US20040064090A1 - Apparatus and methods for treating congestive heart disease - Google Patents

Abstract

Methods and apparatus are provided for treating congestive heart by actively or passively enhancing perfusion to the renal arteries. A first embodiment comprises a specially configured balloon catheter and extracorporeal pump, wherein the pump operates in a “once-through” fashion or alternating volume displacement mode. In another embodiment the catheter includes a pair of balloons to isolate a region of the aorta, and a third balloon that directs flow into the renal arteries. In still further embodiments, a stent or cuff having a constricted region is deployed in or around the aorta, respectively, to create a backpressure upstream of the stent or cuff. Methods of enhancing renal perfusion also are provided.

Description

CROSS-REFERENCE TO RELATED APPLICATIONS
• This application is a continuation of copending U.S. patent application Ser. No. 09/562,493 filed on May 1, 2000, incorporated by reference herein, which is a continuation in part of copending U.S. patent application Ser. No. 09/229,390 filed on Jan. 11, 1999, incorporated by reference herein.[0001]
STATEMENT REGARDING FEDERALLY SPONSORED RESEARCH OR DEVELOPMENT
• Not Applicable[0002]
INCORPORATION-BY-REFERENCE OF MATERIAL SUBMITTED ON A COMPACT DISC
• Not Applicable[0003]
BACKGROUND OF THE INVENTION
• 1. Field of the Invention[0004]
• The present invention relates to apparatus for treating acute renal failure such as that caused by congestive heart disease and other trauma by providing increased blood perfusion to the kidneys, thereby enhancing renal function.[0005]
• 2. Background of the Invention[0006]
• Acute renal failure (“ARF”) is an abrupt decrease in the kidney's ability to excrete waste from a patient's blood. This change in kidney function may be attributable to many causes. A traumatic event, such as hemorrhage, gastrointestinal fluid loss, or renal fluid loss without proper fluid replacement may cause the patient to go into ARF. Patient's may also become vulnerable to ARF after receiving anesthesia, surgery, α-adrenergic argonists or high dose dopamine or patients with hepatorenal syndrome because of related systemic or renal vasoconstriction. Alternatively, systemic vasodilation cause by anaphylaxis; antihypertensive drugs, sepsis or drug overdose may also cause ARF because the body's natural defense is to shut down “non-essential” organs such as the kidneys. Additionally, reduced cardiac output caused by cardiac shock, congestive heart failure, pericardial tamponade or massive pulmonary embolism creates an excess of fluid in the body. Specifically it has long been known that cardiac dysfunction induces a series of events that ultimately contribute to congestive heart failure (“CHF”). One such event is a reduction in renal blood flow due to reduced cardiac output. This reduced flow can in turn result in the retention of excess fluid in the patient's body, leading for example, to pulmonary and cardiac edema.[0007]
• The appearance of ARF significantly increases mortality. ICU patients mortality rates for patients without ARF are approximately 20%. However, once ARF is achieved, the mortality rates jump to between 60% and 80%. Preventing ARF in patients at risk but who have not yet had any renal insufficiency will have a dramatic impact on ICU mortality rates.[0008]
• Chapter 62 of[0009]Heart Disease: A Textbook of Cardiovascular Medicine,(E. Braunwald, ed., 5th ed. 1996), published by Saunders of Philadelphia, Pa., reports that for patients with CHF, the fall in effective renal blood flow is proportional to the reduction in cardiac output. Renal blood flow in normal patients in an age range of 20-80 years averages 600 to 660 ml/min/m²corresponding to about 14 to 20 percent of simultaneously measured cardiac output. Within a wide spectrum of CHF severity, renal blood flow is depressed to an average range of 250 to 450 ml/mm/m².
• Previously known methods of treating ARF attributable to congestive heart failure and deteriorating renal function in patients having CHF principally involve administering drugs, including diuretics that enhance renal function, such as furosemide and thiazide; vasopressors intended to enhance renal blood flow, such as Dopamine; and vasodilators that reduce vasoconstriction of the renal vessels. Many of these drugs, when administered in systemic doses, have undesirable side-effects. Additionally, many of these drugs would not be helpful in treating other causes of ARF. Specifically, administering vasodilators to dilate the renal artery to a patient suffering from systemic vasodilation would merely compound the vasodilation system wide.[0010]
• In addition, for patients with severe CHF (e.g., those awaiting heart transplant), mechanical methods, such as hemodialysis or left ventricular assist devices, may be implemented. Mechanical treatments, such as hemodialysis, however, generally have not been used for long-term management of CHF. Such mechanical treatments would also not be help for patients with strong hearts suffering from ARF.[0011]
• Advanced heart failure (“HF”) requires the combination of potent diuretics and severe restriction of salt intake. Poor patient compliance is a major cause of refractoriness to treatment. On the other hand, as renal urine output decreases with reduced renal perfusion, in the event of dehydration, the required diuretic dosages increase.[0012]
• Recent work has focused on the use of intra-aortic balloon pumps (IABPs) to divert blood flow into the renal arteries. One such technique involves placing an IABP in the abdominal aorta so that the balloon is situated slightly below (proximal to) the renal arteries. The balloon is selectively inflated and deflated in a counterpulsation mode so that increased pressure distal to the balloon directs a greater portion of blood flow into the renal arteries.[0013]
• In view of the foregoing, it would be desirable to provide methods and apparatus for treating and managing ARF without administering high doses of drugs or dehydrating the patient.[0014]
• It further would be desirable to provide methods and apparatus for treating and managing ARF by improving blood flow to the kidneys, thereby enhancing renal function. Specifically, a system which could be used for all ARF patients during critical treatment times would be beneficial. In particular, a system which could be placed easily in a patient during emergency or critical care without the need for surgery or X-ray fluoroscopy guidance would be useful to all patients in danger of ARF.[0015]
• It also would be desirable to provide methods and apparatus for treating and managing ARF that permit the administration of low doses of drugs, in a localized manner, to improve renal function without having an effect system wide.[0016]
• It still further would be desirable to provide methods and apparatus for treating and managing ARF using apparatus that may be percutaneously and transluminally implanted in the patient.[0017]
SUMMARY OF THE INVENTION
• The present invention provides methods and apparatus for treating and managing ARF without administering high doses of drugs or dehydrating the patient by improving blood flow to the kidneys, thereby enhancing renal function.[0018]
• This invention also provides methods and apparatus for treating and managing ARF that permit the administration of low doses of drugs, in a localized manner, to improve renal function.[0019]
• The present invention also provides methods and apparatus for treating and managing ARF using apparatus that may be percutaneously and transluminally implanted in the patient.[0020]
