WO2002047561A1 - Method and apparatus for forming apertures in blood vessels - Google Patents
Method and apparatus for forming apertures in blood vessels Download PDFInfo
- Publication number
- WO2002047561A1 WO2002047561A1 PCT/IL2001/000600 IL0100600W WO0247561A1 WO 2002047561 A1 WO2002047561 A1 WO 2002047561A1 IL 0100600 W IL0100600 W IL 0100600W WO 0247561 A1 WO0247561 A1 WO 0247561A1
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- WIPO (PCT)
- Prior art keywords
- blood vessel
- base section
- head
- cutting
- anvil
- Prior art date
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Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets 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, e.g. tourniquets
- A61B17/064—Surgical staples, i.e. penetrating the tissue
- A61B17/0644—Surgical staples, i.e. penetrating the tissue penetrating the tissue, deformable to closed position
-
- 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, e.g. tourniquets
- A61B17/0057—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
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/064—Surgical staples, i.e. penetrating the tissue
- A61B17/0643—Surgical staples, i.e. penetrating the tissue with separate closing member, e.g. for interlocking with staple
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
- A61B17/115—Staplers for performing anastomosis in a single operation
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/32—Surgical cutting instruments
- A61B17/3205—Excision instruments
- A61B17/32053—Punch like cutting instruments, e.g. using a cylindrical or oval knife
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/34—Trocars; Puncturing needles
- A61B17/3417—Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating
- A61B17/3421—Cannulas
- A61B17/3439—Cannulas with means for changing the inner diameter of the cannula, e.g. expandable
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/34—Trocars; Puncturing needles
- A61B17/3468—Trocars; Puncturing needles for implanting or removing devices, e.g. prostheses, implants, seeds, wires
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/34—Trocars; Puncturing needles
- A61B17/3494—Trocars; Puncturing needles with safety means for protection against accidental cutting or pricking, e.g. limiting insertion depth, pressure sensors
- A61B17/3496—Protecting sleeves or inner probes; Retractable tips
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
- A61B2017/00238—Type of minimally invasive operation
- A61B2017/00243—Type of minimally invasive operation cardiac
- A61B2017/00247—Making holes in the wall of the heart, e.g. laser Myocardial revascularization
- A61B2017/00252—Making holes in the wall of the heart, e.g. laser Myocardial revascularization for by-pass connections, i.e. connections from heart chamber to blood vessel or from blood vessel to blood vessel
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
- A61B2017/1107—Surgical instruments, devices or methods, e.g. tourniquets 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, e.g. tourniquets
- A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
- A61B2017/1135—End-to-side connections, e.g. T- or Y-connections
Definitions
- the present invention relates to punches and similar devices for forming openings in blood vessels.
- BACKGROUND Holes are formed in blood vessels for various reasons, principal among which are (a) for insertion of a tube (and later removing the tube sealing the hole); and (b) forming an anastomosis connection between a graft and the blood vessel.
- An object of some embodiments of the invention relates to methods for forming holes in blood vessels, which methods avoid artifacts (e.g., vessel damage) caused by the hole formation.
- Other embodiments possibly provide alternative or additional benefits.
- a hole former includes a penetration tip which optionally retracts after the tip is inserted through a blood vessel wall, a penetration head that passes through the wall and a base that does not pass through the wall.
- a cutting lip is provided on the base and/or on the penetration head, to cut the vessel wall.
- a shearing action is provided by the base and the head sliding by each other.
- anvil cutting action is provided by locating tissue between an anvil and a cutting edge.
- the head is retracted towards the base to effect the cutting of a blood vessel from inside of the blood vessel.
- An aspect of some embodiments of the invention relates to a retracting hole former, in which the penetration head includes a cuttmg lip and the head rotates as it is retracted towards a base.
- the base rotates, h an exemplary embodiment of the invention, the cutting lip fits inside the base. Alternatively, the cutting lip fits against the base.
- An aspect of some embodiments of the invention relates to a hole former including a receptacle in a distal end of a penetration head for receiving a tissue plug being removed from a vessel wall during the formation of a hole in the vessel wall.
- the receptacle is formed by a cutting lip formed on said penetration head.
- a cutting lip is formed on a base portion of said hole former.
- the cuttmg lip (one or both, if two) can be of various designs, for example, smooth, serrated and/or oblique.
- the receptacle is deep enough to contain tissue plugs from one, two or more hole forming activities, even if the plug falls apart.
- the receptacle includes a plug extraction means.
- a spring element for example a lump of soft silicon or a metal spring, is provided in the receptacle, so that when the hole forming is completed and the hole former removed from the vessel, the plug is ejected from the hole, at least partly, by the spring element.
- an axially retractable catch is provided in the receptacle, which is retracted, for example, manually or by a spring out of said receptacle and/or remains in place when said penetration head is moved away from said base.
- An aspect of some embodiments of the invention relates to a hole former that combines anvil cutting and at least one of knife and shearing cuttmg for forming a hole in a blood vessel
- the anvil cutting is used to cut through an adventitsia of a blood vessel and the other cutting method is used for cutting through an intima of a blood vessel.
- the different cutting methods may be provided using a same cutting lip or using more than one cutting surface.
- an inclined part of the penetration head contacts the base to provide and anvil cutting action, while a cutting lip formed on the penetration head slides past the base to provide knife and/or shearing cutting action.
- the cutting lip provides knife cutting action until it contacts an inclined portion of the base and provides anvil cutting action.
- An aspect of some embodiments of the invention relates to a rotating anvil-cutting hole former.
- at least one of the anvil and the cutting head is spring-loaded so that when the anvil and head meet, one of them can retract, thus preventing and/or reducing damage to the cutting part.
- the penetration head serves as a cutting part and the base is an anvil and is spring loaded.
- the penetration head is retracted and rotated using a thread.
- the head can be rotated an infinite number of times once it reaches the base.
- the head slips a thread, allowing the base to spring forward.
- An aspect of some embodiments of the invention relates to anvil punching against a resilient material, which may be, for example, on the base or on the- enetration head.
- a resilient material which may be, for example, on the base or on the- enetration head.
- the cutting part of the hole former rotates relative to the anvil part.
