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WO1998019618A1 - Procedes et dispositif de marquage de structures corporelles tubulaires - Google Patents

Procedes et dispositif de marquage de structures corporelles tubulaires Download PDF

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Publication number
WO1998019618A1
WO1998019618A1 PCT/US1997/019948 US9719948W WO9819618A1 WO 1998019618 A1 WO1998019618 A1 WO 1998019618A1 US 9719948 W US9719948 W US 9719948W WO 9819618 A1 WO9819618 A1 WO 9819618A1
Authority
WO
WIPO (PCT)
Prior art keywords
side wall
conduit
marker
tubular body
patient
Prior art date
Application number
PCT/US1997/019948
Other languages
English (en)
Inventor
Jon Patrick St. Germain
Todd Allen Berg
Original Assignee
Vascular Science Inc.
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Priority claimed from US08/745,618 external-priority patent/US5976178A/en
Priority claimed from US08/958,461 external-priority patent/US6261315B1/en
Application filed by Vascular Science Inc. filed Critical Vascular Science Inc.
Priority to EP97946464A priority Critical patent/EP0996386A1/fr
Priority to JP52165498A priority patent/JP2002501399A/ja
Priority to AU51626/98A priority patent/AU5162698A/en
Publication of WO1998019618A1 publication Critical patent/WO1998019618A1/fr

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/04—Hollow or tubular parts of organs, e.g. bladders, tracheae, bronchi or bile ducts
    • A61F2/06—Blood vessels
    • A61F2/07—Stent-grafts
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/32—Surgical cutting instruments
    • A61B17/3205—Excision instruments
    • A61B17/32056—Surgical snare instruments
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/39—Markers, e.g. radio-opaque or breast lesions markers
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/04—Hollow or tubular parts of organs, e.g. bladders, tracheae, bronchi or bile ducts
    • A61F2/06—Blood vessels
    • A61F2/064—Blood vessels with special features to facilitate anastomotic coupling
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/11—Surgical instruments, devices or methods for performing anastomosis; Buttons for anastomosis
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/00234—Surgical instruments, devices or methods for minimally invasive surgery
    • A61B2017/00292—Surgical instruments, devices or methods for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means
    • A61B2017/003—Steerable
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/11—Surgical instruments, devices or methods for performing anastomosis; Buttons for anastomosis
    • A61B2017/1107—Surgical instruments, devices or methods for performing anastomosis; Buttons for anastomosis for blood vessels
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/11—Surgical instruments, devices or methods for performing anastomosis; Buttons for anastomosis
    • A61B2017/1135—End-to-side connections, e.g. T- or Y-connections
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B2017/2926—Details of heads or jaws
    • A61B2017/2932—Transmission of forces to jaw members
    • A61B2017/2939—Details of linkages or pivot points
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/30—Devices for illuminating a surgical field, the devices having an interrelation with other surgical devices or with a surgical procedure
    • A61B2090/306—Devices for illuminating a surgical field, the devices having an interrelation with other surgical devices or with a surgical procedure using optical fibres
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/36—Image-producing devices or illumination devices not otherwise provided for
    • A61B90/361—Image-producing devices, e.g. surgical cameras
    • A61B2090/3614—Image-producing devices, e.g. surgical cameras using optical fibre
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/82—Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/86—Stents in a form characterised by the wire-like elements; Stents in the form characterised by a net-like or mesh-like structure
    • A61F2/90—Stents in a form characterised by the wire-like elements; Stents in the form characterised by a net-like or mesh-like structure characterised by a net-like or mesh-like structure
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/95—Instruments specially adapted for placement or removal of stents or stent-grafts
    • A61F2/954—Instruments specially adapted for placement or removal of stents or stent-grafts for placing stents or stent-grafts in a bifurcation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/95—Instruments specially adapted for placement or removal of stents or stent-grafts
    • A61F2/958—Inflatable balloons for placing stents or stent-grafts
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/04—Hollow or tubular parts of organs, e.g. bladders, tracheae, bronchi or bile ducts
    • A61F2/06—Blood vessels
    • A61F2002/065—Y-shaped blood vessels
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/82—Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2002/826—Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents more than one stent being applied sequentially
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00—Catheters; Hollow probes
    • A61M25/01—Introducing, guiding, advancing, emplacing or holding catheters
    • A61M25/0105—Steering means as part of the catheter or advancing means; Markers for positioning
    • A61M25/0108—Steering means as part of the catheter or advancing means; Markers for positioning using radio-opaque or ultrasound markers
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00—Catheters; Hollow probes
    • A61M25/01—Introducing, guiding, advancing, emplacing or holding catheters
    • A61M25/02—Holding devices, e.g. on the body
    • A61M25/04—Holding devices, e.g. on the body in the body, e.g. expansible

