Devices and methods for treating lower extremity vasculature

Abstract

A method of diverting fluid flow from a first vessel including an occlusion to a second vessel includes deploying a prosthesis at least partially in a fistula and making valves in the second vessel incompetent. Making the valves in the second vessel incompetent includes at least one of using a reverse valvulotome to cut the valves, inflating a balloon, expanding a stent, and lining the second vessel with a stent.

1 . (canceled) 
     
     
         2 . A stent implantable in a fistula between an artery and a vein for treating an occlusion in the artery by diverting blood flow from the artery to the vein, the stent comprising:
 a first longitudinal section having a collapsed state and an expanded state, the first longitudinal section comprising a first expanded diameter when in the expanded state, the first longitudinal section being cylindrical, the first longitudinal section configured to appose a sidewall of the artery;   a second longitudinal section having a collapsed state and an expanded state, the second longitudinal section comprising a second expanded diameter larger than the first expanded diameter, the second longitudinal section being cylindrical or frustoconical, the second longitudinal section configured to appose a sidewall of the vein;   a third longitudinal section configured to be longitudinally between the first longitudinal section and the second longitudinal section, the third longitudinal having a collapsed state and an expanded state, the third longitudinal section being frustoconical, the third longitudinal section configured to span interstitial tissue between the artery and the vein;   a first graft material coupled to the second longitudinal section, the first graft material configured to inhibit flow through a sidewall of the second longitudinal section; and   a second graft material coupled to the third longitudinal section, the second graft material configured to inhibit flow through a sidewall of the third longitudinal section,   wherein the second longitudinal section is separate from the third longitudinal section.   
     
     
         3 . The stent of  claim 2 , wherein the first expanded diameter is between 2 mm and 4 mm, and wherein the third longitudinal section has a third expanded diameter between 4 mm and 6 mm. 
     
     
         4 . The stent of  claim 2 , wherein the second longitudinal section and the third longitudinal section are configured to overlap. 
     
     
         5 . The stent of  claim 2 , wherein at the second longitudinal section has a parameter different than at least one of the first longitudinal section and the third longitudinal section, and wherein the parameter comprises at least one of length, radial strut thickness, circumferential strut width, strut shape, cell shape, cut pattern, cut type, material, and shape set. 
     
     
         6 . The stent of  claim 2 ,
 wherein the first graft material comprises PTFE,   wherein the second graft material comprises PTFE,   wherein the first expanded diameter is between 2 mm and 4 mm,   wherein the second expanded diameter is between 5 mm and 7 mm,   wherein the third longitudinal section has a third expanded diameter between 4 mm and 6 mm,   wherein the first longitudinal section has a length between 20 mm and 40 mm,   wherein the second longitudinal section is cylindrical, and   wherein the stent is self-expanding and comprises cut nitinol struts.   
     
     
         7 . A stent implantable in a fistula between an artery and a vein for treating an occlusion in the artery by diverting blood flow from the artery to a vein, the stent comprising:
 a first longitudinal section comprising a first end diameter, the first longitudinal section being cylindrical, the first section configured to appose a sidewall of the artery;   a second longitudinal section comprising a second end diameter larger than the first end diameter, the second longitudinal section being cylindrical or frustoconical, the second longitudinal section configured to appose a sidewall of the vein;   a third longitudinal section configured to be longitudinally between the first longitudinal section and the second longitudinal section, the third longitudinal section being frustoconical, the third longitudinal section configured to span interstitial tissue between the artery and the vein; and   a graft material configured to inhibit flow through a sidewall of the stent,   wherein the second longitudinal section is separate from the third longitudinal section.   
     
     
         8 . The stent of  claim 7 , wherein the first end diameter is between 2 mm and 4 mm, and wherein the third longitudinal section has a third end diameter between 4 mm and 6 mm. 
     
     
         9 . The stent of  claim 7 , wherein the second longitudinal section and the third longitudinal section are configured to overlap. 
     
     
         10 . The stent of  claim 7 , wherein at the second longitudinal section has a parameter different than at least one of the first longitudinal section and the third longitudinal section, and wherein the parameter comprises at least one of length, radial strut thickness, circumferential strut width, strut shape, cell shape, cut pattern, cut type, material, and shape set. 
     
     
         11 . The stent of  claim 7 ,
 wherein the graft material is coupled to the second longitudinal section or the third longitudinal section, the graft material comprising PTFE,   wherein the first end diameter is between 2 mm and 4 mm,   wherein the second end diameter is between 5 mm and 7 mm,   wherein the third longitudinal section has a third end diameter between 4 mm and 6 mm,   wherein the first longitudinal section has a length between 20 mm and 40 mm,   wherein the second longitudinal section is cylindrical, and   wherein the stent is self-expanding and comprises cut nitinol struts.   
     
     
         12 . A stent implantable between a first vessel and a second vessel for treating an occlusion in the first vessel by diverting blood flow from the first vessel to the second vessel, the stent comprising:
 a first longitudinal section comprising a first end diameter, the first section configured to appose a sidewall of the first vessel;   a second longitudinal section comprising a second end diameter different than the first end diameter, the second longitudinal section configured to appose a sidewall of the second vessel; and   a third longitudinal section configured to be longitudinally between the first longitudinal section and the second longitudinal section,   wherein the second longitudinal section is separate from the third longitudinal section.   
     
     
         13 . The stent of  claim 12 , wherein the first end diameter is between 2 mm and 4 mm, and wherein the third longitudinal section has a third end diameter between 4 mm and 6 mm. 
     
     
         14 . The stent of  claim 12 , wherein the third longitudinal section is frustoconical. 
     
     
         15 . The stent of  claim 12 , wherein the first longitudinal section is cylindrical. 
     
     
         16 . The stent of  claim 12 , wherein the second longitudinal section is cylindrical or frustoconical. 
     
     
         17 . The stent of  claim 12 , wherein the second longitudinal section and the third longitudinal section are configured to overlap. 
     
     
         18 . The stent of  claim 12 , wherein at the second longitudinal section has a parameter different than at least one of the first longitudinal section and the third longitudinal section, and wherein the parameter comprises at least one of length, radial strut thickness, circumferential strut width, strut shape, cell shape, cut pattern, cut type, material, and shape set. 
     
     
         19 . A system comprising:
 the stent of  claim 12 ; and   a valve disabling device, wherein the valve disabling device comprises at least one of a reverse valvulotome, a balloon, and a venous stent.   
     
     
         20 . A system comprising:
 the stent of  claim 12 ; and   a dilation balloon configured to dilate at least one the fistula prior to introduction of the stent and the stent after introduction of the stent.   
     
     
         21 . The stent of  claim 12 , further comprising a graft material configured to inhibit flow through a sidewall of the stent,
 wherein the graft material comprises PTFE,   wherein the first end diameter is between 2 mm and 4 mm,   wherein the second end diameter is between 5 mm and 7 mm,   wherein the third longitudinal section has a third end diameter between 4 mm and 6 mm,   wherein the first longitudinal section has a length between 20 mm and 40 mm,   wherein the first longitudinal section is cylindrical,   wherein the second longitudinal section is cylindrical or frustoconical,   wherein the third longitudinal section is frustoconical, and   wherein the stent is self-expanding and comprises cut nitinol struts.