Catheter, medical device for the introduction of a treatment solution

A medical device includes a catheter, which includes a first lumen for injection of a first volume of a treatment solution, the first lumen opening out at the distal end of the catheter; and a junction element extending the first lumen at the end of the catheter including a diameter at the distal end thereof less than the diameter of the catheter.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is the U.S. National Stage of PCT/EP2019/061212, filed May 2, 2019, which in turn claims priority to French patent application number 1800426 filed May 4, 2018. The content of these applications are incorporated herein by reference in their entireties.

FIELD

The field of the invention relates to devices for introducing a solution into a channel of the human body, more particularly vessels and in particular the vein of Marshall. The field of the invention relates to devices for the treatment of certain cardiac pathologies. More particularly, the field of the invention relates to that of catheters comprising a means for directing a solution to be injected into a channel for example of the vein of Marshall type.

STATE OF THE ART

Today, the vein of Marshall is involved in the causes of the occurrence of cardiac pathologies of the cardiac fibrillation type such as atrial fibrillation, called AF. The vein of Marshall is a vein of the heart that a priori is not necessary, but due to its implication in the occurrence of certain pathologies, it is treated during the execution of an act of interventional cardiology at the heart.

Atrial fibrillation AF is an arrhythmia defined by a chaotic activation of the atria. It is triggered by atrial extrasystoles that initiate multiple and variable re-entries. The pulmonary veins, source of extrasystoles and a substrate for the re-entries, are recognized as the fundamental structures at the initiation and in the maintaining of atrial fibrillation. They are therefore the main target of the ablation. Other structures have similar characteristics: superior vena cava, coronary sinus, ligament of Marshall. Although the first two can be treated by the ablation, the ligament of Marshall is not readily accessible by this type of treatment.

The ligament of Marshall is an embryonic remnant resulting from the involution of the left superior vena cava and the musculature thereof. The incomplete apoptosis of the venous musculature leads to the persistence of several muscular connections between the endocardium and the epicardium. The ligament of Marshall is therefore comprised of a venous network of small caliber, also called “vein of Marshall”, closely associated with a muscular arborization. This complex structure is propitious to the initiation and to the maintaining of the atrial fibrillation through automaticity and re-entry mechanisms. Winding between the left pulmonary veins and the left atrium, the vein of Marshall joins with the great cardiac vein to anastomose in the coronary sinus. As with all veins, it is often subject to anatomical path variations.

Because of the fact that it is difficult to treat the vein of Marshall by endocardial ablation—in particular because it is electrically insulated in a fat mass—or epicardial ablation (its very limited diameter does not allow for the introduction of an ablation catheter), other treatment techniques have been investigated.

One of the treatment methods used to date to reduce the implication of the vein of Marshall in the appearance of cardiac fibrillation is the introduction of a solution of the alcohol type into the vein.

Currently, there are catheters for introducing a treatment solution into the vein of Marshall. The existing catheters generally have a main lumen and a second lumen guided to be introduced into the vein of Marshall. However in order to secure the handling and to ensure that the second lumen is indeed introduced, it is necessary for a surgeon or an operator to sufficiently introduce the lumen inside the vein of Marshall.

This action has for consequence an impossibility of treating the zone of the vein located at the anastomosis of the latter with the main vein of the network in which the lumen is introduced. Consequently, the vein of Marshall is partially treated and most often the symptoms are only partially removed.

This problem is not localized to the sole case of the vein of Marshall, there is a need for a catheter and/or an element allowing for the introduction of a treatment solution in veins of small diameters and that open out onto another vein making it possible to treat the anastomosis zone of the vessel41and of the vessel42.

SUMMARY OF THE INVENTION

The method of the invention makes it possible to resolve the aforementioned problems.

According to an aspect the invention relates to a medical device comprising:A catheter characterized in that it comprises a first lumen for injection of a first volume of a treatment solution, the first lumen opening out at the distal end of the catheter;A junction element extending the first lumen at the end of the catheter comprising a diameter at the distal end thereof less than the diameter of the catheter.

An advantage is to allow for the introduction of a volume of alcohol into a localized region inside the vein of Marshall and at the anastomosis thereof while still guaranteeing a seal of the treated zone thanks to a junction element of the catheter.

According to an embodiment, the catheter can be deformable and the deformation can be controlled.

According to an embodiment, said junction element is intended to cooperate with an anastomosis zone of a first vessel with a second vessel. The cooperation extends to form in particular a sealed contact between the junction element and the wall of the anastomosis zone.

According to an embodiment, the junction element is intended to form a sealed circumferential contact with an anastomosis zone of two vessels.

According to an embodiment, the junction element comprises a positioning ring intended to form a bearing surface in contact with the anastomosis zone, the diameter of the positioning ring being greater than the diameter of the catheter.

According to an embodiment the junction element comprises two electrodes arranged at the distal end thereof.

According to an embodiment, the body of the catheter comprises a plurality of electrodes arranged on at least one portion of the circumference thereof.

According to an embodiment, the device comprises a first positioning balloon arranged on the wall of the catheter and intended to create a first sealed border with the wall of a first vessel.

According to an embodiment, the device comprises a second positioning balloon arranged on the wall of the catheter and intended to create a second sealed border with a portion of the wall of the first vessel.

According to an embodiment, the junction element comprises a length comprised between 2 mm and 2 cm. An advantage is to adapt to different geometries of anastomosis and diameter of the coronary sinus and of the vein of Marshall.

According to an embodiment, the junction element comprises a portion having a circumferential edge intended to bear against the walls of a vessel. An advantage is to improve the seal of the zone to be treated by a good contact between the junction element and the wall of a vessel or of an anastomosis zone.