Definitions

  • This invention relates to treatment of a patient's tubular body structures, and more particularly to facilitating location of treatment sites along such structures.
  • a variety of medical treatments involve needing to know a point along a patient's tubular body structure at which a treatment step is to be performed.
  • a tubular bypass graft may need to be installed in a patient's circulatory system. It may be difficult from outside the circulatory system tissue (and possibly other associated tissue) to find the exact location or locations at which either or both ends of the bypass graft should be attached. For example, one or both of these points may be located remotely and relatively inaccessibly in the patient where it is difficult to see. Alternatively or additionally, at one or both of these points the patient's circulatory system tubing may be surrounded by or embedded in other tissue such as fat or the myocardium. The recent trend toward less invasive treatments may increase the difficulty experienced by the physician in locating the point or points along the patient's body tubing at which treatment steps are to be performed.
  • the marker is preferably placed through the side wall of the tubular body structure from inside that structure.
  • the marker preferably extends out of the side wall of the tubular body structure through any adjacent tissue.
  • the marker may be introduced into the patient through a catheter or catheter-like instrumentation that has been inserted longitudinally into the patient along lumens of the patient's tubular body structure.
  • the catheter or catheter-like apparatus may include a distal portion for deflecting a distal portion of the marker structure laterally toward the side wall of the tubular body structure where the marker is to pass through that side wall.
  • the marker is preferably small in cross section and sharply pointed so that it can pass through the side wall tissue but without making a large hole that will leak or be slow to heal if necessary.
  • the marker is preferably adapted for good visibility by whatever means are employed to observe it.
  • the marker may be made radio-opaque for good radiologic (e.g., X-ray or fluoroscopic) observation.
  • the marker may be brightly colored or fluorescent, or may even include a visible light source (e.g., via fiber optics) to facilitate visual detection of the marker.
  • the marker may always remain attached to instrumentation that extends proximally out of the patient so that the marker can be removed from the patient at any time.
  • the marker may be selectively detachable from the instrumentation that is used to install it so that the marker can be left in place in the patient for subsequent use after the instrumentation that was used to install it has been removed from the patient.
  • markers of this invention is as an anchor or stabilizer for other apparatus to be used in treating the patient. Further features of the invention, its nature and various advantages will be more apparent from the accompanying drawings and the following detailed description of the preferred embodiments .
  • FIG. 1 is a simplified sectional view showing an early stage in an illustrative procedure in accordance with this invention. Illustrative apparatus usable in accordance with the invention is shown in FIG. 1.
  • FIG. 2 is another view similar to FIG. 1 showing a later stage in use of the illustrative procedure and apparatus in accordance with the invention .
  • FIG. 3 is another view similar to FIG. 1 showing a still later stage in use of the illustrative procedure and apparatus in accordance with the invention .
  • FIG. 4 is still another view similar to FIG. 1 showing a yet later stage in use of the illustrative procedure and apparatus in accordance with the invention.
  • FIG. 5 is a simplified sectional view of typical body tissue structures that are treatable in accordance with the invention.
  • FIG. 6 is another view similar to FIG. 5 showing other typical body tissue structures that are treatable in accordance with the invention.
  • FIG. 7 is another view similar to FIGS. 5 and 6 showing still other typical body tissue structures that are treatable in accordance with the invention.
  • FIG. 8 is a simplified elevational view of representative portions of an illustrative embodiment of apparatus in accordance with the invention.
  • FIG. 9 is another view similar to FIG. 4 showing another illustrative embodiment of the invention .
