Fluoroscopy-independent, endovascular aortic occlusion system
A system for deploying and selectively inflating a thoracic aortic balloon at a desired location within the thoracic aorta for resuscitative aortic occlusion, inferior to the left subclavian artery, without the aid of fluoroscopy is described. Using CT imaging data, a distance between readily identifiable and consistently located external landmarks of torso extent is measured. Next, using the same data, a second distance from the femoral artery to a desired aortic occlusion location inferior to the left subclavian artery is determined. A correlation between the external measure of torso extent and the desired intra-arterial (i.e. endovascular) distance within the torso is made. Using a nomogram, a calibrated endovascular resuscitative thoracic aortic occlusion system can be positioned to this desired location on any injured individual with end-stage shock and impending cardiovascular collapse or death without the aid of fluoroscopy for delivery or balloon inflation.
1. A vessel occlusion system for occluding a thoracic artery of a patient between the left subclavian artery and an aortic bifurcation to reduce blood flow to the patients extremities, the system comprising:
a balloon shaft including a distal end portion and a proximal end portion, the proximal end portion including a port, the balloon shaft also including pre-calibrated length indicia on an external surface;
an occlusion balloon connected to the distal end portion, the port being in fluid communication with the occlusion balloon;
a balloon inflation lumen extending along a length of the balloon shaft, the balloon inflation lumen being in fluid communication with the balloon and the port;
a curved tip at the distal end portion, the curved tip configured to limit perforation of vessels as the balloon shaft is advanced through blood vessels of the patient toward and through the target blood vessel; and
a nomogram correlating a first distance between at least two externally identifiable boney anatomical landmarks of humans of a pool of humans and a second distance from an insertion puncture to the predetermined location of the humans, wherein a reference distance between the at least two externally identifiable external boney anatomical landmarks of the patients torso, the nomogram configured to enable a comparison of a measurement on the patient to the first distance on the nomogram to determine the correlated second distance such that the predetermined location is the determined second distance from the insertion puncture and the occlusion balloon is to be inserted into the patient and positioned at the predetermined location within the target blood vessel without using fluoroscopy, the pre-calibrated length indicia providing an indication of an insertion distance of the occlusion balloon from the insertion puncture, the nomogram also including a listing of a diameter of the aorta.
2. The system of claim 1 , wherein the predetermined location is comprised of an aortic branch artery landmark.
3. The system of claim 1 , further comprising:
a 6 French percutaneous sheath, the percutaneous sheath configured for insertion at least partially into the patient at the insertion puncture, the balloon shaft sized and configured for insertion into and at least partially through the percutaneous sheath.
4. The system of claim 3 , wherein the percutaneous sheath has a length of approximately ten centimeters.
5. The system of claim 1 , wherein the curved tip is fixed to an endovascular wire.
6. The system of claim 5 , wherein the endovascular wire is configured to extend through the balloon shaft.
7. The system of claim 1 , further comprising:
an endovascular wire;
a percutaneous sheath configured for insertion at least partially into the patient at the insertion puncture; and
a plurality of self-expanding wire struts connected to the endovascular wire, the wire struts biased to an expanded state and movable to a collapsed state when positioned within the percutaneous sheath.
8. The system of claim 7 , wherein the wire struts are connected to the endovascular wire by a leading securement bead and a trailing securement bead, the leading and trailing securement beads located between the occlusion balloon and the curved tip.
9. The system of claim 1 , wherein the curved tip is comprised of a J tip.
10. The system of claim 1 , further comprising:
a multi-port and valve assembly secured to the proximal portion of the balloon shaft.
11. The system of claim 10 , wherein the multi-port and valve assembly includes the port and a pressure monitoring device configured to monitor pressure within the occlusion balloon during inflation.
12. The system of claim 1 , wherein the pre-calibrated length indicia include minor length markers and major length markers.
13. The system of claim 1 , wherein the pre-calibrated indicia include major length markers and minor length markers.
14. The system of claim 13 , wherein the major length markers are spaced in five centimeter increments and the minor length markers are spaced in one centimeter increments.
15. A thoracic aortic occlusion system for occluding a predetermined location in a aorta of a patient between a left subclavian artery and an aortic bifurcation to reduce blood flow to a lower portion of the patient's body, the system comprising:
a balloon shaft including a distal end portion having a distal end and a proximal end portion, the proximal end portion including a port, the balloon shaft also including pre-calibrated length indicia on an external surface;
an occlusion balloon connected to the distal end portion, the port being in fluid communication with the occlusion balloon and a balloon inflation lumen extending through the balloon shaft;
a multi-port and valve assembly connected to the proximal portion, the port positioned on the multi-port and valve assembly;
a curved tip at the distal end portion, the curved tip configured to limit perforation of vessels as the balloon shaft is advanced through blood vessels of the patient toward and through the thoracic aortic zone; and
a nomogram correlating a first distance between a symphysis pubis and a sternal notch of humans of a pool of humans and a second distance from an insertion puncture in a femoral artery to the predetermined location in the aorta of the humans and a diameter of the aorta, the nomogram configured to enable a comparison of a reference distance between the symphysis pubis and the sternal notch measured on the patient between the patient's symphysis pubis and sternal notch and the first distance on the nomogram to determine the correlated second distance such that the predetermined location is the determined second distance from the insertion puncture and the occlusion balloon is to be inserted into the patient and positioned at the predetermined location within the aorta without using fluoroscopy, the pre-calibrated length indicia providing an indication of an insertion distance of the occlusion balloon from the insertion puncture at the insertion puncture.
16. The system of claim 15 , further comprising:
an endovascular wire extending through a lumen in the balloon shaft, the lumen being separate from the balloon inflation lumen.
17. The system of claim 16 , wherein the curved tip is comprised of a J-tip at a distal end of the endovascular wire.
18. The system of claim 16 , further comprising:
a plurality of wire struts connected to the endovascular wire, the plurality of wire struts located proximally relative to the curved tip.
19. The system of claim 15 , wherein the balloon shaft has a length of approximately ninety centimeters.