase in cross section of the tubular portion when retracted;

(b) inserting the tubular portion of the device into a blood vessel distal end first with the retractable mechanism retracted;

(c) deploying the retractable mechanism to a size larger than the opening through which the tubular portion entered the blood vessel;

(d) performing the vascular percutaneous intervention;

(e) retracting the retractable mechanism; and

(f) removing the device from the blood vessel.

73. The method of claim 72, wherein the device is inserted using a retrograde approach, wherein the retractable mechanism is deployed to a size larger than the opening through which the tubular portion entered the blood vessel, and wherein the method further comprises the step of, after (d), repositioning the device to an antegrade approach, wherein the deployed retractable mechanism prevents the tubular portion from exiting the blood vessel.

74. The method of claim 72, wherein the retractable mechanism comprises at least one inflatable balloon.

75. The method of claim 72, wherein the retractable mechanism comprises at least one retractable extension.

76. The method of claim 72, wherein the vascular sheath is in the form of a guide catheter.

77. A method of repositioning a device within a blood vessel between a retrograde approach and an antegrade approach and vice-versa, comprising utilizing the device of claim 72.

78. A method of repositioning a device within a blood vessel between a retrograde approach and an antegrade approach and vice-versa, comprising:

(a) providing a device comprising;

a tubular portion, having a proximal end and a distal end, and a lumen extending from the proximal end to the distal end;

a retractable mechanism near the distal end of the tubular portion, the mechanism providing an increased cross section of the tubular portion when deployed and substantially no increase in cross section of the tubular portion when retracted;

(b) inserting the tubular portion of the device into a blood vessel in one direction distal end first with the mechanism retracted;

(c) deploying the mechanism to a size larger than the opening through which the tubular portion entered the blood vessel;

(d) pulling the device back out of the blood vessel, while maintaining vascular access;

(e) pushing the device back into the blood vessel in the opposite direction whereby the deployed mechanism prevents the device from losing vascular assess.

79. A method for aspirating blood clots, emboli and other materials from a blood vessel comprising the steps of:

(a) providing a device comprising;

a tubular portion, having a proximal end and a distal end, and a lumen extending from the proximal end to the distal end;

a retractable mechanism near the distal end of the tubular portion, the mechanism providing an increased cross section of the tubular portion when deployed and substantially no increase in cross section of the tubular portion when retracted;

(b) inserting the tubular portion of the device into the blood vessel distal end first facing towards the material to be aspirated with the retractable mechanism retracted;

(c) deploying the retractable mechanism to a size that occludes the blood vessel;

(d) removing blood clots, emboli and other materials from the blood vessel;

(e) retracting the retractable mechanism; and

(f) removing the device from the blood vessel.

80. The method of claim 79, wherein the step of (d) removing blood clots, emboli and other materials from the blood vessel comprises aspirating the blood clots, emboli and other materials from the blood vessel through the tubular portion

81. The method of claim 79, wherein the step of (d) removing blood clots, emboli and other materials from the blood vessel comprises pulling the blood clots, emboli and other materials from the blood vessel through the tubular porting using another balloon catheter.

82. The method of claim 79, further comprising the steps of, after (d) removing the blood clot, emboli and other materials from the blood vessel;

partially retracting the retractable mechanism to a size smaller than the blood vessel but larger than the opening through which the tubular portion entered the blood vessel;

pulling the device back out of the blood vessel, while maintaining vascular access, whereby the deployed mechanism prevents the device from losing vascular assess;

pushing the device back into the blood vessel in the opposite direction;

deploying the retractable mechanism to a size that occludes the blood vessel; and

aspirating blood clots, emboli and other materials from the opposite direction of the blood vessel.

83. The method of claim 79, wherein the device is a guide catheter.

84. The method of claim 79, wherein the device is a vascular sheath.

85. A method for performing a vascular percutaneous intervention comprising the steps of:

(a) providing a first device comprising;

a tubular portion, having a proximal end and a distal end, and a lumen extending from the proximal end to the distal end;

a retractable mechanism near the distal end of the tubular portion, the mechanism providing an increased cross section of the tubular portion when deployed and substantially no increase in cross section of the tubular portion when retracted;

(b) inserting the tubular portion of the first device into a donor blood vessel distal end first with the retractable mechanism retracted;

(c) deploying the retractable mechanism to a size larger than the opening through which the tubular portion entered the blood vessel;

(d) connecting the first device to a recipient blood vessel; and

(e) transferring materials from the donor blood vessel, through the tubular portion of the first device, and into the recipient blood vessel.

86. The method of claim 85 wherein the step of (d) connecting the first device to a recipient blood vessel comprises the step of connecting the first device to a tube and inserting the tube into the recipient blood vessel.

87. The method of claims 85 wherein the first device further comprises a side arm and the step of (d) connecting the first device to a recipient blood vessel comprises the step of inserting the side arm the recipient vessel.

88. The method of claim 85 further comprising the step of providing a second device comprising a tubular portion, having a proximal end and a distal end, and a lumen extending from the proximal end to the distal end and wherein the step of (d) connecting the first device to a recipient blood vessel comprises the step of inserting the second device into recipient vessel and connecting the first device to the second device.

89. The method of claim 85, further comprising the step of interposing a pump between the first device and the recipient blood vessel, wherein the pump assists in aspirating materials from the donor blood vessel and into the recipient blood vessel, or visa-versa

90. The method of claim 85, wherein the step of (c) deploying the retractable mechanism to a size larger than the opening through which the tubular portion entered the blood vessel comprises deploying the mechanism to a size that occludes the blood vessel and stops the blood flow through the blood vessel.

91. The method of claim 90, further comprising the steps of:

(f) optionally stopping the transfer of materials from the donor blood vessel into the recipient blood vessel;

(g) optionally aspirating emboli, debris and other materials out of the recipient blood vessel through the tubular portion;

(h) at least partially retracting the retractable mechanism to re-establish blood flow through the donor blood vessel;

(i) deploying the retractable mechanism to a size larger than the opening through which the tubular portion entered the blood vessel and optionally to a size that stops blood flow through the donor blood vessel; and

(j) reestablishing the transfer of materials from the donor blood vessel into the recipient blood vessel if the transfer has been stopped.