An access assembly includes an instrument valve housing and a valve assembly disposed within the instrument valve housing. The instrument valve housing includes upper and lower housing sections. The valve assembly includes a centering mechanism, a seal assembly, and a guard assembly. The centering mechanism is configured to bias the valve assembly towards a generally centered position within the instrument valve housing. The centering mechanism includes a base seal member having an annular base and a flange portion. The flange portion includes an arcuate portion configured to adjustably engage first and second surfaces of the instrument valve housing in a sealing relation. The seal assembly is attachable to the centering mechanism. The seal assembly is configured to engage a surgical instrument inserted into the access assembly in a sealing relation. The guard assembly is attachable to the centering mechanism.

A system of devices for treating an artery includes an arterial access sheath adapted to introduce an interventional catheter into an artery and an elongated dilator positionable within the internal lumen of the sheath body. The system also includes a catheter formed of an elongated catheter body sized and shaped to be introduced via a carotid artery access site into a common carotid artery through the internal lumen of the arterial access sheath. The catheter has an overall length and a distal most section length such that the distal most section can be positioned in an intracranial artery and at least a portion of the proximal most section is positioned in the common carotid artery during use.

A method for delivering a substance to bone includes placing a stabilizing wire in a bone, creating a hole in the bone around the stabilizing wire, and providing a multichannel cannula. The multichannel cannula includes a first channel having an open proximal end and distal end, the first channel being configured to receive the stabilizing wire, and a second channel having an inlet portal and an exit portal that are in fluid communication. The cannula further includes a cap having a delivery port in fluid communication with the inlet portal and a channel for receiving the cannula therein, and a distal tip. The method further includes inserting the multichannel cannula into the hole in the bone such that the first channel receives the stabilizing wire, and delivering the substance into the bone by introducing the substance into the second channel such that the substance exits through the exit portal.

A variable flow stent is described for use with AV fistulas, TIPS procedures or dialysis grafts. The flow may be varied by adjusting the diameter of the stent. Embodiments include: a covered stent having a secondary chamber that functions as an air or fluid bladder; an expandable chamber within an interior stent covering; a retractable jack device with hooks that engage (snag) opposing walls of the stent; and, a stent with a hollow chamber or pocket in the interior stent covering into which an expandable balloon can be inserted. A self-healing valve is described for inflating or deflating expandable elements within the stent and may be implemented using a self-healing membrane. A radiopaque collar may be used to provide a marker surrounding the self-healing valve. If under-shunting or over-shunting occurs over time, the variable diameter stent may be adjusted using a second procedure.

Disclosed is an expandable transluminal sheath, for introduction into the body while in a first, low cross-sectional area configuration, and subsequent expansion of at least a part of the distal end of the sheath to a second, enlarged cross-sectional configuration. The sheath is configured for use in the vascular system and has utility in the performance of procedures in the left atrium. The access route is through the inferior vena cava to the right atrium, where a trans-septal puncture, followed by advancement of the catheter is completed. The distal end of the sheath is maintained in the first, low cross-sectional configuration during advancement to the right atrium and through the atrial septum into the left atrium. The distal end of the sheath is subsequently expanded using a radial dilatation device.

Systems and methods for minimally invasive procedures include a computer-assisted system comprising a manipulator assembly configured to couple to a cannula and a controller coupled to the manipulator assembly. The cannula has a lumen configured to receive a shaft of an instrument. The controller is configured to position a remote center of motion for the manipulator assembly at a first location relative to the cannula, and in response to an indication to reposition the remote center of motion relative to the cannula, reposition the remote center of motion to a second location relative to the cannula while constraining the second location to be located along the cannula. The second location is different from the first location.

A surgical apparatus of the present disclosure includes a wound retractor having a specimen bag attached thereto. The wound retractor includes a proximal ring, a distal ring, and a film extending therebetween. The specimen bag is attached to the distal ring of the wound retractor. Kits of the present disclosure include the surgical apparatus and a wound guard. Where the tissue specimen to be removed from the patient is too large for passing through an incision or wound, the wound guard is introduced into a lumen of the wound retractor. Mechanical devices such as scalpels or morcellators may then be introduced into the lumen of the wound guard and manipulated adjacent the wound guard to break up the tissue specimen without damaging the specimen bag or wound retractor. Methods for using the surgical apparatus and kits of the present disclosure are also provided.

Disclosed is a system and method for the placement of elongate medical members within a patients body using coaptive ultrasound. In a particularly preferred embodiment, a flexible tube includes a first balloon at a distal end of the tube, and a second balloon at the distal end of the tube and positioned within the first balloon. The first and second balloons are inflatable to form one or more echogenic windows between them, which echogenic window may be detected from within a patient's body by an ultrasound probe that is external to the patient's body. Detection of such echogenic window is used to identify an acceptable location on the patient's body at which to insert a guidewire configured to receive an elongate medical member without damage to surrounding patient tissues or organs.

Devices and methods are provided for trans-esophageal aortic flow control. The device comprises a controller, an esophageal tube extending from the controller, an anchor device at a distal end of the esophageal tube and configured to anchor the distal end of the device inside a patient's stomach, and an actuator positioned proximally to the anchoring device by a sufficient distance so that the actuator will be proximal to the intersection of the patient's esophagus with their diaphragm when the anchoring device is positioned inside of the patient's stomach. In this position, the anchoring device is aligned with the location at which the patient's esophagus and aorta cross that is above (or proximal to) the intersection with the patient's diaphragm, with the patient's aorta then positioned between the spine and the esophagus. Thus, when the actuator is engaged, a compressive force is applied by the actuator against the interior of the patient's esophagus and, in turn, upon their underlying aorta so as to significantly occlude blood flow through their aorta and reduce the risk of lethal hemorrhaging from an abdominal wound.

The described invention provides an endovascular device including a tube containing a first end comprising a bifurcation and a second end comprising an opening. The bifurcation at the first end contains a first branch comprising a diameter of the first branch and a second branch comprising a diameter of the second branch, and the opening at the second end contains a primary opening comprising a diameter of the primary opening and a secondary opening comprising a diameter of the secondary opening. The first branch comprising the diameter of the first branch and the primary opening comprising the diameter of the primary opening form a working lumen comprising a diameter of the working lumen and a length of the working lumen, wherein the diameter of the working lumen comprises the diameter of the first branch and the diameter of the primary opening. The second branch comprising the diameter of the second branch and secondary opening comprising the diameter of the secondary opening form a support lumen comprising a diameter of the support lumen and a length of the support lumen, wherein the diameter of the support lumen comprises the diameter of the second branch and the diameter of the secondary opening.

The described invention further provides an endovascular device comprising a tube comprising a side-hole, a first segment comprising a primary opening and a second segment. The first segment extends from the primary opening to the side-hole, and the second segment extends from the side-hole and tapers to an end. The side-hole and the first segment form a working lumen comprising a diameter of the working lumen and a length of the working lumen, and the second segment forms a support lumen comprising a diameter of the support lumen and a length of the support lumen.