  • FIG. 10 is still another view somewhat similar to FIG. 9 showing another illustrative use of the invention.
  • FIG. 11 is another view similar to FIG. 10 showing additional possible uses and apparatus in accordance with this invention.
  • connection may include a need to make a connection to the side wall of a patient's tubular body conduit from the outside of that conduit.
  • the conduit is a blood vessel.
  • this connection must generally be made at a particular point along the tubular conduit (e.g., just downstream from a blockage in that conduit) and under conditions of limited visibility (e.g., because the procedure is being performed remotely inside a patient whose body has not been opened surgically) .
  • Still another difficulty may be the presence of other tissues (e.g., the myocardium or fat) covering the point at which it is desired to make the connection to the tubular conduit.
  • FIG. 1 it is desired to make a connection to the side wall of coronary artery 20 at location 24 which is downstream from blockage 22 in that artery.
  • FIG. 1 suggests that the side wall of artery 20 may be quite exposed on the outside of the heart, the artery may in fact be partly or wholly embedded in other tissue such as the myocardium 16 as shown in FIGS. 5 and 6, or the vessel may be obscured by fat 18 which is on or around the heart as shown in FIG. 7.
  • a guide structure 50 is first inserted into and along lumens of the patient's circulatory system from a remote location such as a femoral (leg) artery of the patient.
  • the distal portion of guide structure 50 (which includes distal spring coil 52 and distal-most tip 54) is inserted along the circulatory system lumens until it enters coronary artery 20, passes through obstruction 22, and extends approximately to or beyond location 24.
  • Guide structure 50 may be similar to guide structures (“guide wires") that are conventionally used to guide angioplasty balloon catheters or other similar apparatus into a patient's circulatory system tubing.
  • Guide structure 50 or key portions thereof may be radiologically viewable to facilitate radiologic observation of the progress of structure 50 into the patient and/or the final positioning of structure 50 in the patient.
  • tubular structure 60 is inserted into the patient along and around guide structure 50 until a distal portion of structure 60 is adjacent to location 24 as shown in FIG. 2.
  • Tubular structure 60 may be a catheter or catheter-like structure, and for convenience may be sometimes referred to herein as a catheter.
  • Structure 60 may be wholly or partly radiologically viewable for purposes similar to the above-described radiologic viewability of structure 50.
  • structure 60 may be usable to convey and release radiologically (e.g., fluoroscopically) viewable liquid, again for purposes similar to the above- described radiologic viewability of structure 50.
  • guide structure 50 may be proximally withdrawn from catheter 60 and from the patient.
  • the distal portion 62 of catheter 60 may then be arcuately deflected toward the side wall of artery 20 at location 24 as shown in FIG. 3. It will be understood that this deflection of distal portion 62 is transverse to the longitudinal axis of artery 20. Any of several techniques may be used to produce this transverse, arcuate deflection.
  • distal portion 62 may be resiliently biased to deflect as shown in FIG. 3 and may be prevented from doing so as long as guide structure 50 is disposed in structure 60. As soon as guide structure 50 is withdrawn, however, distal portion 62 automatically curves to one side as shown in FIG. 3.
  • distal portion 62 may be deflected to one side by one or more pull wires disposed in or on the wall of structure 60.
  • technology of the type shown in Bachinski et al . U.S. patent application No.
  • Catheter 60 may include a structure for selectively occluding vessel 20 to control blood flow along the vessel.
  • a selectively inflatable balloon may be provided around the outside of catheter 60 for stopping blood flow along vessel 20 when the balloon is inflated.
  • the construction of the catheter shaft can include a polytetrafluoroethylene inner liner for optimal wire movement, and an internal braid for torque control and push strength.
  • Catheter 60 may also contain a proximal curve, which matches the curvature of the heart, to orientate the catheter deflection perpendicular to the heart wall.
