WO1999045837A1 - Transillumination catheter and method - Google Patents

Transillumination catheter and method Download PDF

Info

Publication number
WO1999045837A1
WO1999045837A1 PCT/US1999/004487 US9904487W WO9945837A1 WO 1999045837 A1 WO1999045837 A1 WO 1999045837A1 US 9904487 W US9904487 W US 9904487W WO 9945837 A1 WO9945837 A1 WO 9945837A1
Authority
WO
WIPO (PCT)
Prior art keywords
catheter
vessel
artery
internal
light
Prior art date
Application number
PCT/US1999/004487
Other languages
French (fr)
Inventor
Francis G. Duhaylongsod
Hugh L. Narciso, Jr.
Original Assignee
Duke University
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
Application filed by Duke University filed Critical Duke University
Priority to EP99909721A priority Critical patent/EP1061847A1/en
Priority to AU28864/99A priority patent/AU2886499A/en
Publication of WO1999045837A1 publication Critical patent/WO1999045837A1/en

Links

Classifications

    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00Measuring for diagnostic purposes; Identification of persons
    • A61B5/0059Measuring for diagnostic purposes; Identification of persons using light, e.g. diagnosis by transillumination, diascopy, fluorescence
    • A61B5/0082Measuring for diagnostic purposes; Identification of persons using light, e.g. diagnosis by transillumination, diascopy, fluorescence adapted for particular medical purposes
    • A61B5/0084Measuring for diagnostic purposes; Identification of persons using light, e.g. diagnosis by transillumination, diascopy, fluorescence adapted for particular medical purposes for introduction into the body, e.g. by catheters
    • A61B5/0086Measuring for diagnostic purposes; Identification of persons using light, e.g. diagnosis by transillumination, diascopy, fluorescence adapted for particular medical purposes for introduction into the body, e.g. by catheters using infrared radiation
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00Measuring for diagnostic purposes; Identification of persons
    • A61B5/0059Measuring for diagnostic purposes; Identification of persons using light, e.g. diagnosis by transillumination, diascopy, fluorescence
    • A61B5/0082Measuring for diagnostic purposes; Identification of persons using light, e.g. diagnosis by transillumination, diascopy, fluorescence adapted for particular medical purposes
    • A61B5/0084Measuring for diagnostic purposes; Identification of persons using light, e.g. diagnosis by transillumination, diascopy, fluorescence adapted for particular medical purposes for introduction into the body, e.g. by catheters

