Methods and systems for vein harvesting and fistula creation
Veins are removed using a pull catheter introduced over a guidewire which extends between first and second percutaneous access points. Optionally, a side branch management tool including an excision device and/or a viewing scope can be advanced over the same guidewire in the direction opposite to that of the pull catheter. In that way, as the pull catheter inverts the vein being removed, side branches can be selectively viewed and/or severed using the side branch management tool. Arteriovenous fistulas are formed by inverting a length of a vein, mobilizing the inverted length relocating the mobilized end of the vein, and connecting the mobilized end to an artery.
1. A system for vein removal, said system comprising:
a guidewire capable of extending from a proximal location to a space-apart distal location on a vein;
a pull catheter adapted to be introduced over a proximal end of the guidewire in a distal direction and having means for attaching an excised end of the vein to a distal portion thereof so that the attached end can be pulled and inverted by the pull catheter; and
side branch management tool adapted to be introduced over another end of the guidewire and having means for dissecting side venous side branches from the vein which are exposed as the vein is pulled in a proximal direction.
2. A system as in claim 1 , wherein the guidewire has a length in the range from 180 cm to 260 cm and a diameter in the range from 0.2 mm to 0.9 mm.
3. A system as in claim 1 , wherein the pull catheter comprises a catheter body having a length in the range from 40 cm to 80 cm.
4. A system as in claim 3 , wherein the side branch management tool comprises a catheter body having a length in the range from 40 cm to 80 cm.
5. A system as in claim 1 , wherein the attaching means on the pull catheter comprises an aperture or a circumferential trough for tying the vein thereto.
6. A system as in claim 1 , wherein the pull catheter includes at least one lumen for receiving the guidewire.
7. A system as in claim 1 , wherein the dissecting means on the side branch management tool comprises a blade.
8. A system as in claim 1 , wherein the dissecting means comprises a blunt dissector.
9. A system as in claim 1 , wherein the dissecting means comprises an electrosurgical tool.
10. A system as in claim 1 , wherein the pull catheter further comprises a distal extension having a length generally equal to that of the catheter body.
11. A system as in claim 1 , wherein the side branch management tool comprises means for selectively engaging and tensioning a side branch.
12. A system as in claim 11 , wherein the tensioning means comprises a stop which is adapted to rotatorally engage and tension the side branch.
13. A kit for vein removal, said kit comprising:
a guidewire;
a pull catheter
a side branch management tool; and
instructions for use setting forth a method comprising:
exposing first and second spaced-apart locations along a vein;
transecting the vein at each location;
passing the guidewire through a lumen of the vein between the first and the second location;
introducing the pull catheter over the wire between the first location and the second location;
attaching the vein to a distal end of the pull catheter at the second location;
pulling the pull catheter from the second location to remove vein through the first location, wherein the vein is inverted with an inversion line which moves from the second location toward the first location as the vein is inverted; and
excising venous side branches with the side branch management tool as the side branches are exposed by the inversion.