Methods and apparatus for locating body vessels and occlusions in body vessels

• US 7,493,154 B2
• Filed: 10/23/2002
• Issued: 02/17/2009
• Est. Priority Date: 10/23/2002
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Clague, Cynthia T., Keogh, James R., Jahns, Scott E., Bonner, Matthew D.
• Primary Examiner(s): Casler; Brian L.
• Assistant Examiner(s): Roy; Baisakhi
• Application Number:
  US10/278,531
• Publication Number:
  US 20040082850A1
• Time in Patent Office: 2,309 Days
• Field of Search: 600/424, 600/101, 600/114, 600/117, 600/129, 600/585, 600/13, 604/164.13, 604/525, 606/130
• US Class Current: 600/424
• CPC Class Codes: A61B 2017/00022 Sensing or detecting at the treatment site
• 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 2017/22001 Angioplasty, e.g. PCTA
• CPC Class Codes: A61B 2090/061 for measuring dimensions, e.g. length
• CPC Class Codes: A61B 5/06 Devices, other than using radiation, for detecting or locating foreign bodies for removing same A61B17/50 ; determining position of probes within or on the body of the patient
• CPC Class Codes: A61B 5/062 using magnetic field

Abstract

Methods and apparatus employed to locate body vessels and occlusions in body vessels finding particular utility in cardiac surgery, particularly minimally invasive cardiac surgery to locate cardiac arteries and occlusions in cardiac arteries are disclosed. An elongated vessel lumen probe incorporating a lumen probe element at or near the elongated vessel lumen probe distal end is advanced into the vessel lumen. A vessel surface probe manipulated by the surgeon and having a surface probe element sensor is employed to detect the lumen probe element and to follow the progress of the vessel lumen probe element as it approaches and is advanced through or is blocked by an occlusion. In the location of a coronary artery, the surface probe element sensor is moved about against the epicardium over the suspected location of the artery of interest until a surface probe element sensor of the present invention at the surface probe distal end interacts with the lumen probe element of the vessel lumen probe.

Claims

1. A method of identifying an obstruction in and a course of a body vessel of a patient that is hidden from direct view in a surgical field by body tissue overlying a vessel wall of the body vessel surrounding a vessel lumen of the body vessel comprising:

surgically exposing through an incision at least a portion of body tissue overlying the vessel wall;

introducing a vessel lumen probe having a lumen probe element at or near a vessel lumen probe distal end into the vessel lumen;

introducing a surface probe element sensor of a vessel surface probe into the patient through the incision; and

applying the surface probe element sensor of the vessel surface probe over the body tissue overlying the vessel wall, the surface probe element sensor adapted to provide a proximity indicating signal indicating the degree of proximity of the surface probe element sensor to the lumen probe element;

determining the course of the body vessel relative to the body tissue overlying the vessel wall as a function of the relative strength of the signal when the surface probe element sensor is moved over the body tissue overlying the vessel wall relative to the lumen probe element positioned within the vessel lumen; and

determining an obstruction within the body vessel as a function of the relative strength of the signal when the lumen probe element is moved within the vessel lumen.

2. The method of claim 1, further comprising the step of:

sweeping the lumen probe element around the vessel wall within the vessel lumen while monitoring the indication of proximity.

3. The method of claim 1, wherein the lumen probe element comprises a metallic element and the surface probe element sensor comprises a metal detector coil assembly, and the applying step further comprises:

energizing the metal detector coil assembly to develop a signal responsive to the detection of the metallic element through the vessel wall and body tissue overlying the vessel wall.

4. The method of claim 1, wherein the lumen probe element comprises a lumen probe magnet, and the surface probe element sensor comprises a magnet, the lumen probe magnet and surface probe element sensor arranged in polarity to enable magnetic attraction of the lumen probe element and lumen probe distal end toward the vessel wall in proximity to the surface probe element.

5. The method of claim 1, wherein the vessel lumen probe comprises a probe body having a probe lumen extending the length of the probe body to a distal lumen opening, the lumen probe element comprises a lumen probe magnet, and the surface probe element sensor comprises a magnet, the lumen probe magnet and surface probe element sensor arranged in polarity to enable magnetic attraction of the lumen probe magnet and lumen probe distal end toward the vessel wall in proximity to the surface probe element sensor and further comprising the step of:

introducing a guidewire through the probe lumen to exit the distal lumen opening and perforate through the body vessel wall when the lumen probe distal end is magnetically attracted toward the vessel wall.

6. The method of claim 1, wherein the lumen probe element comprises a magnet, and the surface probe element sensor comprises a magnet, whereby magnetic attraction or repulsion force between the magnets provides the proximity indicating signal.