• These and other advantages of the present invention are obtained by providing apparatus and methods that either actively or passively enhance perfusion of the renal arteries with autologous blood. Active perfusion may be accomplished using an extracorporeal pump and one of a number of specially designed catheter sets, while passive perfusion may be accomplished by creating a constriction in the aorta proximal to the renal arteries. Apparatus and method which direct a low dose of drugs in a localized manner are also provided.[0021]
• To facilitate the advancement of the catheter into the patient's coronary artery, a guiding catheter having a distal tip may be first percutaneously introduced into the abdominal aorta of a patient by the Seldinger technique through the brachial or femoral arteries. The catheter is advanced until the preshaped distal tip of the guiding catheter is disposed within the aorta adjacent the ostium of the renal arteries. A balloon catheter embodying features of the invention may then be advanced through the guiding catheter into the patient's abdominal aorta over a guidewire until the balloon on the catheter is disposed at the desired region of the patient's artery. In specific embodiments, the use of a guiding catheter is unnecessary. The advancement of the catheter over a guidewire is sufficient to achieve adequate placement.[0022]
• For active perfusion, the apparatus of the present invention preferably comprises a balloon catheter coupled to a pump. The pump may be extracorporeal or in-line. In one embodiment the catheter has an inlet end configured for placement in a source of arterial blood, such as the aorta or a femoral artery, and an outlet end configured to provide perfusion of one or both renal arteries. Blood is drawn through the catheter from the inlet end and pumped back, using either the same or a different lumen, to one or both renal arteries. Blood drawn into the catheter either may pass through the extracorporeal pump, or alternatively the pump may operate by periodic fluid displacement. Sensors may be provided on the catheter to monitor pressure within the renal arteries, and such pressure data may in turn be used to adjust the pump operation. The balloon catheter has at least one balloon. In specific embodiments, the balloon catheter has 2 balloons. The balloons may be systematically inflated against the aorta wall and deflated to assist in the perfusion of the renal arteries.[0023]
• The balloon may be formed using either compliant or non-compliant materials, preferably compliant. Most optimally, the balloon material is chosen so that inflation of the balloon to a volume sufficient to occlude the aorta, i.e., to a diameter of between 15 and 35 mm, will create a sufficient pressure within the balloon so as to provide the balloon with some degree of mechanical rigidity and to likewise apply a small amount of outward radial force to the aortic wall so as to provide positional and orientational stability to the balloon. Such a pressure is typically between about 4 and about 20 psi. Materials that can achieve such behavior include synthetic polyisoprene and thermoplastic urethane. Material durometer and tensile modulus must be selected appropriately so as to allow for the above properties to be exhibited with a practical balloon-wall thickness. Material with a shore hardness of about 70 A to about 100 A, preferably about 80 A to about 90 A are appropriate. For example, thermoplastic urethane such as Dow Pellethane 2363-80 A, which has a Shore hardness of 80 A, a tensile modulus of 1750 psi at 300% elongation and an ultimate elongation of 550%, can be used for forming the balloon. Balloons may be formed by dipping a shaped mandrel into a mixture of urethane dissolved in a solvent, such as tetrahydrofuran. The mandrel should be shaped so as to produce an uninflated balloon with a diameter of between 3 and 8 mm. The dipping process should be repeated so as to produce a balloon with an uninflated wall thickness of between 0.002 in. and 0.010 in. Alternatively, the balloon can be formed by first melt-extruding a length of tubing and then blow-molding the tube into a balloon form. Dimensions of the tubing and mold would be chosen to achieve the same diameter and thickness described above.[0024]
• The inflated balloon should have a maximum safety-factored diameter of between 15 and 35 mm, to accommodate the range of diameters of the human infrarenal aorta. Alternatively, the device could be available in a range of balloon sizes, such as 15 to 25 mm and 25 to 35 mm. In order to provide positional and orientational stability to the catheter within the aorta, the inflated balloon should have a length of about 2 to about 8 cm, preferably about 3 to about 6 cm. The catheter shaft can be formed by melt extrusion processing of thermoplastic polymers typically used in catheters, such as Hytrel, Pebax or polyurethane.[0025]
• The balloon can be attached to the catheter shaft by either an adhesive bond or a thermal fusion. The later can be used if a thermoplastic balloon material, such as polyurethane, is used. If a thermoset material, such as polyisoprene, is used, an adhesive will be used to attach the balloon. Cyanoacrylate adhesives, such as Loctite 4203 combined with Loctite Primer 770, can be used, as can urethane-based UV-cured adhesives, such as Dymax 205CTH can also be used. In addition, 2-part adhesives, such as epoxies or urethane-based adhesives can be used.[0026]
• In a specific embodiment, the catheter has a pump which is an in-line archimedean screw pump situated within a balloon catheter. An archimedean screw is a screw which allows for fluid movement with the turning of the screw. The balloon catheter has 2 balloons, a distal balloon and a proximal balloon, longitudinally displaced from each other, and the screw pump is preferably situated between the two balloons. However, the screw pump may also be situated at a location distal to the distal balloon. The catheter is placed in the patient within the abdominal aorta. The balloon catheter has a proximal end and a distal end. The catheter distal end is inserted below the renal arteries, specifically the femoral artery, in the patient and advanced until the distal balloon is situated above the renal arteries. Below the renal arteries is defined as toward the patients legs, and above is defined as toward the patient's head. However, in certain embodiments, it may be preferable to enter the patient from above the renal arteries, for example from the brachial arteries. If so, then the placement of the balloons and any blood or drug outlet ports would be inverted on the catheter shaft with respect to any description of preferred embodiments in this application. A blood inlet is located on a portion of the catheter distal end that is distal to the distal balloon. In the specific embodiment, the screw pump is activated, causing blood to enter the catheter through the blood lumen. The screw pump causes a pressure increase in the blood, which then exits the catheter through outlet ports near the renal arteries. Alternatively, some blood may exit the catheter at the proximal end to provide blood to the lower extremities. The balloons may be inflated and deflated to provide blood flow to the patient's lower extremities.[0027]
• The balloon of the catheter is inflated to retain the outlet end of the catheter in position in a renal artery and to prevent backflow of blood into the abdominal aorta. Alternatively, a pair of balloons may be selectively inflated to isolate the region of the abdominal aorta adjacent to the renal arteries. In yet another embodiment, a center balloon is disposed within an isolated region of the abdominal aorta defined by the distal and proximal balloons, and the extracorporeal pump is employed to inflate the third balloon to increase flow to the renal arteries.[0028]
