Devices, systems, and methods for peripheral arteriovenous fistula creation

Abstract

Devices, systems and methods are disclosed for the formation of an arteriovenous fistula in the limb of the patient. Embodiments include an apparatus for the creation, modification and maintenance of a fistula, including the modification of an existing dialysis fistula; and a method of supplying oxygenated blood to the venous circulation of a patient. A kit of anastomotic implants is described which supports a broad base of patient anatomies and fistula locations. The devices, systems and methods can be used to treat patients with one or more numerous ailments including chronic obstructive pulmonary disease, congestive heart failure, hypertension, hypotension, respiratory failure, pulmonary arterial hypertension, lung fibrosis and adult respiratory distress syndrome.

1 . (canceled) 
     
     
         2 . A kit for use in treatment of chronic obstructive pulmonary disease comprising:
 a first anastomotic implant for placement between an anatomical structure containing oxygenated blood and an anatomical conduit supplying blood to a lung of the patient having a first elastic force, a first scaffolding surface area, and a first flange geometry;   a second anastomotic implant for placement between the anatomical structure containing oxygenated blood and the anatomical conduit supplying blood to a lung of the patient having a second elastic force, a second scaffolding surface area, and a second flange geometry; and   a delivery catheter for placing one or both of the anastomotic implants;   wherein at least one of the first elastic force, the first scaffolding surface area, and the first flange geometry of the first anastomotic implant differs from at least one of the second elastic force, the second scaffolding surface area, and the second flange geometry of the second anastomotic implant.   
     
     
         3 . The kit of  claim 2 , wherein the first anastomotic implant and the second anastomotic implant each have a diameter and the diameter of the first anastomotic implant differs from the diameter of the second anastomotic implant. 
     
     
         4 . The kit of  claim 2 , wherein the first anastomotic implant and the second anastomotic implant each have a length and the length of the first anastomotic implant differs from the length of the second anastomotic implant. 
     
     
         5 . The kit of  claim 2 , wherein the anatomical structure containing oxygenated blood is an artery. 
     
     
         6 . The kit of  claim 5 , wherein the artery is selected from the group consisting of: axillary; brachial; ulnar; radial; profundal; femoral; iliac; popliteal and carotid. 
     
     
         7 . The kit of  claim 2 , wherein the anatomical conduit supplying blood to a lung is a vein. 
     
     
         8 . The kit of  claim 7 , wherein the vein is selected from the group consisting of: saphenous; femoral; iliac; popliteal; brachial; basilic; cephalic; medial forearm;
 medial cubital; axillary; and jugular.   
     
     
         9 . The kit of  claim 5 , wherein the artery is less than 4 mm in diameter. 
     
     
         10 . The kit of  claim 7 , wherein the vein is less than 4 mm in diameter. 
     
     
         11 . The kit of  claim 2 , wherein the first anastomotic implant provides one or more of the following functions: scaffolding an opening between a first vessel and a second vessel; reducing neointimal proliferation into flow path of the fistula; preventing tissue from protruding into the flow path of the fistula; placing a portion of the first vessel wall in tension with a tissue of the second vessel wall; reducing bleeding of a tissue neighboring the fistula; and enhancing healing of a tissue neighboring the fistula. 
     
     
         12 . The kit of  claim 2 , wherein the second anastomotic implant provides one or more of the following functions: scaffolding an opening between a first vessel and a second vessel; reducing neointimal proliferation into flow path of the fistula; preventing tissue from protruding into the flow path of the fistula; placing a portion of the first vessel wall in tension with a tissue of the second vessel wall; reducing bleeding of a tissue neighboring the fistula; and enhancing healing of a tissue neighboring the fistula. 
     
     
         13 . The kit of  claim 2 , wherein the first anastomotic implant includes one or more of an anti-bacterial; an anti-thrombogenic; and an anti-prolific agent. 
     
     
         14 . The kit of  claim 2 , wherein the second anastomotic implant includes one or more of an anti-bacterial; an anti-thrombogenic; and an anti-prolific agent. 
     
     
         15 . The kit of  claim 2 , wherein the first anastomotic implant includes a covered portion along its length. 
     
     
         16 . The kit of  claim 2 , wherein the second anastomotic implant includes a covered portion along its length. 
     
     
         17 . The kit of  claim 15 , wherein the covering comprises one or more of:
 polytetrafluoroethylene; Dacron material; Nitinol alloy; stainless steel; urethane; polyethylene;   silicone; and a carbon-containing compound.   
     
     
         18 . The kit of  claim 16 , wherein the covering comprises one or more of:
 polytetrafluoroethylene; Dacron material; Nitinol alloy; stainless steel; urethane; polyethylene;   silicone; and a carbon-containing compound.