  • catheter 60 may be made with a relatively small cross section and may in that case be referred to as a micro-catheter.
  • distal portion 62 of structure 60 When the distal portion 62 of structure 60 is properly curved toward the inner surface of the side wall of coronary artery 20 at location 24 as shown in FIG. 3, elongated marker structure 70 is inserted into and along structure 60 as shown in FIG. 4.
  • Distal portion 62 of structure 60 guides the distal portion 72 of marker structure 70 toward the inner surface of the coronary artery side wall.
  • the distal portion 72 of structure 70 is preferably sharply pointed and relatively slender so that it can be easily pushed through the side wall of the coronary artery and any adjacent tissue (e.g., tissue 16 and/or 18 (FIGS. 5-7)) as shown in FIG. 4.
  • Emergence of the distal portion 72 of structure 70 from artery 20 and any adjacent tissue 16 and/or 18 clearly marks location 24 from the outside of artery 20 and adjacent tissue. (See the paragraphs after the next one for features that enhance the findability of distal portion 72.) Because it is relatively easy for the physician to find projecting distal portion 72, it is correspondingly easy for the physician to find the location 24 at which artery 20 requires treatment (e.g., attachment of an end of a bypass conduit for supplying additional blood flow to artery 20 downstream from obstruction 22) . After marker structure 70 is in place in the patient as shown in FIG. 4, catheter 60 may be proximally withdrawn from the patient if it is not needed for some other purpose.
  • marker structure 70 is shown in more detail in FIG. 8.
  • structure 70 is basically a wire, e.g., of stainless steel or nitinol which may be coated with polytetrafluoroethylene to facilitate sliding relative to catheter 60.
  • the proximal portion 70a of structure 70 may have a relatively large cross section to facilitate pushing the structure from a location which is outside the patient (e.g., adjacent a femoral artery entry point of structures 60 and 70) .
  • proximal portion 70a may have a diameter of about 0.013 inches.
  • Medial portion 70b may taper in the distal direction from this relatively large diameter to the smaller diameter of distal-most portion 70c.
  • portion 70c may be about 0.005 inches, and portion 70b may be about 10 cm in length.
  • Distal-most portion 70c may be about 6 cm in length.
  • Distal-most portion 70c is preferably radiologically viewable (e.g., radio-opaque) to facilitate proper placement and subsequent detection with the aid of radiology (e.g., fluoroscopy) .
  • radiologically viewable e.g., radio-opaque
  • the radiologic viewability of distal-most portion 70c may be enhanced by coating or joining it with gold, platinum, or silver.
  • distal portion 72 is preferably sharply pointed to facilitate tissue penetration.
  • marker structure 70 helps the hole made by structure 70 in the wall of coronary artery 20 self-seal and heal when structure 70 is removed from the patient.
  • marker structure 70, and especially distal portion 72 is also visually viewable; and its visibility may be enhanced by using a bright or even fluorescent color on it.
  • marker structure 70 may carry one or more optical fibers for conveying light from a source outside the patient to the vicinity of distal portion 72, where the light is emitted to facilitate visual detection of the marker. This possibility is illustrated by FIG. 10 in which an optical fiber 80 is shown extending along marker structure 70 and emitting light 82. Optical fiber light can of course also be used in applications like those illustrated by FIG. 4.
  • FIG. 4 shows a marker structure 70 that extends all the way from location 24 proximally out of the patient at the location at which catheter 60 is introduced into the patient.
  • FIG. 9 A possible alternative to this type of construction is shown in FIG. 9.
  • a distal portion 72' of marker structure 70 is selectively detachable from a proximal remainder of that structure (not shown in FIG. 9, but similar to the proximal portion of structure 70 shown in FIG. 4) .
  • a proximal remainder of that structure not shown in FIG. 9, but similar to the proximal portion of structure 70 shown in FIG. 4 .
  • the remainder of the apparatus can be completely withdrawn from the patient. Only portion 72' remains in the patient while the patient waits for the further treatment that will make use of the location marking provided by portion 72 ' .