• In any of the foregoing cases it is expected that blood passing through the catheter, or trapped within the isolated region of the abdominal aorta, will have a higher pressure and flow rate than blood reaching the renal arteries via the abdominal aorta. This, in turn, is expected to improve renal blood flow without the administration of systemic drug doses. The enhanced renal blood flow is expected to provide a proportional increase in renal function, thereby reducing fluid retention.[0029]
• In further alternative embodiments, the catheter may include a drug infusion reservoir that injects a low dose of a drug (e.g., a diuretic or vasodilator) into blood flowing through the lumen, so that the drug-infused blood passes directly into the kidneys, or separate catheters to perfuse the left and right kidneys independently.[0030]
• In a specific embodiment, a balloon catheter having a distal end and a proximal end and at least one lumen therebetween is inserted in a patient below the renal arteries, specifically the femoral artery. The catheter includes a balloon disposed about the catheter shaft. The catheter is advanced until the distal end sits above the renal arteries and the balloon sits at a location below the renal arteries within the patient's abdominal aorta. A drug delivery device is connected to the proximal end of the catheter. The drug delivery device may be extracorporeal or in-line. In specific embodiments, the catheter has at least two lumens. One lumen is an inflation lumen, in fluid communication with the interior of the balloon. The second lumen is an drug delivery lumen, which is in fluid communication with the drug delivery device and with discharge ports which are located on the catheter shaft at a location distal to the balloon. In some embodiments, a third lumen may exist, which is the blood lumen. The blood lumen would have an inlet port on the catheter shaft distal end and an outlet port at a location proximal to the balloon.[0031]
• After placement, the balloon is inflated. When the balloon is inflated against the abdominal aorta wall, the drug delivery device is activated. A drug is delivered through the drug delivery lumen, and the drug enters the patients aorta through the discharge points. Because of the inflated balloon sitting just below the renal arteries, the drug is effectively blocked from entering the lower extremities, and instead flows to the renal arteries. In certain embodiments, the drug is delivered in a pulse fashion, with the balloon inflating at drug delivery and deflating to allow blood to flow between drug delivery pulses.[0032]
• For passive perfusion, apparatus is provided that constricts the abdominal aorta proximal to the renal arteries. In this case, a stent or other device is disposed within the aorta to cause a narrowing of the aorta proximal to the renal arteries, thereby creating a pressure differential across the apparatus that is expected to improve blood flow rate to the renal arteries.[0033]
• Methods of using the apparatus of the present invention for treating ARF are also provided.[0034]
BRIEF DESCRIPTION OF THE DRAWINGS
• Further features of the invention, its nature and various advantages will be more apparent from the accompanying drawings and the following detailed description of the preferred embodiments, in which:[0035]
• FIG. 1 is a partial sectional view of a human circulatory system having perfusion apparatus constructed in accordance with the principles of the present invention implanted therein;[0036]
• FIGS. 2A and 2B are, respectively, a side view of the distal end of the apparatus of the apparatus of FIG. 1, and a cross-sectional view of the apparatus along section line[0037]2B-2B of FIG. 2A;
• FIG. 3 is a partial sectional view of a human circulatory system having an alternative embodiment of the apparatus of FIG. 1 including a double balloon for simultaneous perfusion of both renal arteries;[0038]
• FIG. 4 is a partial sectional view of a human circulatory system having an alternative embodiment of the apparatus of FIG. 1 in which catheter blood flow occurs in one lumen;[0039]
• FIG. 5 is a partial sectional view of a human circulatory system having an alternative embodiment of the apparatus of FIG. 3 in which catheter blood flow occurs in one lumen;[0040]
• FIG. 6 is a partial sectional view of a human circulatory system having an alternative embodiment of the apparatus of FIG. 1 in which blood is pumped using periodic fluid displacement;[0041]
• FIG. 7 is a partial sectional view of a human circulatory system having an alternative embodiment of the apparatus of FIG. 3 which perfuses both renal arteries;[0042]
• FIG. 8 is a partial sectional view of a human circulatory system having an alternative embodiment of the apparatus of the present invention implanted therein;[0043]
• FIGS. 9A and 9B are partial sectional views of the distal end of apparatus labeled with radiopaque markers in, respectively, the inflated and deflated states; and[0044]
• FIGS. 10A and 10B are partial sectional views of a human circulatory system having, respectively, an aortic stent and an inflatable cuff placed proximal of the renal arteries to enhance perfusion.[0045]
• FIG. 11 is an elevational view of a catheter partially in section of a catheter embodying features of the invention including an archimedean screw pump disposed with a patient's abdominal aorta.[0046]
• FIG. 12 is an elevational view partially in section of a catheter embodying features of the invention including an archimedean screw pump.[0047]
• FIG. 13 is an elevational view of an archimedean screw.[0048]
• FIG. 14 is an elevational view, partially in section, of an alternative embodiment of the catheter of the invention including the archimedean screw pump.[0049]
• FIGS. 15A, 15B and[0050]15C are transverse cross sectional views of the catheter of FIG. 12 along lines15A-A,15B-B and15C-C respectively.
• FIG. 16 is an elevational view of a catheter embodying features of the invention including a drug delivery system disposed with a patient's abdominal aorta, FIG. 16B is an enlarged view of area[0051]16B.
• FIG. 17 is an elevational view of an alternative embodiment of a catheter embodying features of the invention including a drug delivery system.[0052]
• FIG. 18 is a transverse cross sectional view of the catheter of FIG. 16 along line[0053]18-18.
• FIG. 19 is an alternative transverse cross sectional view of the catheter of FIG. 16 along line[0054]18-18.
• FIG. 20 is a graphical representation of the balloon inflation and deflation during drug infusion and the drug's affect on the renal arteries.[0055]
DETAILED DESCRIPTION OF THE INVENTION
• The present invention provides several apparatus for treating patients suffering from congestive heart failure (“CHF”) by improving renal blood flow and renal function. Some preferred embodiments of the present invention provide active perfusion of the renal arteries, and comprise a catheter and an extracorporeal pump. The catheter and pump may be used either to withdraw autologous blood from the patient's body and reperfuse that blood into the patient's renal arteries, or to isolate a region of the abdominal aorta and cause a pressure differential within the isolated region that causes perfusion of the renal arteries.[0056]
• Other preferred embodiments of the present invention cause a constriction in the abdominal aorta downstream (proximal) of the renal arteries, so that the pressure differential resulting from the constriction preferentially perfuses the renal arteries.[0057]
• Referring to FIGS. 1 and 2A-[0058]2B, a first illustrative embodiment of an active perfusion apparatus of the present invention comprising catheter andblood pump36 is described.
