Abstract:
A measuring device for measuring tunnel defects in tissue is disclosed. The measuring device can size the defect to aid future deployment of a tissue distension device. Exemplary tunnel defects are atrial septal defects, patent foramen ovales, left atrial appendages, mitral valve prolapse, and aortic valve defects. Methods for using the same are disclosed.

Description:
CROSS-REFERENCE TO RELATED APPLICATION 
   This application is a continuation of PCT Application No. PCT/US 06/28239 filed 19 Jul. 2006 which claims priority to U.S. Provisional Application No. 60/700,359, filed 19 Jul. 2005, both of which are incorporated herein in its entirety. 

   BACKGROUND OF THE INVENTION 
   1. Field of the Invention 
   The invention is related to the measuring devices and measurement of anatomical pathologies. 
   2. Description of the Related Art 
   The ability to accurately measure the dimensions of anatomical structures is of vital importance. In many cases, the anatomical geometry defines the treatment. A small object, small hole, or short length of anatomical pathology can go untreated because it has little to no clinical significance. Larger objects, holes, and longer length of anatomical pathology may lead to adverse clinical outcomes. 
   Additionally, many anatomical pathologies are treated with devices, including implantable devices, that are sized to fit the pathology. Knowledge of the specific size of the pathology aids the selection of an appropriately sized treatment device. Using trial and error techniques to determine the proper size of an implantable treatment device undesirably prolongs the surgical procedure, and fitting and removing improperly sized devices often further traumatizes the already-injured anatomical site. 
   Existing devices do not easily measure tunnel defects in soft tissue within body structures. Tunnel defects can be found in the heart (e.g., patent foramen ovale (PFO), left atrial appendage, mitral valve prolapse, aortic valve defects). Tunnel defects can be found through out the vascular system (e.g., venous valve deficiency, vascular disease, vulnerable plaque, aneurysms (e.g., neurovascular, abdominal aortic, thoracic aortic, peripheral). Tunnel defects can be found in non vascular systems (e.g., stomach with GERD, prostate, lungs). 
   A device for measuring the width of a distended defect in tissue is disclosed. The device has a longitudinal axis. The device can have a first elongated member. The first elongated member can be configured to expand away from the longitudinal axis. The device can have a second elongated member. The first elongated member can be opposite with respect to the longitudinal axis to the second elongated member. The second elongated member can be configured to expand away from the longitudinal axis. The device can have a lumen, for example, in a catheter. The device can have a porous cover on the lumen. 
   A method for sizing a tunnel defect. The method can include inserting a measurement tool into the tunnel defect. The method can include distending the tunnel defect into a distended configuration. The method can include measuring the tunnel defect in the distended configuration. Distending can include radially expanding the measurement tool. Measuring can include bending the first measuring wire around a front lip of the tunnel defect. Measuring can include emitting a contrast fluid in the tunnel defect. 
   BRIEF SUMMARY OF THE INVENTION 
   Tissue distension devices can be deployed to tunnel defects in tissue. The tissue distension devices can be used to substantially close tunnel defects to treat, for example, patent foramen ovale (PFO), left atrial appendage, mitral valve prolapse, aortic valve defects. Examples of tissue distension devices include those disclosed in U.S. patent application Ser. Nos. 10/847,909, filed 19 May 2004; 11/184,069, filed 19 Jul. 2005; and 11/323,640, filed 3 Jan. 2006, all of which are incorporated by reference herein in their entireties. 
   To select a properly fitting tissue distension device, a measuring tool can first be deployed to measure the size of the tunnel defect. The tunnel defect can be measured in a relaxed or distended configuration. The tunnel defect can be distended by the measuring tool before or during measurement. 

   
     BRIEF DESCRIPTION OF THE DRAWINGS 
       FIG. 1  illustrates a variation of the measurement tool in a first configuration. 
       FIGS. 2 and 3  illustrate variation s of cross-section A-A of  FIG. 1 . 
       FIGS. 4 and 5  illustrate variation s of cross-section B-B of  FIG. 1 . 
       FIGS. 5 through 8  illustrate variation s of the measurement tool in a second configuration. 
       FIG. 9  illustrates a variation of the measurement tool in a first configuration in a first configuration. 
       FIGS. 10 and 11  illustrate variations of interlocking element component. 
       FIG. 12  illustrates the variation of the measurement tool of  FIG. 9  in a second configuration. 
       FIG. 13  illustrates a side view of variation of the measurement tool in a second configuration. 
       FIG. 14  illustrates a top view of the measurement tool of  FIG. 13 . 
       FIG. 15  illustrates a variation of cross-section C-C of the measurement tool of  FIG. 13 . 
       FIGS. 16 through 18  illustrate variations of the measurement tool in a second configuration. 