  • marker portion 72' may be placed in the patient during an angiogram and left in position as shown in FIG. 9 until the patient's surgery takes place.
  • Marker portion 72' may be removably attached to the remainder of marker structure 70 by any suitable means.
  • marker portion 72' may be removably attached by a remotely controlled clamp or collet on the distal end of the remainder of marker structure 70.
  • FIGS. 4 and 9 show marker structure 70 being used to mark a location 24 that is spaced downstream from obstruction 22.
  • marked location 24 may be the site intended for an anastomosis connection of an end of a bypass graft to artery 20.
  • marker structure 70 can be alternatively used to mark a location upstream from obstruction 22, or to mark the location of obstruction 22 itself (i.e., by passing distal portion 72/72' out through the side wall of obstruction 22 and the adjacent side wall of artery 20) .
  • FIG. 10 shows marker structure 70 being used to mark a location 24' which is upstream from a total occlusion 22' of artery 20. In cases of total occlusion it is difficult to access the downstream side of the occlusion.
  • a marker 72 just proximal to the lesion can be helpful (e.g., to give the physician a reference point to compare to previously taken angiograms).
  • the markers of this invention can be helpful in many types of further procedures, ranging from open body surgery to laparoscopy and ultimately to minimally invasive techniques such as are described in the first three references mentioned above.
  • this marking may be detectable visibly, radiologically, or both.
  • the marker may be removed from the patient (e.g., by pulling it proximally out of the patient via its point of entry into the patient) .
  • FIG. 11 illustrates another possible use of a marker in accordance with this invention.
  • marker 70 is additionally used as a locator and anchor for additional instrumentation 100 that is brought up to the outside of vessel 20 after the distal portion 72 of the marker has been extended out through the side wall of the vessel.
  • Instrumentation 100 includes a catheter 110 from which snare 120 and cannula 130 are selectively extendable.
  • Snare 120 is used to snare (grip) the distal portion 72 of marker 70, thereby anchoring the distal portion of catheter 110 relative to the location along vessel 20 at which portion 72 emerges from that vessel. For example, this may be just upstream from total occlusion 22' in vessel 20.
  • cannula 130 is extended distally from the distal end of catheter 110 so that the cannula pierces the side wall of vessel 20 just downstream from total occlusion 22'.
  • Another elongated structure 140 may then be extended distally from the distal end of cannular 130 so that the distal portion of structure 140 continues down along vessel 20 downstream from occlusion 22'.
  • Elongated structure 140 e.g., a wire
  • Instrumentation 100 may be brought to the position shown in FIG. 11 either via a surgical opening of the patient or percutaneously (e.g., laparoscopically or intraluminally) .
  • elongated structure 140 may include a distal-most portion 142 which is adapted for temporarily securing the distal end of structure 140 in vessel 20.
  • distal-most portion 142 may be a spring coil, a resilient braid (e.g., of nitinol wire strands), an inflatable balloon, or the like.
  • the portion 144 of structure 140 just proximal to distal-most portion 142 may be relatively flexible to facilitate following any curvature of the portion of vessel 20 into which structure 140 is inserted.
  • the still more proximal portion 146 of structure 140 which extends to vessel 20 may be relatively stiff to help provide a stable guideway along which a graft conduit can be delivered to vessel 20.
  • elongated structure 140 positioned as shown in FIG. 11, may be used during graft delivery. All of elements 60, 70, 110, and 120 may therefore be removed or at least retracted prior to delivery of the graft conduit along structure 140.
  • marker structure 70 is only illustrative, and other dimensions and materials can be used if desired.
  • the above-described use of the invention in connection with procedures involving a coronary artery is only illustrative, and that the invention can be used at any other suitable locations in a patient's circulatory system or other tubular body structures.
  • use of the invention as an aid to subsequent bypass graft procedures is only illustrative, and the invention is equally applicable as a preliminary to many other types of patient treatments .

