Vascular access devices and methods for lower limb interventions
A guide sheath device with an integrated stabilization wire is provided. The guide sheath device includes an elongate member having a proximal and distal end and a lumen there between and a stabilization wire integrated to the elongate member.
1. A guide sheath apparatus for performing a lower extremity endovascular procedure, the apparatus comprising:
an elongate member having a proximal and distal end and a lumen therebetween, the elongate member configured to be inserted into a lower extremity vasculature via a contralateral percutaneous access; and
a stabilization wire having a proximal end and a distal end partially integrated into and along a wall of the elongate member, wherein the stabilization wire bifurcates away from the elongate member at a transition point between the proximal end and the distal end of the elongate member, and the stabilization wire is configured to exit the lower extremity vasculature via an ipsilateral percutaneous access.
2. The guide sheath apparatus of claim 1 , further comprising a snare device configured to be inserted into the lower extremity vasculature via an ipsilateral percutaneous access.
3. The guide sheath apparatus of claim 2 , wherein the snare device comprises a snare sheath containing a snare wire having a snare loop at a distal end of the snare wire, the snare loop configured to snare and capture the distal end of the stabilization wire.
4. The apparatus of claim 1 , wherein the transition point comprises at least a radio opaque marker.
5. The guide sheath apparatus of claim 1 , wherein the transition point is closer to the distal end of the elongate member than the proximal end of the elongate member.
6. The guide sheath apparatus of claim 1 , wherein the stabilization wire is one of a flat wire or a round wire.
7. The guide sheath apparatus of claim 1 , wherein the proximal end of the elongate member is configured to be outside the contralateral percutaneous access and the distal end of the elongate member is configured to be outside the ipsilateral percutaneous access.
8. The guide sheath apparatus of claim 4 , wherein the distal end of the stabilization wire is configured to be anchored in place by a locking tool outside the ipsilateral percutaneous access.
9. The guide sheath apparatus of claim 1 , wherein the lumen of the elongate member is configured to allow passage of one or more guidewires.
10. The guide sheath apparatus of claim 1 , wherein the elongate member comprises any of a metal tubing, reinforced or unreinforced polymeric tubing or a combination thereof.
11. The guide sheath apparatus of claim 10 , wherein the metal tubing comprises stainless steel, nickel titanium, cobalt chromium, copper or aluminum.
12. The guide sheath apparatus of claim 10 , wherein the reinforced polymeric tubing comprises braided or coil structures made from any of stainless steel, nickel titanium, composites, metal reinforced polymer, or polymer.
13. The guide sheath apparatus of claim 1 , wherein the elongate member comprises one or more radiopaque markers or a radio-opaque filler along its length.
14. The guide sheath apparatus of claim 13 , wherein the one or more radiopaque markers are at at least one of a distal tip and the transition point.
15. The guide sheath apparatus of claim 13 , wherein the one or more radiopaque markers enable visual guidance of location of stabilization wire transition under fluoroscopy.
16. The guide sheath apparatus of claim 13 , wherein the one or more radiopaque markers comprises a coil or tube fabricated using one or more selected from the group consisting of gold, platinum, iridium, and barium sulfate loaded polymer.
17. A method for performing an endovascular procedure, the method comprising:
inserting a guide sheath having a proximal and a distal end and an elongate member having a lumen therebetween via a contralateral percutaneous access into a lower extremity vasculature, the elongate member having a proximal and a distal end and comprising a stabilization wire partly integrated into and along a wall of the elongate member, a distal end of the stabilization wire bifurcating away from the elongate member at a transition point between the proximal end and the distal end of the elongate member;
inserting a snare device via an ipsilateral access site into the lower extremity vasculature;
capturing the distal end of the stabilization wire with the snare device;
externalizing the stabilization wire at the ipsilateral access site and positioning the distal end of the elongate member within the lower extremity vasculature at or near the ipsilateral access site by applying a tensile force to the snare device and a push force to the guide sheath;
reversibly anchoring the externalized stabilization wire at the ipsilateral access site.
18. The method of claim 17 , wherein reversibly anchoring the externalized stabilization wire at the ipsilateral access site stabilizes the distal end of the elongate member positioned within the lower extremity vasculature at or near the ipsilateral access site.
19. The method of claim 17 , wherein the snare device comprises a snare catheter with a coaxial snare wire having a snare loop at its distal end.
20. The method of claim 19 , wherein capturing the distal end of the stabilization wire by the snare device comprises positioning the distal end of the stabilization wire inside the snare loop and cinching the stabilization wire inside the snare loop under fluoroscopic visualization.
21. The method of claim 17 , further comprising guiding the guide sheath by fluoroscopic imaging using one or more radiopaque fillers or radiopaque markers on the elongate member.
22. The method of claim 17 , wherein the one or more radiopaque markers are attached to the elongate member by any of welding, heat fusing, adhesive bonding, mechanical locking, crimping, laminating or soldering.