Catheter-based methods for enlarging blood vessels to facilitate the formation of penetration tracts, fistulas and/or blood flow channels
First Claim
1. A method for locating a target blood vessel of a patient and penetrating the target vessel with a penetrating element, comprising:
- providing a transluminally insertable tissue penetration device having a penetrating element thereon passable through the wall of a target blood vessel from the exterior thereof;
providing an imaging apparatus for locating a target blood vessel;
causing at least a target region of the target vessel to dilate;
locating the target region of the target vessel using the imaging apparatus;
transluminally positioning the tissue penetration device within a blood vessel or internal body cavity adjacent the target vessel such that the penetrating element is aimed at the dilated target region;
passing the aimed penetrating element from the penetration device through the wall of the target blood vessel.
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Accused Products
Abstract
Methods, devices and systems wherein a penetrating catheter or other penetrating device is used to penetrate into a target blood vessel, and wherein the target vessel is dilated prior to the penetration so as to improve the imaging, aiming at and/or penetration into the target vessel. In one embodiment, a tissue penetrating catheter device that is useable to penetrate from a blood vessel in which it is positioned to a target vessel comprises a flexible catheter advanceable into the first blood vessel and a tissue penetrator lumen adapted to receive an operative tissue penetrator which is usable to penetrate from the blood vessel to the target vessel when properly aimed. An imaging transducer may be fixedly mounted on or within the penetrating catheter to provide an imaging signal from which an image of the target vessel can be obtained. A target vessel dilating catheter is inserted into the target vessel and used to dilate the target vessel prior to imaging, aiming of the penetrator at and/or puncture thereof. Such vessel dilating catheters may comprise one or more occlusion member(s) (e.g., one or two balloons) to block flow through the target vessel and/or to isolate and pressurize a region of the vessel. Alternatively, the dilating catheter may comprise a dilating member that expands within the target vessel to cause a portion of the target vessel wall to enlarge, stretch, expand, bulge or otherwise dilate.
276 Citations
21 Claims
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1. A method for locating a target blood vessel of a patient and penetrating the target vessel with a penetrating element, comprising:
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providing a transluminally insertable tissue penetration device having a penetrating element thereon passable through the wall of a target blood vessel from the exterior thereof;
providing an imaging apparatus for locating a target blood vessel;
causing at least a target region of the target vessel to dilate;
locating the target region of the target vessel using the imaging apparatus;
transluminally positioning the tissue penetration device within a blood vessel or internal body cavity adjacent the target vessel such that the penetrating element is aimed at the dilated target region;
passing the aimed penetrating element from the penetration device through the wall of the target blood vessel. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9)
providing a vessel occlusion catheter that has an occluder formed thereon;
positioning the vessel occlusion catheter within the patient'"'"'s vasculature associated with the target vessel; and
,using the occluder of the vessel and occlusion catheter to at least partially occlude a portion of the vasculature in which it is positioned, thereby causing dilation of at least a portion of the target vessel.
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6. The method of claim 1, wherein the “
- causing”
step comprises;providing a vessel dilation catheter that has an enlargeable member that is alternately disposable in a compact configuration and an enlarged configuration;
placing the vessel dilation catheter in the patient'"'"'s vasculature associated with the target vessel such that the enlargeable member is located in the target vessel; and
enlarging the enlargeable member to cause dilation of the target vessel.
- causing”
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7. The method of claim 1, wherein the “
- causing”
step;providing a double occlusion catheter having a proximal occluder and a distal occluder at spaced apart locations thereon;
using the proximal and distal occluders to occlude the lumen of the target vessel at first and second locations; and
,infusing a fluid into the lumen of the target vessel between the proximal and distal occluders to dilate the portion of the target vessel located between said first and second locations.
- causing”
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8. The method of claim 1, wherein the step of causing comprises:
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providing a double dilator catheter having a proximal dilator and a distal dilator at spaced apart locations thereon;
using the proximal and distal dilators to dilate the target region of the target vessel between the first and second locations.
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9. The method of claim 1, wherein the step of causing comprises:
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providing a dilation catheter having a catheter body and a dilation member thereon, the dilation member initially provided on the catheter body in a retracted state to permit advancement of the catheter body so that the dilation member is located in the target vessel, the dilation member being expandable from the retracted state to dilate a target region of the target vessel, the dilation member including a relief area for passage of the penetrating element;
positioning the dilation catheter in the target region of the target vessel; and
expanding the dilation member in the target region of the target vessel.
