Percutaneous bypass with branching vessel

• US 6,390,098 B1
• Filed: 12/23/1999
• Issued: 05/21/2002
• Est. Priority Date: 03/06/1997
• Status: Expired due to Term

• Current Assignee: Boston Scientific Scimed (Boston Scientific Corporation)
• Original Assignee: Scimed Life Systems Incorporated (Boston Scientific Corporation)
• Inventors: LaFontaine, Daniel M., Wang, Lixiao, Hastings, Roger N., Euteneuer, Charles L.
• Primary Examiner(s): McDermott, Corrine
• Assistant Examiner(s): Koh, Choon P.
• Application Number:
  US09/471,591
• Time in Patent Office: 880 Days
• Field of Search: 128/898, 623/1.13, 623/901, 604/8
• US Class Current: 128/898
• CPC Class Codes: A61B 17/064 Surgical staples, i.e. penetrating the tissue
• 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 2017/00243 cardiac
• 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 2017/1135 End-to-side connections, e.g. T- or Y-connections Y-shaped blood vessel prostheses A61F2002/065
• CPC Class Codes: A61B 2018/00214 Expandable means emitting energy, e.g. by elements carried thereon
• CPC Class Codes: A61B 2018/00386 Coronary vessels
• CPC Class Codes: A61B 2090/3929 Active markers
• CPC Class Codes: A61B 2090/3958 emitting a signal
• 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 2/954 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 2002/065 Y-shaped blood vessels
• CPC Class Codes: A61F 2002/828 Means for connecting a plurality of stents allowing flexibility of the whole structure
• CPC Class Codes: A61M 25/0082 Catheter tip comprising a tool
• CPC Class Codes: Y10S 623/901 Method of manufacturing prosthetic device

Abstract

In order to bypass a restriction in a parent vessel, a first site in a branch vessel branching from the aorta is accessed intraluminally. An occlusion is formed at the first site, and the aperture is formed in the branching vessel, intraluminally, proximal of the first site. An aperture is formed in the parent vessel distal of the restriction, and a lumen is formed which communicates between the branching vessel proximal of the occlusion, and the parent vessel distal of the restriction.

Claims

1. A method of percutaneously bypassing a restriction in a restricted artery of a mammal having an aorta and a branching vessel branching from the aorta, the method comprising:

intraluminally accessing a first site in the branching vessel;

intraluminally forming an aperture in the branching vessel at the first site;

forming an aperture in the restricted artery distal of the restriction; and

providing a conduit to form a lumen communicating through the aperture in the branching vessel with a lumen in the branching vessel proximal of the first site and through the aperture in the restricted artery with a lumen of the restricted artery distal of the restriction.

2. The method of claim 1 wherein forming an aperture in the branching vessel comprises severing the branching vessel at the first site to form a severed end and wherein providing a conduit comprises intraluminally suturing the severed end of the branching vessel about the aperture in the restricted artery such that a lumen in the branching vessel communicates with a lumen in the restricted vessel.

3. The method of claim 1 wherein forming an aperture in the branching vessel comprises severing the branching vessel at the first site to form a severed end and wherein providing a conduit comprises:

inserting the severed end of the branching vessel through the aperture in the restricted artery within the lumen of the restricted artery; and

delivering adhesive in the restricted artery proximate the severed end to attach the severed end to the restricted artery.

4. The method of claim 1 wherein providing a conduit comprises:

delivering a graft to the branching vessel;

advancing a first end of the graft through the aperture in the branching vessel; and

attaching the graft to the restricted artery such that a lumen in the graft communicates with a lumen in the restricted artery through the aperture in the restricted artery and with a lumen in the branching vessel.

5. The method of claim 4 wherein attaching the graft to the restricted artery comprises:

advancing the first end of the graft through the aperture in the restricted artery; and

deploying a stent in the first end of the graft to attach the first end of the graft to the restricted artery.

6. The method of claim 4 wherein attaching the graft to the restricted artery comprises:

advancing the first end of the graft through the aperture in the restricted artery; and

delivering adhesive to the restricted artery proximate the first end of the graft to attach the first end of the graft to the restricted artery.

7. The method of claim 1 wherein forming an aperture in the branching vessel comprises severing the branching vessel at the first site to form a severed end and wherein providing a conduit comprises attaching a region of the branching vessel proximate the severed end to a region of the restricted artery proximate the aperture such that a lumen in the branching vessel communicates with a lumen in the restricted artery and further comprising:

inserting a first magnetic member in the severed end; and

manipulating a second magnetic member residing outside the branching vessel to position the severed end proximate the region of the restricted artery through magnetic interaction between the first and second magnetic members.

8. The method of claim 4 and further comprising:

prior to forming the aperture in the branching vessel, forming a temporary occlusion in the branching vessel.

9. The method of claim 1 and further comprising:

prior to forming the aperture in the branching vessel, temporarily occluding the branching vessel proximal of a region in the branching vessel where the aperture is to be formed.

10. The method of claim 8 wherein the step of forming the temporary occlusion comprises:

advancing an expandable member through the branching vessel; and

expanding the expandable member to occlude the branching vessel.

11. The method of claim 1 wherein providing a conduit comprises:

injecting contrast medium through the conduit and through the region of the restricted artery distal of the restriction; and

positioning an end of the conduit proximate a region of the restricted artery distal of the restriction based on observation of the contrast medium.

