Medical grafting methods and apparatus

• US 6,514,196 B1
• Filed: 11/15/2000
• Issued: 02/04/2003
• Est. Priority Date: 04/23/1997
• Status: Expired due to Fees

• Current Assignee: St Jude Medical ATG Incorporated (Abbott Laboratories Incorporated)
• Original Assignee: St Jude Medical ATG Incorporated (Abbott Laboratories Incorporated)
• Inventors: Sullivan, Daniel J., Bachinski, Thomas J., Goldsteen, David S.
• Primary Examiner(s): Lacyk, John P.
• Application Number:
  US09/712,968
• Time in Patent Office: 811 Days
• Field of Search: 128/897-898, 600/36, 606/151, 606/191, 606/108, 606/113, 606/185, 606/194, 606/195, 623/1, 623/3, 623/11, 623/12, 604/8, 604/49-54, 604/158-159, 604/163-164, 604/272
• US Class Current: 600/36
• CPC Class Codes: A61B 17/32056 Surgical snare instruments for removing or smashing calculi A61B2017/2212; tonsillotomes A61B17/26
• CPC Class Codes: A61B 2017/003 Steerable
• CPC Class Codes: A61B 2017/2939 Details of linkages or pivot points
• CPC Class Codes: A61B 2090/306 using optical fibres
• CPC Class Codes: A61B 2090/3614 using optical fibre
• CPC Class Codes: A61F 2/064 with special features to facilitate anastomotic coupling anastomosis of natural blood vessels A61B17/11
• CPC Class Codes: A61F 2/90 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 2/958 Inflatable balloons for placing stents or stent-grafts
• CPC Class Codes: A61F 2002/826 more than one stent being applied sequentially
• CPC Class Codes: A61M 2025/0175 having telescopic features, interengaging nestable members movable in relations to one another
• CPC Class Codes: A61M 2025/0233 specifically adapted for attaching to a body wall by means which are on both sides of the wall, e.g. for attaching to an abdominal wall
• CPC Class Codes: Y10S 623/903 Blood vessel

Abstract

Methods and apparatus for delivering and installing a new length of tubing between two sections of a patient'"'"'s existing body organ tubing and at least partly outside of that existing structure. For example, the new length of tubing may be for the purpose of providing the patient with a coronary bypass. The new tubing may be an artificial graft, a natural graft (harvested elsewhere from the patient), or both. The new tubing is delivered to and installed at the operative site primarily by working through the patient'"'"'s existing tubular body organ structure. This avoids the need for any significant surgery on the patient.

Claims

1. Apparatus for installing a tubular conduit between first and second spaced locations of a patient'"'"'s tubular body structure comprising:

elongated instrumentation configured to be inserted into and along a lumen of the tubular body structure so that a distal portion of the instrumentation reaches the first location via the lumen, the instrumentation including;

penetrating structure configured to form a first aperture through the tubular body structure at the first location, to extend through the first aperture to the second location, and to form a second aperture through the tubular body structure at the second location; and

conduit delivery structure configured to deliver the conduit so that it extends between the first and second apertures.

2. The apparatus defined in claim 1 wherein the penetrating structure comprises:

a longitudinal structure having a distal portion configured to pass through a wall of the tubular body structure at the first location.

3. The apparatus defined in claim 2 wherein the longitudinal structure has a sharply pointed distal tip.

4. The apparatus defined in claim 2 wherein a distal portion of the longitudinal structure is threaded to threadedly engage the wall of the tubular body structure when the longitudinal structure is rotated about its longitudinal axis.

5. The apparatus defined in claim 2 wherein the longitudinal structure is axially reciprocable relative to a lumen in the elongated instrumentation so that the distal portion of the longitudinal structure can be selectively distally extended beyond the remainder of the elongated instrumentation.

6. The apparatus defined in claim 2 wherein the longitudinal structure comprises:

a plurality of substantially concentric members mounted in telescopic relationship to one another.

7. The apparatus defined in claim 6 wherein the concentric members are selectively distally extendable so that they can be successively inserted into the first aperture to gradually enlarge the first aperture.

8. The apparatus defined in claim 7 wherein distal ends of at least some of the concentric members are tapered inwardly in the distal direction to facilitate entry of those members into the first aperture.