       FIG. 19  is a close-up view of the a portion of the measurement tool of  FIG. 18  including the first measuring wire only, for illustrative purposes, transforming from a radially contracted to a radially expanded configuration. 
       FIGS. 20 through 23  illustrate variations of the measurement tool in a second configuration. 
       FIGS. 24 through 30  illustrate variations of the measuring wire. 
       FIG. 31  illustrates a section of tissue having a tunnel defect. 
       FIG. 32  illustrates the tunnel defect of  FIG. 31 . 
       FIGS. 33 through 35  illustrate a variation of a method for deploying an embodiment of the measurement tool. 
       FIGS. 36 through 39  illustrate variations of methods for using variations of the measurement tool. 
   

   DETAILED DESCRIPTION 
     FIG. 1  illustrates an anatomical measurement tool  2 , such as a tool for measuring the width in a relaxed and/or distended configuration of a tunnel defect in tissue, in a radially contracted configuration. The measurement tool  2  can have a longitudinal axis  4 . The anatomical measurement tool  2  can have a catheter  6 , a first measuring wire  8 , and a second measuring wire  10 . The measuring wires  8  and  10  can be deformable, resilient, or combinations thereof over the length of the measuring wires. 
   The catheter  6  can have a catheter porous section  12 . The catheter  6  can be entirely substantially non-porous. The catheter  6  can have a catheter non-porous section  14 . The catheter porous section  12  can partially or completely circumferentially surround the catheter  6 . The catheter porous section  12  can have holes or pores in the catheter outer wall  28 . The pores can have pore diameters from about 10 μm (0.04 mil) to about 1 mm (0.04 in.), more narrowly from about 2 μm (0.08 mil) to about 300 μm (10 mil), for example about 150 μm (6.0 mil). 
   The first and second measuring wires  8  and  10  can each have at least one wire radially constrained section  16  and at least one wire radially unconstrained section  18 . The measuring wires  8  and  10  can transition from the wire constrained sections to the wire radially unconstrained sections  18  at the wire proximal sheath ports  20 . The first and second measuring wires  8  and  10  between the wire proximal sheath ports  20  and the wire distal anchor  22  can be the radially unconstrained sections. The measuring wires  8  and  10  can be distally fixed to the catheter  6  at a wire distal anchor  22 . The wire distal anchor  22  can be a hinged or otherwise rotatable attachment, for example, to allow the measuring wire to rotate away from the longitudinal axis  4  at the wire distal anchor  22  during use. 
   The measurement tool  2  can have a tip  24  extending from a distal end of the catheter  6 . The tip  24  can be blunt or otherwise atraumatic (e.g., made or coated with a softer material than the catheter  6 , made with a soft substantially biocompatible rubber tip). A guide lumen  26  can extend from the tip  24 . The guide lumen  26  can be configured to slidably receive a guidewire. The guide lumen  26  can have a guide lumen wall  27 . The guide lumen  26  can exit through a dimple in the tip  24 . The tip  24  need not be dimpled at the exit of the guide lumen  26 . 
     FIG. 2  illustrates that the catheter  6  can have a catheter outer wall  28 . The catheter outer wall  28  can be porous, or non-porous, or partially porous and partially non-porous. The catheter  6  can have a fluid lumen  30 . The guide lumen  26  can be configured central to the cross-section of the catheter  6  or offset from the center of the cross-section, for example attached to the catheter outer wall  28 . 
   The first measuring wire  8  can removably and slidably reside in or removably and slidably attach to a recessed or raised first track  32  in the catheter outer wall  28 . The second measuring wire  10  can removably and slidably reside in or removably and slidably attach to a recessed or raised second track  34  in the catheter outer wall  28 . 
   To transform the measurement tool  2  from the radially contracted configuration to the radially expanded configuration, the first and second measuring wires  8  and  10  in the wire radially constrained section  16  can be longitudinally translated, as shown by arrows, in a distal direction. The first and second wires  8  and  10 , for example, rotatably fixed at the wire distal anchor  22  and not radially constrained between the wire proximal sheath ports  20  and the wire distal anchor  22 , can translate, as shown by arrows, radially outward from the longitudinal axis  4 . 
     FIG. 3  illustrates that the first and second measuring wires  8  and  10  in the wire radially unconstrained section  18  can be adjacent to, and reside on or attach to, the catheter outer wall  28 . The catheter outer wall  28  can have no tracks for the measuring wires. 
     FIG. 4  illustrates that the first and second measuring wires  8  and  10  can be slidably attached to and/or encased by first  36  and second  38  sheaths, respectively. The interior of the sheaths can be coated with a low-friction material (e.g., polytetraflouroethylene (PTFE), such as Teflon® by E.I. du Pont de Nemours and Company, Wilmington, Del.). 