- the penetration head when the penetration head is forcefully retracted, it pushes aside the resilient material and retracts into a predefined axial aperture in the anvil.
- An aspect of some embodiments of the invention relates to designing hole former parameters.
- D designates an outer diameter of a cutting lip
- d designates a minimum diameter of the hole former between the penetration head and the base.
- the hole remover is designed to achieved a desired hole diameter.
- D designates an outer diameter of a cutting lip
- d designates a minimum diameter of the hole former between the penetration head and the base.
- the hole remover is designed to achieved a desired hole diameter.
- D designates an outer diameter of a cutting lip
- d designates a minimum diameter of the hole former between the penetration head and the base.
- the hole remover is designed to achieved a desired hole diameter.
- D designates an outer diameter of a cutting lip
- d designates a minimum diameter of the hole former between the penetration head and the base.
- the hole remover is designed to achieved a desired hole diameter.
- D designates an outer diameter of a cutting lip
- d designates a minimum diameter of the hole former between the penetration head and the
- the penetration head which optionally serves as an anvil or as a plug holder for holding the vessel wall, is expandable, for example, as a spiral, as a deformable silicon element or as a plurality of radially extending (and, optionally, interconnected) arms.
- the penetration head may serve as a cutter, for example, in the spiral embodiment.
- retraction of the penetration tip causes expansion of the penetration head.
- an anvil is provided opposite only some of a circumference of a cutting lip.
- the penetration tip and head comprise a threaded tube and the hole forming is performed by retracting the thread relative a base.
- a penetration head in an alternative exemplary embodiment of the invention, includes a disk that is inserted on its side and/or in a distorted configuration into the vessel wall after the penetration tip enters the vessel. The disk is then used for the hole fomiing operation, for example, as an anvil. h the examples of the threaded head and disk head, the cutting action may be, for example, knife, shearing and/or anvil, optionally utilizing a cutting lip on the penetration head.
- the penetration tip has the form of a one, two or more sided knife. Alternatively, the penetration tip has the form of a screw. Alternatively or additionally, the penetration head is deeply scalloped on one, two, three or more sides.
- the penetration head has a cross-section of a cross or a- polygon, rather than having a circular cross-section as in some other embodiments.
- one, two or more cutting spikes are formed as a cutting lip of the penetration head.
- the spikes have a wide base and a narrow tip and a cutting surface along their outer edge.
- two spikes are provided, with bases that together bridge the entire circumference of the penetration head.
- the base has the shape of a needle with an aperture, optionally oblique, at its tip.
- the needle itself may have, for example, a symmetric or an asymmetric conical tip.
- the edges of the aperture are sharpened.
- a tissue penetration tip is provided through the aperture and includes a trans-axial extension that has the general profile of the aperture. In use, the penetration tip is inserted into a blood vessel so that the trans-axial extension also passes through the blood vessel wall. The penetration tip is then retracted, pulling the blood vessel towards the base, so that the sharpened lips of the base and/or an optionally sharpened surface of the trans-axial extension cut the vessel wall.
- the hole former includes a visual indication of the relative motion of the penetration head and the base and/or of the base relative to the rest of the hole former.
- a slot is formed in the base or an extension of the base, through which a marking on an extension of the penetration head is visible.
- the hole former is provided via a delivery system.
- the delivery system includes a window for viewing relative motion of the hole former and/or of other delivered tool, such as an anastomotic connector delivery tool, which optionally includes a similar progress indication.
- reaching a desired point of progress is alternatively or additionally marked by a loud mechanical click.
- the side cutter includes an L shaped element having a sharpened tip.
- the tip is poked into a blood vessel and one arm of the L inserted into the blood vessel following the tip.
- the L element is optionally rotated so that its arm is parallel to the vessel axis.
- the L element is then retracted relative to a base, providing cutting action by an optional sharpened inner lip on the L and/or shearing action against the base.
- the base is optionally sharpened.
- the base may be provided on one sides of the L element or it may sandwich the L element.
- the cutting arm- of the L is parallel to the base, alternatively, the arm may be inclined towards the base or away from the base.
- hole forming apparatus for forming an opening in a blood vessel, comprising: a penetration head adapted to be inserted through a wall of a blood vessel; a base section; at least one cutting surface defined on at least one of said penetration head and said base section and adapted to contact first an intima surface of said blood vessel; and a shaft operatively connected to said cutting surface and configured to rotate said cutting surface relative to said blood vessel, while said penetration head and said base section are brought towards each other, to effect a removal of a plug tissue section from said blood vessel.
- said cutting surface is defined on said penetration head and wherein said shaft rotates said penetration head.
- said cutting surface is defined on said base section and wherein said shaft rotates said base section.
- said plug is knife-cut by said cutting surface.
- said plug is formed by a shear-cut between said penetration head said base section.
- said plug is formed by an anvil-cut between said penetration head and said base section.
- said hole forming apparatus is adapted for insertion of said penetration head from outside a blood vessel.
- said hole forming apparatus is adapted for insertion of said penetration head from inside a blood vessel.
- said penetration head is adapted to pierce said blood vessel wall.
- said cutting edge defines a tissue receptacle for holding said plug.
- hole forming apparatus for forming an opening in a blood vessel, comprising: a penetration head adapted to be inserted through a wall of a blood vessel; a base section; at least one cutting surface defined on at least one of said penetration head and said base section and defining a tissue receptacle for receiving a plug of said blood vessel wall; and a shaft operatively connected to and configured to bring said penetration head and said base section and operative towards each other, to effect a removal of a plug from said blood vessel into said tissue receptacle.
- said cutting surface is defined on said penetration head.
- said tissue receptacle is adapted to be retracted into said base section.
- said cutting surface is defined on said base section.
- the apparatus comprises a resilient element in said tissue receptacle that is compressed by said plug.
- the apparatus comprises a plug extractor mounted on said shaft and adapted to moved axially relative to said tissue receptacle to remove said plug.