Definitions

  • the present invention relates generally to methods and devices for facilitating surgical procedures, and more particularly to methods and devices for transilluminating an internal blood vessel, artery or vein within a patient during a cardiac surgery procedure to facilitate locating and manipulating the vessel, artery or vein.
  • Minimally invasive surgical techniques have revolutionized cardiac surgery. Minimally invasive cardiac surgery enjoys the advantages of reduced morbidity, quicker recovery times, and improved cosmesis over conventional open-chest cardiac surgery. Recent advances in endoscopic instruments and percutaneous access to a patient's thoracic cavity have made minimally invasive surgery possible. Reduction in morbidity, lower cost, and reduced trauma has made minimally invasive surgery desirable. However, many problems and controversies still surround the viability of minimally invasive cardiac surgical procedures. One such problem is the difficulties of locating and manipulating small vessels, arteries, or veins in a closed-chest, blind environment during, for example, a minimally invasive coronary artery bypass graft (CABG) procedure.
  • CABG minimally invasive coronary artery bypass graft
  • the coronary arteries typically have a diameter in the range of between about 1 to 5 mm, and the coronary bypass graft vessels have a diameter on the order of about 1 to 4 mm for an arterial graft such as a thoracic artery, or about 4 to 8 mm for a vein graft such as a saphenous vein. Locating and manipulating these tiny vessels is sufficiently difficult in conventional open-chest cardiac surgical procedures, and is made substantially more difficult in closed-chest, less invasive mini-thoracotomy procedures and in minimally invasive endoscopic procedures where the cardiac surgeon may not be able to view these vessels directly. Endoscopic instruments are
  • An alternative technique for performing minimally invasive cardiac surgery procedures is needed which facilitates locating and manipulating vessels by illumination from within the vessels.
  • the technique should employ transillumination of a coronary vessel or coronary bypass graft vessel with light at predetermined wavelengths that are not substantially absorbed by the vessel itself, blood, other bodily fluids, or surrounding tissues and the like.
  • the surgical technique can be applied for example, to the following areas, although it is to be understood that the present invention is by no means limited to these specific cardiac surgery procedures: (1) dissecting a left (or right) internal thoracic artery (LITA or RITA) from the chest wall in preparation for anastomosing the LITA to a native coronary vessel in a CABG procedure; (2) locating the LITA graft in a CABG repeat procedure; (3) locating the coronary artery to which a coronary bypass graft vessel is to be anastomosed; and (4) harvesting a free graft vessel, such as a saphenous vein, in preparation for anastomosing the free graft vessel to a native coronary artery in a CABG procedure.
  • LITA or RITA left (or right) internal thoracic artery
  • RITA internal thoracic artery
  • Ambartsoumian A., "Infrared Transillumination Gastroscopy,” Gastrointestinal Endoscopy 1995:41(3):270-71.
  • Illuminators for transilluminating internal organs or vessels have been used in the fields of urology and gastroentology.
  • An illuminator placed in the urethra or esophagus facilitates laproscopic and cystoscopic procedures by illuminating these organs thus avoiding unwanted damage to the organs. See, e.g., United States Patent No. 5,624,432 to Angelchik (describing the preferred use of an illuminated bougie for illuminating the esophagus).
  • Transillumination has also been used to facilitate the proper intracorporeal placement of catheters.
  • illuminators are generally well known by those skilled in the art, they typically have application for diagnostic or therapeutic purposes. Examples of such devices include the illuminators disclosed in United States Patent Nos. 5,169,395 to Narciso, Jr., 5,196,005 to Doiron et al, 5,269,777 to Doiron et al, 5,330,465 to Doiron et al., 5,441,497 to Narciso Jr., and 5,454,794 to Narciso, Jr. et al.
  • the devices described in those patents generally have the ability to deliver light to luminal surfaces such as blood vessels and are typically used for the diagnosis and treatment of a variety of medical conditions, with particular application to performing photodynamic therapy (PDT) in the treatment of diseased tissue such as tumors, inducing hyperthermia, or performing both percutaneous and intraoperative phototherapy of cardiovascular disease.
  • PDT photodynamic therapy
  • the present invention is believed to be the first use of transillumination to facilitate CABG surgery by any one of the methods described below.
  • the present invention discloses methods and devices for identifying vasculature.
  • the identification methods and devices described herein can be used in conjunction with a combined technique involving laparoscopy and endoscopy to facilitate viewing and manipulating internal vessels during CABG and other cardiac surgery procedures.
  • the techniques of the present invention can be used in open-chest coronary surgery where a partial or median sternotomy is used to gain access to the heart, in closed-chest less invasive coronary surgery procedures where a mini-thoracotomy is used to gain access to the heart, or in totally endoscopic procedures where a series of small holes, or ports, in the chest wall are used to gain access to the heart.
  • a method of the present invention is for identifying vasculature and generally comprises the steps of introducing an indicator in a peripheral vessel and advancing a portion of the indicator into an internal vessel to identify the vessel.
  • a catheter for identifying vasculature is adapted to be introduced into a peripheral vessel and a portion thereof advanced into an internal vessel.
  • the catheter generally comprises a light delivery portion at a distal end thereof, and an expandable member located proximal to the light delivery portion.
  • a system for delivering energy to an internal vessel of a patient generally comprises a catheter and a catheter guide.
  • the catheter comprises a flexible, elongated shaft having a proximal end, a distal end, and an energy transmitting diffuser located at the distal end of the shaft.
  • the catheter guide has an opening which is sized and dimensioned to permit the catheter to be inserted longitudinally within the guide.
  • the guide is configured for introduction into the peripheral vessel and advancement to the internal vessel to facilitate delivery of the catheter into the internal vessel. Additional features and advantages of the invention will be set forth in or are apparent from the detailed descriptions of the preferred embodiments found herein below.
  • Fig. 1 is a schematic illustration of the transillumination catheter of the present invention.
  • Fig. 2 is a longitudinal cross-sectional view of a distal end of the transillumination catheter of Fig. 1.
  • Fig. 3 schematically illustrates insertion of the transillumination catheter into a brachial artery of a patient for advancement to a left internal thoracic artery via a left subclavian artery.
  • Fig. 4 is an enlarged view of a patient's heart schematically showing the transillumination catheter disposed within a subclavian artery and being advanced towards the left internal thoracic artery.
  • Fig. 5 is an enlarged view of a patient's heart schematically showing the transillumination catheter disposed within a subclavian artery and being advanced towards the left internal thoracic artery in a repeat CABG procedure.
  • Fig. 6 is an enlarged view of a patient's heart schematically showing the transillumination catheter disposed within a stenotic coronary artery.
  • Fig. 7 schematically illustrates insertion of the transillumination catheter of Fig. 1 into a saphenous vein of a patient for illumination of the vein prior to harvesting it for a coronary anastomosis procedure, along with showing other vessels which can be illuminated.
  • Fig. 8 is a schematic diagram of an alternative embodiment of the transillumination catheter of Fig. 1.
  • Fig. 9 shows the transilluminator catheter device of Fig. 8 positioned within a LITA graft vessel which has an anastomotic fastener positioned about an external surface of a free end portion of the graft vessel.
  • Fig. 10 shows the free end portion of the graft vessel everted over a portion of the anastomotic fastener.
  • Fig. 11 shows the graft vessel with the transillumination catheter of Fig. 8 positioned therein being inserted into the target vessel through an incision in the target vessel.
  • Fig. 12 is an elevated view of the anastomotic fastener following light irradiation and radial expansion of a balloon of the transillumination catheter.
  • Fig. 13 is an elevated view of the anastomotic fastener after the transillumination catheter has been removed from the graft vessel showing the completed anastomosis.
  • Fig. 14 is a schematic diagram of an alternative embodiment of the transillumination catheter of Fig. 1.
  • Fig. 15 is a schematic illustration of a catheter guide and guide wire for facilitating placement of the transillumination catheter into an internal vessel.
  • an indicator for identifying vasculature is shown and is generally indicated by the reference numeral 10.
  • the indicator 10 of the present invention is useful for delivering energy, such as visible, infrared, or ultraviolet light energy, to within a vessel, artery or vein during a coronary surgery procedure, such as a CABG procedure, to illuminate the vessel, artery or vein.
  • energy such as visible, infrared, or ultraviolet light energy
  • the indicator 10 can be used to facilitate open-chest coronary surgery procedures, closed- chest less invasive mini-thoracotomy surgery procedures, and totally endoscopic minimally invasive procedures.
  • the indicator 10 comprises a transillumination catheter having a light delivery portion for transmitting light to identify a vessel.
  • the light is preferably diffused over a section of the distal end of the catheter 10 to sufficiently illuminate the vessel.
  • the catheter 10 includes a fiber optic connector 23 at a proximal end of the catheter which is in optical communication with an energy source (not shown), such as a laser or a broad-band light source.
  • an energy source such as a laser or a broad-band light source.
  • a wavelength of between about 400 and 700 nm, and more preferably between about 600 and 700 nm is preferred since this range of wavelengths will facilitate the emitted light energy to pass through bodily tissue.
  • the fiber optic connector 23 can also be optically connected to an ultraviolet or infrared light energy source.
  • Ultraviolet light typically has a wavelength of between about 100 and 400 nm, and infrared light typically has a wavelength of between about 700 and 15,000 nm.
  • the light from the light source is delivered to a single optical fiber or bundle of optical fibers 25 enclosed within a first, inner catheter sheath 21.
  • the optical fiber or bundle of optical fibers 25 is contained within and extends the length of the catheter 10 from the fiber optic connector 23 to the distal portion of the catheter 10 proximal to the light diffusing end member 14 of the catheter.
  • the catheter 10 includes a Y-shaped adapter 20 towards its mid-portion which is in fluid communication with an opaque, outer catheter sheath 18 which terminates at the proximal face of light diffusing end member 14.
  • Inner catheter sheath 18 is sufficiently flexible to navigate tortuous vessels without great difficulty, and is preferably made from one or more biocompatible thermoplastic materials which have the optical and thermal properties required for this device to be operable such as Teflon®, polyurethane, polyethylene, polyethylene terephthalate, or other suitable biocompatible materials or combinations thereof.
  • the Y-shaped adapter 20 includes a balloon inflation/deflation port 22 through which a fluid may be administered and fluidly communicated through an inflation/deflation channel
  • the distal end of the transillumination catheter 10 includes a light diffusing end member 14 which is optically coupled to the distal face of optical fiber 25.
  • the light diffusing end member 14 is marked by a pair of radiopaque markers 13 for visualization of the catheter 10 under x-ray fluoroscopy.
  • Radiopaque markers 13 can be fabricated from gold, platinum, platinum-iridium, or any one of a number of other relatively dense materials.
  • the distal portion of the catheter 10 is curved as shown to provide steering capabilities through a vessel which obviates the need for a distal guidewire or an internal steering wire or other steering mechanism.
  • the shape of the distal portion of the catheter can be set thermally during processing or an additional coil (not shown) can be placed into the distal portion of catheter 10 as is well known by a person of ordinary skill in the art.
  • the transillumination catheter 10 is preferably dimensioned and configured for introduction into a peripheral vessel, such as a brachial artery 48 or radial artery 51 of a patient, and advanced to an internal thoracic artery of the heart (i.e., the LITA) through a subclavian artery (i.e., the left subclavian artery 90).
  • a peripheral vessel such as a brachial artery 48 or radial artery 51 of a patient
  • an internal thoracic artery of the heart i.e., the LITA
  • subclavian artery i.e., the left subclavian artery 90
  • the catheter 10 may be configured to be inserted directly into a vein graft, such as a sapahenous vein, for illuminating the vein graft, in which case the catheter 10 will have a similar length of between about 20 to 60 cm.
  • the catheter 10 may be adapted for introduction into a femoral artery 82 and advancement to a coronary or other vessel, such as an internal thoracic artery for example, wherein the catheter will need to be longer in length, for example about 90 to 120 cm.
  • the catheter 10 may be adapted for introduction into several coronary arteries and other vessels, such as a right coronary artery 60, a left main coronary artery 58, a left anterior descending artery 64, a left circumflex 62, an aorta 56, and any branches of the left or right coronary artery (i.e., the posterior descending artery), from the same or other peripheral vessels such as a radial artery 51, left cartoid artery 52, right cartoid artery 54, brachial artery 48, left (or right) subclavian artery 90, or femoral artery 82, in which case its length will vary depending on the particular vessel and route of administration chosen. (See Figs. 3-7).
  • a longitudinal cross-sectional view of the distal end of the transillumination catheter 10 is shown.
  • optical fiber (or bundle of optical fibers) 25 is circumferentially surrounded by cladding 27 which promotes complete internal reflection of the light transmitted down the core of optical fiber 25.
  • the distal portion of the cladding 27 is surrounded by an optical fiber centering sleeve 29.
  • the light is transmitted from the distal face of optical fiber 25 to the light diffusing medium 15 encased within light diffusing end member 14.