• [0059]Catheter36 comprises a hollow flexible tube havinginlet port31,outlet port33, andballoon32.Ports31 and33 may optionally include one-way valves, such as duck-bill valves, that control the direction of flow. As shown in FIG. 2B,catheter30 includesinlet lumen38,outlet lumen39 and inflation lumen40.Catheter30 preferably comprises a flexible biocompatable material typically used in catheter construction, such as polyethylene, polyurethane or nylon.
• [0060]Balloon32, which is configured to retaindistal end41 ofcatheter30 in renal artery RA, is inflated and deflated using an inflation medium, e.g., saline, supplied byinflation device34 through inflation lumen40.Balloon32 preferably comprises a compliant bio-compatible material, such as nylon.Inflation device34 preferably comprises, e.g., a syringe, a pressurized cylinder or a pump.
• [0061]Blood pump36 is coupled in-line withcatheter30, and includes pump36adriven by variable speed motor36b.Blood pump36 may comprise any of a number of previously known devices, such as a roller pump, centrifuge pump, or positive-displacement type pump.Blood pump36 may in addition include control circuitry that receives signals from sensors disposed incatheter30 to monitor local pressures, for example, renal and aortic pressure. Such monitored values may then be used by the control circuitry to adjust the perfusion pressure, blood flow rate or pump speed used to perfuse the kidneys.
• [0062]Catheter30 also optionally comprises ablood oxygenation element42 disposed within the extracorporeal blood circuit.Oxygenation element42, if provided, supplies oxygen to oxygen-poor blood prior to perfusion into renal artery RA.Oxygenation element42 may comprise, for example, a blood oxygenator such as used in cardiopulmonary bypass. Alternatively, the blood perfused into the renal artery may be mixed with saline supersaturated with oxygen, for example, as described in U.S. Pat. No. 5,797,876, which is incorporated herein by reference.
• In operation, blood enters[0063]catheter30 throughinlet port31 and is drawn out of the patient's body throughinlet lumen39 toinlet tube35 ofpump36. The blood then passes throughblood pump36, which controls the volume and pressure of blood delivered to the renal artery. Blood then passes throughpump outlet tube37, back throughoutlet lumen39 ofcatheter30, and is delivered to the renal artery throughoutlet port33. As described hereinabove, operation of the blood pump may be adjusted responsive to pressure or flow parameters measured in the renal arteries, the aorta, or elsewhere withincatheter30.
• [0064]Catheter30 preferably is implanted in circulatory system C so thatinlet port31 is disposed in abdominal aorta AA, whileoutlet port33 is disposed in renal artery RA. Whenballoon32 inflates, it engages the walls of the renal artery and retainsholes31 and33 in position.Balloon32 also prevents backflow of high pressure blood exiting throughoutlet port33 from flowing backwards into abdominal aorta AA. Accordingly,blood entering catheter30 viainlet port31 passes into the renal artery RA and kidney K throughoutlet port33, thereby enhancing renal blood flow and renal function.
• Referring now to FIG. 3, an alternative embodiment of the active perfusion apparatus of the present invention, comprising[0065]catheter50 and pump36, is described.Catheter50 is similar in construction tocatheter30 of FIGS.1 &2A-2B, and includesinlet lumen38,outlet lumen39, and inflation lumen40.Catheter50 is coupled toballoon inflation device34,blood pump36, includingpump inlet tube35 andpump outlet tube37. Unlikecatheter30, however,distal region56 ofcatheter50 is disposed in the abdominal aorta, not the renal artery, andcatheter50 includesproximal balloon53 in addition toballoon52 located betweeninlet port51 and outlet port54.
• In particular,[0066]inlet port51 is disposed indistal region56 ofcatheter50, and again may optionally include a one-way flow valve. Outlet port54 comprises several apertures communicating withoutlet lumen39, and may in addition optionally include one-way flow valves. The positions of the apertures forming outlet port54 betweenballoons52 and53 and adjacent renal arteries RA ensures that the blood is deposited into both kidneys simultaneously, thereby enhancing renal blood flow and function.
• Balloons[0067]52 and53 are inflated/deflated with an inflation medium, such as saline, usinginflation device34. When inflated, balloons52 and53 isolate the region of the aorta there between (including the renal arteries) from the remainder of the aorta. Consequently,blood exiting catheter50 via outlet port54 is directed into renal arteries RA. In addition, because for this embodiment inflation of theballoons52 and53 occludes blood flow to the patient's lower extremities, balloons52 and53 must be periodically deflated. Accordingly,inflation device34 preferably comprises a pump that deflatesballoons52 and53 at predetermined intervals, or is synchronized to the patient's heart rhythm viacontroller55. In the latter case,controller55 may comprise, for example, a previously known EKG device or blood oximeter.
• In operation,[0068]catheter50 is percutaneously and transluminally introduced in the patient's abdominal aorta via a cut-down to the femoral artery. Oncecatheter50 is disposed so that balloons52 and53 straddle renal arteries RA, the balloons are inflated byinflation device34. When inflated, the balloons holdinlet port51 and outlet port54 in position within aorta AA. The balloons also serve to prevent high pressure blood exiting through outlet port54 from flowing out of the isolated region into other regions of the aorta.Blood pump36 pumps blood through the fluid circuit frominlet port51 to outlet port54. Periodically, e.g., every 15 seconds, balloons52 and53 are deflated to re-establish blood flow to the lower extremities for a short period of time to prevent ischemia of the lower limbs.
• Alternatively, balloons[0069]52 and53 may be connected to separate inflation lumens. In this embodiment,balloon52 completely occludes aorta AA whileballoon53 is only partially inflated, thereby permitting some flow to the lower extremities during perfusion of the kidneys without periodic deflation of the balloons. Alternatively,balloon53 may periodically be inflated/deflated to completely or partially occlude aorta AA independently ofballoon52.
• Referring now to FIG. 4, a further alternative embodiment of an active perfusion apparatus is described that utilizes a single lumen for blood flow.[0070]Catheter60 is similar in construction tocatheter30 of FIGS.1 &2A-2B and is coupled toinflation device34 andblood pump36, includingpump inlet tube35 andpump outlet tube37. Becausecatheter60 provides a “once-through” flow path, it includes only a single blood flow lumen and inflation lumen (thereby omitting, for example,outlet lumen39 of FIG. 2B).
• In particular,[0071]catheter60 includesinlet line63 havinginlet port61, andoutlet line64 having outlet port62.Inlet line63 is coupled to pumpinlet pump35, whileoutlet line64 is coupled to pumpoutlet tube37.Balloon65 is disposed onoutlet line64, is configured to engage and retain outlet port62 in renal artery RA, and is inflated with inflation medium injected viainflation device34.
• In operation,[0072]inlet line63 is inserted into the patient's femoral artery, and outlet line then is inserted percutaneously and transluminally into aorta AA via a cut-down in the contralateral femoral artery.Balloon65 is inflated to engage the walls of renal artery RA, retain outlet port62 in position, and prevent backflow of high pressure blood into abdominal aorta AA. When blood pump36 is activated, blood flows intoinlet port61, throughinlet line63 and pumpinlet tube35 to pump36, and is returned bypump36 throughpump outlet tube37,outlet line64 and outlet port62 into renal artery RA. Accordingly,blood entering catheter60 viainlet port61 passes into the renal artery RA and kidney K through outlet port62, thereby enhancing renal blood flow and renal function.