12. The method of claim 1 wherein providing a conduit comprises:

placing an emitter in one of the region of the restricted artery distal of the restriction and the end of the conduit, the emitter emitting location signals;

placing a sensor in another of the region of the restricted artery distal of the restriction and the end of the conduit, the sensor sensing the location signals and providing an output indicative of the location signals sensed; and

positioning an end of the conduit proximate a region of the restricted artery distal of the restriction based on the output from the sensor.

13. The method of claim 12 wherein placing an emitter comprises:

placing a light emitter in one of the region of the restricted artery distal of the restriction and the end of the conduit; and

wherein placing a sensor comprises placing a fiber optic bundle in another of the region of the restricted artery distal of the restriction and the end of the conduit, the fiber optic bundle sensing light emitted by the light emitter and providing the output indicative of the light sensed.

14. The method of claim 12 wherein placing an emitter comprises:

placing an ultrasound emitter in one of the region of the restricted artery distal of the restriction and the end of the conduit; and

wherein placing a sensor comprises placing an ultrasound imager in another of the region of the restricted artery distal of the restriction and the end of the conduit, the ultrasound imager sensing ultrasound signals emitted by the ultrasound emitter and providing the output as an ultrasound image indicative of the ultrasound signals sensed.

15. The method of claim 12 wherein placing an emitter comprises:

placing an electromagnetic signal emitter in one of the region of the restricted artery distal of the restriction and the end of the conduit; and

wherein placing a sensor comprises placing an electromagnetic sensing array in another of the region of the restricted artery distal of the restriction and the end of the conduit, the electromagnetic sensing array sensing electromagnetic signals emitted by the electromagnetic signal emitter and providing the output indicative of the electromagnetic signals sensed.

16. The method of claim 1 wherein providing a conduit comprises:

placing a first emitter in a region of the restricted artery distal of the restriction and a second emitter in an end of the conduit, the first and second emitters emitting location signals;

sensing the location signals and providing an operator perceptible output indicative of the location of the end of the conduit relative to the region of the restricted artery distal of the restriction; and

positioning the end of the conduit proximate the region of the restricted artery distal of the restriction based on the operator perceptible output.

17. The method of claim 1 wherein providing a conduit comprises:

inserting a first magnetic member in an end of the conduit; and

manipulating a second magnetic member residing outside the conduit to position the end of the conduit proximate the region of the restricted artery through magnetic interaction between the first and second magnetic members.

24. The method of claim 4 wherein prior to forming the apertures in the branching vessel and the restricted artery comprising the step of:

forming temporary occlusions in the branching vessel and the restricted artery.

25. The method of claim 4 wherein the step of delivering the graft and attaching the graft to the restriction artery comprises the step of:

positioning the graft relative to the restricted artery using one of a contrast medium;

light sensing elements, ultrasound or electromagnetic sensing elements or cooperating magnetic members.

18. A method of bypassing a restriction in a parent vessel of a mammal having an aorta and a branching vessel branching from the aorta, the method comprising:

intraluminally accessing a first site in the branching vessel;

intraluminally severing the branching vessel at the first site to form a severed end;

forming an aperture in the parent vessel distal of the restriction; and

attaching a region of the branching vessel proximate the severed end to a region of the parent vessel proximate the aperture such that a lumen in the branching vessel communicates with a lumen in the parent vessel.

19. A method of percutaneously bypassing a restriction in a restricted artery of a mammal having an aorta and a branching vessel branching from the aorta, the method comprising:

intraluminally accessing a first site in the branching vessel;

intraluminally forming an aperture in the branching vessel at a first site;

forming an aperture in the restricted artery distal of the restriction; and

attaching a first end of a graft to the branching vessel proximate the aperture therein and attaching a second end of the graft to a region of the restricted artery proximate the aperture therein such that a lumen in the branching vessel communicates with a lumen in the restricted artery through the graft.

20. The method of claim 19 and the step of attaching the first and second ends of the graft to the branching vessel and the restricted artery comprises the step of:

deploying a stent proximate to the first and second ends.

21. The method of claim 19 and further comprising the step of injecting a contrast medium to locate a position of the restriction in the restricted artery.

22. The method of claim 19 wherein the graft is a bifurcated stent graft including a first passageway between the first end and the second end and a second passageway between the first end and a third end and comprising the step of:

attaching the third end to the branding vessel distal of the aperture in the branching artery.

23. The method of claim 22 wherein the graft includes a third passageway between the second end and a fourth end and comprising the step of:

attaching the fourth end of the graft to the restricted artery.

26. A method of percutaneously bypassing a restriction in a restricted artery of a mammal having an aorta and a branching vessel branching from the aorta, the method comprising:

intraluminally accessing the branching vessel;

intraluminally forming a temporary occlusion in the branching vessel;

intraluminally forming an aperture in the branching vessel at a first site distal of the temporary occlusion;

forming an aperture in the restricted artery distal of the restriction; and

providing a conduit to form a lumen communicating through the aperture in the branching vessel with a lumen in the branching vessel proximal of the first site and through the aperture in the restricted artery with a lumen of the restricted artery distal of the restriction.

27. The method of claim 26 wherein intraluminally forming a temporary occlusion comprises:

advancing an expandable member through the branching vessel to the region proximal of the aperture in the branching vessel; and

expanding the expandable member to occlude the branching vessel.