- hole forming apparatus for forming an opening in a blood vessel, comprising: a penetration head adapted to be inserted through a wall of a blood vessel; a base section; a cutting surface defined on at least one of said penetration head and said base section; an anvil surface defined on at least one of said penetration head and said base section; and a shaft operatively connected to and configured to bring said penetration head and said base section towards each other, to effect a removal of a plug from said blood vessel by cutting action of said cutting surface and by anvil cutting action of said anvil surface.
- said cutting action comprises shearing cutting action between said cutting surface and said base section.
- said cutting action comprises knife cutting action by said cutting surface.
- said cutting surface takes part in said anvil cutting action. Alternatively, said anvil surface does not contact said cutting surface.
- At least one of said cutting surface and said anvil surface rotate.
- said anvil cutting action and said cutting action are applied to different layers of said blood vessel.
- said anvil cutting action applies to an adventitsia layer of said blood vessel.
- said anvil cutting action comprises impulse anvil motion.
- hole forming apparatus for forming an opening in a blood vessel comprising: a penetration head adapted to be inserted through a wall of a blood vessel; a base section; a cutting surface defined on at least one of said penetration head and said base section; an anvil surface defined on at least one of said penetration head and said base section; and a shaft operatively connected to and configured to bring said penetration head and said base section towards each other, to effect an anvil action between said cutting surface and said anvil surface, wherein at least one of said anvil surface and said cutting surface rotate relative to said blood vessel.
- said rotation is mechanically synchronized to said bringing.
- said anvil has a resilient backing that is deformed when said cutting surface contacts said anvil surface.
- said anvil springs back intermittently during said rotation.
- said rotation is mechanically unlimited in number of rotations.
- said anvil surface is inclined.
- said inclined anvil surface shifts in a direction other than said rotation and said bringing towards each other when contacted by said cutting surface.
- hole forming apparatus for forming an opening in a blood vessel, comprising: a penetration head adapted to be inserted through a wall of a blood vessel; a base section; a cutting surface defined on at least one of said penetration head and said base section; a resilient anvil portion having a surface defined on at least one of said penetration head and said base section; and a shaft operatively connected to and operative to bring said penetration head and said base section towards each other, to effect an anvil action between said cutting surface and said anvil surface.
- said anvil surface is resilient.
- said anvil portion is resiliently retractable.
- a method of designing a hole forming apparatus for forming an opening in a blood vessel comprising: selecting a blood vessel punch design including an inner shaft having a diameter d and a cutting edge having a diameter D; selecting a ratio between d and D and a value of D to effect a desired punched hole diameter.
- the method comprises selecting a depth of a tissue receptacle portion of said punch design to affect said diameter.
- a deformable hole former comprising: a base section; and a deformable penetration head comprising a section formed of a resilient material, said head being adapted to be inserted tlirough a wall of a blood vessel and adapted to deform to a configuration with a larger diameter after said penetration than during said penetrating; and a shaft operatively connected to and operative to bring said penetration head and said base section towards each other, to effect a removal of a plug of tissue between said penetration head and said base section.
- the former comprises a retracting penetration tip adapted to deform said head when retracted.
- a deformable hole former comprising: a base section; and a deformable penetration head comprising at least one of a radially expanding spiral, a distorting disc and a plurality of radially extending arms, said head being adapted to be inserted through a wall of a blood vessel and adapted to deform to a configuration with a larger cross-section than during said penetrating; and a shaft operatively connected to and operative to bring said penetration head and said base section towards each other, to effect a removal of a plug of tissue between said penetration head and said base section.
- said disc is maintained in an axial orientation during said penetration.
- hole forming apparatus for forming an opening in a blood vessel, comprising: a threaded penetration head having a thread adapted to be inserted through a wall of a blood vessel; a base section; a shaft operatively connected to and operative to bring said penetration head and said base section towards each other, to effect a cutting motion by said thread.
- said thread comprises a cutting edge.
- said thread cooperates with said base section to perform a shearing cutting action when they are brought together.
- said thread cooperates with said base section to perform an anvil cutting action.
- hole forming apparatus for forming an opening in a blood vessel, comprising: a needle defining an oblique aperture at its tip; and a puller adapted to fit through said aperture and having a radially extending extension, said puller being adapted to engage a wall of said blood vessel towards the needle.
- said oblique aperture defines a sharp cutting edge.
- hole forming apparatus for forming an opening in a blood vessel comprising: two elements that cooperate to remove blood vessel tissue when moved towards each other; a handle; and a visual indicator embedded in said handle, that indicates a degree of relative motion of said elements.
- an incision maker comprising: an "L" shaped spike having a sharpened tip at the end of an arm thereof; and at least one base surface generally parallel to said arm and adapted to perform a shearing cut against said arm.
- the incision maker comprises at least two generally parallel base surfaces.
- said base surface is not parallel to said arm.
- Fig. 1A illustrates a hole former having an outer cutting lip, in accordance with an exemplary embodiment of the invention
- Fig. IB illustrates a hole former having an inner cutting lip, in accordance with an exemplary embodiment of the invention
- FIGS. 2A-2E are cut-through views of an exemplary hole former, in accordance with an exemplary embodiment of the invention.
- Fig. 3 illustrates various dimensions of a penetration head that may be relevant in accordance with an exemplary embodiment of the invention
- FIGS. 4 A and 4B illustrate plug removal mechanisms in accordance with an exemplary embodiment of the invention
- Fig. 5 illustrates a base retraction mechanism, in accordance with an exemplary embodiment of the invention
- Fig. 6 illustrates an alternative hole former, in accordance with an exemplary embodiment of the invention
- Figs. 7A-7I illustrate various penetration tip and penetration head designs, in accordance with exemplary embodiments of the invention.
- FIGs. 8A and 8B illustrate an expanding penetration head, in accordance with an exemplary embodiment of the invention
- FIGS. 9A and 9B illustrate an alternative expanding penetration head, in accordance with an exemplary embodiment of the invention.
- FIG. 10A and 10B illustrate another alternative expanding penetration head, in accordance with an exemplary embodiment of the invention
- Figs. 11A and 11B illustrate a geometry changing anvil, in accordance with an exemplary embodiment of the invention
- Fig. 12 illustrates a resilient anvil hole former, in accordance with an exemplary embodiment of the invention
- Fig. 13 illustrates a thread-type penetration head, in accordance with an exemplary embodiment of the invention
- Figs. 14A and 14B illustrate a needle-type hole former, in accordance with an exemplary embodiment of the invention
- Figs. 15A and 15B illustrate two variants of an incision maker, in accordance with an exemplary embodiment of the invention.