     FIG. 5  illustrates that the first sheath  36  and/or the second sheath  38  can be inside the catheter  6  (i.e., radially interior to the catheter outer wall  28 ). 
   The wire distal anchor  22  and wire sheaths can be fixedly attached to the catheter  6 . The wire distal anchor  22  and wire sheaths can be slidably attached to the catheter  6 . 
   The catheter  6  and/or tip  24  can have stop. The stop can be longitudinally fixed with respect to the catheter  6  and/or the tip  24 . The stop can be the tip  24 , for example if the diameter of the tip  24  is larger than the diameter of the wire distal anchor  22 . The stop can be configured to interference fit against the wire distal anchor  22  when the wire distal anchor  22  is distally translated beyond a maximum translation point with respect to the catheter  6  and/or tip  24 . 
     FIG. 6  illustrates the measurement tool  2  in a radially expanded configuration. The first and second measuring wires  8  and  10  in the wire radially unconstrained section  18  can bow, flex, or othenvise be radially distanced with respect to the longitudinal axis  4  from the catheter  6 . The first and second  8  measuring wires  8  and  10  can expand in a single plane (i.e., coplanar). 
   The measuring wires  8  and  10  can be longitudinally translated, as shown by arrows  40 , in the wire radially constrained sections  16 . The first and second measuring wires  8  and  10  in the wire radially unconstrained sections  18  can be radially expanded or otherwise translated, as shown by arrows  41 , away from the catheter  6  (e.g., longitudinal axis  4 ) into a radially expanded configuration, for example by distally translating the measuring wires  8  and  10  in the wire radially constrained sections  16 . The first and second measuring  8  and  10  wires in the wire radially unconstrained sections  18  can be radially contracted or otherwise translated toward the catheter  6  (e.g., longitudinal axis  4 ) into a radially contracted configuration, for example by proximally translating the measuring wires  8  and  10  in the wire radially constrained section  16 . 
   The measuring wires  8  and  10  can have wire first diameters  43   a , wire second diameters  43   b , and wire third diameters  43   c . In the radially expanded configuration, the wire first diameters  43   a  can be adjacent to the wire distal anchor  22 . In the radially expanded configuration, the wire second diameters  43   b  can be substantially half-way along the wire length between the wire distal anchor  22  and the wire proximal sheath port  20 . In the radially expanded configuration, the wire third diameters can be adjacent to the proximal sheath port  20 . The wire first diameter  43   a  can be substantially equal to the wire third diameter  43   c . The wire second diameter  43   b  can be less than, greater than, or equal to the wire first diameter  43   a  and/or the wire third diameter  43   c.    
     FIG. 7  illustrates that the catheter porous section  12  can have a porous section length  42 . The longitudinal distance between the wire distal anchor  22  and the wire proximal sheath ports  20  (i.e., the wire radially unconstrained section  18 ) can be an unconstrained wire longitudinal length  44 . The unconstrained wire longitudinal length  44  can be less than, substantially equal to (as shown in  FIGS. 1 and 6 ), or greater than (as shown in  FIG. 7 ) the catheter non-porous section  14 . 
   The catheter  6  can have a catheter first diameter  45   a , a catheter second diameter  45   a , a catheter third diameter  45   a , and a catheter fourth diameter  45   a . The catheter first diameter  45   a  can be adjacent to the wire distal anchor  22  and/or otherwise between the catheter porous section  12  and the wire distal anchor  22 . The catheter second diameter  45   b  can be at the catheter porous section  12 . The catheter third diameter  45   c  can be adjacent to the wire proximal sheath  20  and/or otherwise between the catheter porous section  12  and the wire proximal sheath port  20 . The catheter fourth diameter  45   d  can be proximal to the wire proximal sheath port  20 . 
   The catheter first diameter  45   a  can be substantially equal to the catheter third diameter  45   c . The catheter second diameter  45   b  can be less than, greater than, or equal to the catheter first section  45   a  and/or the catheter third section  45   c . The catheter fourth section  45   d  can be less than, greater than, or equal to the catheter first diameter  45   a  and/or catheter second diameter  45   b  and/or catheter third diameter  45   c.    
     FIG. 8  illustrates that the first and second wires can have substantially discrete angles when the wires are in the radially expanded configurations. Each wire can have a wire first hinge point  46  and a wire second hinge point  48 . The wire hinge points can be biased (e.g., before the measurement tool  2  is configured in the first configuration) to bend when the tension on the measuring wire is decreased. The wire hinge points can have hinges, bends, seams, links, other articulations, or combinations thereof. 
   The wire first hinge point  46  can have a wire first hinge angle  50 . The wire second hinge point  48  can have a wire second hinge angle  52 . In a radially expanded configuration, the wire hinge first and second angles can be from about 10° to about 170°, more narrowly from about 30° to about 150°, yet more narrowly from about 45° to about 135°, for example about 125°. 
