Percutaneous bypass with branching vessel

Abstract

In order to bypass a restriction in a parent vessel, a first site in a branch vessel branching from the aorta is accessed intraluminally. An occlusion is formed at the first site, and the aperture is formed in the branching vessel, intraluminally, proximal of the first site. An aperture is formed in the parent vessel distal of the restriction, and a lumen is formed which communicates between the branching vessel proximal of the occlusion, and the parent vessel distal of the restriction.

What is claimed is:  
     
         1 . A method of bypassing a restriction in a parent vessel of a mammal having an aorta and a branching vessel branching from the aorta, the method comprising: 
 intraluminally accessing a first site in the branching vessel;    intraluminally forming an aperture in the branching vessel at the first site;    forming an aperture in the parent vessel distal of the restriction; and    providing a conduit to form a lumen communicating through the aperture in the branching vessel with a lumen in the branching vessel proximal of the first site and through the aperture in the parent vessel with a lumen of the parent vessel distal of the restriction.    
     
     
         2 . The method of  claim 1  wherein forming an aperture in the branching vessel comprises: 
 severing the branching vessel at the first site to form a severed end.  
 
     
     
         3 . The method of  claim 2  wherein providing a conduit comprises: 
 attaching a region of the branching vessel proximate the severed end to a region of the parent vessel proximate the aperture such that a lumen in the branching vessel communicates with a lumen in the parent vessel.  
 
     
     
         4 . The method of  claim 3  wherein attaching a region of the branching vessel comprises: 
 intraluminally suturing the severed end of the branching vessel about the aperture in the parent vessel.  
 
     
     
         5 . The method of  claim 3  wherein attaching a region of the branching vessel comprises: 
 inserting the severed end of the branching vessel through the aperture in the parent vessel within the lumen of the parent vessel; and  
 connecting the severed end to the parent vessel.  
 
     
     
         6 . The method of  claim 5  wherein connecting the severed end comprises: 
 deploying a stent in the parent vessel to attach the severed end to the parent vessel.  
 
     
     
         7 . The method of  claim 5  wherein connecting the severed end comprises: 
 delivering adhesive in the parent vessel proximate the severed end to attach the severed end to the parent vessel.  
 
     
     
         8 . The method of  claim 1  wherein providing a conduit comprises: 
 delivering a graft to the branching vessel;  
 advancing a first end of the graft through the aperture in the branching vessel; and  
 attaching the graft to the parent vessel such that a lumen in the graft communicates with a lumen in the parent vessel through the aperture in the parent vessel and with a lumen in the IMA.  
 
     
     
         9 . The method of  claim 8  wherein attaching the graft to the parent vessel comprises: 
 advancing the first end of the graft through the aperture in the parent vessel; and  
 deploying a stent in the first end of the graft to attach the first end of the graft to the parent vessel.  
 
     
     
         10 . The method of  claim 8  wherein attaching the graft to the parent vessel comprises: 
 advancing the first end of the graft through the aperture in the parent vessel; and  
 delivering adhesive to the parent vessel proximate the first end of the graft to attach the first end of the graft to the parent vessel.  
 
     
     
         11 . The method of  claim 3  and further comprising: 
 guiding the severed end proximate a region of the parent vessel distal of the restriction prior to attaching the severed end to the parent vessel.  
 
     
     
         12 . The method of  claim 11  wherein guiding the severed end comprises: 
 inserting a first magnetic member in the severed end; and  
 manipulating a second magnetic member residing outside the branching vessel to position the severed end proximate the region of the parent vessel through magnetic interaction between the first and second magnetic members.  
 
     
     
         13 . The method of  claim 1  wherein the restriction in the parent vessel is an incomplete occlusion, and further comprising: 
 prior to forming an aperture in the parent vessel, forming a total occlusion in the parent vessel proximal of a region where the aperture is to be formed.  
 
     
     
         14 . The method of  claim 1  and further comprising: 
 prior to forming an aperture in the branching vessel, forming an occlusion in the branching vessel distal of the first site.  
 
     
     
         15 . The method of  claim 1  and further comprising: 
 prior to forming the aperture in the branching vessel, temporarily occluding the branching vessel proximal of a region in the branching vessel where the aperture is to be formed.  
 
     
     
         16 . The method of  claim 15  wherein temporarily occluding comprises: 
 advancing an expandable member through the branching vessel to the region proximal of the aperture in the branching vessel; and  
 expanding the expandable member to occlude the branching vessel.  
 