7. The method of claim 1, wherein the lumen probe element comprises an electrically conductive, vessel probe electrode, and the surface probe element sensor comprises an electrically conductive, surface probe electrode, and the applying step further comprises:

applying electrical energy between the electrically conductive, vessel probe electrode and the electrically conductive, surface probe electrode; and

measuring the impedance between the between the electrically conductive, vessel probe electrode and the electrically conductive, surface probe electrode to develop an impedance signal related to the proximity of the electrically conductive, vessel probe electrode to the electrically conductive, surface probe electrode.

8. The method of claim 7, further comprising the step of:

applying RF energy between the vessel probe electrode and the surface probe electrode at an energy level and for a duration sufficient to form an opening through the vessel wall.

9. The method of claim 8, further comprising the step of:

attaching a graft at the opening in a manner that prevents leakage of blood.

10. The method of claim 9, wherein the graft is a free graft.

11. The method of claim 9, wherein the graft is an attached graft.

12. The method of claim 9, wherein the attaching step further comprises the use of one or more anastomotic devices selected from the group comprising a suture, a staple, a ring, a clip, a sleeve, a stent and a coupler.

13. The method of claim 9, wherein the attaching step further comprises the use of one or more anastomotic agents selected from the group comprising a sealant, a glue and an adhesive.

14. The method of claim 9, wherein the attaching step further comprises the use of a robot.

15. The method of claim 9, wherein the attaching step further comprises the use of a laser.

16. The method of claim 1, wherein the vessel lumen probe comprises a probe sheath having a sheath lumen extending the length of the vessel lumen probe to a distal lumen opening, and a probe wire extending through the sheath lumen having an electrically conductive, vessel probe electrode, and the surface probe element sensor comprises an electrically conductive, surface probe electrode, and wherein:

the introducing step further comprises;

advancing the probe sheath and probe wire into the vessel lumen; and

manipulating the probe wire to extend the vessel probe electrode toward the vessel wall; and

the applying step further comprises;

applying electrical energy between the electrically conductive, vessel probe electrode and the electrically conductive, surface probe electrode; and

measuring the impedance between the between the electrically conductive, vessel probe electrode and the electrically conductive, surface probe electrode to develop an impedance signal related to the proximity of the electrically conductive, vessel probe electrode to the electrically conductive, surface probe electrode.

17. The method of claim 1, wherein the vessel lumen probe comprises a light transmitting and emitting light pipe having a light pipe proximal end adapted to be coupled to a light source and a light pipe distal end operable as the lumen probe element from which light source light is emitted, and the surface probe element sensor comprises a photosensor that responds to the frequency of light emitted by the light emitter and transmitted through the vessel wall and body tissue overlying the vessel wall.

18. The method of claim 1, wherein the vessel lumen probe comprises a light transmitting and emitting light pipe having a light pipe proximal end adapted to be coupled to a light source and a light pipe distal end operable as the lumen probe element from which light source light is emitted, the light pipe extending through the lumen of a light pipe sheath, and the surface probe element sensor comprises a photosensor that responds to the frequency of light emitted from the light pipe distal end and transmitted through the vessel wall and body tissue overlying the vessel wall, and wherein:

the introducing step comprises;

advancing the light pipe sheath and light transmitting and emitting pipe into the vessel lumen;

advancing the light transmitting and emitting light pipe out of the sheath lumen to dispose the light pipe distal end toward the vessel wall; and

transmitting light through the light pipe;

the applying step comprises applying the surface probe over the body tissue overlying the vessel wall so that the photosensor provides a proximity indicating signal indicating the degree of proximity of the photosensor to the light pipe distal end, whereby the location of the vessel lumen is determinable as a function of the relative strength of the signal.

19. The method of claim 18, further comprising the step of:

transmitting laser light energy through the light pipe at an energy level and for a duration sufficient to form an opening through the vessel wall.

20. The method of claim 19, further comprising the step of:

attaching a graft at the opening in a manner that prevents leakage of blood.

21. The method of claim 20, wherein the graft is a free graft.

22. The method of claim 20, wherein the graft is an attached graft.

23. The method of claim 20, wherein the attaching step further comprises the use of one or more anastomotic devices selected from the group comprising a suture, a staple, a ring, a clip, a sleeve, a stent and a coupler.

24. The method of claim 20, wherein the attaching step further comprises the use of one or more anastomotic agents selected from the group comprising a sealant, a glue and an adhesive.

25. The method of claim 20, wherein the attaching step further comprises the use of a robot.

26. The method of claim 1, further comprising the step of:

forming an opening through the vessel wall.

27. The method of claim 26, further comprising the step of:

attaching a graft at the opening in a manner that prevents leakage of blood.

28. The method of claim 26, further comprising the step of:

passing a guidewire through the opening.