• Alternatively,[0073]inlet line63 andoutlet line64 may be inserted in the same femoral artery. Also, the inlet and outlet lines may be incorporated into one concentric device. For example, a 9 Fr. pumping catheter may lie in the lumen of a 12 Fr. sheath; blood is pumped out of the body in the space between the catheter and the sheath and pumped back through the catheter. Additionally, blood may be removed from a vein instead of an artery. In this case, the venous blood may be oxygenated using an oxygenation element as described hereinabove with respect to FIG. 1. Temperature regulation also may be performed prior to blood perfusion into renal artery RA.
• With respect to FIG. 5, a further embodiment of an active perfusion apparatus of the present invention is described.[0074]Catheter70 of FIG. 5 combines elements ofcatheters50 and60. Likecatheter50,catheter70 employsballoons52 and53 controlled byballoon inflation device34 to periodically isolate a region of the abdominal aorta, including the renal arteries, to permit selective perfusion of the renal arteries. Likecatheter60,catheter70 includes separate inlet and outlet lines and provides a “once-through” flow path. In particular, blood flows intoinlet port71 ofinlet line73, illustratively placed in the subclavian artery and extending into the aortic arch, throughpump inlet tube35 and toblood pump36. The blood then is pumped throughpump outlet tube37,outlet line74 and into renal arteries RA via outlet port72. As opposed tocatheter60, in which the blood inlet is disposed in the femoral artery,inlet port71 is instead placed in the aortic arch because the femoral arteries are occluded during inflation ofballoons52 and53.
• As will be obvious to one skilled in the art,[0075]catheters60 &70 may alternatively withdraw blood from other sources than those illustrated in FIGS. 4 & 5. They may alternatively withdraw blood from a different artery or a different location in the preferred artery. Venous blood perfused in conjunction with saline supersaturated with oxygen or passed through an external oxygenator may also be used.
• Referring to FIGS. 6 and 7, still further embodiments of active perfusion systems of the present invention are described, in which blood is pumped using a periodic displacement method, and no blood is cycled out of the body.[0076]Catheter100 includesballoon32 coupled toinflation device34.Catheter120 includesballoons52 and53 coupled toinflation device34.
• Each of[0077]catheters100 and120 are coupled toextracorporeal pump110, which causes active perfusion of one or both renal arteries as follows.Pump110 includes shaft111 having piston111adisposed incylinder112 and piston111bdisposed incylinder115. Piston111ais displaced by pressurized gas or liquid introduced intocylinder112 throughports113 and114 in an alternating fashion. This, in turn, displaces the shaft111 and piston111bincylinder115.Cylinder115 is connected tocatheter100 byconnector tube116.
• With piston[0078]111ain its most distal stroke position within cylinder112 (in direction B),catheter100 andtube116 are initially primed with saline solution, so thatcatheter100 is initially filled with saline. As pistons111aand111bare displaced proximally (in direction A) by the introduction of a pressurized gas or fluid throughport113, movement of piston111bin direction A causes suction within the saline-filled blood lumen ofcatheter100 that draws blood through one-way inlet hole101 and into the blood lumen. When piston111bis displaced in direction B by the introduction of a pressurized gas or fluid throughport114, the blood is forced out of one-way outlet hole102 and into the renal artery. In this manner, renal perfusion is achieved without removing blood from the patient's body.
• In FIG. 6, if[0079]inlet port101 and outlet port102 each include one-way valves,catheter100 may use s single lumen for blood flow, with operation ofpump110 causing a reversal of flow in the lumen when the direction of piston111breverses. As for the previous embodiments,catheter100 is disposed in circulatory system C so thatinlet port101 is disposed in abdominal aorta AA, while outlet port102 is disposed in renal artery RA.Balloon32 is inflated byinflation device34 to engage the walls of the renal artery and retain port102 in position.
• Likewise,[0080]catheter120 of FIG. 7 also may employ a single blood lumen and one-way valves on the inlet and outlet ports, rather than separate blood inlet and outlet lumens. Operation ofcatheter120, including cyclic inflation and deflation ofballoons52 and53, is otherwise as described hereinabove with respect tocatheter50 of FIG. 3.
• Each of[0081]catheters30,50,60,70,100, and120 further optionally include a side port (not shown) for coupling the catheter to a drug infusion device, which periodically infuses low doses of therapeutic agents into blood flowing through the catheter. Because the infused drugs are delivered directly into the kidneys, smaller doses may be employed, while achieving enhanced therapeutic action and fewer side-effects.
• In FIG. 8, a further alternative embodiment employing an extracorporeal pump is described.[0082]Catheter130 comprises occlusion balloons131 and132 disposed on either side ofcenter balloon133, pump134,valve135,controller136 andinflation tubes137 and138.Valve135 selectively couplesinflation tube137 andballoons131 and132 to pump134 to inflate and deflateballoons131 and132, or couplesinflation tube138 to pump134 to inflate and deflatecenter balloon133.
• Each of balloons[0083]131-133 are made of a compliant material, such as polyurethane.Balloons131 and132 are spaced apart alongcatheter130 so that when the catheter is placed in the abdominal aorta, the balloons straddle the renal arteries, i.e., balloon131 is disposed above the renal arteries andballoon132 is disposed below. When fully inflated, balloons131 and132 occlude the aorta and isolate the region between the balloons from the proximal and distal portions of the aorta.Balloon133 is disposed oncatheter130 betweenballoons131 and132 so that it spans the section of AA that branches into the renal arteries.
• [0084]Catheter130 includes at least a first inflation lumen that communicates withballoons131 and132, andinflation tube137, and a second inflation lumen that communicates withcenter balloon133 andinflation tube138.Valve135 is coupled toinflation tubes137 and138 to alternately inflateballoons131 and132, orcenter balloon133, responsive tocontroller136. In particular,controller136 may be configured to inflate and deflateballoons131 and132 at a first predetermined time interval, and to inflate and deflatecenter balloon133 at a second predetermined time interval. Alternatively, controller may be actuated responsive to the patient's heart rhythm, as determined, for example, by an EKG monitor or blood oximeter.
• In operation,[0085]catheter130 is percutaneously and transluminally inserted into a patient's abdominal aorta via a cut-down to the femoral artery.Catheter130 is disposed, using for example, radiopaque bands near balloons131-133 visualized under a fluoroscope, so thatballoons131 and132 are on opposite sides of the junction to the renal arteries.Controller136 is then actuated to causevalve135 to coupleinflation tube137 toballoons131 and132, thereby inflating those balloons to isolate a region of the abdominal aorta. This in turn traps an amount of blood betweenballoons131 and132 in abdominal aorta AA.
• [0086]Controller136 then actuatesvalve135 to couplecenter balloon133 to pump134 viainflation tube138. Inflation ofcenter balloon133 forces the trapped blood out of abdominal aorta AA into renal arteries RA. All three balloons are then deflated, and the process is repeated. In this manner, renal blood flow and function is enhanced.