9. The apparatus defined in claim 7 wherein distal portions of at least some of the concentric members are threaded and rotatable about a central longitudinal axis so that those concentric members threadedly engage the wall of the tubular body structure when the member is rotated with its threads in contact with the wall.

10. The apparatus defined in claim 1 wherein the penetrating structure comprises:

selectively operable securing structure configured to releasably secure a distal portion of the penetrating structure to the tubular body structure adjacent the first aperture.

11. The apparatus defined in claim 10 wherein the securing structure comprises:

a selectively radially enlargeable structure around the remainder of the penetrating structure configured to be disposed adjacent the first aperture.

12. The apparatus defined in claim 11 wherein the enlargeable structure comprises:

an inflatable balloon.

13. The apparatus defined in claim 10 wherein the securing structure comprises:

first and second selectively radially enlargeable structures around the remainder of the penetrating structure configured to be disposed on respective opposite sides of the first aperture respectively inside and outside of the tubular body structure.

14. The apparatus defined in claim 13 wherein the first and second selectively radially enlargeable structures are resiliently biased toward one another when radially enlarged with the wall of the tubular body structure between them so that the radially enlargeable structures clamp the wall between them.

15. The apparatus defined in claim 13 wherein each of the first and second radially enlargeable structures is independently radially enlargeable.

16. The apparatus defined in claim 13 wherein each of the radially enlargeable structures comprises:

an inflatable balloon.

17. The apparatus defined in claim 1 wherein the penetrating structure comprises:

a distal portion which is selectively laterally deflectable under control from an axially remote location.

18. The apparatus defined in claim 1 wherein the penetrating structure comprises:

visible image transmitting structure configured to make an image of a portion of the patient adjacent a distal portion of the penetrating structure visible at an axially remote location.

19. The apparatus defined in claim 18 wherein the visible image transmitting structure comprises:

optical fiber extending axially along the penetrating structure for transmitting light from a distal portion of the penetrating structure to a proximal portion of the penetrating structure.

20. The apparatus defined in claim 18 wherein the visible image transmitting structure comprises:

optical fiber extending axially along the penetrating structure for transmitting light from a proximal portion of the penetrating structure to a distal portion of the penetrating structure.

21. The apparatus defined in claim 1 wherein the penetrating structure comprises:

a tubular structure having a distal portion which is selectively anchorable through the first aperture.

22. The apparatus defined in claim 21 wherein the penetrating structure further comprises:

a longitudinal portion which is selectively distally extendable from a distal end of the tubular structure.

23. The apparatus defined in claim 22 wherein the longitudinal portion comprises:

a distal portion which is selectively laterally deflectable under control from an axially remote location.

24. The apparatus defined in claim 22 wherein the longitudinal portion comprises:

visible image transmitting structure configured to make an image of a portion of the patient adjacent a distal portion of the longitudinal portion visible at an axially remote location.

25. The apparatus defined in claim 22 wherein the longitudinal portion comprises:

a longitudinal structure having a distal portion configured to pass through a wall of the tubular body structure at the second location.

26. The apparatus defined in claim 25 wherein the distal portion of the longitudinal structure is configured to extend along a lumen of the tubular body structure adjacent the second location after passing through the wall at the second location.

27. The apparatus defined in claim 25 wherein the longitudinal structure has a sharply pointed distal tip.

28. The apparatus defined in claim 25 wherein a distal portion of the longitudinal structure is threaded to threadedly engage the wall of the tubular body structure when the longitudinal structure is rotated about its longitudinal axis.

29. The apparatus defined in claim 25 wherein the longitudinal structure is axially reciprocable relative to a lumen in the longitudinal portion so that the distal portion of the longitudinal structure can be selectively distally extended beyond the remainder of the longitudinal portion.

30. The apparatus defined in claim 25 wherein the longitudinal structure comprises:

a first structure configured to initially pierce the wall of the tubular body structure at the second location to initiate the second aperture; and

a second structure configured to enlarge the second aperture.

31. The apparatus defined in claim 30 wherein the first and second structures are separately movable toward the wall of the tubular body structure at the second location.

32. The apparatus defined in claim 30 wherein the second structure is substantially concentric around the first structure.