     FIG. 9  illustrates that the catheter  6  can have an inner tube  27 , and/or an outer tube  25 , and/or a catheter exterior  23 . The inner tube  27  can be slidably or fixedly attached to the outer tube  25 . The outer tube  25  can be slidably or fixedly attached to the catheter exterior  23 . The inner tube  27 , and/or the outer tube  25 , and/or the catheter exterior  23  can be flexible or rigid. 
   The inner tube  27  can have forceps or rails  29  extending therefrom. The rails  29  can be rigid or flexible. The rails  29  can be rotationally and/or translatably attached to the inner tube  27 . The rails  29  can be configured to guide the measuring wires  8  and  10 , for example as the measuring wires  8  and  10  deploy, and/or to attach to or otherwise grab the measuring wires  8  and  10  and/or to attach to or otherwise grab a separate implant, such as a previously deployed embolic filtering device, and/or to grab tissue. 
   The distal end of the inner tube  27  can have a deployment port  31 . 
   The inner tube  27 , and/or the outer tube  25 , and/or the catheter exterior  201  can be made from one or more flexibly connected, interlocking elements. For example, the interlocking elements can be spiral cut. The interlocking elements can be tube mid components  33  and/or tube end components  35 . The tube end component of the inner tube  27  can have the deployment port  31 . 
   The catheter exterior  23  can have a catheter exterior diameter  201 . The outer tube  25  can have an outer tube diameter  33 . The inner tube  27  can have an inner tube diameter  39 . The catheter exterior diameter  201  can be greater than or less than the outer tube diameter  33 . The outer tube diameter  33  can be greater than or less than the inner tube diameter  39 . The inner tube diameter  39  can be greater than or less than the catheter exterior diameter  201 . 
     FIG. 10  illustrates that the tube mid component  33  can have an element longitudinal axis  45 . The element longitudinal axis  45  can be perpendicular or at an angle to a plane formed by either longitudinal end of the tube mid-component  33 . The tube mid component  33  can have angularly alternating male interlocking elements  41  and female interlocking elements  43  around each longitudinal end of the tube mid component  33 . The male interlocking elements  41  can be configured to fixedly or releasably, and/or rotatably attach to the female interlocking elements  43 . 
     FIG. 11  illustrates that the tube end component  35  can have a tube end port  47  at least at one longitudinal end of the tube end component  35 . The tube end port  47  can have no interlocking elements. The tube end port  47  can form a plane parallel or at an angle to the element longitudinal axis  45 . 
     FIG. 12  illustrates that as the measurement tool  2  transforms from the first configuration of the second configuration, the remainder of the catheter  6  can translate, as shown by arrow  49 , out of the end of the deployment port  31 . The measuring wires  8  and  10  can resiliently radially expand, as shown by arrows  51 , when released from the deployment port  31 . The measuring wires  8  and  10  can be deformably radially expand, as shown by arrows  51 , by an external force. 
     FIGS. 13 through 15  illustrate that the measurement tool  2  can have four or more measuring wire  8   a ,  8   b ,  10   a  and  10   b . In a radially expanded configuration, the measuring wires can extend from the catheter  6  in substantially opposite directions. For example, the first measuring wire  8   a  can extend substantially opposite to the fourth measuring wire  10   b . The second measuring wire  10   a  can extend substantially opposite to the third measuring wire  8   b . The angle between each measuring wire can be about 90°. Three or more than four measuring wires can be used and the angle between measuring wires can be from about 0° to about 350°, more narrowly from about 30° to about 180°, for example about 45°. 
     FIG. 16  illustrates that the measurement tool  2  can have about 12 measuring wires. The measuring wires can be radially expandable in a configuration where the first measuring wire  8  deploys substantially longitudinally adjacent to a third measuring wire  54 . The measuring wires can be radially expandable in a configuration where the second measuring wire  10  deploys substantially longitudinally adjacent to a fourth measuring wire  56 . 
   The measuring wires can each have a unique or paired longitudinal position for their wire proximal sheath ports  20  and wire distal anchors  22 . For example, the first and second measuring wires  8  and  10 , respectively, can exit from wire first proximal sheath ports  58  and can be fixed at wire first distal anchors  60 . The third and fourth measuring wires  54  and  56 , respectively, can exit from one or two wire second proximal sheath ports  70  and can be fixed at one or two wire second distal anchors  71 . The wire first distal anchors  60  can be distal to the wire second distal anchors  71 . The wire first proximal sheath ports  58  can be at a substantially equivalent longitudinal position to the wire second distal anchors  71 . The wire second distal anchors  71  can be distal to the wire second proximal sheath ports  70 . This longitudinal spacing of the wire distal anchors  22  and wire proximal sheath ports can be used for all of the measuring wires. 