- side vessel which is typically a target vessel. If an incision is made in the side vessel, expanding the incision to an elliptical or circular opemng, as typically required in an anastomosis connection, may cause tearing and/or distortion of the target vessel.
- An alternative method is to punch or cut out a hole in the vessel (e.g., using the methods described in the background). However, the inventors have found that such punching may create a hole with one or more tears on its circumference. For example, punching a 2.5 mm diameter hole in an aorta, typically causes a tear, which, once the anastomosis is completed, may expand and cause a leak.
- the size of the hole in the aorta has been shown to affect the probability of causing a tear, however, a minimal hole size may be required in order to prevent distortion of the aorta when performing an anastomosis of a larger diameter.
- a blood vessel is formed of several layers.
- the outermost layer is a tough fibrous layer called the adventitsia.
- the innermost layer is called the intima.
- the inventors have found that if the cutting proceeds from the outside in, the adventitia may catch on the cutting element and distort the intima before it is cut. In addition, the inventors have determined that different cutting methods may be useful for the different layers of the blood vessel.
- a portion (a plug) is cut out of the vessel wall, it is typically desirable to prevent the plug from falling into the blood flow, hi addition, the plug may fall apart during or after the hole formation.
- Fig. 1A illustrates a hole former 100 in accordance with an exemplary embodiment of the invention, comprising a base tube 102 and a penetration head 104 for insertion through a wall of a blood vessel 106.
- vessel 106 comprises an intima layer 108 and an adventitsia layer 110.
- the tip of penetration head 104 may comprises a retractable penetration tip.
- penetration head 104 comprises a cutting lip 114 that cuts into vessel 106 when retracted towards the vessel.
- cutting lip 114 is formed as the rim of a cup 116 having a wall 112. Cup 116 desirably serves to contain a tissue plug that is cut out of vessel 106 by cutting lip 114.
- base tube 102 defines an anvil surface 118 that contacts cutting lip 114 when penetration head 104 is retracted sufficiently.
- lip 114 performs a knife cutting action until it nears anvil 118, where it performs an anvil cutting action, which may be suitable for cutting through adventitsia 110.
- Fig. IB shows an alternative hole former 130, in which the knife cutting action and the anvil action are performed by different surfaces.
- Wall 112 has an outer diameter smaller than an inner diameter of base tube 102, so that cup 116 can be retracted into a bore 138 of tube
- anvil cutting is provided between a cutting lip 142 of base tube 102 and an anvil portion 140, optionally inclined, of penetration head 104.
- one or both of penetration head 104 and base tube 102 rotate, in same or in opposite directions.
- oscillatory rotation is provided.
- one or both of head 104 and tube 102 may be moved.
- the motion is intermittent, allowing an impulse anvil cutting action to be achieved.
- Coupling between advancing and rotation is optional.
- coupling is achieved by a threading that links advancing to rotation.
- rotation is performed after retraction (e.g., when the edges begin to pinch the vessel wall).
- rotation and retraction are controlled separately, for example using one control for rotation and one for retraction.
- Figs. 2A-2E are cut-through views of an exemplary hole former 200, in accordance with an exemplary embodiment of the invention and similar to the embodiment of Fig. IB.
- Fig. 2A shows an optional retracting penetration tip 202 that is retracted by retracting a shaft 208 to which it is attached after penetration, so that the sharp tip does not damage the far wall of the blood vessel.
- the retraction of the tip unlocks a retraction mechanism that manually or automatically (e.g., using a spring or a motor) retracts the penetration head towards the base section.
- a shaft 206 used for retracting penetration head 104.
- Former 200 is shown mounted in a delivery system 210, optionally a split delivery system.
- Fig. 2B shows a handle section of former 200, which comprises, for example, a rotating handle 212.
- a slot 210 is used to guide the retraction of penetration tip 202 once the tip penetrates a blood vessel.
- a threading 214 is used, for example, to control the retraction and rotation of penetration head 104 during use of hole former 200.
- Fig. 2C shows a central section of former 200, including an optional clip 220 for locking former 200 into delivery system 210.
- Fig. 2D shows a section of former 200 in which base tube 102 is coupled to the rest of former 200.
- an optional volume 222 is used to contain a resilient element (e.g., silicon or a spring) that couples base tube 102 to former 200.
- Fig. 2E shows exemplary measurements for system 200 for use in a human aorta.
- base tube 102 is advanced into the formed hole, for example, to prevent blood leakage.
- Fig. 3 illustrates various dimensions of a penetration head 304 that may be relevant in accordance with an exemplary embodiment of the invention.
- a diameter d is the outer diameter of a shaft 30, used to retract head 304.
- a diameter D is the outer diameter defined by a cutting lip 314.
- a depth W is a depth of a tissue receptacle area 316 that contains the plug. The inventors have determined that the size of tissue plug removed from the target vessel is dependent on the geometry of the tissue receptacle. Thus, if W is too small, the tissue plug will be restricted in size. Similarly, if D is near d, there is less room for the tissue plug.
- the use of a cutting lip 314 rather than a blunt end ensures that less tissue will slip past, since lip 314 cuts into the tissue and holds it in place.
- the receptacle geometry is designed to affect a certain plug geometry. For example, if the receptacle fills up before cutting is completed, the plug diameter will decrease. The direction of decrease along the thickness of the plug may depend on the direction of cutting and/or receptacle orientation. For example, if the tissue receptacle and/or cutting lips are formed on tube 102, the decrease will be towards the blood vessel.
- knife cuts may be used to ensure that earlier cut tissue will have a known diameter, while a shearing cut can be used to ensure that later cut tissue will have a geometry based on available receptacle volume.
- An hourglass profile may be achieved by cutting from both sides of the vessel towards the middle, while using a limited volume tissue receptacle defined between the two cutting sides.
- rotation/axial ratios may be used, for example, 1/1 - one rotation per mm advance, hi one example, at least 10 or at least 30 rotations are provided during a hole forming. In another example, only one, or fewer rotations are provided.