29. The method of claim 28, further comprising the step of:

passing the guidewire into an interior chamber of an organ.

30. The method of claim 29, wherein the organ is a heart.

31. The method of claim 28, further comprising the step of:

passing the guidewire through an intercostal space.

32. The method of claim 1, further comprising the step of:

harvesting the body vessel.

33. The method of claim 32, wherein the harvested body vessel is used in a CABG procedure.

34. The method of claim 1, further comprising the step of:

avoiding the body vessel during a medical procedure.

35. The method of claim 34, wherein the medical procedure is selected from the group comprising cell delivery, gene delivery, drug delivery, lead delivery, and tissue ablation.

36. The method of claim 1, further comprising the steps of:

applying a marker to the determined location; and

marking the body tissue overlying the vessel wall at the determined location with the marker.

37. The method of claim 1, further comprising the steps of:

applying a marker containing marking ink to the determined location; and

dispensing marking ink from the marker onto the body tissue overlying the vessel wall at the determined location.

38. The method of claim 1, wherein:

the step of obtaining surgical access comprises obtaining surgical access to the epicardium of the heart of the patient;

the introducing step comprises introducing the vessel lumen probe having a lumen probe element at or near a vessel lumen probe distal end through the arterial system and into the arterial lumen of a coronary artery; and

the applying step comprises applying the surface probe element sensor over the tissue overlying the epicardium and arterial wall and moving the surface probe element to determine the path of the coronary artery and any obstruction of the coronary artery.

39. A system for identifying an obstruction in and a course of a body vessel in a patient that is hidden from direct view in a surgical field by body tissue overlying a vessel wall of the body vessel surrounding a vessel lumen of the body vessel comprising:

a vessel lumen probe having a lumen probe element at or near a vessel lumen probe distal end adapted to be introduced into the vessel lumen, wherein the lumen probe element is adapted to be positioned adjacent a luminal side of the vessel wall; and

a vessel surface probe having a surface probe element sensor at or near a vessel surface probe distal end adapted to be positioned through an incision in the patient and applied and moved about over the body tissue overlying the vessel wall, the surface probe element sensor adapted to provide a proximity indicating signal indicating the degree of proximity of the surface probe element sensor to the lumen probe element, wherein the course of the body vessel relative to the body tissue overlying the vessel wall is determinable as a function of the relative strength of the signal when the surface probe element sensor is moved over the body tissue overlying the vessel wall relative to the lumen probe element positioned within the vessel lumen, and wherein an obstruction within the body vessel is determinable as a function of the relative strength of the signal when the lumen probe element is moved within the vessel lumen.

40. The system of claim 39, wherein the vessel lumen probe further comprises means for sweeping the lumen probe element around the vessel wall within the vessel lumen while monitoring the indication of proximity.

41. The system of claim 39, wherein the lumen probe element comprises a metallic element and the surface probe element sensor comprises a metal detector coil assembly, and the applying step further comprises:

energizing the metal detector coil assembly to develop a signal responsive to the detection of the metallic element through the vessel wall and body tissue overlying the vessel wall.

42. The system of claim 39, wherein the lumen probe element comprises a lumen probe magnet, and the surface probe element sensor comprises a magnet, the lumen probe magnet and surface probe magnet selected in polarity to enable magnetic attraction of the lumen probe element and lumen probe distal end toward the vessel wall in proximity to the surface probe element.

43. The system of claim 39, wherein the vessel lumen probe comprises an elongated probe body having a probe body lumen extending the length of the probe body to a distal lumen opening, the lumen probe element comprises a lumen probe magnet, and the surface probe element sensor comprises a magnet, the lumen probe magnet and surface probe element sensor selected in polarity to enable magnetic attraction of the lumen probe magnet and lumen probe distal end toward the vessel wall in proximity to the surface probe magnet, the probe body lumen enabling introduction of a device or material to or into the interior vessel wall.

44. The system of claim 43, wherein the probe body is formed of a probe body proximal section joined to a probe body distal section by a joint enabling rotation of the probe body distal section with respect to the probe body proximal section, the lumen probe magnet is mounted to the probe body distal section along one side of the probe body distal section, and the probe lumen distal end opening is substantially aligned to the one side of the probe body distal section, whereby the probe body distal section is rotatable at the joint under the magnetic field attraction of the lumen probe magnet toward the surface probe magnet and the probe lumen distal end opening is directed toward the vessel wall that the one side of the probe body distal section faces.

45. The system of claim 44, further comprising an elongated wire extending between wire proximal and distal ends and sized to fit into and be advanced through the probe body lumen of the probe body proximal and distal sections to locate the wire distal end at or extending through the vessel wall.