  • Light diffusing medium 15 is fabricated from an optically clear substrate such as silicone with optical scattering centers distributed within the substrate.
  • the optical scattering centers can be fabricated from alumina, silica, titanium oxide, calcium carbonate, or other suitable materials. By varying the concentration of scattering centers in the light diffusing medium 15 from lowest at the optical fiber 25 to greatest at the rounded cap 12, as shown, either discretely or continuously, the light output distribution from the light diffusing end member 14 can be made both radially and axially uniform. Alternatively, the optical scattering centers can be uniformly distributed throughout light diffusing medium 15.
  • the transillumination catheter 10 shown in Figs. 1-2 can be used in any one of several novel ways to facilitate locating and manipulating vessels, arteries or veins in coronary surgery procedures.
  • Fig. 4 shows one such novel use of transillumination catheter 10 for
  • the LITA transillumination technique can be used in open-chest coronary surgery where a partial or median sternotomy is used to gain access to the heart or in closed-chest less invasive coronary surgery procedures where a mini- thoracotomy is used to gain access to the heart
  • the harvest of the LITA 46 (or RITA 45) for coronary bypass grafting can also be performed thoracoscopically through three small skin incisions as fully described in Duhaylongsod, F.G. M.D., Mayfield, W.R. M.D., Wolf, R.K.
  • a transillumination catheter such as catheter 10 in Figs. 1-2, is first percutaneously inserted into a peripheral vessel, such as a brachial artery 48, by conventional means and advanced with the aid of x-ray fluoroscopy into the LITA 46 via a subclavian artery to provide illumination of the LITA, as schematically illustrated in Figs. 3-4.
  • the catheter 10 can also be percutaneously inserted into other peripheral vessels as well, such as a radial artery 51 or a femoral artery 82, by a suitable technique, such as the Seldinger technique, and advanced through a subclavian artery into the LITA (or other coronary vessel).
  • a transillumination catheter placed within the LITA helps to facilitate the procedure of locating, manipulating and dissecting the LITA from the chest wall without damage or unnecessary morbidity to the surrounding tissues and body structures.
  • the left lung is deflated to allow access to the heart and LITA.
  • a 6 to 8 cm left anterior thoracotomy incision is then made in the patient's chest in the fourth intercostal space. Other sites may be suitable depending on the patient's anatomy, such as the fifth or sixth intercostal space.
  • a retractor is used to spread apart the ribs to provide access to the heart and the LITA.
  • the LITA is then dissected under direct vision with suitable instruments introduced through the thoractomy incision, such as scissors, pliers and the like.
  • the balloon 16 of catheter 10 is used to internally seal the LITA graft vessel prior to transecting the distal end of the LITA graft in preparation for the coronary anastomosis procedure. This obviates the need for using external clamps to provide hemostasis within the graft vessel prior to transection.
  • the resulting LITA pedicle is transected with a suitable instrument such as scissors through the thoracotomy. Papaverine is then injected directly through the LITA, which is prepared for coronary anastomosis to a stenotic coronary artery 64.
  • the anastomosis of the LITA to the coronary artery is then performed directly through the thoracotomy incision by using conventional suturing means, or by using a novel distal anastomosis device and procedure such as described below in connection with Figs. 8-13 and in co-pending patent application for Anastomosis Device and Method, filed on March 9, 1998, and invented by Hugh Narciso, Jr.
  • cardiac stabilization such as described in co-pending provisional patent application, serial number 60/055,127, for Compositions, Apparatus and Methods for Facilitating Surgical Procedures, filed August 8, 1997, and invented by Francis G. Duhaylongsod, M.D., may be used during the procedure.
  • Other pharmacological or mechanical methods may also be used.
  • a second preferred intended novel use of the present invention is for locating the
  • LITA for example, in a repeat coronary surgical procedure, such as in a redo CABG procedure, to prevent injury while attempting to correct an imperfect anastomosis graft between the LITA and a stenotic native coronary artery, such as the LAD.
  • locating the LITA during repeat CABG surgery is critical to the safety of the patient because the graft LITA represents one of the major supplies of blood to the heart.
  • the LITA When the LITA is anastomosed to the LAD, for example, it typically is placed across the anterior surface of the heart, directly under the sternum, as shown in Fig. 5. If a second, or redo, CABG procedure needs to be performed, the cardiac surgeon typically needs to bisect the sternum to gain access to the heart. Often in doing so, the surgeon inadvertently
  • a transillumination catheter such as catheter 10 in Figs. 1-2, is percutaneously inserted into a peripheral vessel, such as a brachial artery 48 or radial artery 51 , and advanced into the LITA 46 via a subclavian artery 90 to provide illumination of the LITA, as schematically illustrated in Fig. 5.
  • a peripheral vessel such as a brachial artery 48 or radial artery 51
  • a subclavian artery 90 to provide illumination of the LITA, as schematically illustrated in Fig. 5.
  • a partial or median stemotomy is a procedure by which a saw or other appropriate cutting instrument is used to make a midline, longitudinal incision along a portion or the entire axial length of the patient's sternum, allowing two opposing sternal halves to be separated laterally.
  • a large opening into the thoracic cavity is thus created, through which a surgeon may directly visualize and operate upon the heart to correct the imperfect anastomosis or diseased graft vessel.
  • Another preferred intended novel use for the present invention is for locating and manipulating stenotic coronary vessels to which a graft vessel is being anastomosed in a CABG procedure.
  • the stenotic native coronary artery to which a graft vessel is being anastomosed is obscured by surrounding fat or cardiac tissues. The cardiac surgeon must cut through tissues to access the coronary artery for purposes of creating a clear field of view to perform the anastomosis procedure.
  • catheter 10 is percutaneosuly inserted into a peripheral vessel
  • Fig. 6 schematically illustrates another preferred novel use of the transillumination catheter 10 of the present invention for harvesting a free vessel graft, typically a saphenous vein 84, from a patient undergoing a CABG procedure.
  • Fig. 7 schematically illustrates another preferred novel use of the transillumination catheter 10 of the present invention for harvesting a free vessel graft, typically a saphenous vein 84, from a patient undergoing a CABG procedure.
  • a transilluminator catheter 10 is percutaneously inserted under the skin and inserted into a saphenous vein 84. With the transilluminator in place and the saphenous vein 84 illuminated, a surgeon gently dissects the saphenous vein 84 with suitable surgical instruments, such as scissors and the like.
  • the device may be used to transilluminate other bypass graft vessels such as a gastroepiploic artery 72 or an inferior epigastric artery 78.
  • the use of a transillumination device placed within the vein to be harvested makes the harvesting procedure simpler and facilitates location and extraction of the graft vessel.
  • the transillumination catheter can be used in combination with conventional endoscopic techniques to simplify the process of harvesting the vein graft in an endoscopic procedure.
  • FIG 8 illustrates an alternative embodiment of the transillumination catheter 10 of Figs. 1-2 generally indicated by reference numeral 100, wherein like numerals represent like parts.
  • the optical fiber 25, fiber optic connector 23, catheter sheath 21, and light diffusing end member 14 have the same general function and arrangement as described in Figs. 1-2.
  • Transillumination catheter 100 can be used to facilitate the coronary surgical procedures described above akin to catheter 10, and can also be used to facilitate joining a transected graft vessel to a stenotic target vessel in a coronary anastomosis, as will be described in greater detail below.
  • the Y-adapter 20 of catheter 10 is replaced with a three arm adapter 40 which incorporates two separate and independent balloon inflation/deflation ports
  • Balloon 50 is affixed to the outer sheath 18' so that the balloon 50 overlies a substantial
  • the wall of the balloon 50 is transparent at the wavelength of light being delivered to (or received from) the surrounding tissue from light diffusing end member 14.
  • Distal and proximal to balloon 50 are radiopaque marker bands 13' for visualization under x-ray fluoroscopy.
  • the provision of a second balloon 50 is advantageous where the transillumination catheter 100 of the present invention is used in connection with a novel distal anastomosis device disclosed in co-pending patent application for "Anastomosis Device and Method," filed on March 9, 1998 , and sharing a common inventor (Hugh L. Narciso, Jr.), the entire contents of which are fully incorporated by reference herein.
  • an anastomotic fastener which in one embodiment comprises a tubular sleeve formed of a deformable material, such as a light-activated polymeric material (i.e., a polycaprolactone material) which becomes formable (i.e., fluent) upon the application of light energy to the material at a specific frequency, wavelength or wavelengths.
  • a deformable material such as a light-activated polymeric material (i.e., a polycaprolactone material) which becomes formable (i.e., fluent) upon the application of light energy to the material at a specific frequency, wavelength or wavelengths.
  • the anastomotic fastener is configured to be positioned radially adjacent a free end portion of a graft vessel, such as a LITA graft, which is then preferably everted over a portion of the tubular sleeve.
  • the deformable material may be selectively irradiated and molded in vivo by providing an energy source that produces radiation at a frequency, wavelength, or wavelengths that are readily absorbed by the material. Radial expansion of the graft vessel will permit the deformable material in its moldable state to be shaped such that the free end portion of the graft vessel in its everted configuration is in secure conforming engagement with an inner wall of the target vessel, resulting in an intima-to-intima anastomosis.
  • Transillumination catheter 100 can be used in lieu of the light-diffusing catheter described in the subject co-pending patent application to irradiate and radially expand the anastomotic fastener device. For example, with reference to Figs.
  • transillumination catheter 100 is first inserted into a LITA graft vessel 110 in a similar fashion as described above in connection with Figs. 3-4, and the LITA graft vessel 110 can be illuminated and then dissected and transected using balloon 16' to seal the LITA prior to transecting it.
  • a deformable anastomosis fastener device 120 can be positioned about an external
  • the LITA graft vessel 110 is then inserted into a target vessel 112, such as an LAD having a stenotic region 113, through an incision in a wall of the target vessel 112.
  • a target vessel 112 such as an LAD having a stenotic region 113
  • light energy at a given wavelength or wavelengths is supplied to the light diffusing end member 14 of catheter 100 from the energy source (not shown) via optical fiber 25 to irradiate, or illuminate, the tubular member 120 with light at a wavelength or wavelengths at which the deformable material readily absorbs.
  • tubular member 120 Upon absorption of the light energy, the deformable material forming tubular member 120 is transformed into its moldable, fluent state. Inflation of the balloon 50 causes the tubular member 120 to radially expand outwardly, thereby pressing the LITA graft vessel 110 into conforming engagement with an inner wall of target vessel 112 (see Fig. 12). If it is necessary to move catheter 100 longitudinally within the graft vessel 110 to, for example, precisely position balloon 50 radially adjacent tubular member 120, balloon 16' can be deflated slightly. This will permit longitudinal movement of the catheter 100 within the graft vessel 110, at which point balloon 16' can then be re-inflated fully to firmly seal the graft vessel 110 and prevent blood flow into the anastomosis site.
  • the deformable material By discontinuing the supply of light energy from the energy source, the deformable material will become non-fluent and remain in its molded configuration. Both balloons 16', 50 are then deflated and the catheter device 100 is withdrawn from the LITA graft vessel 110 to complete the anastomosis (see Fig. 13).
  • FIG 14 is a third alternative embodiment of a transillumination catheter generally indicated by reference numeral 200.
  • the transillumination catheter 200 is similar in most respects to the transillumination catheter 10 of Figs. 1-2, except that the distal end of the catheter 200 is substantially straight, and does not have a curved configuration as does the distal end of catheter 10.
  • a catheter guide 205 is shown in schematic form in Fig. 15.
  • the guide 205 comprises a flexible, elongate tubular body 210 which is sized and dimensioned to permit catheter 200 to be longitudinally inserted within the tubular body 210.
  • the guide 205 facilitates placement of
  • transillumination catheter 200 within an internal vessel, such as a LITA graft vessel.
  • the catheter 200 may be formed with a guide wire lumen (not shown) as described in U.S. Patent No. 5,169,395, which is incorporated herein by reference.
  • the lumen may be used for insertion of a guidewire or insertion of a fluoroscopic dye to assist in guiding the catheter.
  • the guide 205 is first percutaneously inserted into a peripheral vessel, such as a brachial artery 48, radial artery 51 or femoral artery 82, and advanced over a guidewire 220 by conventional means to an internal vessel, such as LITA graft vessel. With the distal end of tubular body 210 positioned a short distance within the internal vessel, the guidewire 220 is pulled back and removed from tubular body 210. Subsequently, transillumination catheter 200 can be longitudinally inserted into tubular body
  • tubular body 210 may be advanced into the internal vessel to a position at which transillumination of the vessel is required. Subsequently, the distal end of transillumination catheter 200 is advanced up to the distal end of tubular body 210, and the tubular body 210 is then pulled back a short distance over the transillumination catheter 200 to expose the light transmitting distal end member 14' of the catheter 200. The transillumination catheter 200 is then used to illuminate the internal vessel as described above.
  • the guide 205 is advantageous in that it can be used to effectively guide catheter 200 into an internal vessel, obviating the need to shape the distal end of catheter 200 or to provide a guidewire or other steering mechanism within catheter 200.

