Tissue opening locator and everter and method

• US 6,964,675 B2
• Filed: 08/13/2001
• Issued: 11/15/2005
• Est. Priority Date: 12/07/1995
• Status: Expired due to Fees

• Current Assignee: LOMA Linda University Medical Center (Mission Healthcare Services LLC)
• Original Assignee: LOMA Linda University Medical Center (Mission Healthcare Services LLC)
• Inventors: Zhu, Yong Hua, Kirsch, Wolff M.
• Primary Examiner(s): Jackson, Gary
• Application Number:
  US09/929,700
• Publication Number:
  US 20010053922A1
• Time in Patent Office: 1,555 Days
• Field of Search: 606/213, 606/108, 600/201
• US Class Current: 606/213
• CPC Class Codes: A61B 17/0057 Implements for plugging an opening in the wall of a hollow or tubular organ, e.g. for sealing a vessel puncture or closing a cardiac septal defect sutures A61B17/04; closing rectum or urethra near body surface A61F2/0009
• CPC Class Codes: A61B 17/02 for holding wounds open; Tractors specula A61B1/32 ; drainage appliances for wounds A61M27/00
• CPC Class Codes: A61B 17/0206 with antagonistic arms as supports for retractor elements
• CPC Class Codes: A61B 17/0682 for applying U-shaped staples or clamps, e.g. without a forming anvil
• CPC Class Codes: A61B 17/08 Wound clamps or clips, i.e. not or only partly penetrating the tissue suture bridges A61B17/0466; Devices for bringing together the edges of a wound
• CPC Class Codes: A61B 17/10 for applying or removing wound clamps, e.g. containing only one clamp or staple A61B17/076 takes precedence; containing multiple wound clamps A61B17/068; Wound clamp magazines containers, packaging elements or packages specially adapted for particular articles or with special means for dispensing contents B65D83/00, B65D85/00
• CPC Class Codes: A61B 17/122 Clamps or clips , e.g. for the umbilical cord for the vas deferens A61F6/206
• CPC Class Codes: A61B 17/128 for applying or removing clamps or clips
• CPC Class Codes: A61B 17/3439 with means for changing the inner diameter of the cannula, e.g. expandable A61B17/3423, A61B17/3431 take precedence; catheters A61M25/0662
• CPC Class Codes: A61B 2017/306 holding by means of suction
• CPC Class Codes: B29K 2067/003 PET, i.e. poylethylene terephthalate

Abstract

An apparatus for facilitating the locating, everting, and closing of an opening in a blood vessel. The apparatus can include a closure instrument having an elongated member defining a longitudinal axis and proximal and distal ends. The elongated member has a vacuum lumen extending at least a portion of the length thereof for conveying a vacuum and terminating in a vacuum port adjacent the distal end of the elongated member. The distal end of the elongated member is dimensioned to be positioned proximal a vessel opening in a blood vessel whereby vessel edge portions defining the vessel opening are at least partially drawn toward the vacuum port in response to a vacuum conveyed through the vacuum lumen. At least one surgical clip is mounted adjacent the distal end of the elongated member and is adapted to be formed to an at least partially formed condition thereof. The one clip is positioned with respect to the vacuum port so as to engage the vessel edge portions drawn toward the vacuum port when the clip is moved to the formed condition, thus at least partially closing the vessel opening. A method for locating, everting, and closing an opening in a blood vessel is also disclosed.

Claims

1. A device for precisely locating a wound in a blood vessel, comprising:

an elongate tube having a proximal end, a distal end, and an elongate lumen, the tube being configured to slidably accommodate a guidewire therewithin; and

at least two indicator holes through an outer wall of the tube and communicating with the lumen, a distance between the distal end and each of the indicator holes being substantially the same.

2. The device of claim 1, wherein a guide point is defined on the tube proximal of the indicator holes a distance at least equal to a thickness of a blood vessel wall.