- a smooth cutting action may indicate a large value for W, so that the tissue plug is substantially inaccessible form outside.
- mechanisms to assist in removing the plug are provided.
- Fig. 4 A shows a penetration head 400 in which a tissue extractor 420 is provided for pulling a tissue plug out of a tissue receptacle 416.
- extractor 420 includes one or more radial extensions (or a lip) 422 that lie inside receptacle 416.
- An optional resilient element 424 for example a spring a soft rubber is provided to allow tissue retractor 420 to be pushed towards base 102.
- retractor 420 is free-moving.
- Fig. 4B shows an alternative mechanism 440, in which a resilient element 442, such as a spring or a silicon plug is provided in tissue receptacle 416.
- the resilient element is compressed by the plug during the hole forming operation and rebounds when the operation is complete, to urge out the plug.
- a cutting lip contacts a non-moving element, and may be damaged thereby.
- Fig. 5 illustrates a base retraction mechanism 500, in accordance with an exemplary embodiment of the invention, which allows base 102 to resiliently retract.
- base 102 is pushed back by the lips instead of the lips being ground down.
- One potential advantage of such resilient contact is that it allows a looser manufacturing tolerance when designing a thread for coupling axial and rotational motion of penetration head 104.
- mechanism 500 comprises a resilient element 502 (or base 102 may be made resilient) such as a lump of soft silicon rubber or a spring, that allows some axial motion of base 102.
- An additional potential advantage of such resilience is that it allows penetration head 104 to continue rotating after it contacts base 102.
- An additional potential advantage is that if penetration head jumps a thread after it contacts base 102, this causes an impulse motion of head 104 relative to base 102, which may assist in cutting the adventitsia.
- Fig. 6 illustrates an alternative hole former 600, in accordance with an exemplary embodiment of the invention
- former 600 comprises a penetration head 604 with an optional retracting penetration tip (not shown).
- Slicing action is optionally provided between the upper edge of penetration head 604 and the inner diameter of a base 602.
- knife cutting action is provided by an inner lip 608 of penetration head and/or a forward lip 610 of base 602.
- head 604 and base 602 rotate.
- head 604 is retracted using a threaded drive actuated in handle 606.
- head 604 (and similarly heads on other embodiments described herein) may be retracted using a. spring loaded mechanism.
- One exemplary system comprises an aperture (or transparent portion) 620 defined in handle 606 and a second aperture 622 formed in base 602.
- One or more visual markings 624 on a shaft 614 that is coupled to penetration head 604 may be visible through the apertures/transparent sections to indicate a relative location of penetration head 604 and base 602.
- Another exemplary indication system comprises a transparent dome 612 through which is visible the extension of a bar 610 (which extends as penetration head 604 is retracted), is visible.
- references 624 indicate contacts (rather than markings) on shaft 614 short together leads 632 to allow a battery (not shown) to power light 630, a LED for example.
- a mechanical (or electrical) sound such as a click is sounded when the retraction of head 604 is completed. Possibly, different sounds are generated during retraction and after head 604 contacts base 602.
- a resistor and slide arrangement is used to indicate progress on a meter other suitable scale display.
- Figs. 7A-7I illustrate various penetration tip and penetration head designs, in accordance with exemplary embodiments of the invention.
- the penetration tips are optionally retractable in each of the diagrams shown.
- Fig. 7A shows a penetration head 700 including a head body 704 that is deeply scalloped on one, two, three or more sides and a penetration tip 702, that is conical.
- Fig. 7B shows a penetration head 710 including a head body 714 that is asymmetric and sharpened along one edge 716 thereof and having a matching knife shaped penetration tip 712.
- Fig. 7C shows a penetration head 720 including a conical head body 724 and a penetration tip " 722, that is scalloped.
- Fig. 7D shows a penetration head 730 including a conical head body 734 and a penetration tip 732, that is a one sided knife.
- Fig. 7E shows a penetration head 740 in which scalloping on a head body 744 matches scalloping on a penetration tip 742.
- Fig. 7F shows a penetration head 750 in which a head body 754 is a truncated cone having a longer and sharper penetration tip 752, for example, having a length that is 2 or three times its diameter.
- Fig. 7G shows a penetration head 760 in which a head body 764 is bulbous and blunt, with a regular penetration tip 762.
- Fig. 7H shows a penetration head 770 in which a head body 774 is associated with a threaded penetration tip 772 that si optionally rotated as it is advanced.
- Fig. 71 shows a penetration head 780 in which a head body 784 and its associated penetration tip 782 are formed in the shape of a knife having the cross-section of a cross.
- one or both of the cutting lips on the penetration head and base 102 may be oblique relative to the axis or relative to the radius of the system (e.g., have a non-constant radius).
- Such oblique elements may be provided, for example, for embodiments with inner lip cutting or with outer lip cutting.
- the different parts may have different degrees of obliqueness.
- Figs. 8A and 8B illustrate an expanding penefration head 800, in accordance with an exemplary embodiment of the invention.
- Head 800 comprises a penetration tip 802 mounted on a shaft 810.
- a plurality of arms 804 extend radially at an angle from shaft 810.
- the arms are contained in slots 808 defined in shaft 810.
- the arms spring out when shaft 810 exits a confining outer base tube 812 and after it passes through the confinement of a wall of vessel 106.
- arms 804 end in rounded tips 806.
- Fig. 8B shows a top view of Fig. 8 A.
- arms 804 are slivers formed out of the body of shaft 810.
- shaft 802 is retracted relative to base portion 812. Cutting action may be achieved by a cutting edge 814 of tube 812. Alternatively or additionally, tips 806 serve as a partial anvil for urging tissue against cutting edge 814. Optionally, shaft 802 and/or base 812 are rotated.
- FIGs. 9A and 9B illustrate an alternative expanding penetration head 904, in accordance with an exemplary embodiment of the invention.
- a hole former system comprises a base tube 902 having a cutting edge 912 and an expanding head that has a small diameter when inserted . through a vessel 106 (Fig. 9A) and a larger diameter during hole forming (Fig. 9B).