Abstract

A method of identifying vasculature comprising the steps of introducing an indicator (10) in a peripheral vessel, and advancing a portion of the indicator into an internal vessel to identify said vessel. A catheter (18) for identifying vasculature is also disclosed. The catheter (18) is adapted to be introduced into a peripheral vessel and a portion thereof advanced into an internal vessel. The catheter (18) comprises a light delivery portion (14) at a distal end thereof and an expandable member (10) located proximal to the light delivery portion (14).

Description

TRANSILLUMINATION CATHETER AND METHOD
FIELD OF THE INVENTION
The present invention relates generally to methods and devices for facilitating surgical procedures, and more particularly to methods and devices for transilluminating an internal blood vessel, artery or vein within a patient during a cardiac surgery procedure to facilitate locating and manipulating the vessel, artery or vein.
BACKGROUND OF THE INVENTION
Minimally invasive surgical techniques have revolutionized cardiac surgery. Minimally invasive cardiac surgery enjoys the advantages of reduced morbidity, quicker recovery times, and improved cosmesis over conventional open-chest cardiac surgery. Recent advances in endoscopic instruments and percutaneous access to a patient's thoracic cavity have made minimally invasive surgery possible. Reduction in morbidity, lower cost, and reduced trauma has made minimally invasive surgery desirable. However, many problems and controversies still surround the viability of minimally invasive cardiac surgical procedures. One such problem is the difficulties of locating and manipulating small vessels, arteries, or veins in a closed-chest, blind environment during, for example, a minimally invasive coronary artery bypass graft (CABG) procedure. The coronary arteries typically have a diameter in the range of between about 1 to 5 mm, and the coronary bypass graft vessels have a diameter on the order of about 1 to 4 mm for an arterial graft such as a thoracic artery, or about 4 to 8 mm for a vein graft such as a saphenous vein. Locating and manipulating these tiny vessels is sufficiently difficult in conventional open-chest cardiac surgical procedures, and is made substantially more difficult in closed-chest, less invasive mini-thoracotomy procedures and in minimally invasive endoscopic procedures where the cardiac surgeon may not be able to view these vessels directly. Endoscopic instruments are
1 currently used by the cardiac surgeon to view the internal thoracic cavity during a minimally invasive surgical procedure, but the use of these instruments alone has inherent drawbacks. For example, it is often difficult to differentiate the often tiny coronary arteries or coronary bypass graft vessels from other surrounding vessels and tissues with the use of endoscopic instruments alone during a minimally invasive surgical procedure.
An alternative technique for performing minimally invasive cardiac surgery procedures, therefore, is needed which facilitates locating and manipulating vessels by illumination from within the vessels. The technique should employ transillumination of a coronary vessel or coronary bypass graft vessel with light at predetermined wavelengths that are not substantially absorbed by the vessel itself, blood, other bodily fluids, or surrounding tissues and the like. The surgical technique can be applied for example, to the following areas, although it is to be understood that the present invention is by no means limited to these specific cardiac surgery procedures: (1) dissecting a left (or right) internal thoracic artery (LITA or RITA) from the chest wall in preparation for anastomosing the LITA to a native coronary vessel in a CABG procedure; (2) locating the LITA graft in a CABG repeat procedure; (3) locating the coronary artery to which a coronary bypass graft vessel is to be anastomosed; and (4) harvesting a free graft vessel, such as a saphenous vein, in preparation for anastomosing the free graft vessel to a native coronary artery in a CABG procedure. Each of these procedures will be explained in greater detail hereinafter. Transillumination within the body of a patient has been recognized for at least a century. As long ago as the mid-1800's, British physicians began detecting scrotal cancer by holding a lamp behind the testes and noting the shadows the tumors cast. See "Transillumination: Looking Right Through You," Science, Vol. 261, July 30, 1993 at page 560. Transillumination of the stomach was reported as early as 1911. Intraoperative transillumination of the small intestine and colon also is generally well known. See, e.g.,
Ambartsoumian, A., "Infrared Transillumination Gastroscopy," Gastrointestinal Endoscopy 1995:41(3):270-71. Illuminators for transilluminating internal organs or vessels have been used in the fields of urology and gastroentology. An illuminator placed in the urethra or esophagus facilitates laproscopic and cystoscopic procedures by illuminating these organs thus avoiding unwanted damage to the organs. See, e.g., United States Patent No. 5,624,432 to Angelchik (describing the preferred use of an illuminated bougie for illuminating the esophagus). Transillumination has also been used to facilitate the proper intracorporeal placement of catheters. See, e.g., United States Patent No. 5,370,640 to Kolff, which discloses the use of a fiberoptic stylet device for facilitating the intracorpoeal placement of a retrograde coronary sinus catheter into the coronary sinus of a heart of a patient.
Although illuminators are generally well known by those skilled in the art, they typically have application for diagnostic or therapeutic purposes. Examples of such devices include the illuminators disclosed in United States Patent Nos. 5,169,395 to Narciso, Jr., 5,196,005 to Doiron et al, 5,269,777 to Doiron et al, 5,330,465 to Doiron et al., 5,441,497 to Narciso Jr., and 5,454,794 to Narciso, Jr. et al. The devices described in those patents generally have the ability to deliver light to luminal surfaces such as blood vessels and are typically used for the diagnosis and treatment of a variety of medical conditions, with particular application to performing photodynamic therapy (PDT) in the treatment of diseased tissue such as tumors, inducing hyperthermia, or performing both percutaneous and intraoperative phototherapy of cardiovascular disease. However, despite the fact that transillumination has long been known, the present invention is believed to be the first use of transillumination to facilitate CABG surgery by any one of the methods described below.
SUMMARY OF THE INVENTION
The present invention discloses methods and devices for identifying vasculature. The identification methods and devices described herein can be used in conjunction with a combined technique involving laparoscopy and endoscopy to facilitate viewing and manipulating internal vessels during CABG and other cardiac surgery procedures. The techniques of the present invention can be used in open-chest coronary surgery where a partial or median sternotomy is used to gain access to the heart, in closed-chest less invasive coronary surgery procedures where a mini-thoracotomy is used to gain access to the heart, or in totally endoscopic procedures where a series of small holes, or ports, in the chest wall are used to gain access to the heart. A method of the present invention is for identifying vasculature and generally comprises the steps of introducing an indicator in a peripheral vessel and advancing a portion of the indicator into an internal vessel to identify the vessel.
In another aspect of the invention, a catheter for identifying vasculature is adapted to be introduced into a peripheral vessel and a portion thereof advanced into an internal vessel.
The catheter generally comprises a light delivery portion at a distal end thereof, and an expandable member located proximal to the light delivery portion.
In yet another aspect of the invention, a system for delivering energy to an internal vessel of a patient generally comprises a catheter and a catheter guide. The catheter comprises a flexible, elongated shaft having a proximal end, a distal end, and an energy transmitting diffuser located at the distal end of the shaft. The catheter guide has an opening which is sized and dimensioned to permit the catheter to be inserted longitudinally within the guide. The guide is configured for introduction into the peripheral vessel and advancement to the internal vessel to facilitate delivery of the catheter into the internal vessel. Additional features and advantages of the invention will be set forth in or are apparent from the detailed descriptions of the preferred embodiments found herein below.
BRIEF DESCRIPTION OF THE DRAWINGS
Fig. 1 is a schematic illustration of the transillumination catheter of the present invention.
Fig. 2 is a longitudinal cross-sectional view of a distal end of the transillumination catheter of Fig. 1.
Fig. 3 schematically illustrates insertion of the transillumination catheter into a brachial artery of a patient for advancement to a left internal thoracic artery via a left subclavian artery. Fig. 4 is an enlarged view of a patient's heart schematically showing the transillumination catheter disposed within a subclavian artery and being advanced towards the left internal thoracic artery.
Fig. 5 is an enlarged view of a patient's heart schematically showing the transillumination catheter disposed within a subclavian artery and being advanced towards the left internal thoracic artery in a repeat CABG procedure.
Fig. 6 is an enlarged view of a patient's heart schematically showing the transillumination catheter disposed within a stenotic coronary artery.
Fig. 7 schematically illustrates insertion of the transillumination catheter of Fig. 1 into a saphenous vein of a patient for illumination of the vein prior to harvesting it for a coronary anastomosis procedure, along with showing other vessels which can be illuminated.
Fig. 8 is a schematic diagram of an alternative embodiment of the transillumination catheter of Fig. 1.
Fig. 9 shows the transilluminator catheter device of Fig. 8 positioned within a LITA graft vessel which has an anastomotic fastener positioned about an external surface of a free end portion of the graft vessel.
Fig. 10 shows the free end portion of the graft vessel everted over a portion of the anastomotic fastener.
Fig. 11 shows the graft vessel with the transillumination catheter of Fig. 8 positioned therein being inserted into the target vessel through an incision in the target vessel.
Fig. 12 is an elevated view of the anastomotic fastener following light irradiation and radial expansion of a balloon of the transillumination catheter. Fig. 13 is an elevated view of the anastomotic fastener after the transillumination catheter has been removed from the graft vessel showing the completed anastomosis.
Fig. 14 is a schematic diagram of an alternative embodiment of the transillumination catheter of Fig. 1.
Fig. 15 is a schematic illustration of a catheter guide and guide wire for facilitating placement of the transillumination catheter into an internal vessel.
DESCRIPTION OF THE INVENTION
Referring now to the drawings, and first to Fig. 1, an indicator for identifying vasculature is shown and is generally indicated by the reference numeral 10. The indicator 10 of the present invention is useful for delivering energy, such as visible, infrared, or ultraviolet light energy, to within a vessel, artery or vein during a coronary surgery procedure, such as a CABG procedure, to illuminate the vessel, artery or vein. Such transillumination of an internal vessel facilitates locating and manipulating the vessel during the surgical procedure. The indicator 10 can be used to facilitate open-chest coronary surgery procedures, closed- chest less invasive mini-thoracotomy surgery procedures, and totally endoscopic minimally invasive procedures.
The indicator 10 comprises a transillumination catheter having a light delivery portion for transmitting light to identify a vessel. The light is preferably diffused over a section of the distal end of the catheter 10 to sufficiently illuminate the vessel. The catheter 10 includes a fiber optic connector 23 at a proximal end of the catheter which is in optical communication with an energy source (not shown), such as a laser or a broad-band light source. In the latter case, a wavelength of between about 400 and 700 nm, and more preferably between about 600 and 700 nm, is preferred since this range of wavelengths will facilitate the emitted light energy to pass through bodily tissue. The fiber optic connector 23 can also be optically connected to an ultraviolet or infrared light energy source. Ultraviolet light typically has a wavelength of between about 100 and 400 nm, and infrared light typically has a wavelength of between about 700 and 15,000 nm. The light from the light source is delivered to a single optical fiber or bundle of optical fibers 25 enclosed within a first, inner catheter sheath 21. The optical fiber or bundle of optical fibers 25 is contained within and extends the length of the catheter 10 from the fiber optic connector 23 to the distal portion of the catheter 10 proximal to the light diffusing end member 14 of the catheter.
The catheter 10 includes a Y-shaped adapter 20 towards its mid-portion which is in fluid communication with an opaque, outer catheter sheath 18 which terminates at the proximal face of light diffusing end member 14. Inner catheter sheath 18 is sufficiently flexible to navigate tortuous vessels without great difficulty, and is preferably made from one or more biocompatible thermoplastic materials which have the optical and thermal properties required for this device to be operable such as Teflon®, polyurethane, polyethylene, polyethylene terephthalate, or other suitable biocompatible materials or combinations thereof.
The Y-shaped adapter 20 includes a balloon inflation/deflation port 22 through which a fluid may be administered and fluidly communicated through an inflation/deflation channel
30 (see Fig. 2) created between the external sheath 18 and inner sheath 21 to the balloon 16. The distal end of the transillumination catheter 10 includes a light diffusing end member 14 which is optically coupled to the distal face of optical fiber 25. The light diffusing end member 14 is marked by a pair of radiopaque markers 13 for visualization of the catheter 10 under x-ray fluoroscopy. Radiopaque markers 13 can be fabricated from gold, platinum, platinum-iridium, or any one of a number of other relatively dense materials. The distal portion of the catheter 10 is curved as shown to provide steering capabilities through a vessel which obviates the need for a distal guidewire or an internal steering wire or other steering mechanism. The shape of the distal portion of the catheter can be set thermally during processing or an additional coil (not shown) can be placed into the distal portion of catheter 10 as is well known by a person of ordinary skill in the art.
The transillumination catheter 10 is preferably dimensioned and configured for introduction into a peripheral vessel, such as a brachial artery 48 or radial artery 51 of a patient, and advanced to an internal thoracic artery of the heart (i.e., the LITA) through a subclavian artery (i.e., the left subclavian artery 90). This will generally require a catheter
7 length of between about 20 to 60 cm. In addition, the catheter 10 may be configured to be inserted directly into a vein graft, such as a sapahenous vein, for illuminating the vein graft, in which case the catheter 10 will have a similar length of between about 20 to 60 cm. Alternatively, the catheter 10 may be adapted for introduction into a femoral artery 82 and advancement to a coronary or other vessel, such as an internal thoracic artery for example, wherein the catheter will need to be longer in length, for example about 90 to 120 cm. The catheter 10 may be adapted for introduction into several coronary arteries and other vessels, such as a right coronary artery 60, a left main coronary artery 58, a left anterior descending artery 64, a left circumflex 62, an aorta 56, and any branches of the left or right coronary artery (i.e., the posterior descending artery), from the same or other peripheral vessels such as a radial artery 51, left cartoid artery 52, right cartoid artery 54, brachial artery 48, left (or right) subclavian artery 90, or femoral artery 82, in which case its length will vary depending on the particular vessel and route of administration chosen. (See Figs. 3-7).
Referring now to Fig. 2, a longitudinal cross-sectional view of the distal end of the transillumination catheter 10 is shown. As seen in Fig. 2, optical fiber (or bundle of optical fibers) 25 is circumferentially surrounded by cladding 27 which promotes complete internal reflection of the light transmitted down the core of optical fiber 25. The distal portion of the cladding 27 is surrounded by an optical fiber centering sleeve 29. The light is transmitted from the distal face of optical fiber 25 to the light diffusing medium 15 encased within light diffusing end member 14. Light diffusing medium 15 is fabricated from an optically clear substrate such as silicone with optical scattering centers distributed within the substrate. The optical scattering centers can be fabricated from alumina, silica, titanium oxide, calcium carbonate, or other suitable materials. By varying the concentration of scattering centers in the light diffusing medium 15 from lowest at the optical fiber 25 to greatest at the rounded cap 12, as shown, either discretely or continuously, the light output distribution from the light diffusing end member 14 can be made both radially and axially uniform. Alternatively, the optical scattering centers can be uniformly distributed throughout light diffusing medium 15.
