Fenestration devices, systems, and methods
The present disclosure provides methods and apparatuses for guiding an endovascular tool, such as a puncturing tool or an angioscope, in a radial direction, such as toward or through the sidewall of a vessel, stent, or stent graft, using elongate members and specialized catheters. The present disclosure provides methods and apparatuses for locating branch vessels from within a grafted main vessel while maintaining continuous blood flow to the branch vessel. Another aspect of the present disclosure involves a reverse cannulation system, particularly useful for stenting the abdominal aorta proximate the renal arteries and stenting the renal artery.
1. A guide device deployable through a vessel comprising:
an expandable member including a plurality of slats, each of which is movable between a collapsed position and an outwardly extending, expanded position, at least one of the slats including an inner surface, an outer surface, and an aperture extending between and through the inner surface and the outer surface and the aperture being located on the slat that permits an endovascular tool to pass from a guide tube through the aperture;
the guide tube having a distal tip operatively coupled to the expandable member;
a first elongate member comprising a first lumen; and
a second elongate member comprising a second lumen, wherein the expandable member extends between a first end connected to the first elongate member and an opposite second end connected to the second elongate member, such that the expandable member expands outwardly in response to longitudinal displacement of the second elongate member relative to the first elongate member, wherein the longitudinal displacement of the second elongate member is configured to apply a compression or a tension force to the expandable member and is configured to result in a radial expansion of the expandable member.
2. The guide device of claim 1 , wherein the expandable member moves in response to selective actuation of the expandable member between the collapsed and expanded positions.
3. The guide device of claim 1 , wherein the guide tube is flexible and is configured to bend as the expandable member outwardly bends in response to corresponding longitudinal displacement of the second elongate member relative to the first elongate member.
4. The guide device of claim 1 , wherein the expandable member has a discontinuous structure to allow perfusion of fluid therethrough when in an expanded position.
5. The guide device of claim 1 , wherein the expandable member is configured to permit perfusion of fluid around the guide device when the expandable member is in the collapsed configuration and to permit perfusion between the plurality of slats of the expandable member when the expandable member is in the expanded positions.
6. The guide device of claim 1 , wherein the radial expansion of the expandable member is substantially radially symmetrical.
7. The guide device of claim 1 , wherein the expandable member comprises nitinol.
8. The guide device of claim 1 , wherein the expandable member is adjustable across a range of expanded position diameters.
9. The guide device of claim 1 , wherein the distal tip comprises a radiopaque material.
10. The guide device of claim 1 , wherein at least a portion of the first elongate member, the second elongate member, and the guide tube are coaxial along their lengths.