• With reference to FIGS.[0087]9A-9B, a further feature of the present invention is described. As will be apparent to those skilled in the art of interventional procedures, precise monitoring and control of the inflation and deflation of the intra-aortic balloons is critical to the efficacy of devices that utilize them. FIGS. 9A and 9B depictballoon150, which may correspond, for example, to balloon52 ofcatheter50, in a deflated state and an inflated state, respectively.Balloon150 preferably includesradiopaque markers152.Markers152 inflate withballoon150 so as to allow imaging of the balloon during inflation, and a determination of whether or not the balloon is in contact with the blood vessel, illustratively shown as the aortic artery AA.Radiopaque markers152 advantageously may be used with any of the balloons devices described hereinabove.
• Referring now to FIGS. 10A and 10B, further alternative embodiments of apparatus of the present invention are described that rely upon passive perfusion of the renal arteries. In accordance with this aspect of the present invention, in FIG.[0088]10A stent160 having constrictedregion161 is placed in the aortic artery AA proximal to the renal arteries RA to constrict the aorta below the renal artery junction, and thereby create a pressure differential across the stent.Stent160 may be constructed for deployment using known techniques, and may be, for example, a self-expanding coiled sheet, tubular member or balloon expandable structure.
• Alternatively, for treatment of chronic congestive heart failure,[0089]external cuff165 as shown in FIG. 10B may be placed around the aortic artery AA proximal to the renal arteries RA to constrict the aorta and create the pressure differential across the cuff.Cuff165 preferably comprises a biocompatible, toroidal balloon.Cuff165 may be placed using known techniques and may be inflated during or after placement using an inflation medium supplied throughlumen166. Applicants expect that the backpressure created by the constriction imposed bystent160 orexternal cuff165 will improve flow rate to the renal arteries and other proximal organs.
• As described hereinabove with respect to the embodiment of FIG. 1, all of the foregoing embodiments, may include sensors at relevant locations to measure pressure or flow related parameters, such as renal and aortic pressure in the system of FIG. 1, or distal and proximal aortic pressures and renal pressure in the system of FIG. 3. Such measurements may then be used to monitor or control perfusion of the kidneys. for example, by adjusting the perfusion pressure or blood flow rate.[0090]
• One preferred embodiment is shown at FIGS.[0091]11-15. FIG. 11 shows acatheter211 embodying features of the invention disposed within a patient'saorta210. Thecatheter211 has an elongatedshaft212 having aproximal end213 and adistal end214. The balloondistal end214 has two occlusion balloon,proximal balloon215 anddistal balloon216, disposed about a portion.Proximal balloon215 is positioned below the patient'srenal arteries220, whiledistal balloon216 is positioned above therenal arteries220.Proximal balloon215 distal end is about 5 cm to about 15 cm fromdistal balloon216 proximal end, preferably about 5 to about 10 cm. Bothproximal balloon215 anddistal balloon216 are capable of inflation to about 20 to about 30 millimeters outside diameter. The catheterdistal end214 also includes ablood inlet217. Betweenballoon215 and216 is located anarchimedean screw pump218.Screw pump218 includes ahousing219, arotor221 and aseal222. Theseal222 may or may not let blood pass. The catheterproximal end213 includes adrive mechanism223. The drive mechanism may be a DC, AC or pneumatic motor capable of maintaining high speed, about 5000 to about 30,000 rpm, and moderate torques for periods lasting at least 20 minutes. Also connected to the catheterproximal end213 areinflation sources224 and225 forproximal balloon215 anddistal balloon216 respectively. Thescrew pump218 may be controlled automatically by anautocontroller226, which may also be automated to control the inflation of theproximal balloon215 and thedistal balloon216.
• FIG. 12 better illustrates the inner workings of[0092]catheter211 at the catheterdistal end214. Adrive shaft227 is located withinmain lumen228. Thedrive shaft227 is connected to thedrive mechanism223 on its proximal and, and thescrew pump218 in its distal end. Thedrive mechanism223 turns thedrive shaft227, which then turns therotor221. Blood enters thecatheter211 through theinlet217 and travels to thescrew pump housing219. Therotor221 turns, causing a pressure increase within thehousing219. Blood then exits out theblood outlet229 at a higher pressure. As was shown in FIG. 11, the housing is located near therenal arteries220. Therefore, blood exits from thehousing219 throughblood outlet229 into therenal arteries220. More than one blood outlet may be disposed about the radial face of thecatheter shaft212. Blood flows in total at a rate of about 600 ml/min to about 1200 ml/min, preferably about 800 to about 1200 ml/min out theblood outlet229 into theabdominal aorta210. This higher pressure blood then moves through therenal arteries220, which are constricted causing ARF. In an alternative embodiment, theseal222 may allow some blood to pass into themain lumen228. An additional blood outlet then may be provided proximal toproximal balloon215, thereby providing blood to the lower extremities. This may also be accomplished by providing a blood pass through lumen in addition to the lumen shown in this embodiment (not shown). Asscrew pump218 is causing high pressure blood to exit theblood outlet229, theproximal balloon215 anddistal balloon216 may be inflated. Theballoons215 and216 may also be inflated prior to thescrew pump218 activation. Theinflation source224 is activated, and an inflation fluid entersinflation lumen230, which is in fluid communication withproximal balloon215. Either simultaneously or at a desired time,inflation source225 is activated, sending an inflation fluid intoinflation lumen231, which is in fluid communication withdistal balloon216. Theballoons215 and216 inflate against theaorta210 to a final outer diameter indicated in phantom, thereby isolating the area surrounding therenal arteries220. This allows the increased pressure caused by the pump to be most effective. Higher pressure blood will be more likely to enter therenal arteries220, thereby effectively perfusing the constrictedrenal arteries220. In embodiments which do not include a blood pass through lumen (not shown) or all blood to flow past theseal222, theballoons215 and216 may be deflated periodically to allow blood flow to the lower extremities, or occlusion may be controlled such that some blood leaks by theballoons215 and216 without compromising pressure in therenal arteries220.
• The[0093]drive shaft227 may be a flexible component to accomplish torque transmission from the motor to the rotor and overcome any curvature of the catheter shaft imparted by the vasculature. Thedrive shaft227 may be made of a coiled wire or a flexible mandrel or a combination of these, possibly of stainless steel or superelastic nitinol. Thedrive shaft227 may be coated with a low friction and high temperature resistant material such as Teflon. The engagement between thedrive mechanism223 and thedrive shaft227 may be accomplished by means of a threaded connection, set screw and collar connection, or a snap fit engagement. Thedrive shaft227 may be press fit, welded, threaded, or adhesive bonded to therotor221.