The transillumination catheter 10 shown in Figs. 1-2 can be used in any one of several novel ways to facilitate locating and manipulating vessels, arteries or veins in coronary surgery procedures. Fig. 4 shows one such novel use of transillumination catheter 10 for
8 locating and illuminating a LITA graft vessel 46 prior to dissecting the LITA graft from the chest wall in preparation for a CABG procedure. The LITA transillumination technique can be used in open-chest coronary surgery where a partial or median sternotomy is used to gain access to the heart or in closed-chest less invasive coronary surgery procedures where a mini- thoracotomy is used to gain access to the heart The harvest of the LITA 46 (or RITA 45) for coronary bypass grafting can also be performed thoracoscopically through three small skin incisions as fully described in Duhaylongsod, F.G. M.D., Mayfield, W.R. M.D., Wolf, R.K. M.D., "Thoracoscopic Harvest of the Internal Thoracic Artery for Coronary Bypass Grafting: A Multicenter Experience in 219 Cases," presented at the "Facts & Myths of Minimally Invasive Cardiac Surgery: Current Trends in Thoracic Surgery IV" symposium before the
34th Annual Meeting of the Society of Thoracic Surgeons, New Orleans, LA, January 24, 1998, the entire contents of which are incorporated by reference herein. The following is an exemplary usage of the LITA transillumination technique in a standard mini-thoracotomy procedure. A transillumination catheter, such as catheter 10 in Figs. 1-2, is first percutaneously inserted into a peripheral vessel, such as a brachial artery 48, by conventional means and advanced with the aid of x-ray fluoroscopy into the LITA 46 via a subclavian artery to provide illumination of the LITA, as schematically illustrated in Figs. 3-4. As noted above, the catheter 10 can also be percutaneously inserted into other peripheral vessels as well, such as a radial artery 51 or a femoral artery 82, by a suitable technique, such as the Seldinger technique, and advanced through a subclavian artery into the LITA (or other coronary vessel). Applicants have demonstrated that the use of a transillumination catheter placed within the LITA helps to facilitate the procedure of locating, manipulating and dissecting the LITA from the chest wall without damage or unnecessary morbidity to the surrounding tissues and body structures.
After establishment of general anesthesia with a double-lumen endobronchial tube, for example, allowing complete collapse of the left or right lung, the left lung is deflated to allow access to the heart and LITA. A 6 to 8 cm left anterior thoracotomy incision is then made in the patient's chest in the fourth intercostal space. Other sites may be suitable depending on the patient's anatomy, such as the fifth or sixth intercostal space. A retractor is used to spread apart the ribs to provide access to the heart and the LITA. The LITA is then dissected under direct vision with suitable instruments introduced through the thoractomy incision, such as scissors, pliers and the like. The balloon 16 of catheter 10 is used to internally seal the LITA graft vessel prior to transecting the distal end of the LITA graft in preparation for the coronary anastomosis procedure. This obviates the need for using external clamps to provide hemostasis within the graft vessel prior to transection. Following dissection of the LITA, the resulting LITA pedicle is transected with a suitable instrument such as scissors through the thoracotomy. Papaverine is then injected directly through the LITA, which is prepared for coronary anastomosis to a stenotic coronary artery 64. The anastomosis of the LITA to the coronary artery is then performed directly through the thoracotomy incision by using conventional suturing means, or by using a novel distal anastomosis device and procedure such as described below in connection with Figs. 8-13 and in co-pending patent application for Anastomosis Device and Method, filed on March 9, 1998, and invented by Hugh Narciso, Jr. If required, cardiac stabilization such as described in co-pending provisional patent application, serial number 60/055,127, for Compositions, Apparatus and Methods for Facilitating Surgical Procedures, filed August 8, 1997, and invented by Francis G. Duhaylongsod, M.D., may be used during the procedure. Other pharmacological or mechanical methods may also be used. A second preferred intended novel use of the present invention is for locating the
LITA, for example, in a repeat coronary surgical procedure, such as in a redo CABG procedure, to prevent injury while attempting to correct an imperfect anastomosis graft between the LITA and a stenotic native coronary artery, such as the LAD. As noted above, locating the LITA during repeat CABG surgery, for example, is critical to the safety of the patient because the graft LITA represents one of the major supplies of blood to the heart.
When the LITA is anastomosed to the LAD, for example, it typically is placed across the anterior surface of the heart, directly under the sternum, as shown in Fig. 5. If a second, or redo, CABG procedure needs to be performed, the cardiac surgeon typically needs to bisect the sternum to gain access to the heart. Often in doing so, the surgeon inadvertently
10 compromises the LITA graft 46 and the patient has limited alternatives if the LITA graft cannot be repaired.
To alleviate this concern, as described above, a transillumination catheter, such as catheter 10 in Figs. 1-2, is percutaneously inserted into a peripheral vessel, such as a brachial artery 48 or radial artery 51 , and advanced into the LITA 46 via a subclavian artery 90 to provide illumination of the LITA, as schematically illustrated in Fig. 5. We have demonstrated that light diffusing from a transillumination catheter at a specific wavelength or wavelengths (for example, at a wavelength of between about 400 and 700 nm, and more preferably between about 600 and 700 nm) which is placed within the lumen of the LITA graft vessel is completely visible through the chest wall of the patient. With a transilluminator catheter in place and the LITA graft 46 illuminated, using current techniques, a surgeon can accurately perform a partial or median stemotomy to gain access into the patient's thoracic cavity while avoiding the illuminated LITA graft vessel, thus obviating difficulties associated with a compromised LITA graft 46. A partial or median stemotomy is a procedure by which a saw or other appropriate cutting instrument is used to make a midline, longitudinal incision along a portion or the entire axial length of the patient's sternum, allowing two opposing sternal halves to be separated laterally. A large opening into the thoracic cavity is thus created, through which a surgeon may directly visualize and operate upon the heart to correct the imperfect anastomosis or diseased graft vessel. Another preferred intended novel use for the present invention is for locating and manipulating stenotic coronary vessels to which a graft vessel is being anastomosed in a CABG procedure. When performing CABG surgery, the stenotic native coronary artery to which a graft vessel is being anastomosed is obscured by surrounding fat or cardiac tissues. The cardiac surgeon must cut through tissues to access the coronary artery for purposes of creating a clear field of view to perform the anastomosis procedure. In some instances, it is possible for the cardiac surgeon to compromise the stenotic coronary artery while attempting to cut through the fat and cardiac tissues. However, with a transilluminator catheter in place within the coronary artery, the cardiac surgeon will be able to dissect the surrounding tissues from the coronary artery thus exposing the artery for the anastomosis procedure. In this preferred use of catheter 10, the catheter 10 is percutaneosuly inserted into a peripheral vessel,
11 such as a brachial artery 48 or radial artery 51, as schematically illustrated in Fig. 6. Illumination of the transillumination catheter 10 will help the surgeon to visualize the stenotic coronary artery, such as a stenotic left anterior descending artery 64 while the graft vessel, such as the LITA pedicle 46 shown in Fig. 6, is being anastomosed to it. Fig. 7 schematically illustrates another preferred novel use of the transillumination catheter 10 of the present invention for harvesting a free vessel graft, typically a saphenous vein 84, from a patient undergoing a CABG procedure. Fig. 7 illustrates the location of various vessels, including the abdominal aorta 74, the common iliac artery 76 and the femoral vein 80. A transilluminator catheter 10 is percutaneously inserted under the skin and inserted into a saphenous vein 84. With the transilluminator in place and the saphenous vein 84 illuminated, a surgeon gently dissects the saphenous vein 84 with suitable surgical instruments, such as scissors and the like. The device may be used to transilluminate other bypass graft vessels such as a gastroepiploic artery 72 or an inferior epigastric artery 78. The use of a transillumination device placed within the vein to be harvested makes the harvesting procedure simpler and facilitates location and extraction of the graft vessel. The transillumination catheter can be used in combination with conventional endoscopic techniques to simplify the process of harvesting the vein graft in an endoscopic procedure.
Figure 8 illustrates an alternative embodiment of the transillumination catheter 10 of Figs. 1-2 generally indicated by reference numeral 100, wherein like numerals represent like parts. For example, the optical fiber 25, fiber optic connector 23, catheter sheath 21, and light diffusing end member 14 have the same general function and arrangement as described in Figs. 1-2. Transillumination catheter 100 can be used to facilitate the coronary surgical procedures described above akin to catheter 10, and can also be used to facilitate joining a transected graft vessel to a stenotic target vessel in a coronary anastomosis, as will be described in greater detail below.
As shown in Fig. 8, the Y-adapter 20 of catheter 10 is replaced with a three arm adapter 40 which incorporates two separate and independent balloon inflation/deflation ports
42, 44 which allow the addition of fluid, such as saline, through an inflation/deflation channel
(not shown) defined by outer sheath 18' to the distal balloons 16' and 50, respectively. Balloon 50 is affixed to the outer sheath 18' so that the balloon 50 overlies a substantial
12 portion of the light diffusing end member 14 of catheter 100. The wall of the balloon 50 is transparent at the wavelength of light being delivered to (or received from) the surrounding tissue from light diffusing end member 14. Distal and proximal to balloon 50 are radiopaque marker bands 13' for visualization under x-ray fluoroscopy. The provision of a second balloon 50 is advantageous where the transillumination catheter 100 of the present invention is used in connection with a novel distal anastomosis device disclosed in co-pending patent application for "Anastomosis Device and Method," filed on March 9, 1998 , and sharing a common inventor (Hugh L. Narciso, Jr.), the entire contents of which are fully incorporated by reference herein. As described therein, an anastomotic fastener is disclosed which in one embodiment comprises a tubular sleeve formed of a deformable material, such as a light-activated polymeric material (i.e., a polycaprolactone material) which becomes formable (i.e., fluent) upon the application of light energy to the material at a specific frequency, wavelength or wavelengths. The anastomotic fastener is configured to be positioned radially adjacent a free end portion of a graft vessel, such as a LITA graft, which is then preferably everted over a portion of the tubular sleeve. The deformable material may be selectively irradiated and molded in vivo by providing an energy source that produces radiation at a frequency, wavelength, or wavelengths that are readily absorbed by the material. Radial expansion of the graft vessel will permit the deformable material in its moldable state to be shaped such that the free end portion of the graft vessel in its everted configuration is in secure conforming engagement with an inner wall of the target vessel, resulting in an intima-to-intima anastomosis. Transillumination catheter 100 can be used in lieu of the light-diffusing catheter described in the subject co-pending patent application to irradiate and radially expand the anastomotic fastener device. For example, with reference to Figs. 9-13, transillumination catheter 100 is first inserted into a LITA graft vessel 110 in a similar fashion as described above in connection with Figs. 3-4, and the LITA graft vessel 110 can be illuminated and then dissected and transected using balloon 16' to seal the LITA prior to transecting it. With a free end portion of the LITA graft vessel 110 exposed as shown in Fig. 9 and balloon 16 expanded to occlude the vessel, a deformable anastomosis fastener device 120 can be positioned about an external
13 surface of (or inserted into) a free end portion of the LITA graft 110, which preferably is then everted over a portion of the tubular sleeve 120 (see Figs. 9-10). The LITA graft vessel 110 is then inserted into a target vessel 112, such as an LAD having a stenotic region 113, through an incision in a wall of the target vessel 112. With the anastomotic fastener 120 securely positioned in the target vessel 112, light energy at a given wavelength or wavelengths is supplied to the light diffusing end member 14 of catheter 100 from the energy source (not shown) via optical fiber 25 to irradiate, or illuminate, the tubular member 120 with light at a wavelength or wavelengths at which the deformable material readily absorbs. Upon absorption of the light energy, the deformable material forming tubular member 120 is transformed into its moldable, fluent state. Inflation of the balloon 50 causes the tubular member 120 to radially expand outwardly, thereby pressing the LITA graft vessel 110 into conforming engagement with an inner wall of target vessel 112 (see Fig. 12). If it is necessary to move catheter 100 longitudinally within the graft vessel 110 to, for example, precisely position balloon 50 radially adjacent tubular member 120, balloon 16' can be deflated slightly. This will permit longitudinal movement of the catheter 100 within the graft vessel 110, at which point balloon 16' can then be re-inflated fully to firmly seal the graft vessel 110 and prevent blood flow into the anastomosis site. By discontinuing the supply of light energy from the energy source, the deformable material will become non-fluent and remain in its molded configuration. Both balloons 16', 50 are then deflated and the catheter device 100 is withdrawn from the LITA graft vessel 110 to complete the anastomosis (see Fig. 13).
Figure 14 is a third alternative embodiment of a transillumination catheter generally indicated by reference numeral 200. The transillumination catheter 200 is similar in most respects to the transillumination catheter 10 of Figs. 1-2, except that the distal end of the catheter 200 is substantially straight, and does not have a curved configuration as does the distal end of catheter 10. A catheter guide 205 is shown in schematic form in Fig. 15. The guide 205 comprises a flexible, elongate tubular body 210 which is sized and dimensioned to permit catheter 200 to be longitudinally inserted within the tubular body 210. Tubular body
210 may be manufactured from any suitable, relatively flexible biocompatible plastic such as polyethylene, polyurethane, silicone, and the like. The guide 205 facilitates placement of
14 transillumination catheter 200 within an internal vessel, such as a LITA graft vessel. The catheter 200 may be formed with a guide wire lumen (not shown) as described in U.S. Patent No. 5,169,395, which is incorporated herein by reference. The lumen may be used for insertion of a guidewire or insertion of a fluoroscopic dye to assist in guiding the catheter. In use of the above system, the guide 205 is first percutaneously inserted into a peripheral vessel, such as a brachial artery 48, radial artery 51 or femoral artery 82, and advanced over a guidewire 220 by conventional means to an internal vessel, such as LITA graft vessel. With the distal end of tubular body 210 positioned a short distance within the internal vessel, the guidewire 220 is pulled back and removed from tubular body 210. Subsequently, transillumination catheter 200 can be longitudinally inserted into tubular body
210 and advanced transluminally through it such that the light transmitting diffusing end member 14' is placed within the internal vessel and extends beyond the distal end of the tubular body 210. Alternatively, tubular body 210 may be advanced into the internal vessel to a position at which transillumination of the vessel is required. Subsequently, the distal end of transillumination catheter 200 is advanced up to the distal end of tubular body 210, and the tubular body 210 is then pulled back a short distance over the transillumination catheter 200 to expose the light transmitting distal end member 14' of the catheter 200. The transillumination catheter 200 is then used to illuminate the internal vessel as described above. The guide 205 is advantageous in that it can be used to effectively guide catheter 200 into an internal vessel, obviating the need to shape the distal end of catheter 200 or to provide a guidewire or other steering mechanism within catheter 200.
It should be understood that while the above is a complete description of the preferred embodiments of the invention, various alternatives, modifications and equivalents may be used. Therefore, the above description should not be taken as limiting the scope of the invention which is defined by the following claims.
15