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10. A percutaneous, transluminal method for penetrating from a host vessel into a target vessel, said method comprising the steps of:
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a. providing a tissue penetration catheter that is advanceable into the lumen of a host vessel and has a penetrator that is advanceable laterally therefrom said penetrator comprising an elongate member having a lumen extending therethrough;
b. transluminally advancing the tissue penetrating catheter into the host vessel;
c. causing at least a target region of the target vessel to dilate;
d. positioning the tissue penetrating catheter such that its penetrator is aimed at the dilated target region of the target vessel;
e. passing the penetrator from the tissue penetrating catheter, through the wall of the host vessel, through the wall of the target vessel and into the lumen of the target vessel at the target region;
f. passing a guide wire through the lumen of the penetrator and into the lumen of the target vessel; and
,g. retracting the tissue penetrator into the tissue penetrating catheter leaving the guidewire in place such that it extends from the lumen of the artery into the lumen of the target vessel. - View Dependent Claims (11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21)
providing a vessel occlusion catheter that has an occluder formed thereon;
positioning the vessel occlusion catheter within the patient'"'"'s vasculature associated with the target vessel; and
,using the occluder of the vessel and occlusion catheter to at least partially occlude a portion of the vasculature in which it is positioned, thereby causing dilation of at least a portion of the target vessel.
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12. A method according to claim 11 wherein the occluder comprises a balloon and wherein the step of “
- using the occluder”
comprises inflating the balloon.
- using the occluder”
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13. A method according to claim 11 wherein the host vessel is an artery, and wherein it is desired to cause arterial blood to flow from the artery into the target vessel, and wherein the method further comprises the step of:
enlarging the penetration tract, created by passing the penetrator from the tissue penetrating catheter between the artery and the target vessel, to create a blood flow channel through which blood may flow from the artery and into the target vessel.
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14. A method according to claim 10 wherein the step of causing at least a target region of the target vessel to dilate comprises:
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providing a vessel dilation catheter that has an enlargeable member that is alternately disposable in a compact configuration and an enlarged configuration;
placing the vessel dilation catheter in the patient'"'"'s vasculature associated with the target vessel such that the enlargeable member is located in the target vessel; and
enlarging the enlargeable member to cause dilation of the target vessel.
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15. A method according to claim 14 wherein the target vessel is a target vein, the method further comprises the step of:
implanting an occluder to at least partially occlude a vein to cause arterial blood that enters the target vein through the blood flow channel to subsequently flow through the target vein in a direction opposite normal venous flow.
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16. A method according to claim 10 wherein the step of causing at least a target region of the target vessel to dilate comprises:
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providing a double occlusion catheter having a proximal occluder and a distal occluder at spaced apart locations thereon;
using the proximal and distal occluders to occlude the lumen of the target vessel at first and second locations; and
,infusing a fluid into the lumen of the target vessel between the proximal and distal occluders to dilate the portion of the target vessel located between said first and second locations.
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17. A method according to claim 16 wherein the double occlusion catheter further comprises a first perfusion opening formed in the catheter at a location proximal to the proximal occluder, a second perfusion opening formed in the catheter at a location distal to the distal occluder and a perfusion lumen that extends through the catheter between the first and second perfusion openings such that when the occluders are occluding the lumen of the target vessel and, blood may flow in one of the perfusion openings, through the perfusion lumen and out of the other perfusion opening and wherein the method further comprises
allowing blood to flow in one of the perfusion openings, through the perfusion lumen and out of the other perfusion opening while the lumen of the target vessel is occluded by the occluders. -
18. A method according to claim 16 wherein the target vessel is a target vein, and wherein the step of causing at least a target region of the target vessel to dilate comprises:
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providing a venous occlusion/blocker delivery catheter that has a temporary venous occluder formed thereon and is capable of implanting a permanent vein occluder into the lumen of the vein in which it is positioned;
positioning the venous occlusion/blocker delivery catheter within a vein; and
,using the temporary vein occluder to at least partially occlude the vein in which the venous occlusion catheter is positioned, thereby causing temporary dilation of at least a portion of the target vein;
and wherein, after the step of passing the penetrator from the tissue penetrating catheter is completed, the method further comprises;
terminating the temporary occlusion of the vein commenced in the step of causing at least a target region of the target vessel to dilate thereby allowing the target vein to return to a non-dilated state; and
,using the venous occlusion/blocker delivery catheter to implant a permanent vein blocker in the lumen of a vein to cause arterial blood that enters the target vein through the blood flow channel to flow through the target vein in a direction opposite normal venous blood flow.
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19. A method according to claim 10 wherein the target vessel is a target vein, the method further comprising:
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repositioning the tissue penetrating catheter to a second location and causing the penetrator to advance a second time to form a second penetration tract between the target vein and an artery; and
,enlarging the second penetration tract to form a second blood flow channel through which arterial blood that has entered the target vein through the blood flow channel will pass from the target vein, through the second blood flow channel and into an artery.
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20. A method according to claim 10 further comprising the step of:
imaging a dilated portion of the target vessel while the occlusion of the step of causing at least a target region of the target vessel to dilate is being performed and using the image so obtained to aim the penetrating catheter such that its penetrator will pass from the penetrating catheter into the dilated region of the target vessel.
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21. A method according to claim 20 wherein an imaging apparatus is associated with the penetrating catheter and wherein the imaging of the target vessel is carried out using that imaging apparatus.
Specification