• FIG. 13 is a detailed view of the[0094]screw pump rotor221. The rotor is a single helix rotor having ahub232 and ablade233. The rotor generally is about 1 cm to about 5 cm, preferably about 2 cm to about 4 cm long. The diameter of the rotor is about 0.1 inch to about 0.25 inch, preferably about 0.15 inch to about 0.2 inch. The distance on thehub232 betweenblade233 turns may be uniform. In some embodiments, the distance betweenblade233 turns is not uniform. In certain embodiments, the rotor is a single helix progressive pitch rotor, and thekick area234 has a greater distance on thehub232 betweenblade233 turns. FIG. 14 illustrates an alternative embodiment of the catheter of the invention, wherein thescrew pump218 is located distal to thedistal balloon216.Blood outlet229 is still located betweenproximal balloon215 anddistal balloon216.
• The[0095]rotor221 may be an overall cylindrical component consisting of ahelical blade233 around ahub232 designed to transfer rotational motion of the rotor to translational motion of the blood. 1-5 helical blade components, preferably 1-3 helical blade components may wrap thehub232 of the rotor. Thehub232, will be minimized to increase the blood volume capacity between theblades233. A progressive pitch, or variable, pitch blade may be used to gradually accelerate the blood along the length of therotor221. The helix may progress from a high pitch to low pitch configuration the last of which is known as the kick of theblade234. Maximizing acceleration of the blood while minimizing possible cavitation or hemolysis within the system is preferred. Therotor221 may be machined, injection molded, or cast as one component or assembled from multiple parts, such as separate blade and core components. Therotor221 may be made of metal or plastic. Therotor221 will be encased within a housing designed to confine the travel of the blood to a translational volume exchange. Thehousing219 may be cylindrical and fit closely with the diameter of therotor221. Thehousing219 androtor221 will work together to maximize the translational motion of the blood and control the centrifugal forces imparted on the fluid. Thehousing219 may be constructed of a metal or plastic. Thehousing219 will be a bearing surface for therotor blades233 and will be required to withstand the forces and temperatures generated by therotor221. It may be a portion of thecatheter shaft212 in which therotor221 is housed but not a separate component requiring connection to thecatheter shaft212. If thehousing219 is a separate component it may be secured to thecatheter shaft212 by heat fusing, adhesive bonding, chemically welding, or barb fitted. Thehousing219 of thescrew pump218 will be at least as long as therotor221 and may taper at either end of therotor221 to optimize the intake and outlet volume of the pumping area.
• The centrifugal force imparted on the blood by the rotor will help the blood progress toward the outlet do to its placement along the outer diameter of the catheter shaft. A backpressure will be created within the central lumen of the catheter to prevent the flow of blood beyond the outlet. This backpressure will be created either by a o-ring tip seal between the central lumen ID and drive shaft or by a pressurized fluid flow within the annular space between the drive shaft and catheter ID. This fluid will also serve to reduce temperatures created by the spinning components. The fluid may be saline or dextrose and may be heparinized.[0096]
• Another preferred embodiment is disclosed in FIGS.[0097]16-19. FIG. 16 shows acatheter311 embodying features of the invention placed within a patient'saorta310. The catheter has ashaft312, a proximal end313 and adistal end314.Shaft312 may include markers along the length to assist a user in proper placement (not shown). Such markers are especially helpful along the proximal end313, to aid in placement without the use of X-ray fluoroscopy guidance. Thedistal end314 includes adistal tip portion315.Distal tip portion315 is placed above the patient'srenal arteries320. Thedistal end314 additionally includes aninflatable balloon316.Inflatable balloon316 is placed below the patient'srenal arteries320.Inflatable balloon316 is about 5 cm to about 20 cm from thedistal tip portion315 , preferably about 10 cm to about 15 cm. Thedistal tip portion315 includesdischarge ports317. Discharge ports may be formed of slits. In an alternative embodiment illustrated in FIG. 17, thedischarge ports317 aresideholes338, placed along a pigtail shapeddistal tip portion339 with a taperedclosed tip340. If thedistal tip portion315 of thecatheter311 is closed, it may be sealed or include a sealing surface which mated with an obturator or a stiffening mandrel. In such an even, it may become necessary to use a duck-billed valve to provide for guidewire passage without losing the fluid seal.
• The proximal end[0098]313 is connected to asystem console318. Thesystem console318 includes an inflation source321 and adrug delivery source322. Inflation source321 is in fluid communication withinflation lumen323. An inflation fluid travels throughinflation lumen323, which is in fluid communication with theinflatable balloon316, and inflatesinflatable balloon316.Drug delivery source322 is in fluid communication withdrug delivery lumen324. A drug may be introduced into thedrug delivery lumen324 and travels to thedistal tip portion315. At thedistal tip portion315, thedrug delivery lumen324 is in fluid communication with thedischarge ports317, thereby discharging the drug into the patient'saorta310. In alternative embodiments, thecatheter311 additionally includes a blood pass throughlumen325. The blood pass throughlumen325 will have an inlet port on the distal tip portion315 (not shown) and an outlet situated on the catheter proximal to the balloon (not shown) to supply blood to the lower extremities during balloon inflation.
• The[0099]systems console318 additionally includes an autocontrol device319. An example of such an autocontrol device would be a microprocessor-control module with a user interface. FIG. 20 illustrates the benefit of including an autocontrol device319 in thesystem console318. Theballoon316 may be inflated periodically to correspond to drug delivery. Therefore, the drug will be directed into the patient'srenal arteries320 because theballoon316 has isolated therenal arteries320. This allows for a localized delivery of a drug to therenal arteries320 without having a system-wide effect on the patient's body. A preferred drug for this apparatus would include a drug which is a short-acting vasodilator.
• As illustrated in FIG. 20, the delivery of the drug will by synchronized with the aortic occlusion to divert the blood flow and infused drug to the renal arteries. The time lag between the beginning of balloon inflation and the beginning of drug infusion in a cycle is called T1. The lag time between the end of drug infusion and balloon deflation is called T2. The balloon will occlude the aorta in order to deliver a high amount of drug to the renal arteries, and only a minor amount to the lower extremities. The therapy will be automated to keep the drug level in the renal arteries at a set minimum to ensure increased renal perfusion is sustained. The drug may be delivered in increasingly small amounts, as well, as therapy progresses and the reduce the patient's risk of systemic effects of too much drug.[0100]
• While preferred illustrative embodiments of the invention are described above, it will be apparent to one skilled in the art that various changes and modifications may be made therein without departing from the invention, and the appended claims are intended to cover all such changes and modifications that fall within the true spirit and scope of the invention. Additionally, although various features of the invention are disclosed in specific embodiments, one or more of the features may be used and exchangeable in other embodiments disclosed herein.[0101]