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Abstract

Afin de faciliter un emplacement subséquent d'un point, le long d'une structure corporelle tubulaire d'un patient (par exemple un vaisseau du système circulatoire), on insère un dispositif de marquage dans une lumière de cette structure et le long de celle-ci. Au niveau du point recherché le long de cette lumière, on fait sortir une portion distale du dispositif de marquage, à travers une paroi latérale de ladite structure, de façon à ce que cette portion saille de ladite paroi et marque de façon visible et/ou radiologique le point recherché le long de la structure tubulaire. On peut également utiliser le dispositif de marquage en tant qu'élément d'ancrage destiné à un autre instrument apporté sur l'extérieur de la structure corporelle tubulaire (par exemple en vue d'une utilisation, lors d'un traitement ultérieur de la structure corporelle tubulaire).
PCT/US1997/019948 1996-11-07 1997-11-05 Procedes et dispositif de marquage de structures corporelles tubulaires WO1998019618A1 (fr)

Priority Applications (3)

Application Number Priority Date Filing Date Title
EP97946464A EP0996386A1 (fr) 1996-11-07 1997-11-05 Procedes et dispositif de marquage de structures corporelles tubulaires
JP52165498A JP2002501399A (ja) 1996-11-07 1997-11-05 管状肉体構造マーキング方法および装置
AU51626/98A AU5162698A (en) 1996-11-07 1997-11-05 Tubular body structure marking methods and apparatus

Applications Claiming Priority (4)

Application Number Priority Date Filing Date Title
US08/745,618 US5976178A (en) 1996-11-07 1996-11-07 Medical grafting methods
US08/745,618 1997-04-23
US08/958,461 US6261315B1 (en) 1997-10-28 1997-10-28 Tubular body structure marking methods and apparatus
US08/958,461 1997-10-28

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Cited By (27)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5989276A (en) * 1996-11-08 1999-11-23 Advanced Bypass Technologies, Inc. Percutaneous bypass graft and securing system
WO2000027312A1 (fr) * 1998-11-06 2000-05-18 St. Jude Medical Cardiovascular Group, Inc. Appareil de revascularisation tres peu invasif et procedes
US6110188A (en) * 1998-03-09 2000-08-29 Corvascular, Inc. Anastomosis method
US6149681A (en) * 1996-09-20 2000-11-21 Converge Medical, Inc. Radially expanding prostheses and systems for their deployment
US6241741B1 (en) 1998-03-09 2001-06-05 Corvascular Surgical Systems, Inc. Anastomosis device and method
US6283951B1 (en) 1996-10-11 2001-09-04 Transvascular, Inc. Systems and methods for delivering drugs to selected locations within the body
US6379319B1 (en) 1996-10-11 2002-04-30 Transvascular, Inc. Systems and methods for directing and snaring guidewires
US6554764B1 (en) 2000-11-13 2003-04-29 Cardica, Inc. Graft vessel preparation device and methods for using the same
US6746464B1 (en) 1995-10-13 2004-06-08 Transvascular, Inc. Device, system and method for interstitial transvascular intervention
US6843795B1 (en) 1998-06-10 2005-01-18 Converge Medical, Inc. Anastomotic connector for sutureless anastomosis systems
US6858035B2 (en) 2001-07-05 2005-02-22 Converge Medical, Inc. Distal anastomosis system
US6893449B2 (en) 1999-05-18 2005-05-17 Cardica, Inc. Device for cutting and anastomosing tissue
US6920882B2 (en) 1998-11-06 2005-07-26 St. Jude Medical Atg, Inc. Medical grafting methods and apparatus
US6962595B1 (en) 2002-01-22 2005-11-08 Cardica, Inc. Integrated anastomosis system
US6966917B1 (en) 2000-11-09 2005-11-22 Innovation Interventional Technologies B.V. Deformable connector for mechanically connecting hollow structures
US6972023B2 (en) 2001-07-05 2005-12-06 Converge Medical, Inc. Distal anastomosis system
US7004949B2 (en) 1998-08-12 2006-02-28 Cardica, Inc. Method and system for attaching a graft to a blood vessel
US7018388B2 (en) 1998-08-12 2006-03-28 Cardica, Inc. Method and system for attaching a graft to a blood vessel
US7022127B2 (en) 1997-10-24 2006-04-04 Innovative Interventional Technologies Bv Mechanical anastomosis system for hollow structures
US7048751B2 (en) 2001-12-06 2006-05-23 Cardica, Inc. Implantable medical device such as an anastomosis device
US7105002B2 (en) 1998-03-09 2006-09-12 Ethicon, Inc. Anastomosis device and method
US7128749B1 (en) 1999-05-18 2006-10-31 Cardica, Inc. Sutureless closure and deployment system for connecting blood vessels
US7144405B2 (en) 1999-05-18 2006-12-05 Cardica, Inc. Tissue punch
US7223274B2 (en) 2002-01-23 2007-05-29 Cardica, Inc. Method of performing anastomosis
US7303569B2 (en) 2000-10-12 2007-12-04 Cardica, Inc. Implantable superelastic anastomosis device
US7335216B2 (en) 2002-01-22 2008-02-26 Cardica, Inc. Tool for creating an opening in tissue
US7585306B2 (en) 2003-12-24 2009-09-08 Maquet Cardiovascular Llc Anastomosis device, tools and methods of using