   The measuring wires on each side of the catheter  6  (e.g., the first, third, fifth, seventh, ninth and eleventh measuring wires or the second, fourth, sixth, eighth, tenth and twelfth measuring wires) can pass through the same or different sheaths. 
     FIG. 17  illustrates that the measuring wires can have distal ends that are not attached to the catheter  6  when the measuring wires are in radially expanded configurations. Any or all measuring wire can have a terminal end  62 . When the measurement tool  2  is in a radially expanded configuration, the terminal ends  62  can be unattached to the catheter  6 . When the measurement tool  2  is in a radially expanded configuration, the measuring wires can have a medial turn  64 , bend, hinge, or otherwise angle medially between the terminal ends  62  and the wire proximal ports. A length of the measuring wires can be biased to turn or bend medially when that length of the measuring wire is in a relaxed configuration. The measurement tool  2  can have about eight measuring wires. 
     FIG. 18  illustrates that the measuring wires can form a substantially circular or oval loop when the measuring wire is in the radially expanded configuration. The measurement tool  2  can have six measuring wires. 
     FIG. 19  illustrates that the loop of wire radially unconstrained section  18  can expand when the measuring wires transform from the radially contracted configuration to the radially expanded configuration. The measuring wires can be longitudinally translated, as shown by arrows  40 , in the wire radially constrained sections  16 . Along the length of the measuring wires near the wire proximal port, the measuring wires can translate along the longitudinal wire-axis, as shown by arrow  66 . The measuring wires in the wire radially unconstrained sections  18  can be radially expanded or otherwise translated, as shown by arrow, away from the catheter  6  (e.g., longitudinal axis  4 ) into a radially expanded configuration, for example by distally translating the measuring wires in the wire radially constrained sections  16 . The measuring wires in the wire radially unconstrained sections  18  can be radially contracted or otherwise translated toward the catheter  6  (e.g., longitudinal axis  4 ) into a radially contracted configuration, for example by proximally translating the measuring wires in the wire radially constrained section  16 . 
     FIG. 20  illustrates that the measuring wires can exit from the respective wire sheaths at the respective wire proximal pores. The measuring wires can all exit the wire proximal ports on the same side of the catheter  6 , or immediately turn to the same side of the catheter  6  after exiting the proximal wire ports. When the measurement tool  2  is in a radially expanded configuration, the measuring wires can have a proximal turn  68 , bend, hinge, or otherwise angle proximally after exiting the proximal wire port. When the measurement tool  2  is in a radially expanded configuration, the measuring wires can have a medial turn  64 , bend, hinge, or otherwise angle toward the longitudinal axis  4 , for example, between the proximal bend  68  and the terminal end  62 . Any length of the measuring wires can be biased to turn or bend when that length of the measuring wire is in a relaxed configuration.  FIG. 21  illustrates that the measuring wire can have a proximal turn  68 , bend, hinge, or otherwise angle proximally. 
     FIG. 22  illustrates that the catheter  6  can be removably or fixedly attached to a coupler  72 . The coupler  72  can be removably or fixedly attached to a handle  74 . The coupler  72  can be made from any material disclosed herein including rubber, elastic, or combinations thereof. The coupler  72  can have a substantially cylindrical configuration. The coupler  72  can have threads. The coupler  72  can have slots. The coupler  72  can have a joint or hinge. The coupler  72  can be flexible or rigid. The coupler  72  can be resilient or deformable. 
   The coupler  72  can be flexible. The coupler  72  can substantially bend, for example, permitting the longitudinal axis  4  of the handle  74  to be a substantially non-zero angle (e.g., from about 0° to about 90° C.) with respect to the longitudinal axis  4  of the catheter  6 . The coupler  72  can permit substantially resistance free rotation between the longitudinal axis  4  of the catheter  6  and the longitudinal axis  4  of the handle  74 . 
     FIG. 23  illustrates that the coupler  72  can be removably or fixedly attached to the catheter  6  on the proximal and distal end of the coupler  72 . The coupler  72  can have and/or be proximally adjacent to the wire proximal sheath ports  20 . 
     FIG. 24  illustrates that the measuring wire  76  can have a wire body  78  and one or more markers  80 . The wire body  78  can have no markers  80 . The markers  80  can be echogenic, radiopaque, magnetic, or configured to be otherwise visible by an imaging technique known to one having ordinary skill in the art. The markers  80  can be made from any material disclosed herein including platinum (e.g., pure or as powder mixed in glue). 