46. The system of claim 39, wherein the lumen probe element comprises a magnet, and the surface probe element sensor comprises a magnet, whereby magnetic attraction or repulsion force between the magnets provides the proximity indicating signal.

47. The system of claim 39, wherein the lumen probe element comprises an electrically conductive, vessel probe electrode, and the surface probe element sensor comprises an electrically conductive, surface probe electrode, and further comprising:

means for applying electrical energy between the electrically conductive, vessel probe electrode and the electrically conductive, surface probe electrode; and

means for measuring the impedance between the electrically conductive, vessel probe electrode and the electrically conductive, surface probe electrode to develop an impedance signal related to the proximity of the electrically conductive, vessel probe electrode to the electrically conductive, surface probe electrode.

48. The system of claim 39, wherein:

the surface probe element sensor comprises an electrically conductive, surface probe electrode; and

the vessel lumen probe comprises an elongated probe sheath enclosing a sheath lumen extending from a probe sheath proximal end to a distal lumen opening near a probe sheath distal end and an elongated probe wire sized to fit within the sheath lumen, the probe wire having an electrically conductive, vessel probe electrode adapted to move with respect to the distal lumen opening through manipulation of the probe wire to extend the vessel probe electrode toward the vessel wall;

and further comprising;

means for applying electrical energy between the electrically conductive, vessel probe electrode and the electrically conductive, surface probe electrode; and

means for measuring the impedance between the electrically conductive, vessel probe electrode and the electrically conductive, surface probe electrode to develop an impedance signal related to the proximity of the electrically conductive, vessel probe electrode to the electrically conductive, surface probe electrode.

49. The system of claim 39, wherein:

the vessel lumen probe comprises an elongated light transmitting and emitting light pipe having a light pipe proximal end adapted to be coupled to a light source and a light pipe distal end from which light source light is emitted; and

the surface probe element sensor comprises a photosensor that responds to the frequency of light emitted by the light emitter and transmitted through the vessel wall and body tissue overlying the vessel wall.

50. The system of claim 39, wherein:

the vessel lumen probe comprises;

an elongated probe sheath enclosing a sheath lumen extending from a probe sheath proximal end to a distal lumen opening near a probe sheath distal end; and

an elongated light transmitting and emitting light pipe having a light pipe proximal end adapted to be coupled to a light source and a light pipe distal end from which light source light is emitted, the light transmitting and emitting light pipe sized to be extended through the sheath lumen to dispose the light pipe distal end in proximity with the vessel wall within the vessel lumen; and

the surface probe element sensor comprises a photosensor that responds to the frequency of light emitted from the light pipe distal end and transmitted through the vessel wall and body tissue overlying the vessel wall.

51. The system of claim 39, further comprising a marker adapted to be applied to the body tissue overlying the vessel wall at the determined location to mark the determined location.

52. The system of claim 39, wherein the vessel surface probe further comprises a marker adapted to be applied to the body tissue overlying the vessel wall at the determined location to mark the determined location.

53. The system of claim 39, further comprising a marker containing marking ink adapted to be applied to the body tissue overlying the vessel wall at the determined location to dispense marking ink to mark the determined location.

54. The system of claim 39, wherein the vessel surface probe further comprises a marker containing marking ink adapted to be applied to the body tissue overlying the vessel wall at the determined location to dispense marking ink to mark the determined location.

55. A system for identifying an obstruction in and a course of a coronary artery vessel in a surgical field that is hidden from direct view by epicardial tissue overlying an vessel arterial wall of the coronary artery surrounding an vessel arterial lumen of the coronary artery comprising:

a vessel lumen probe having a lumen probe element at or near a vessel lumen probe distal end adapted to be introduced through an arterial system and into the arterial lumen of the coronary artery, wherein the lumen probe element is adapted to be positioned adjacent a luminal side of the arterial wall; and

a vessel surface probe having a surface probe element sensor adapted to be applied and moved about over the epicardial tissue overlying the arterial wall, the surface probe element sensor adapted to provide a proximity indicating signal indicating the degree of proximity of the surface probe element sensor to the lumen probe element, wherein the course of the coronary artery is determinable as a function of the relative strength of the signal when the surface probe element sensor is moved over the epicardial tissue overlying the arterial wall relative to the lumen probe element positioned within the arterial lumen, and wherein an obstruction within the coronary artery vessel is determinable as a function of the relative strength of the signal when the lumen probe element is moved within the arterial lumen.

56. The system of claim 55, wherein the vessel lumen probe further comprises means for sweeping the lumen probe element around the arterial wall within the coronary artery while monitoring the indication of proximity.

57. The system of claim 55, further comprising a marker adapted to be applied to the tissue overlying the arterial wall at the determined location to mark the determined location.