33. The apparatus defined in claim 1 wherein the penetrating structure comprises:

a longitudinal structure configured to extend from the lumen of the tubular body structure adjacent the first location, out of the first aperture to the second aperture, and through the second aperture into a further lumen of the tubular body structure adjacent the second location.

34. The apparatus defined in claim 33 wherein the penetrating structure further comprises:

a tissue piercing structure configured to initially pierce the tubular body structure at the second location to initiate the formation of the second aperture through which the longitudinal structure can then pass into the further lumen of the tubular body structure.

35. The apparatus defined in claim 34 wherein the tissue piercing structure comprises:

a tubular member having a sharpened distal projection from a portion of the periphery of its distal end, the distal projection being configured to pierce the tubular body structure at the second location.

36. The apparatus defined in claim 35 wherein the tubular member is disposed substantially concentrically around an axial portion of the longitudinal structure.

37. The apparatus defined in claim 36 wherein the longitudinal structure is longitudinally movable relative to the tubular member.

38. The apparatus defined in claim 37 wherein the longitudinal structure is configured to pass along the distal projection through the second aperture initiated by the distal projection and thereby into the further lumen of the tubular body structure.

39. The apparatus defined in claim 38 wherein a distal portion of the longitudinal structure is configured to threadedly engage the interior of the further lumen.

40. The apparatus defined in claim 33 wherein the conduit delivery structure is axially movable along the longitudinal structure.

41. The apparatus defined in claim 40 wherein the conduit delivery structure is configured to allow the longitudinal structure to pass axially through the conduit delivery structure.

42. The apparatus defined in claim 33 wherein the conduit delivery structure comprises:

an enlarging structure configured to follow the longitudinal structure into the second aperture and to enlarge the second aperture as it enters the second aperture.

43. The apparatus defined in claim 1 wherein the conduit delivery structure is configured to selectively secure a distal portion of the conduit to the tubular body structure adjacent the second aperture.

44. The apparatus defined in claim 1 wherein the conduit delivery structure is configured to selectively secure a proximal portion of the conduit to the tubular body structure adjacent the first aperture.

45. The apparatus defined in claim 1 wherein the conduit delivery structure is configured to selectively radially enlarge a distal portion of the conduit inside the tubular body structure adjacent the second aperture.

46. The apparatus defined in claim 1 wherein the conduit delivery structure is configured to selectively radially enlarge a proximal portion of the conduit inside the tubular body structure adjacent the first aperture.

47. The apparatus defined in claim 1 wherein the conduit delivery structure comprises:

a tubular structure configured to receive the conduit concentrically inside the tubular structure.

48. The apparatus defined in claim 47 wherein the conduit delivery structure further comprises:

a conduit engaging structure configured to selectively axially move the conduit relative to the tubular structure.

49. The apparatus defined in claim 48 wherein the conduit engaging structure includes a portion configured to be disposed substantially concentrically inside the conduit.

50. The apparatus defined in claim 49 wherein the portion of the conduit engaging structure which is configured to be disposed substantially concentrically inside the conduit includes:

a selectively radially expandable structure configured to selectively engage the interior of the conduit when radially expanded.

51. The apparatus defined in claim 50 wherein the radially expandable structure comprises:

a selectively inflatable balloon.

52. Apparatus for introducing a longitudinal structure into a lumen of a patient'"'"'s tubular body structure comprising:

a tubular member having a sharpened distal projection from a portion of the circumference of the distal periphery of the tubular member, the distal projection being configured to pierce the tubular body structure to initiate the formation of an aperture through the tubular body structure into the lumen; and

a longitudinal structure disposed substantially concentrically inside the tubular member and configured to move longitudinally relative to the tubular member so that a distal portion of the longitudinal structure can pass along the distal projection through the aperture and thereby into the lumen.

53. The apparatus defined in claim 52 wherein a distal portion of the longitudinal structure comprises:

a coil of wire extending distally from a proximal portion of the longitudinal structure.

54. The apparatus defined in claim 53 wherein the distal portion of the longitudinal structure comprises:

a safety ribbon extending distally from a proximal connection to the proximal portion of the longitudinal structure to a distal connection to a distal portion of the coil of wire.

55. The apparatus defined in claim 52 wherein the tubular member comprises a hypotube.

56. The apparatus defined in claim 52 wherein the longitudinal structure comprises a wire.