Claims

WHAT IS CLAIMED IS:
1. A method of identifying vasculature comprising the steps of introducing an indicator in a peripheral vessel, and advancing a portion of the indicator into an internal vessel to identify said vessel.
2. The method of claim 1 wherein the step of introducing an indicator comprises introducing a catheter having a light delivery portion, and further comprising the step of activating the light delivery portion to transmit light and identify the vessel.
3. The method of claim 2 further including the step of diffusing the transmitted light.
4. The method of claim 3 wherein the light has a wavelength in the range of 100 to 1100 nm.
5. The method of claim 3 wherein the light has a wavelength in the range of 400 to 700 nm.
6. The method of claim 3 wherein the light has a wavelength in the range of 600 to 700 nm.
7. The method of claim 2 further comprising the step of occluding blood flow through the internal vessel.
8. The method of claim 7 wherein said catheter comprises a balloon and said step of occluding comprises expanding the balloon.
9. The method of claim 8 further comprising the step of transecting a distal end of said internal vessel in preparation for a coronary anastomosis after expanding the balloon.
16
10. The method of claim 9 wherein said internal vessel is an internal thoracic artery and further comprising the step of sealingly joining a free end of said internal thoracic artery to a stenotic coronary artery after transecting the distal end of said internal thoracic artery.
11. The method of claim 1 wherein the internal vessel comprises an internal thoracic artery.
12. The method of claim 1 wherein the internal vessel comprises a right coronary artery.
13. The method of claim 1 wherein the internal vessel comprises a left main coronary artery.
14. The method of claim 1 wherein the internal vessel comprises a left anterior descending artery.
15. The method of claim 1 wherein the internal vessel comprises a left circumflex.
16. The method of claim 1 wherein the internal vessel comprises an aorta.
17. The method of claim 1 wherein the internal vessel comprises any branches of a right or left coronary artery.
18. The method of claim 1 wherein the internal vessel comprises a bypass graft vessel.
19. The method of claim 18 wherein the bypass graft vessel comprises a gastroepiploic artery
20. The method of claim 18 wherein the bypass graft vessel comprises an inferior epigastric artery.
17
21. The method of claim 1 wherein the peripheral vessel comprises a brachial artery.
22. The method of claim 1 wherein the peripheral vessel comprises a radial artery.
23. The method of claim 1 wherein the peripheral vessel comprises a femoral artery.
24. The method of claim 1 wherein the peripheral vessel comprises a carotid artery.
25. The method of claim 11 further comprising the step of dissecting at least a portion of the internal thoracic artery after advancing the indicator.
26. The method of claim 11 further comprising the step of separating a sternum after advancing the indicator.
27. A method of identifying a saphenous vein for a surgical procedure comprising the steps of introducing at least a portion of an indicator having a light delivery portion at a distal end thereof into the saphenous vein and transmitting light through the light delivery portion to identify the vein.
28. A catheter for identifying vasculature, the catheter adapted to be introduced into a peripheral vessel and a portion thereof advanced into an internal vessel, the catheter comprising a light delivery portion at a distal end thereof, and an expandable member located proximal to said light delivery portion.
29. The catheter of claim 28 further comprising an optical fiber.
30. The catheter of claim 28 wherein said light delivery portion is adapted to transmit energy having a wavelength in the range of 100 to 1100 nm.
18
31. The catheter of claim 28 wherein said light delivery portion is adapted to transmit energy having a wavelength in the range of 400 to 700 nm.
32. The catheter of claim 28 wherein said light delivery portion is adapted to transmit energy having a wavelength in the range of 600 to 700 nm.
33. The catheter of claim 28 further comprising a second expandable member located distal to said first expandable member and surrounding a substantial portion of said light delivery portion.
34. The catheter of claim 28 further comprising a bend in the distal end thereof to facilitate positioning the catheter in the internal vessel.
35. A method of performing a coronary artery bypass graft procedure on a patient's heart comprising the steps of:
forming at least one opening in the patient's chest;
locating a bypass graft vessel to provide an arterial blood supply;
illuminating said bypass graft vessel;
dissecting at least a portion of said bypass graft vessel;
transecting a distal end portion of said bypass graft vessel; and
connecting said distal end portion of the bypass graft vessel to a coronary artery with said bypass graft vessel in fluid communication with said coronary artery.
19
36. The method of claim 35 wherein said illuminating step comprises inserting a catheter having a light delivery portion into said bypass graft vessel.
37. The method of claim 36 wherein said light delivery portion is adapted to deliver light having a wavelength in the range of 100 to 1100 nm.
38. The method of claim 36 wherein said light delivery portion is adapted to deliver light having a wavelength in the range of 400 and 700 nm.
39. The method of claim 36 wherein said light delivery portion is adapted to deliver light having a wavelength in the range of 600 to 700 nm.
40. The method of claim 36 wherein said catheter comprises a balloon and further comprising the step of occluding said bypass graft vessel by inflating the balloon prior to said transecting step.
41. A system for delivering energy to an internal vessel of a patient comprising:
a catheter comprising a flexible, elongated shaft having a proximal end, a distal end, and an energy transmitting diffuser located at the distal end of the shaft; and
a catheter guide having an opening which is sized and dimensioned to permit said catheter to be inserted longitudinally within said guide, said guide being configured for introduction into the peripheral vessel and advancement to said internal vessel to facilitate delivery of said catheter into said internal vessel.
42. The system of claim 41 further comprising a guidewire adapted to extend through a longitudinal opening within the catheter guide.
20
PCT/US1999/004487 1998-03-13 1999-03-01 Transillumination catheter and method WO1999045837A1 (en)