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Publication number Priority date Publication date Assignee Title
US4202349A (en) * 1978-04-24 1980-05-13 Jones James W Radiopaque vessel markers
EP0393972A1 (fr) * 1989-04-15 1990-10-24 Robert Graham Urie Dispositif pour localiser une lésion
EP0416793A1 (fr) * 1989-08-30 1991-03-13 Angeion Corporation Cathéter
DE4235506A1 (de) * 1992-10-21 1994-04-28 Bavaria Med Tech Katheter zur Injektion von Arzneimitteln
WO1996032892A1 (fr) * 1995-04-17 1996-10-24 Hussman Karl L Fibres optiques servant a la localisation

Patent Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US4202349A (en) * 1978-04-24 1980-05-13 Jones James W Radiopaque vessel markers
EP0393972A1 (fr) * 1989-04-15 1990-10-24 Robert Graham Urie Dispositif pour localiser une lésion
EP0416793A1 (fr) * 1989-08-30 1991-03-13 Angeion Corporation Cathéter
DE4235506A1 (de) * 1992-10-21 1994-04-28 Bavaria Med Tech Katheter zur Injektion von Arzneimitteln
WO1996032892A1 (fr) * 1995-04-17 1996-10-24 Hussman Karl L Fibres optiques servant a la localisation