3. The device of claim 2, wherein the distance is at least about 0.5 mm.

4. The device of claim 2, wherein the distance is slightly larger than a thickness of a human femoral artery wall.

5. The device of claim 2 additionally comprising a source of suction communicating with the lumen.

6. The device of claim 5, wherein the tube comprises a substantially transparent portion configured to enable a clinician to identify fluid being sucked through the lumen.

7. The device of claim 5 additionally comprising a retractor having at least two elongate retractor members, each of the members having a distal end.

8. The device of claim 7, wherein the retractor members are releasably mounted onto the tube so that the distal ends of the refractor members are positioned at the guide point.

9. The device of claim 1, wherein a main body of the elongate tube is defined proximal the indicator holes, and the tube tapers from the distal end to a point generally adjacent the indicator holes so that a raised portion is formed generally around the indicator holes, the tube having a greater diameter in the raised portion than in the main body.

10. The device of claim 9, wherein a guide point is defined on the tube proximal of the indicator holes a distance at least equal to a thickness of a blood vessel wall, and the guide point is disposed proximal of a proximal end of the raised portion.

11. The device of claim 1, wherein the lumen concentrically surrounds a guidewire lumen, the guidewire lumen communicating with a distal opening formed along a longitudinal axis of the tube and being adapted to slidably accommodate a guidewire threaded therethrough.

12. A device for locating a vascular wound, comprising:

a retractor comprising two elongate members adapted to move relative to each other between open and closed positions, each member having a distal end and a proximal end, and the members are adapted to define a longitudinal channel therebetween when in the closed position; and

a catheter comprising;

a lumen connected to a source of negative pressure;

an opening formed through an outer wall of the catheter and communicating with the lumen; and

a guide point defined on an outer surface of the catheter proximal of the opening, a longitudinal distance between the opening and the guide point being at least the same as the thickness of a vascular vessel wall;

wherein the distal ends of the retractor members are positioned at or adjacent the guide point.

13. A device as in claim 12, wherein the guide point comprises a notch formed in the catheter.

14. A device as in claim 12, wherein the catheter has a distal opening and a proximal opening, and the catheter is adapted to slidably receive a guidewire through the distal and proximal openings.

15. A device as in claim 12, wherein the catheter comprises a first lumen and a second lumen, the first lumen being adapted to slidably accommodate a guidewire therethrough, the second lumen concentrically surrounding the first lumen, communicating with the opening, and being connected to the source of negative pressure.

16. A device as in claim 15, wherein the longitudinal distance between the guide point and the opening is slightly greater than a wall thickness of a human femoral artery.

17. A device as in claim 12, wherein the distance is at least about 0.5 mm.

18. A device as in claim 17 additionally comprising a raised portion of the catheter surrounding the opening, the catheter having a greater diameter in the raised portion than in adjoining portions of the catheter.

19. A device as in claim 18, wherein the guide point is positioned proximal of a proximal end of the raised portion.

20. A device as in claim 19, wherein the guide point is at least about 0.5 mm proximal the proximal end of the raised portion.

21. A device as in claim 17 further comprising a second opening through the catheter outer wall, the second opening located substantially the same distance from the catheter distal end as the first opening.

22. A device as in claim 17, wherein the refractor additionally comprises a handle portion operatively connected to the movable members.

23. A device as in claim 22, wherein the channel extends the entire length of the movable members.

24. A device as in claim 22, wherein the handle portion comprises two handles and a locking mechanism, and the handles are operatively connected at a hinge.

25. A device as in claim 24, wherein the handles and hinge are adapted so that squeezing the handles together moves the movable retractor members apart from each other.

26. A device as in claim 25, wherein the handles are biased apart from each other.

27. A device as in claim 24, wherein the locking mechanism comprises a toothed arcuate stop member extending from a first handle and a release member extending from a second handle, and the release member includes a stop adapted to releasably engage the stop member teeth.