Devices and methods for ligating anatomical structures

Abstract

Devices and methods for ligating anatomical structures are provided herein. In particular, the devices and methods provided herein can be used to ligate the left atrial appendage.

1 . A ligating device comprising:
 a catheter comprising a proximal end and a distal end;   a ligating element located within the catheter, wherein the ligating element comprises a lumen and a first end and a second end, wherein the first end and the second protrude from the proximal end of the catheter; and   a control element located within the lumen of the ligating element, the control element comprising a first end that protrudes from the first end of the ligating element, wherein a distal portion of the control element forms an open loop upon exit from the distal end of the catheter, and wherein the open loop is compressed when the distal portion of the control element is located within the catheter, and further wherein the control element forces the ligating element to adopt a lariat configuration when outside of the catheter.   
   
   
       2 . A ligating device according to  claim 1 , wherein the control element is removable, such that the control element can be pulled out of the lumen of the ligating element. 
   
   
       3 . A ligating device according to  claim 1 , wherein the control element comprises a second end, and wherein the second end of the control element protrudes from the ligating element. 
   
   
       4 . A ligating device according to  claim 1 , wherein a portion of the ligating element comprises a knot formed therein. 
   
   
       5 . A ligating device according to  claim 4 , wherein the control element extends through the portion of the ligating element that comprises the knot. 
   
   
       6 . A ligating device according to  claim 1 , wherein the control element comprises a distal portion and a proximal portion, and further wherein the distal portion is thinner than the proximal portion. 
   
   
       7 . A ligating device according to  claim 1 , wherein the ligating element comprises a knot formed therein, and wherein the control element comprises a distal end that is located distal from the knot. 
   
   
       8 . A ligating device according to  claim 7 , wherein a secondary control element is located within a portion of the ligating element, wherein a distal end of the second control element is located proximal from the knot such that the second control element does not extend through the knot. 
   
   
       9 . A ligating device according to  claim 1 , wherein the ligating element comprises a hollow suture and the control element comprises shape memory material. 
   
   
       10 . A ligating device according to  claim 1 , wherein the lariat is formed at an angle with respect to an elongate portion of the control element from which the lariat extends. 
   
   
       11 . A ligating device according to  claim 1 , wherein the control element comprises an angled portion when the control element is located outside of the catheter. 
   
   
       12 . A ligating device according to  claim 1 , further comprising a positioning element attached to the lariat of the ligating element. 
   
   
       13 . A ligating device according to  claim 1 , further comprising an appendage positioning element. 
   
   
       14 . A ligating device according to  claim 1 , wherein control element comprises magnetizable material such that the position of the ligating element can be manipulated by a magnetic device. 
   
   
       15 . A ligating device according to  claim 1 , further comprising a sheath in which the catheter is located. 
   
   
       16 . A ligating device comprising:
 a catheter comprising a proximal end and a distal end;   an elongate element located within the catheter, the elongate element comprising a proximal end and a distal end;   a ligating element located within the catheter, wherein the ligating element is attached to the distal end of the elongate element, and further wherein the ligating element comprises an original shape of a closed loop;   a control element located within the catheter, the control element comprising a first end that protrudes from the proximal end of the catheter, wherein a portion of the control element is contained within the ligating element, wherein pulling on the first end of the control element opens the ligating element from its original closed loop shape to open the ligating element into a lariat configuration.   
   
   
       17 . A ligating device according to  claim 16 , wherein the ligating element is rotatably attached to the elongate element. 
   
   
       18 . A ligating device comprising:
 a catheter comprising a proximal end and a distal end;   an elongate element located within the catheter, the elongate element comprising a proximal end and a distal end;   a ligating element located within the catheter, wherein the ligating element is attached to the distal end of the elongate element, and further wherein the ligating element comprises a ring clip whose natural position is closed;   a hollow control element attached to the ligating element; and   a conduit in fluid communication with the hollow control element, wherein the conduit extends to the proximal end of the catheter, wherein pressurized fluid delivered to the control element inflates the control element to open the ligating element.   
   
   
       19 . A ligating device according to  claim 18 , wherein the control element is located inside of the ligating element. 
   
   
       20 . A ligating device according to  claim 18 , wherein the control element is located outside of the ligating element. 
   
   
       21 . A ligating device according to  claim 18 , wherein the conduit is located within the elongate element. 
   
   
       22 . A ligating device according to  claim 18 , further comprising a source of pressurized fluid in fluid communication with the conduit. 
   
   
       23 . A ligating device comprising:
 a catheter comprising a proximal end and a distal end;   a control element located within the catheter, wherein the control element comprises an elongate U-shape with both ends protruding from the proximal end of the catheter and the bottom of the U-shape positioned near the distal end of the catheter;   a ligating element attached to one end of the control element;   wherein the end of the control element that is not attached to the ligating element can be pulled to advance the ligating element through the catheter.   
   
   
       24 . A ligating device according to  claim 23 , wherein the ligating device further comprises a tubular sheath surrounding a portion of the control element at the distal end of the catheter, wherein advancing the ligating element also advances the ligating element through the tubular sheath. 
   
   
       25 . A ligating device comprising:
 a catheter comprising a proximal end and a distal end;   a control element located within the catheter, the control element comprising a first elongate portion located within the catheter, the first elongate portion comprising a proximal end and a distal end, wherein the control element further comprises a second elongate portion located within the catheter, the second elongate portion comprising a proximal end and a distal end; and   a ligating element attached to the distal ends of the first elongate portion and the second elongate portion, wherein manipulation of the first elongate portion and the second elongate portion cause the ligating element to form a lariat.   
   
   
       26 . A method of ligating an anatomical structure, the method comprising:
 advancing a ligating device according to  claim 1  to a selected anatomical structure; and   operating the ligating device to ligate the selected anatomical structure.   
   
   
       27 - 30 . (canceled)