   The markers  80  can be uniformly and/or non-uniformly distributed along the length of the wire body  78 . The markers  80  can be uniformly and/or non-uniformly distributed along the radius of the wire body  78 . The markers  80  can be separate and discrete from the wire body  78 . The markers  80  can be attached to the wire body  78 . The markers  80  can be incorporated inside the wire body  78 . The marker  80  can have configuration symmetrical about one, two, three, or more axes. The marker  80  can have an omnidirectional configuration. The marker  80  can have a configuration substantially spherical, ovoid, cubic, pyramidal, circular, oval, square, rectangular, triangular, or combinations thereof. The marker&#39;s radius can be smaller than or substantially equal to the wire body&#39;s radius at the location of the marker  80 .  FIG. 25  illustrates that the marker&#39;s radius can be greater than the wire body&#39;s radius at the location of the marker  80 . 
     FIG. 26  illustrates that the marker  80  can have a unidirectional configuration. The marker  80  can be configured in the shape of an arrow. All or subsets of the markers  80  on a wire body  78  can be aligned, for example all of the unidirectionally configured markers  80  can be oriented in the same longitudinal or radial direction (e.g., distally, proximally) along the wire body  78 . 
     FIG. 27  illustrates that the markers  80  can have alphanumeric characters. The alphanumeric characters can increase in value (e.g., 1, 2, 3, or A, B, C, or I, II, III) incrementally along the length and/or radius of the wire. The markers  80  can include unit values (e.g., mm, in.) 
     FIG. 28  illustrates that the markers  80  can be configured as a cylinder (e.g., disc), ring (e.g., toroid, band), partial cylinder, partial ring, or combinations thereof.  FIG. 29  illustrates that the markers  80  can be integrated with the measuring wire  76 .  FIG. 30  illustrates that the markers  80  can be wires or threads. The markers  80  can extend along the length and/or radius of the wire body  78 . 
   Any or all elements of the measurement tool  2  and/or other devices or apparatuses described herein can be made from, for example, a single or multiple stainless steel alloys, nickel titanium alloys (e.g., Nitinol), cobalt-chrome alloys (e.g., ELGILOY® from Elgin Specialty Metals, Elgin, Ill.; CONICHROME® from Carpenter Metals Corp., Wyomissing, Pa.), nickel-cobalt alloys (e.g., MP35N® from Magellan Industrial Trading Company, Inc., Westport, Conn.), molybdenum alloys (e.g., molybdenum TZM alloy, for example as disclosed in International Pub. No. WO 03/082363 A2, published 9 Oct. 2003, which is herein incorporated by reference in its entirety), tungsten-rhenium alloys, for example, as disclosed in International Pub. No. WO 03/082363, polymers such as polyethylene teraphathalate (PET), polyester (e.g., DACRON® from E. I. Du Pont de Nemours and Company, Wilmington, Del.), polypropylene, aromatic polyesters, such as liquid crystal polymers (e.g., Vectran, from Kuraray Co., Ltd., Tokyo, Japan), ultra high molecular weight polyethylene (i.e., extended chain, high-modulus or high-performance polyethylene) fiber and/or yarn (e.g., SPECTRA® Fiber and SPECTRA® Guard, from Honeyvell International, Inc., Morris Township, N.J., or DYNEEMA® from Royal DSM N. V., Heerlen, the Netherlands), polytetrafluoroethylene (PTFE), expanded PTFE (ePTFE), polyether ketone (PEK), polyether ether ketone (PEEK), poly ether ketone ketone (PEKK) (also poly aryl ether ketone ketone), nylon, polyether-block co-polyamide polymers (e.g., PEBAX® from ATOFINA, Paris, France), aliphatic polyether polyurethanes (e.g., TECOFLEX® from Thennedics Polymer Products, Wilmington, Mass.), polyvinyl chloride (PVC), polyurethane, thermoplastic, fluorinated ethylene propylene (FEP), absorbable or resorbable polymers such as polyglycolic acid (PGA), poly-L-glycolic acid (PLGA), polylactic acid (PLA), poly-L-lactic acid (PLLA), polycaprolactone (PCL), polyethyl acrylate (PEA), polydioxanone (PDS), and pseudo-polyamino tyrosine-based acids, extruded collagen, silicone, zinc, echogenic, radioactive, radiopaque materials, a biomaterial (e.g., cadaver tissue, collagen, allograft, autograft, xenograft, bone cement, morselized bone, osteogenic powder, beads of bone) any of the other materials listed herein or combinations thereof. Examples of radiopaque materials are barium sulfate, zinc oxide, titanium, stainless steel, nickel-titanium alloys, tantalum and gold. For example, the measuring wires  8  and  10 , and/or any other element of the measuring tool  2  can have tantalum and/or be wrapped with or otherwise attached to tantalum ribbon. 