- head 904 comprises a resilient and/or expandable element 908, for example comprising silicon or other fluid or semi-fluid material, that is deformed and caused to expand out so that extensions 916 (or a disc) are formed.
- a penetration tip 906 of head 904 (and optionally an associated base 914) or the whole of head 904 are retracted relative to a base portion 910 of head 904, this causes the silicon element 908 to be axially compressed and radially extend.
- element 908 may be expanded or it may be deformed by the advancement of a rod into the element from the direction of tube 902.
- extensions 916 serve to urge the wall of vessel 106 towards base 902.
- extensions 916 serve as an anvil for cutting edge 912.
- silicon element 908 has one or more hard patches on its surface. In an exemplary embodiment of the invention, such hard patches can be used for the anvil cutting action, however, they are not required.
- extensions 916 fit inside base tube 902 and provide for shearing cutting action.
- the expansion of element 908 causes one or more sharp spikes or cutting edges (not shown) to extend in the direction of base 102.
- extensions 916 are inclined at the point of contact with cutting edge 912, providing for an angular anvil cutting action.
- the resilience of element 908 is such that when cutting edge 912 meets/nears extensions 916, the extensions give, allowing a sliding of edge 912 relative to extensions 916.
- a soft anvil or scissors part can provide some benefits over a free cutting action, hi addition, the resiliency of the silicon can be manipulated (during manufacture) to provide a maximum hardness that still allows the silicon to be deformed.
- Figs. 10A and 10B illustrate a hole former 1000 that includes an expanding penetration head 1004, in accordance with an exemplary embodiment of the invention.
- head 1004 comprises a thin sheet 1008 that is tightly wound around its axis, as shown in a cross-section 1006.
- Fig. 10B shows former 1000 after deployment, when head 1004 is released to achieve a conical shape.
- a cross-section is shown as reference 1012.
- a shaft 1010 is optionally welded to the side or to the tip of head 1004.
- sheet 1008 is manufactured out of shaft 1010.
- head 1004 may be retracted towards a base tube 1002 to provide for cutting action, for example, knife, shearing and/or anvil cutting action, as described herein, depending, inter alia, on the relative geometry of head 1004 and base 1002.
- FIGs. 11A and 11B illustrate a hole former 1100 including a geometry changing anvil 1104, in accordance with an exemplary embodiment of the invention.
- Hole former 1100 includes a penetration tip 1114 mounted on a shaft 1110 and a base tube 1102.
- a cut-assisting disk 1104, optionally having an aperture 1106 is mounted on shaft 1110.
- an over tube 1112 (or other similar restraining element) maintains disk 1104 in a distorted configuration, for example, the disk being held between an extension 1108 of tube 1112 and shaft 1110.
- a second extension 1116 holds another portion of disk 1104 against penetration tip 1114.
- Fig. 11B penetration tip 1114 and disk 1104 are inserted through a blood vessel wall and tube 1112 is retracted, thus freeing disk 1104 to achieve an orientation perpendicular to shaft 1110.
- Disk 1104 can now be used as an anvil or as a shearing base, depending, inter alia, on the relative geometries of disk 1104 and base 1102.
- disk 1104 includes one or more spikes or a cutting edge 1118, so that it can be used for cutting.
- aperture 1106 of disk 1110 has a geometry that mates the cross-section of shaft 1110, preventing rotation.
- disk 1104 is aligned with a direction of a cut formed by penetration tip 1114.
- disk 1104 has a sharp edge that assist in forming a cut.
- disk 1104 is made oblique by the distortion, so that its trans-axial dimension is small. Alternatively or additionally, disk 1104 is always oblique. Alternatively or additionally, disk 1104 is maintained in a distorted configuration by tension, between one part that is held by the penetration tip 1114 and another part that is held back by over tube 1112.
- disk 1104 is plastically distorted, for example, by the advance of over tube 1112 flattening disk 1104.
- disk 1104 is bi- stable between the configurations of Figs. 11 A and 1 IB.
- FIG. 12 illustrates a resilient anvil hole former 1200, in accordance with an exemplary embodiment of the invention.
- Former 1200 comprises a penetration head 1204, for example as described above, which includes a wall 1206 having a cutting edge 1208.
- a base 1202 is also provided, however, unlike some of the embodiments described above, base 1202 has a front end 1210 that is resilient.
- cutting edge 1208 can penetrate into front end 1210.
- cutting edge 1208 compresses end 1210 and then optionally slides into an hollow axis 1214 defined by the distorted base 1202.
- the degree of resilience is selected to assist in cutting adventitsia tissue.
- Fig. 13 illustrates a hole former 1300 including a thread-type penetration head 1304, in accordance with an exemplary embodiment of the invention.
- Head 1304 comprises a shaft 1310 on which a threading 1308 is provided.
- a retractable penetration tip 1306 is provided, h use, shaft 1310 is inserted through a blood vessel wall and then rotated to advance the shaft using the threading.
- penetration head 1304 is refracted towards a base 1302, to cut the wall tissue, hi one example a cutting edge 1312 is provided on thread 1308.
- a shearing cutting action is performed between a thread turn and base 1302.
- Figs. 14A and 14B are perpendicular side views of a needle-type hole former 1400, in accordance with an exemplary embodiment of the invention.
- a hollow pointed needle 1402 is formed with an oblique aperture 1408 optionally having a sharpened cutting lip 1410.
- a penetration tip 1404 is extended through a wall of a blood vessel and then retracted towards the needle.
- tip 1404 includes an extension 1406, for example an elastically extending extension that extends once the penetration tip passes out of the needle and through the tissue.
- extension 1406 serves as a knife.
- the tip of extension 1406 is inserted into the target blood vessel first and then turned, for example as in the embodiment of Fig. 15.
- Figs. 15A and 15B illustrate two variants of an incision maker, in accordance with an exemplary embodiment of the mvention.
- Fig. 15A shows an incision maker 1500.
- Two moving parts are provided, a base face 1510 coupled to a first handle 1514 and an 'L" shaped spike 1504 coupled to a second handle 1512.
- Other handle designs may be used.
- the two parts are optionally coupled using a spring 1516.