     
     
         17 . The method of  claim 1  wherein providing a conduit comprises: 
 positioning an end of the conduit proximate a region of the native vessel distal of the restriction.  
 
     
     
         18 . The method of  claim 17  wherein positioning an end of the conduit comprises: 
 injecting contrast medium through the conduit and through the region of the native vessel distal of the restriction; and  
 moving the end of the conduit based on observation of the contrast medium.  
 
     
     
         19 . The method of  claim 17  wherein positioning an end of the conduit comprises: 
 placing an emitter in one of the region of the native vessel distal of the restriction and the end of the conduit, the emitter emitting location signals;  
 placing a sensor in another of the region of the native vessel distal of the restriction and the end of the conduit, the sensor sensing the location signals and providing an output indicative of the location signals sensed; and  
 moving the end of the conduit based on the output from the sensor.  
 
     
     
         20 . The method of  claim 19  wherein placing an emitter comprises: 
 placing a light emitter in one of the region of the native vessel distal of the restriction and the end of the conduit; and  
 wherein placing a sensor comprises placing a fiber optic bundle in another of the region of the native vessel distal of the restriction and the end of the conduit, the fiber optic bundle sensing light emitted by the light emitter and providing the output indicative of the light sensed.  
 
     
     
         21 . The method of  claim 19  wherein placing an emitter comprises: 
 placing an ultrasound emitter in one of the region of the native vessel distal of the restriction and the end of the conduit; and  
 wherein placing a sensor comprises placing an ultrasound imager in another of the region of the native vessel distal of the restriction and the end of the conduit, the ultrasound imager sensing ultrasound signals emitted by the ultrasound emitter and providing the output as an ultrasound image indicative of the ultrasound signals sensed.  
 
     
     
         22 . The method of  claim 19  wherein placing an emitter comprises: 
 placing an electromagnetic signal emitter in one of the region of the native vessel distal of the restriction and the end of the conduit; and  
 wherein placing a sensor comprises placing an electromagnetic sensing array in another of the region of the native vessel distal of the restriction and the end of the conduit, the electromagnetic sensing array sensing electromagnetic signals emitted by the electromagnetic signal emitter and providing the output indicative of the electromagnetic signals sensed.  
 
     
     
         23 . The method of  claim 19  wherein placing an emitter comprises: 
 placing a radio frequency (RF) signal emitter in one of the region of the native vessel distal of the restriction and the end of the conduit; and  
 wherein placing a sensor comprises placing an RF sensor in another of the region of the native vessel distal of the restriction and the end of the conduit, the RF sensor sensing RF signals emitted by the RF signal emitter and providing the output indicative of the RF signals sensed.  
 
     
     
         24 . The method of  claim 17  wherein positioning an end of the conduit comprises: 
 placing a first emitter in the region of the native vessel distal of the restriction and a second emitter in the end of the conduit, the first and second emitters emitting location signals;  
 sensing the location signals and providing an operator perceptible output indicative of the relative location of the region of the native vessel distal to the restriction and the end of the conduit;  
 and  
 moving the second end of the graft based on the operator perceptible output from the sensor.  
 
     
     
         25 . The method of  claim 17  wherein positioning an end of the conduit comprises: 
 inserting a first magnetic member in the end of the conduit; and  
 manipulating a second magnetic member residing outside the conduit to position the end of the conduit proximate the region of the parent vessel through magnetic interaction between the first and second magnetic members.  
 
     
     
         26 . A method of bypassing a restriction in a parent vessel of a mammal having an aorta and a branching vessel branching from the aorta, the method comprising: 
 intraluminally accessing a first site in the branching vessel;    intraluminally severing the branching vessel at the first site to form a severed end;    forming an aperture in the parent vessel distal of the restriction; and    attaching a region of the branching vessel proximate the severed end to a region of the parent vessel proximate the aperture such that a lumen in the IMA communicates with a lumen in the parent vessel.    
     
     
         27 . A method of bypassing a restriction in a parent vessel of a mammal having an aorta and a branching vessel branching from the aorta, the method comprising: 
 intraluminally accessing a first site in the branching vessel;    intraluminally forming an aperture in the branching vessel at the first site to form a severed end;    forming an aperture in the parent vessel distal of the restriction; and    attaching a first end of a graft to the branching vessel proximate the aperture therein and attaching a second end of the graft to a region of the parent vessel proximate the aperture therein such that a lumen in the branching vessel communicates with a lumen in the parent vessel through the graft.