   Any or all elements of the measurement tool  2  and/or other devices or apparatuses described herein, can be, have, and/or be completely or partially coated with agents and/or a matrix a matrix for cell ingrowth or used with a fabric, for example a covering (not shown) that acts as a matrix for cell ingrowth. The matrix and/or fabric can be, for example, polyester (e.g., DACRON® from E. I. Du Pont de Nemours and Company, Wilmington, Del.), polypropylene, PTFE, ePTFE, nylon, extruded collagen, silicone or combinations thereof. 
   The measurement tool  2  and/or elements of the measurement tool  2  and/or other devices or apparatuses described herein and/or the fabric can be filled, coated, layered and/or otherwise made with and/or from cements, fillers, glues, and/or an agent delivery matrix known to one having ordinary skill in the art and/or a therapeutic and/or diagnostic agent. Any of these cements and/or fillers and/or glues can be osteogenic and osteoinductive growth factors. 
   Examples of such cements and/or fillers includes bone chips, demineralized bone matrix (DBM), calcium sulfate, coralline hydroxyapatite, biocoral, tricalcium phosphate, calcium phosphate, polymethyl methacrylate (PMMA), biodegradable ceramics, bioactive glasses, hyaluronic acid, lactoferrin, bone morphogenic proteins (BMPs) such as recombinant human bone morphogenetic proteins (rhBMPs), other materials described herein, or combinations thereof. 
   The agents within these matrices can include any agent disclosed herein or combinations thereof, including radioactive materials; radiopaque materials; cytogenic agents; cytotoxic agents; cytostatic agents; thrombogenic agents, for example polyurethane, cellulose acetate polymer mixed with bismuth trioxide, and ethylene vinyl alcohol; lubricious, hydrophilic materials; phosphor cholene; anti-inflammatory agents, for example non-steroidal anti-inflammatories (NSAIDs) such as cyclooxygenase-1 (COX-1) inhibitors (e.g., acetylsalicylic acid, for example ASPIRIN® from Bayer AG, Leverkusen, Germany; ibuprofen, for example ADVIL® from Wyeth, Collegeville, Pa.; indomethacin; mefenamic acid), COX-2 inhibitors (e.g., VIOXX® from Merck &amp; Co., Inc., Whitehouse Station, N.J.; CELEBREX® from Pharmacia Corp., Peapack, N.J.; COX-1 inhibitors); immunosuppressive agents, for example Sirolimus (RAPAMUNE®, from Wyeth, Collegeville, Pa.), or matrix metalloproteinase (MMP) inhibitors (e.g., tetracycline and tetracycline derivatives) that act early within the pathways of an inflammatory response. Examples of other agents are provided in Walton et al, Inhibition of Prostoglandin E 2  Synthesis in Abdominal Aortic Aneurysms,  Circulation , Jul. 6, 1999, 48-54; Tambiah et al, Provocation of Experimental Aortic Inflammation Mediators and Chlamydia Pneumoniae,  Brit. J. Surgery  88 (7), 935-940; Franklin et al, Uptake of Tetracycline by Aortic Aneurysm Wall and Its Effect on Inflammation and Proteolysis,  Brit. J. Surgery  86 (6), 771-775; Xu et al, Sp1 Increases Expression of Cyclooxygenase-2 in Hypoxic Vascular Endothelium,  J. Biological Chemistry  275 (32) 24583-24589; and Pyo et al, Targeted Gene Disruption of Matrix Metalloproteinase-9 (Gelatinase B) Suppresses Development of Experimental Abdominal Aortic Aneurysms,  J. Clinical Investigation  105 (11), 1641-1649 which are all incorporated by reference in their entireties. 
   Methods of Use 
     FIG. 31  illustrates a section of tissue  82  that can have a tunnel defect  84  passing through the tissue  82 .  FIG. 32  illustrates that the tunnel defect  84  can have a defect front face  86  and a defect back face (not shown). A defect front lip  88  can be defined by the perimeter of the defect front face  86 . A defect back lip  90  can be defined by the perimeter of the defect back face. The tunnel defect  84  can have a defect height  92 , a defect depth  94  and a defect width  96 . 
     FIG. 33  illustrates that a guidewire  98  can be deployed through the tunnel defect  84 . The guidewire  98  can be passed through the guide lumen  26  in the measurement tool  2 . The measurement tool  2  can be in a radialy contracted (as shown) or radially expanded configuration. The measurement tool  2  can be translated, as shown by arrow, along the guidewire  98 . The measurement tool  2  can be translated to the tunnel defect  84  with or without the use of the guidewire  98 . 
     FIG. 34  illustrates that the measurement tool  2  can be translated into the tunnel defect  84 . The guidewire  98  can be left in place or removed. The location of the measurement tool  2  can be monitored by dead reckoning, and/or imaging, and/or tracking along the length of the guidewire  98 . The measurement tool  2  can be positioned so that the tunnel defect  84  is located adjacent to the catheter porous section  12 . The measurement tool  2  can be positioned so that the tunnel defect  84  is located substantially between the most distal wire distal anchor  22  and the most proximal wire proximal sheath. 