- a tip 1506 of an arm 1509 of spike 1504 is inserted into a blood vessel, for example a coronary artery.
- Incision maker 1500 is then turned so that arm 1509 is inside the vessel and parallel to the vessel axis (assuming that is the desired cut direction, as an oblique cut or a trans-axial cut may be desired).
- Arm 1509 is then retracted towards face 1510 and the vessel wall is cut using a shearing cut.
- an inner face 1508 of arm 1509 is sharp and functions as a knife.
- Fig. 15B shows an alternative embodiment of an incision maker in accordance with the invention, in which two base faces 1560 are provided, one on either side of a spike 1554 (only one face is visible).
- a spike tip 1556 of an arm 1559 and an optionally cutting edge 1558 of arm 1159 may function as before.
- face 1560 and arm 1559 while optionally in substantially parallel are not parallel to each other, for example, spreading out (as shown) or pointing in.
- the design is optionally changed to accommodate one or more of the following factors:
- the tissue receptacle is located on the base and has a cutting lip that extends forward.
- the tissue receptacle is on the penetration head but the base advances forwards towards the receptacle.
- the elements described as tubes are not generally required to be tubes.
- the apertured base tube can be replaced by a slotted solid rod, in which the slot carries a shaft for retraction of the penetration head. The shaft need not attach to the center of the penetration head.
- hole formers can be used to create incomplete removal of plugs, for example, to create rectangular or triangular flaps.
- the above devices are used in combination with anastomosis-related tools as described in PCT applications and publications WO 99/62415, WO 00/56226, WO 00/56228, WO 01/41623, WO 01/41624, PCT LO 1/00267, PCT/ILO 1/00069, PCT/ILOl/00074, and PCT/ILO 1/00266, the disclosures of which are incorporated herein by reference. However, they may also be used as stand alone devices or as part of surgical kits for other uses and/or anastomosis connectors.
- surgical kits which include sets of medical devices suitable for making a single or a small number of anastomosis connections and/or apertures. Measurements are provided to serve only as exemplary measurements for particular cases, the exact measurements applied will vary depending on the application.
- the terms "comprises”, “comprising”, “includes”, “including” or the like means “including but not limited to”.
Abstract
Description
Claims
Priority Applications (29)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
AU2001267814A AU2001267814A1 (en) | 2000-12-11 | 2001-06-28 | Method and apparatus for forming apertures in blood vessels |
CA002431404A CA2431404A1 (en) | 2000-12-11 | 2001-06-28 | Method and apparatus for forming apertures in blood vessels |
EP01945603A EP1349506A1 (en) | 2000-12-11 | 2001-06-28 | Method and apparatus for forming apertures in blood vessels |
JP2002549140A JP2004520099A (en) | 2000-12-11 | 2001-06-28 | Method and apparatus for forming a stoma in a blood vessel |
IL15635801A IL156358A0 (en) | 2000-12-11 | 2001-06-28 | Method and apparatus for forming apertures in blood vessels |
BRPI0114275-5A BR0114275A (en) | 2000-09-28 | 2001-09-25 | anastomotic connector, supply system for an anastomotic connector, removal device on a connector, method for mounting a graft on a connector, template, and blood vessel cutter |
PCT/IL2001/000903 WO2002030172A2 (en) | 2000-09-28 | 2001-09-25 | Anastomotic connection system |
KR10-2003-7004275A KR20030068134A (en) | 2000-09-28 | 2001-09-25 | Anastomotic connection system |
CA002425336A CA2425336A1 (en) | 2000-09-28 | 2001-09-25 | Anastomotic connection system |
AU2001295847A AU2001295847A1 (en) | 2000-09-28 | 2001-09-25 | Anastomotic connection system |
EP01976583A EP1359850A2 (en) | 2000-09-28 | 2001-09-25 | Anastomotic connection system |
JP2002533625A JP2005506095A (en) | 2000-09-28 | 2001-09-25 | Anastomosis system |
IL15513301A IL155133A0 (en) | 2000-09-28 | 2001-09-25 | Anastomotic connection system |
EP01982696A EP1349507A2 (en) | 2000-12-11 | 2001-11-04 | Method and apparatus for forming apertures in blood vessels |
IL15631701A IL156317A0 (en) | 2000-12-11 | 2001-11-04 | Method and apparatus for forming apertures in blood vessels |
CA002431405A CA2431405A1 (en) | 2000-12-11 | 2001-11-04 | Method and apparatus for forming apertures in blood vessels |
JP2002549114A JP2004528056A (en) | 2000-12-11 | 2001-11-04 | Method and apparatus for forming a stoma in a blood vessel |
AU2002214237A AU2002214237A1 (en) | 2000-12-11 | 2001-11-04 | Method and apparatus for forming apertures in blood vessels |
PCT/IL2001/001019 WO2002047532A2 (en) | 2000-12-11 | 2001-11-04 | Method and apparatus for forming apertures in blood vessels |
CA002442056A CA2442056A1 (en) | 2001-03-20 | 2002-03-18 | Method and apparatus for forming apertures in blood vessels |
JP2002572902A JP2005503185A (en) | 2001-03-20 | 2002-03-18 | Method and apparatus for forming small holes in blood vessels |
IL15795802A IL157958A0 (en) | 2001-03-20 | 2002-03-18 | Method and apparatus for forming apertures in blood vessels |
EP02707066A EP1414367A2 (en) | 2001-03-20 | 2002-03-18 | Method and apparatus for forming apertures in blood vessels |
PCT/IL2002/000215 WO2002074188A2 (en) | 2001-03-20 | 2002-03-18 | Method and apparatus for forming apertures in blood vessels |
US10/402,375 US20040092975A1 (en) | 1999-03-19 | 2003-03-27 | Anastomotic connection system |
US10/459,373 US20040049221A1 (en) | 1998-05-29 | 2003-06-11 | Method and apparatus for forming apertures in blood vessels |
