# US 2021/0275211 A1 · Steerable endoluminal punch

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- Number: US 2021/0275211 A1
- Document ID: US20210275211A1
- Status: Published application
- Kind: A1
- Application number: 17/189,155
- Filed: 2021-03-01
- Published: 2021-09-09
- Earliest claimed: 2019-01-02
- Assignees: Indian Wells Medical, Inc.
- Applicants: Indian Wells Medical, Inc.
- Inventors: Jay A. Lenker; Peter van der Sluis
- Web page: https://patentgrep.com/patent/US20210275211A1

## CPC

- A61B 17/3403: {Needle locating or guiding means}
- A61B 90/37: {Surgical systems with images on a monitor during operation}
- A61B 17/00234: {for minimally invasive surgery (A61B17/0218, A61B17/0469, A61B17/12013, A61B17/1285, A61B17/29, A61B17/320016 take precedence)}
- A61B 17/3415: {for introducing tubes or catheters, e.g. gastrostomy tubes, drain catheters (A61B17/3417 takes precedence; body piercing catheter guide needles A61M25/06)}
- A61B 17/3468: {for implanting or removing devices, e.g. prostheses, implants, seeds, wires (devices for implanting seeds A61M37/0069)}
- A61B 90/36: {Image-producing devices or illumination devices not otherwise provided for}
- A61B 90/39: {Markers, e.g. radio-opaque or breast lesions markers}
- A61B 2017/00203: {with speech control or speech recognition}
- A61B 2017/00243: {cardiac}
- A61B 2017/00305: {Constructional details of the flexible means}
- A61B 2017/00318: {Steering mechanisms}
- A61B 2017/3413: {guided by ultrasound}
- A61B 2017/3425: {for internal organs, e.g. heart ports}
- A61B 2090/374: {NMR or MRI}
- A61B 2090/376: {using X-rays, e.g. fluoroscopy}
- A61B 2090/378: {using ultrasound}
- A61B 2090/3966: {Radiopaque markers visible in an X-ray image}
- A61B: DIAGNOSIS; SURGERY; IDENTIFICATION (usefulness limited to only animals A61D)

## Abstract

Methods for performing certain medical procedures wherein a steerable endoluminal punch is used to not only gain access but to create a channel or punch through tissue, thus facilitating follow-up therapeutic procedures. The distal end of the steerable endoluminal punch is controllably articulated by the operator using a control device at the proximal end.

## Claims

### Claim 1

A method of placing marker devices in the proximity of a tumor comprising:
creating a percutaneous stick in the skin proximate the region of the tumor;
inserting a steerable endoluminal punch into the percutaneous stick and driving the endoluminal punch toward the tumor under radiographic, ultrasound, MRI guidance or the like;
deploying one or more markers proximate the tumor, wherein the markers possess radiographic density for imaging, or characteristics capable of providing therapeutic benefit to the patient; and
removing the steerable endoluminal punch such that the markers remain in the proximity of the tumor.

### Claim 2

A method of achieving vascular access through an inside out procedure comprising:
creating a percutaneous access point to a femoral vein;
inserting a steerable endoluminal punch into the percutaneous access point;
advancing the steerable endoluminal punch through a blockage in the vasculature and to a position cranial to the clavicle;
articulating the steerable endoluminal punch such that its distal tip is curved and directed toward the surface of the skin;
advancing a sharp central stylet through the steerable endoluminal punch and out through the skin of the patient;
advancing the steerable endoluminal punch such that its distal end is exposed outside the patient's skin;
removing the central stylet;
inserting a guidewire through the central lumen of the steerable endoluminal punch; and
removing the steerable endoluminal punch leaving the guidewire in place to facilitate reverse access to the patient's vasculature.

### Claim 3 (depends on 2)

The method of claim 2 further comprising the step of inserting a blunt stylet within the steerable endoluminal punch and advancing the steerable endoluminal punch through the vasculature without the guidewire, which can be inserted later following removal of the blunt stylet.