Claims (34)

What is claimed is:

1. Apparatus for perfusing a kidney in vivo, the apparatus comprising:

a catheter having an inlet port, the inlet port configured for placement in a source of autologous blood, an outlet port, and a lumen in fluid communication with inlet port and the outlet port;

a first inflatable member disposed on the catheter adjacent to the outlet port; and

a pump that causes blood to flow from the inlet port to the outlet port, so that blood exiting the outlet port is directed to a renal artery.

2. The apparatus ofclaim 1 wherein the outlet port is adapted to be disposed within the renal artery and the first inflatable member retains the outlet port in the renal artery.

3. The apparatus ofclaim 1 further comprising a second inflatable member, wherein the outlet port is disposed between the first and second inflatable members, and the first and second inflatable members are adapted to isolate a region of the aorta when inflated.

4. The apparatus ofclaim 1 wherein the lumen includes an inlet lumen coupled to the inlet port and an outlet lumen coupled to the outlet port, wherein the inlet lumen is coupled to an inlet of the pump and the outlet lumen is coupled to an outlet of the pump.

5. The apparatus ofclaim 1 further comprising an oxygenation element coupled between the inlet port and the outlet port of the catheter.

6. The apparatus ofclaim 1 wherein the pump includes a piston and shaft that reciprocate, reciprocation of the piston and shaft alternately causing blood to be drawn into the lumen through the inlet port and expelled from the lumen through the outlet port.

7. The apparatus ofclaim 4 further comprising one or more one-way valves that permit blood to flow only from the inlet port to the outlet port.

8. The apparatus ofclaim 1 wherein a first portion of the catheter is adapted to be disposed through either a patient's femoral artery or upper aortic artery and a second portion of the catheter is adapted to be disposed in the patient's aorta through the contralateral femoral artery.

9. The apparatus ofclaim 1 further comprising radiopaque markers disposed on any of the first and second occlusion balloons and the center balloon.

10. The apparatus ofclaim 1 wherein pump further comprises control circuitry that adjusts operation of the pump responsive to a preselected measured parameter.

11. Apparatus for perfusing one or more kidneys in vivo comprising:

a catheter having first and second inflation lumens; and

first and second occlusion balloons coupled in fluid communication to the first inflation lumen;

a center balloon coupled in fluid communication to the second inflation lumen; and

a valve for selectively coupling the first and second occlusion balloons to the first inflation lumen or coupling the center balloon to the second inflation lumen;

and a pump coupled to the valve.

12. The apparatus ofclaim 11 further comprising a controller that first causes the pump to inflate the first and second balloons to trap an amount of blood, and then causes the pump to inflate the center balloon.

13. Apparatus for enhancing perfusion of a patient's kidneys, the apparatus comprising:

a stent having a constricted region, the stent adapted to be placed in the aorta at a location below the patient's junction to the renal arteries.

14. Apparatus for enhancing perfusion of a patient's kidneys, the apparatus comprising:

a cuff having a constricted region, the cuff adapted to be placed around the aorta at a location below the patient's junction to the renal arteries.

15. A method of enhancing perfusion of a patient's kidney in vivo, the method comprising:

providing a catheter having an inlet port, an outlet port, a lumen there between, a first inflatable member and a pump;

inserting the catheter through the patient's aorta so that the outlet port is disposed in a renal artery;

inflating the inflatable member to retain the outlet port in the renal artery;

disposing the inlet port in a source of autologous blood;

coupling the pump to the catheter; and

activating the pump to cause blood to flow from the inlet port to the outlet port.

16. The method ofclaim 15 wherein coupling the pump to the catheter comprises coupling the pump between the inlet port and the outlet port.

17. The method ofclaim 15 wherein the pump includes a piston and shaft that reciprocate and activating the pump comprises reciprocating the piston and shaft alternately to cause blood to be drawn into the lumen through the inlet port and expelled from the lumen through the outlet port.

18. The method ofclaim 17 wherein catheter further comprises one or more one-way valves and activating the pump further comprises activating the pump further comprises permitting blood to flow only from the inlet port to the outlet port through the one or more one-way valves.

19. The method ofclaim 15 further comprising:

measuring a flow-related parameter; and

adjusting operation of the pump responsive to the measured flow-related parameter.

20. The method ofclaim 15 further comprising oxygenating blood flowing between the inlet port and the outlet port.

21. A method of enhancing perfusion to a patient's kidney in vivo, the method comprising:

providing a catheter having an inlet port, an outlet port, a lumen there between, first and second inflatable members and a pump;

inserting the catheter through the patient's aorta so that the outlet port is disposed in the patient's aorta;

inflating the first and second inflatable members to isolate a region of the aorta including the patient's junction to the renal arteries;

disposing the inlet port in a source of autologous blood;

coupling the pump to the catheter; and

activating the pump to cause blood to flow from the inlet port to the outlet port.

22. The method ofclaim 21 wherein coupling the pump to the catheter comprises coupling the pump between the inlet port and the outlet port.

23. The method ofclaim 21 wherein the pump includes a piston and shaft that reciprocate and activating the pump comprises reciprocating the piston and shaft alternately to cause blood to be drawn into the lumen through the inlet port and expelled from the lumen through the outlet port.

24. The method ofclaim 21 further comprising oxygenating blood flowing between the inlet port and the outlet port.

25. A method of enhancing perfusion to a patient's kidneys in vivo, the method comprising:

providing a catheter having first, second and third balloons, the third balloon disposed between the first and second balloons;

placing the catheter in the patient's aorta so that the first and second balloons straddle a region of the aorta including the patient's junction to the renal arteries;

inflating the first and second balloons to trap an amount of blood within the region and isolate the region;

inflating the third balloon to direct the trapped blood into the renal arteries.

26. The method ofclaim 21 further comprising deflating the first, second and third balloons to re-establish blood flow through the aorta.

27. A method for enhancing perfusion of a patient's kidneys, the method comprising:

providing a stent having a constricted region; and

deploying the stent in a patient's aorta at a location below the junction to the renal arteries to create a backpressure in the aorta.

28. A method for enhancing perfusion of a patient's kidneys, the method comprising:

providing an inflatable cuff;

surgically placing the inflatable cuff around a patient's aorta at a location below the junction to the renal arteries constricted region; and

inflating the inflatable cuff to create a backpressure in the aorta.

29. An apparatus for perfusing a patient's kidneys with blood, comprising:

an elongated catheter shaft having a first end, a second end, a blood inlet port, a blood outlet port, and at least one lumen extending between the blood inlet port and the blood outlet port;

an in-line blood pump; and

at least one expandable member proximate to the second end which has an expanded configuration which secures the expanded expandable member within the abdominal aorta.

30. The apparatus ofclaim 29 wherein the in-line pump is an archimedean screw pump.

31. The apparatus ofclaim 29 comprising at least two expandable members longitudinally displaced from one another along the catheter shaft.

32. The apparatus ofclaim 31 wherein the blood outlet port is located between the two expandable members.

33. The apparatus ofclaim 31 wherein the in-line blood pump is an archimedean screw pump and the archimedean screw pump is located at a transverse location between the two expandable members.

34. An apparatus for locally delivering a drug to a patient's kidney comprising:

an elongated catheter shaft having a first end, a second end including at least one discharge port, and at least one lumen in fluid communication with the discharge ports;

a drug source; and

at least one expandable member proximate to the second end which has an expanded configuration which secures the expanded expandable member within the abdominal aorta.

Images