US10/459,407 US20040073247A1 (en) | 1998-05-29 | 2003-06-11 | Method and apparatus for forming apertures in blood vessels |
US10/668,059 US20050101983A1 (en) | 1998-05-29 | 2003-09-22 | Method and apparatus for forming apertures in blood vessels |
US10/809,274 US20050038454A1 (en) | 1998-05-29 | 2004-03-25 | Anastomotic delivery system |
Applications Claiming Priority (4)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
PCT/IB2000/000310 WO2000056228A1 (en) | 1999-03-19 | 2000-03-20 | Low profile anastomosis connector |
US60/254,689 | 2000-12-11 | ||
ILPCT/IL01/00267 | 2001-03-20 | ||
ILPCT/IL01/00266 | 2001-03-20 |
Related Child Applications (3)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
US10/402,375 Continuation-In-Part US20040092975A1 (en) | 1998-05-29 | 2003-03-27 | Anastomotic connection system |
US10/459,407 Continuation US20040073247A1 (en) | 1998-05-29 | 2003-06-11 | Method and apparatus for forming apertures in blood vessels |
US10/459,373 Continuation-In-Part US20040049221A1 (en) | 1998-05-29 | 2003-06-11 | Method and apparatus for forming apertures in blood vessels |
Publications (1)
Publication Number | Publication Date |
---|---|
WO2002047561A1 true WO2002047561A1 (en) | 2002-06-20 |
Family
ID=11003895
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
PCT/IL2001/000600 WO2002047561A1 (en) | 1998-05-29 | 2001-06-28 | Method and apparatus for forming apertures in blood vessels |
Country Status (1)
Country | Link |
---|---|
WO (1) | WO2002047561A1 (en) |
Cited By (11)
Publication number | Priority date | Publication date | Assignee | Title |
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WO2004028376A1 (en) | 2002-09-25 | 2004-04-08 | By-Pass, Inc. | Sliding surgical clip |
US6814743B2 (en) | 2001-12-26 | 2004-11-09 | Origin Medsystems, Inc. | Temporary seal and method for facilitating anastomosis |
WO2011143432A1 (en) * | 2010-05-12 | 2011-11-17 | Ethicon Endo-Surgery, Inc. | Instrument for debriding fistula and applying therapeutic cells |
US8858546B2 (en) | 2010-05-12 | 2014-10-14 | Ethicon Endo-Surgery, Inc. | Instrument for debriding fistula and applying therapeutic cells |
WO2014150010A3 (en) * | 2013-03-15 | 2014-11-06 | Acclarent, Inc. | Apparatus and method for treatment of ethmoid sinusitis |
US9433437B2 (en) | 2013-03-15 | 2016-09-06 | Acclarent, Inc. | Apparatus and method for treatment of ethmoid sinusitis |
EP3154450A4 (en) * | 2014-06-13 | 2018-01-10 | Intershunt Technologies, Inc. | Method and catheter for creating an interatrial aperture |
US10993735B2 (en) | 2014-06-13 | 2021-05-04 | InterShunt Technologies, Inc. | Method and catheter for creating an interatrial aperture |
US10993736B2 (en) | 2014-06-13 | 2021-05-04 | InterShunt Technologies, Inc. | Method and catheter for creating an interatrial aperture |
US11369405B2 (en) | 2014-06-13 | 2022-06-28 | InterShunt Technologies, Inc. | Method and septostomy device for creating an interatrial aperture |
US11957374B2 (en) | 2021-04-13 | 2024-04-16 | InterShunt Technologies, Inc. | Method and catheter for creating an interatrial aperture |
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Cited By (18)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US6814743B2 (en) | 2001-12-26 | 2004-11-09 | Origin Medsystems, Inc. | Temporary seal and method for facilitating anastomosis |
US7947062B2 (en) | 2001-12-26 | 2011-05-24 | Maquet Cardiovascular Llc | Temporary anastomotic seal and method |
US11123052B2 (en) | 2001-12-26 | 2021-09-21 | Maquet Cardiovascular Llc | Temporary anastomotic seal and method |
US9345461B2 (en) | 2001-12-26 | 2016-05-24 | Maquet Cardiovascular Llc | Temporary anastomotic seal and method |
WO2004028376A1 (en) | 2002-09-25 | 2004-04-08 | By-Pass, Inc. | Sliding surgical clip |
WO2011143432A1 (en) * | 2010-05-12 | 2011-11-17 | Ethicon Endo-Surgery, Inc. | Instrument for debriding fistula and applying therapeutic cells |
US8858546B2 (en) | 2010-05-12 | 2014-10-14 | Ethicon Endo-Surgery, Inc. | Instrument for debriding fistula and applying therapeutic cells |
US8986331B2 (en) | 2010-05-12 | 2015-03-24 | Ethicon Endo-Surgery, Inc. | Instrument for debriding fistula and applying therapeutic cells |
US9433437B2 (en) | 2013-03-15 | 2016-09-06 | Acclarent, Inc. | Apparatus and method for treatment of ethmoid sinusitis |
US9629684B2 (en) | 2013-03-15 | 2017-04-25 | Acclarent, Inc. | Apparatus and method for treatment of ethmoid sinusitis |
US10524869B2 (en) | 2013-03-15 | 2020-01-07 | Acclarent, Inc. | Apparatus and method for treatment of ethmoid sinusitis |
WO2014150010A3 (en) * | 2013-03-15 | 2014-11-06 | Acclarent, Inc. | Apparatus and method for treatment of ethmoid sinusitis |
EP3154450A4 (en) * | 2014-06-13 | 2018-01-10 | Intershunt Technologies, Inc. | Method and catheter for creating an interatrial aperture |
US10639060B2 (en) | 2014-06-13 | 2020-05-05 | InterShunt Technologies, Inc. | Method and catheter for creating an interatrial aperture |
US10993735B2 (en) | 2014-06-13 | 2021-05-04 | InterShunt Technologies, Inc. | Method and catheter for creating an interatrial aperture |
US10993736B2 (en) | 2014-06-13 | 2021-05-04 | InterShunt Technologies, Inc. | Method and catheter for creating an interatrial aperture |
US11369405B2 (en) | 2014-06-13 | 2022-06-28 | InterShunt Technologies, Inc. | Method and septostomy device for creating an interatrial aperture |
US11957374B2 (en) | 2021-04-13 | 2024-04-16 | InterShunt Technologies, Inc. | Method and catheter for creating an interatrial aperture |
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