     FIG. 35  illustrates that the measurement tool  2  can be radially expanded. The measuring wires in the wire radially constrained section  16  can be distally longitudinally translated. The measuring wires  8  and  10  can translate radially (i.e., away from the longitudinal axis  4 ). The measuring wires  8  and  10  can radially distend the tunnel defect  84 , for example causing the tunnel defect  84  to widen, as shown by arrows  99 , and shorten (i.e., contract height-wise), as shown by arrows  101 . The measuring wires  8  and  10  can radially distend the tunnel defect  84 , for example, until the tunnel defect  84  will no longer distend without structurally damaging the tunnel defect  84 . 
     FIG. 36  illustrates that the coupler  72  can bend, for example to maintain substantially plane of the tunnel defect  84  and the longitudinal axis  4  at the location where the measurement tool  2  passes through the tunnel defect  84 . The coupler  72  can disengage at the coupler&#39;s distal (or proximal) end, for example, leaving the distal end of the measurement tool  2  in the tunnel defect  84 . The distal end of the measurement tool  2  can then be used, for example, to distend the tunnel defect  84  to substantially close and treat the tunnel defect  84 . 
     FIG. 37  illustrates that the measuring wires can be radially translated, as shown by arrows  103 , beyond the extent that the tunnel defect  84  can be distended without structural damage. The measuring wires  8  and  10  can deform around the front and back defect lips. Portions of the measuring wires can configure into wire overdeployment sections  100  proximal and distal to the tunnel defect  84 . The wire overdeployment sections  100 , or markers  80  thereon, can be imaged, for example using x-rays (e.g., radiography, fluoroscopy), ultrasound, or magnetic resonance imaging (MRI). The wire overdeployment sections  100  can illustrate the defect width  96  (i.e., the length between the wire deployment sections) when the defect is in a fully distended configuration. 
     FIG. 38  illustrates that the measurement tool  2  can have no catheter porous section  12 , for example, when the measurement tool  2  is used for the measurement method as shown in  FIG. 37 . The methods of use shown in  FIGS. 37 and 38  can, for example, measure the defect depth  94  and/or the defect height  92 . 
   The measuring tool  2  of  FIGS. 13 through 15  can be used to distend and measure the tunnel defect  84  in more than one plane concurrently, and/or alternately in quick succession. 
     FIG. 39  illustrates that contrast fluid or particles can be deployed into the fluid lumen  30  of the catheter  6 , for example, when tunnel defect  84  is in a fully distended configuration. The contrast fluid can be radiopaque, echogenic, visible contrast (e.g., dyes, inks), any other material disclosed herein, or combinations thereof. The fluid pressure of the contrast fluid or particles can be increased. The contrast fluid or particles can emit, as shown by arrows  102 , through the catheter porous section  12 . The contrast fluid or particles outside of the catheter  6  can configure into a marker cloud  104 . The marker cloud  104  can move into position around the tissue  82 . The marker cloud  104  can illustrate the defect dimensions (i.e., visible with imaging systems known to those having ordinary skill in the art, including x-ray, CAT, MRI, fiber optic camera, ultrasound/sonogram) when the defect is in a fully distended configuration. 
   A drug can be deployed from the catheter porous section  12 , for example, similar to the method of deploying the contrast fluid. 
   A distension device size can be determined as described, supra. The measurement tool  2  can be radially contracted and removed from the tunnel defect  84 , or the coupler  72  and/or the elements of the measurement tool  2  proximal to the coupler  72  can be detached from the remainder of the measurement tool  2  and removed. If the entire measurement tool  2  is removed from the tunnel defect  84 , a distension device can be selected that has a size that substantially matches (e.g., is equivalent when the distension device is in a substantially or completely radially expanded configuration) the size of the distended tunnel defect  84 . The distension device can be deployed to the tunnel defect  84 , for example along the guidewire  98 . The guidewire  98  can be removed. The distension device can be, for example, a filter, stopper, plug, any distending device described in U.S. patent application Ser. Nos. 10/847,909, filed 19 May 2004; 11/184,069, filed 19 Jul. 2005; and 11/323,640, filed 3 Jan. 2006, all of which are incorporated by reference herein in their entireties, or any combinations thereof. 
   Any elements described herein as singular can be pluralized (i.e., anything described as “one” can be more than one). Any species element of a genus element can have the characteristics or elements of any other species element of that genus. The above-described configurations, elements or complete assemblies and methods and their elements for carrying out the invention, and variations of aspects of the invention can be combined and modified with each other in any combination.