Priority Applications (2)

Application Number Priority Date Filing Date Title
EP99909721A EP1061847A1 (en) 1998-03-13 1999-03-01 Transillumination catheter and method
AU28864/99A AU2886499A (en) 1998-03-13 1999-03-01 Transillumination catheter and method

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US09/042,433 1998-03-13
US09/042,433 US6113588A (en) 1998-03-13 1998-03-13 Transillumination catheter and method

Publications (1)

Publication Number Publication Date
WO1999045837A1 true WO1999045837A1 (en) 1999-09-16

Family

ID=21921916

Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/US1999/004487 WO1999045837A1 (en) 1998-03-13 1999-03-01 Transillumination catheter and method

Country Status (4)

Country Link
US (3) US6113588A (en)
EP (1) EP1061847A1 (en)
AU (1) AU2886499A (en)
WO (1) WO1999045837A1 (en)

Cited By (14)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2006081408A2 (en) 2005-01-26 2006-08-03 Kalser, Gary Illuminating balloon catheter and method of using the catheter
US8591497B2 (en) 2006-01-25 2013-11-26 Mayser, Llc Stretch valve balloon catheter and methods for producing and using same
US9005165B2 (en) 2006-01-25 2015-04-14 Mayser, Llc Zero-pressure balloon catheter and method for using the catheter
US9044571B2 (en) 2006-01-25 2015-06-02 Leonard Pinchuk Stretch valve balloon catheter and methods for producing and using same
US9056192B2 (en) 2006-01-25 2015-06-16 Mayser, Llc Stretch valve balloon catheter and methods for producing and using same
US9272120B2 (en) 2006-01-25 2016-03-01 Mayser, Llc Stretch valve balloon catheter and methods for producing and using same
US9572954B2 (en) 2005-01-26 2017-02-21 Mayser, Llc Stretch valve balloon catheter and methods for producing and using same
US9586022B2 (en) 2006-01-25 2017-03-07 Mayser, Llc Stretch valve balloon catheter and methods for producing and using same
US9642992B2 (en) 2005-01-26 2017-05-09 Mayser, Llc Stretch valve balloon catheter and methods for producing and using same
US9669193B2 (en) 2006-01-25 2017-06-06 Mayser, Llc Stretch valve balloon catheter and methods for producing and using same
US9675237B2 (en) 2005-01-26 2017-06-13 Mayser, Llc Illuminating balloon catheter and method for using the catheter
US9713698B2 (en) 2006-01-25 2017-07-25 Mayser, Llc Stretch valve balloon catheter and methods for producing and using same
US10137282B2 (en) 2010-11-10 2018-11-27 Mayser, Llc Stretch valve balloon catheter and methods for producing and using same
US11813421B2 (en) 2010-11-10 2023-11-14 Mayser, Llc Stretch valve balloon catheter and methods for producing and using same

Families Citing this family (51)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
NL1007349C2 (en) 1997-10-24 1999-04-27 Suyker Wilhelmus Joseph Leonardus System for the mechanical production of anastomoses between hollow structures; as well as device and applicator for use therewith.
US6176864B1 (en) * 1998-03-09 2001-01-23 Corvascular, Inc. Anastomosis device and method
WO2001013060A1 (en) 1999-08-13 2001-02-22 Advanced Sensor Technologies Llc Probe position sensing system for use in a coordinate measuring machine
US7101366B2 (en) * 2000-02-15 2006-09-05 Eva Corporation Apparatus and method for performing a surgical procedure
US6966917B1 (en) 2000-11-09 2005-11-22 Innovation Interventional Technologies B.V. Deformable connector for mechanically connecting hollow structures
US6558313B1 (en) 2000-11-17 2003-05-06 Embro Corporation Vein harvesting system and method
US6648911B1 (en) 2000-11-20 2003-11-18 Avantec Vascular Corporation Method and device for the treatment of vulnerable tissue site
US6629924B2 (en) * 2000-12-15 2003-10-07 Jayson D. Aydelotte Enhanced endotracheal tube
US7329223B1 (en) * 2001-05-31 2008-02-12 Abbott Cardiovascular Systems Inc. Catheter with optical fiber sensor
US7992573B2 (en) * 2001-06-19 2011-08-09 The Trustees Of The University Of Pennsylvania Optically guided system for precise placement of a medical catheter in a patient
CN100446723C (en) * 2001-06-19 2008-12-31 宾夕法尼亚大学理事会 Optical guidance system for invasive catheter placement
WO2003020103A2 (en) * 2001-09-04 2003-03-13 Amit Technology Science & Medicine Ltd. Method of and device for therapeutic illumination of internal organs and tissues
US7131963B1 (en) * 2002-06-27 2006-11-07 Advanced Cardiovascular Systems, Inc. Catheters and methods of using catheters
US7493154B2 (en) * 2002-10-23 2009-02-17 Medtronic, Inc. Methods and apparatus for locating body vessels and occlusions in body vessels
US20040236231A1 (en) * 2003-05-23 2004-11-25 Embro Corporation Light catheter for illuminating tissue structures
US8480696B2 (en) 2004-06-16 2013-07-09 Medtronic, Inc. Minimally invasive coring vein harvester
US7762951B2 (en) * 2004-06-25 2010-07-27 Medtronic, Inc. Vein harvesting system including dilator shaft and removable retractor housing
US20060036274A1 (en) * 2004-06-25 2006-02-16 Usher Raymond W One-piece vessel harvester
US7515970B2 (en) 2004-08-18 2009-04-07 Cardiac Pacemakers, Inc. Transeptal lead
US20080039715A1 (en) * 2004-11-04 2008-02-14 Wilson David F Three-dimensional optical guidance for catheter placement
US20070122344A1 (en) 2005-09-02 2007-05-31 University Of Rochester Medical Center Office Of Technology Transfer Intraoperative determination of nerve location
US20070073160A1 (en) 2005-09-13 2007-03-29 Children's Medical Center Corporation Light-guided transluminal catheter
US8954134B2 (en) 2005-09-13 2015-02-10 Children's Medical Center Corporation Light-guided transluminal catheter
US20070167864A1 (en) * 2005-11-29 2007-07-19 Lopez George A Cardiac output measurement devices and methods
US8500631B2 (en) * 2006-03-27 2013-08-06 Ethicon Endo-Surgery, Inc. Methods and devices for percutaneous illumination
US20080161744A1 (en) 2006-09-07 2008-07-03 University Of Rochester Medical Center Pre-And Intra-Operative Localization of Penile Sentinel Nodes
US20080097408A1 (en) * 2006-10-20 2008-04-24 Infraredx, Inc. Pullback Carriage Interlock System and Method for Catheter System
AU2008209480A1 (en) 2007-01-22 2008-07-31 California Institute Of Technology Method for quantitative 3-D imaging
KR20100017235A (en) 2007-04-23 2010-02-16 캘리포니아 인스티튜트 오브 테크놀로지 An aperture system with spatially-biased aperture for defocusing-based imaging
US9572583B2 (en) 2007-11-21 2017-02-21 St. Jude Medical, Atrial Fibrillation Division, Inc. Methods and systems for occluding vessels during cardiac ablation
US8663321B2 (en) 2007-12-06 2014-03-04 L. Van Thomas Crisco Minimally invasive method for coronary bypass and other treatments
US8406860B2 (en) 2008-01-25 2013-03-26 Novadaq Technologies Inc. Method for evaluating blush in myocardial tissue
US10219742B2 (en) 2008-04-14 2019-03-05 Novadaq Technologies ULC Locating and analyzing perforator flaps for plastic and reconstructive surgery
EP2285421B1 (en) 2008-05-02 2018-04-11 Novadaq Technologies ULC Methods for production and use of substance-loaded erythrocytes for observation and treatment of microvascular hemodynamics
EP2428932A1 (en) 2008-08-27 2012-03-14 California Institute of Technology Method and device for high-resolution three-dimensional imaging which obtains camera pose using defocusing
US8465479B2 (en) 2009-01-09 2013-06-18 Ncontact Surgical, Inc. Method and devices for performing biatrial coagulation
US20100191043A1 (en) * 2009-01-27 2010-07-29 Maquet Cardiovascular Llc Methods and devices for isolating a vessel
US10492671B2 (en) * 2009-05-08 2019-12-03 Novadaq Technologies ULC Near infra red fluorescence imaging for visualization of blood vessels during endoscopic harvest
US20110015484A1 (en) * 2009-07-16 2011-01-20 Alvarez Jeffrey B Endoscopic robotic catheter system
US8773507B2 (en) 2009-08-11 2014-07-08 California Institute Of Technology Defocusing feature matching system to measure camera pose with interchangeable lens cameras
WO2011133406A1 (en) * 2010-04-20 2011-10-27 Gharib, Morteza Catheter based 3-d defocusing imaging
DK2612297T3 (en) 2010-09-03 2017-11-13 California Inst Of Techn THREE-DIMENSIONAL IMAGE SYSTEM
CA2914778A1 (en) 2012-06-21 2013-12-27 Novadaq Technologies Inc. Quantification and analysis of angiography and perfusion
US20140378792A1 (en) * 2013-06-24 2014-12-25 William S. Krimsky Anti-fouling sleeve for indwelling catheters
WO2015072152A1 (en) * 2013-11-14 2015-05-21 学校法人 聖マリアンナ医科大学 Carbon monoxide poisoning resolving device, jacket for carbon monoxide poisoning treatment having said device, and catheter for carbon monoxide poisoning treatment
JP6549705B2 (en) 2014-09-29 2019-07-24 ノバダック テクノロジーズ ユーエルシー Imaging of target fluorophores in biological material in the presence of autofluorescence
JP6487544B2 (en) 2014-10-09 2019-03-20 ノバダック テクノロジーズ ユーエルシー Quantification of absolute blood flow in tissues using fluorescence-mediated photoelectric plethysmography
US11406264B2 (en) 2016-01-25 2022-08-09 California Institute Of Technology Non-invasive measurement of intraocular pressure
EP3580609B1 (en) 2017-02-10 2023-05-24 Stryker European Operations Limited Open-field handheld fluorescence imaging systems and methods
US11413109B2 (en) 2018-02-12 2022-08-16 Gyrus Acmi, Inc. Electrosurgical instrument with a functional element
GR1009925B (en) * 2019-12-13 2021-02-01 Δημητριος Νικολαου Χατζης Cutting and angleing device for intraluminal navigation