Cited By (42)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US6746464B1 (en) 1995-10-13 2004-06-08 Transvascular, Inc. Device, system and method for interstitial transvascular intervention
US7846172B2 (en) 1995-10-13 2010-12-07 Medtronic Vascular, Inc. Device, system and method for interstitial transvascular intervention
US6149681A (en) * 1996-09-20 2000-11-21 Converge Medical, Inc. Radially expanding prostheses and systems for their deployment
US6379319B1 (en) 1996-10-11 2002-04-30 Transvascular, Inc. Systems and methods for directing and snaring guidewires
US7316655B2 (en) 1996-10-11 2008-01-08 Medtronic Vascular, Inc. Systems and methods for directing and snaring guidewires
US6283951B1 (en) 1996-10-11 2001-09-04 Transvascular, Inc. Systems and methods for delivering drugs to selected locations within the body
US7083631B2 (en) 1996-11-08 2006-08-01 Converge Medical, Inc. Percutaneous bypass graft and securing system
US5989276A (en) * 1996-11-08 1999-11-23 Advanced Bypass Technologies, Inc. Percutaneous bypass graft and securing system
US7022127B2 (en) 1997-10-24 2006-04-04 Innovative Interventional Technologies Bv Mechanical anastomosis system for hollow structures
US7105002B2 (en) 1998-03-09 2006-09-12 Ethicon, Inc. Anastomosis device and method
US6110188A (en) * 1998-03-09 2000-08-29 Corvascular, Inc. Anastomosis method
US6241741B1 (en) 1998-03-09 2001-06-05 Corvascular Surgical Systems, Inc. Anastomosis device and method
US6843795B1 (en) 1998-06-10 2005-01-18 Converge Medical, Inc. Anastomotic connector for sutureless anastomosis systems
US7041110B2 (en) 1998-08-12 2006-05-09 Cardica, Inc. Method and system for attaching a graft to a blood vessel
US7108702B2 (en) 1998-08-12 2006-09-19 Cardica, Inc. Anastomosis device having at least one frangible member
US7004949B2 (en) 1998-08-12 2006-02-28 Cardica, Inc. Method and system for attaching a graft to a blood vessel
US7018388B2 (en) 1998-08-12 2006-03-28 Cardica, Inc. Method and system for attaching a graft to a blood vessel
US6920882B2 (en) 1998-11-06 2005-07-26 St. Jude Medical Atg, Inc. Medical grafting methods and apparatus
EP1547533A3 (fr) * 1998-11-06 2006-04-26 St. Jude Medical ATG, Inc. Appareil de révasculatisation très peu invasif.
WO2000027312A1 (fr) * 1998-11-06 2000-05-18 St. Jude Medical Cardiovascular Group, Inc. Appareil de revascularisation tres peu invasif et procedes
US7175637B2 (en) 1999-05-18 2007-02-13 Cardica, Inc. Sutureless closure and deployment system for connecting blood vessels
US7357807B2 (en) 1999-05-18 2008-04-15 Cardica, Inc. Integrated anastomosis tool with graft vessel attachment device and cutting device
US7611523B2 (en) 1999-05-18 2009-11-03 Cardica, Inc. Method for sutureless connection of vessels
US7468066B2 (en) 1999-05-18 2008-12-23 Cardica, Inc. Trocar for use in deploying an anastomosis device and method of performing anastomosis
US7309343B2 (en) 1999-05-18 2007-12-18 Cardica, Inc. Method for cutting tissue
US7172608B2 (en) 1999-05-18 2007-02-06 Cardica, Inc. Sutureless closure and deployment system for connecting blood vessels
US6893449B2 (en) 1999-05-18 2005-05-17 Cardica, Inc. Device for cutting and anastomosing tissue
US7128749B1 (en) 1999-05-18 2006-10-31 Cardica, Inc. Sutureless closure and deployment system for connecting blood vessels
US7144405B2 (en) 1999-05-18 2006-12-05 Cardica, Inc. Tissue punch
US7303569B2 (en) 2000-10-12 2007-12-04 Cardica, Inc. Implantable superelastic anastomosis device
US6966917B1 (en) 2000-11-09 2005-11-22 Innovation Interventional Technologies B.V. Deformable connector for mechanically connecting hollow structures
US6554764B1 (en) 2000-11-13 2003-04-29 Cardica, Inc. Graft vessel preparation device and methods for using the same
US6786862B2 (en) 2000-11-13 2004-09-07 Cardica, Inc. Graft vessel preparation device and methods for using the same
US6972023B2 (en) 2001-07-05 2005-12-06 Converge Medical, Inc. Distal anastomosis system
US6858035B2 (en) 2001-07-05 2005-02-22 Converge Medical, Inc. Distal anastomosis system
US7048751B2 (en) 2001-12-06 2006-05-23 Cardica, Inc. Implantable medical device such as an anastomosis device
US7029482B1 (en) 2002-01-22 2006-04-18 Cardica, Inc. Integrated anastomosis system
US7455677B2 (en) 2002-01-22 2008-11-25 Cardica, Inc. Anastomosis device having a deployable section
US6962595B1 (en) 2002-01-22 2005-11-08 Cardica, Inc. Integrated anastomosis system
US7335216B2 (en) 2002-01-22 2008-02-26 Cardica, Inc. Tool for creating an opening in tissue
US7223274B2 (en) 2002-01-23 2007-05-29 Cardica, Inc. Method of performing anastomosis
US7585306B2 (en) 2003-12-24 2009-09-08 Maquet Cardiovascular Llc Anastomosis device, tools and methods of using

Also Published As

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JP2002501399A (ja) 2002-01-15
AU5162698A (en) 1998-05-29

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