Citations (9)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP0311295A2 (en) * 1987-10-07 1989-04-12 University College London Improvements in surgical apparatus
US5169395A (en) 1991-04-26 1992-12-08 Pdt Cardiovascular, Inc. Laser delivery system
US5176881A (en) * 1989-08-11 1993-01-05 The University Of Tennessee Research Corporation Fiber optic-based regenerable biosensor
US5196005A (en) 1991-11-26 1993-03-23 Pdt Systems, Inc. Continuous gradient cylindrical diffusion tip for optical fibers and method for making
US5269777A (en) 1990-11-01 1993-12-14 Pdt Systems, Inc. Diffusion tip for optical fibers
EP0617912A1 (en) * 1993-04-01 1994-10-05 Terumo Kabushiki Kaisha Measuring apparatus using sensor in blood
US5370640A (en) 1993-07-01 1994-12-06 Kolff; Jack Intracorporeal catheter placement apparatus and method
US5624432A (en) 1991-10-07 1997-04-29 Angelchik; Jean P. Illuminating bougie and methods for diagnostic, therapeutic and surgical procedures
WO1997032182A1 (en) * 1996-02-27 1997-09-04 Massachusetts Institute Of Technology Method and apparatus for performing optical measurements using a fiber optic imaging guidewire, catheter or endoscope

Family Cites Families (12)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5042980A (en) * 1989-05-26 1991-08-27 C. R. Bard, Inc. Optical fiber diffusion tip for uniform illumination
US5237638A (en) * 1991-03-14 1993-08-17 Pdt Systems Silicone optical waveguide
US5217456A (en) * 1992-02-24 1993-06-08 Pdt Cardiovascular, Inc. Device and method for intra-vascular optical radial imaging
US5237985A (en) * 1992-06-22 1993-08-24 Crystal Wind, Inc. Uterine retractor
US5267995A (en) * 1992-09-01 1993-12-07 Pdt Systems Optical waveguide with flexible tip
US5588952A (en) * 1993-08-02 1996-12-31 Dandolu; Bhaktavathsala R. Intracardiac illuminator with suction
US5454794A (en) * 1993-10-15 1995-10-03 Pdt Systems, Inc. Steerable light diffusing catheter
US5441497A (en) * 1994-07-14 1995-08-15 Pdt Cardiovascular, Inc. Light diffusing guidewire
US5698866A (en) * 1994-09-19 1997-12-16 Pdt Systems, Inc. Uniform illuminator for phototherapy
US5980549A (en) * 1995-07-13 1999-11-09 Origin Medsystems, Inc. Tissue separation cannula with dissection probe and method
US5925054A (en) * 1996-02-20 1999-07-20 Cardiothoracic Systems, Inc. Perfusion device for maintaining blood flow in a vessel while isolating an anastomosis
US5722426A (en) * 1996-02-26 1998-03-03 Kolff; Jack Coronary light probe and method of use

Patent Citations (10)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP0311295A2 (en) * 1987-10-07 1989-04-12 University College London Improvements in surgical apparatus
US5176881A (en) * 1989-08-11 1993-01-05 The University Of Tennessee Research Corporation Fiber optic-based regenerable biosensor
US5269777A (en) 1990-11-01 1993-12-14 Pdt Systems, Inc. Diffusion tip for optical fibers
US5169395A (en) 1991-04-26 1992-12-08 Pdt Cardiovascular, Inc. Laser delivery system
US5624432A (en) 1991-10-07 1997-04-29 Angelchik; Jean P. Illuminating bougie and methods for diagnostic, therapeutic and surgical procedures
US5196005A (en) 1991-11-26 1993-03-23 Pdt Systems, Inc. Continuous gradient cylindrical diffusion tip for optical fibers and method for making
US5330465A (en) 1991-11-26 1994-07-19 Laser Therapeutics, Inc. Continuous gradient cylindrical diffusion tip for optical fibers and method for using
EP0617912A1 (en) * 1993-04-01 1994-10-05 Terumo Kabushiki Kaisha Measuring apparatus using sensor in blood
US5370640A (en) 1993-07-01 1994-12-06 Kolff; Jack Intracorporeal catheter placement apparatus and method
WO1997032182A1 (en) * 1996-02-27 1997-09-04 Massachusetts Institute Of Technology Method and apparatus for performing optical measurements using a fiber optic imaging guidewire, catheter or endoscope

Cited By (19)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2006081408A2 (en) 2005-01-26 2006-08-03 Kalser, Gary Illuminating balloon catheter and method of using the catheter
EP1874383A2 (en) * 2005-01-26 2008-01-09 Gary Kalser Illuminating balloon catheter and method of using the catheter
EP1874383A4 (en) * 2005-01-26 2010-06-09 Gary Kalser Illuminating balloon catheter and method of using the catheter
US9878124B2 (en) 2005-01-26 2018-01-30 Mayser, Llc Stretch valve balloon catheter and methods for producing and using same
US8801699B2 (en) 2005-01-26 2014-08-12 Mayser, Llc Illuminating balloon catheter and method for using the catheter
US9675237B2 (en) 2005-01-26 2017-06-13 Mayser, Llc Illuminating balloon catheter and method for using the catheter
US9642992B2 (en) 2005-01-26 2017-05-09 Mayser, Llc Stretch valve balloon catheter and methods for producing and using same
US9572954B2 (en) 2005-01-26 2017-02-21 Mayser, Llc Stretch valve balloon catheter and methods for producing and using same
US9272120B2 (en) 2006-01-25 2016-03-01 Mayser, Llc Stretch valve balloon catheter and methods for producing and using same
US9056192B2 (en) 2006-01-25 2015-06-16 Mayser, Llc Stretch valve balloon catheter and methods for producing and using same
US9586022B2 (en) 2006-01-25 2017-03-07 Mayser, Llc Stretch valve balloon catheter and methods for producing and using same
US9044571B2 (en) 2006-01-25 2015-06-02 Leonard Pinchuk Stretch valve balloon catheter and methods for producing and using same
US9669193B2 (en) 2006-01-25 2017-06-06 Mayser, Llc Stretch valve balloon catheter and methods for producing and using same
US9005165B2 (en) 2006-01-25 2015-04-14 Mayser, Llc Zero-pressure balloon catheter and method for using the catheter
US9713698B2 (en) 2006-01-25 2017-07-25 Mayser, Llc Stretch valve balloon catheter and methods for producing and using same
US8591497B2 (en) 2006-01-25 2013-11-26 Mayser, Llc Stretch valve balloon catheter and methods for producing and using same
US10137282B2 (en) 2010-11-10 2018-11-27 Mayser, Llc Stretch valve balloon catheter and methods for producing and using same
US11103682B2 (en) 2010-11-10 2021-08-31 Mayser, Llc Stretch valve balloon catheter and methods for producing and using same
US11813421B2 (en) 2010-11-10 2023-11-14 Mayser, Llc Stretch valve balloon catheter and methods for producing and using same

Also Published As

Publication number Publication date
AU2886499A (en) 1999-09-27
US20020052597A1 (en) 2002-05-02
US6113588A (en) 2000-09-05
US20020038120A1 (en) 2002-03-28
EP1061847A1 (en) 2000-12-27

Similar Documents

Publication Publication Date Title
US6113588A (en) Transillumination catheter and method
US5904147A (en) Intravascular catheter and method of controlling hemorrhage during minimally invasive surgery
AU763132B2 (en) Kit for endovascular venous surgery
US6958035B2 (en) Medical device sheath apparatus and method of making and using same
US6277137B1 (en) Tissue separation cannula with dissection probe and method
US5875782A (en) Methods and devices for minimally invasive coronary artery revascularization on a beating heart without cardiopulmonary bypass
US7384423B1 (en) Tissue dissection method
US5873889A (en) Tissue separation cannula with dissection probe and method
JP4138251B2 (en) Direct visual subcutaneous tissue retractor
US6832984B2 (en) Minimally invasive surgery device
US8961502B2 (en) Device for irradiating an internal body surface
US20040236231A1 (en) Light catheter for illuminating tissue structures
US6685666B1 (en) Catheters for breast surgery
WO1998006450A9 (en) Balloon catheter with visible or magnetic marker
US20080195085A1 (en) Economical, two component, thermal energy delivery and surface cooling apparatus and its method of use
JPH10108827A (en) Infrared ray system for visualizing body portion
US7909762B2 (en) Vein harvesting system including dilator shaft and removable retractor housing
US20070010875A1 (en) Method and apparatus to attach an unsupported surgical component
JP2000505315A (en) Tissue separation cannula with incision probe and method
WO2002007632A1 (en) Illuminating devices for medical use
JP2022516171A (en) Positioning of the tube in the lumen by transillumination
Katzir Optical fibers in medicine
Van Stiegmann et al. Flexible angioscopy seems faster and more specific than arteriography
Itoh et al. Vascular endoscopy for major vascular reconstruction: experimental and clinical studies
JP3211141B2 (en) Body lumen identification device

Legal Events

Date Code Title Description
AK Designated states

Kind code of ref document: A1

Designated state(s): AL AM AT AU AZ BA BB BG BR BY CA CH CN CU CZ DE DK EE ES FI GB GD GE GH GM HR HU ID IL IN IS JP KE KG KP KR KZ LC LK LR LS LT LU LV MD MG MK MN MW MX NO NZ PL PT RO RU SD SE SG SI SK SL TJ TM TR TT UA UG US UZ VN YU ZW

AL Designated countries for regional patents

Kind code of ref document: A1

Designated state(s): GH GM KE LS MW SD SL SZ UG ZW AM AZ BY KG KZ MD RU TJ TM AT BE CH CY DE DK ES FI FR GB GR IE IT LU MC NL PT SE BF BJ CF CG CI CM GA GN GW ML MR NE SN TD TG

121 Ep: the epo has been informed by wipo that ep was designated in this application
DFPE Request for preliminary examination filed prior to expiration of 19th month from priority date (pct application filed before 20040101)
NENP Non-entry into the national phase

Ref country code: KR

WWE Wipo information: entry into national phase

Ref document number: 1999909721

Country of ref document: EP

WWP Wipo information: published in national office

Ref document number: 1999909721

Country of ref document: EP

REG Reference to national code

Ref country code: DE

Ref legal event code: 8642

WWW Wipo information: withdrawn in national office

Ref document number: 1999909721

Country of ref document: EP