According to an embodiment, the junction element comprises a profile that has a concave or straight portion extending from the distal end of the catheter in the direction of the distal end of the junction element.

According to an embodiment, the junction element comprises a profile that has a substantial conical shape. An advantage is to allow for a sinking of the end of the catheter adapting to different geometries of the vessels treated.

According to an embodiment, the junction element comprises a rounded distal end. An advantage is to ensure a good seal while still limiting damage to the tissues.

According to an embodiment, the junction element is made from a deformable material comprising a ductibility that is higher than a predefined threshold.

According to an embodiment, the junction element is made from a deformable material comprising an elasticity that is higher than a predefined threshold.

According to an embodiment, the junction element comprises a profile of which the diameter varies so as to form a sealed wall between a first vessel and a second vessel when the distal end of the catheter is positioned bearing against the wall of the vessel.

According to an embodiment, the catheter comprises at least one electrode arranged at the distal surface of the body of the catheter making it possible to record the electrical activity in the vessel.

According to an embodiment, the first lumen comprises a diameter comprised between 2 F and 5 F, preferably 4 F.

According to another aspect, the invention relates to a usage of a device of the invention for the treatment of the vein of Marshall and of the anastomosis thereof. The treatment relates in particular to the alcoholization of this region, in particular in the objective of carrying out a chemical ablation.

DESCRIPTION

FIG. 1shows an embodiment of a device of the invention along a longitudinal cross-section. The device1comprises a catheter10provided with a first lumen LU1. The longitudinal cross-section shows an example of a catheter10that comprises a coaxial lumen LU1.

FIG. 3Adiagrammatically shows the device of the invention arranged in a first vessel41. The catheter10comprises a lumen LU1making it possible to convey, for example, a volume of a first solution SOL1intended to penetrate into a second vessel42, such as a vein. The invention is particularly advantageous when it is applied to the introduction of a volume of liquid SOL1into the vein of Marshall42. The device1of the invention makes it possible to reach the anastomosis43of the vein of Marshall42with sufficient precision so that the solution SOL1can penetrate into said vein.FIG. 5shows a three-dimensional view of the vein of Marshall42at the surface of the myocardium. In a particular application case, the vessel41is the coronary sinus and the vessel42is the vein of Marshall.

According to an embodiment, the solution SOL1injected is an alcohol solution. An advantage is to treat the zone close to the anastomosis43which could not be carried out with the solutions addressed to the problem of the AF.

According to another example, the solution SOL1injected is an iodine solution. An advantage is to make it possible to improve the quality of images acquired by a medical imaging system. An interest is to have a single catheter10that makes it possible to provide different functions ranging from the positioning of the catheter10to the treating of the zone to be treated.

FIG. 1shows an injector31comprising a solution SOL1intended to be injected into a vessel42of the human body. A piston32is shown so as to illustrate the function aiming to engage the solution SOL1into the lumen LU1. A valve30makes it possible in this example to open or not the passage to a volume of a solution SOL1to be transmitted. Furthermore, the valve30can make it possible to remove a volume of air and/or to control the pressure inside the lumen LU1. Other embodiments can be considered so as to generate a controlled pressure of the solution SOL1so that it can be injected into the zone to be treated43by the lumen LU1and the appendix20extending the lumen LU1.

According to another example, the first lumen LU1allows for the passage of a guide to direct the catheter10until it reaches the anastomosis of the vessel42. An advantage is to make it possible to reach, for example, the inside of the vein of Marshall using a guide.

According to an example of a treatment method, the catheter10of the invention makes it possible to chain a first treatment at the anastomosis43and a second treatment inside the vessel42, for example, thanks to a second lumen LU2, such as an angioplasty balloon, able to be displaced within the first lumen LU1and of which the diameter does not exceed that of the appendix20.FIG. 3Bshows a case where the second lumen LU2comprises a termination that forms an appendix20, such as a termination with a conical shape or that has a triangular section.

According to an embodiment, the first lumen LU1is a lumen of diameter 4 F.

FIG. 3Ashows, indeed, a vein of Marshall42opening out onto a vein41. The catheter10is introduced into the vein41in such a way as to have the outlet17of the distal end of the appendix20in the anastomosis of the vein of Marshall42. For this purpose, the catheter10was deflected and has a deformation that was able to be controlled using a proximal handle12. So as to illustrate the deformation function of the catheter10, the non-deformed trace of the catheter10is retained inFIG. 3A.

When the end17of the appendix20is well positioned with respect to the anastomosis of the vessel42, i.e. making it possible to ensure the occlusion thereof and the seal thereof, the solution SOL1then flows in the vein of Marshall42. An advantage of the invention is to make it possible to treat the proximal end of the vessel42, i.e. the zone43that would not have been treated if an arm of a member of the catheter10had penetrated into the vein42.

Junction Element

According to an embodiment, the device1comprises a junction element20that forms a distal appendix that extends the lumen LU1which is integrated into the catheter10.

The junction element20can be fixed to the catheter10in different ways. It can be screwed or snap-fit for example if the distal end13of the catheter10provides a suitable fastening. According to another embodiment, the appendix is welded or glued in such a way as to form a single secured part of the catheter10.

FIG. 7Ashows an embodiment wherein the junction element20comprises a channel22that extends the lumen LU1. It further comprises a circumferential groove21intended to cooperate with an internal groove130of the distal end13of the catheter10ofFIG. 7B. In this embodiment, the junction element20can be made from a slightly deformable material so as to be able to be inserted and provide the occlusion and the seal. According to this embodiment, seals can be added and a gluing can be carried out in order to reinforce the integral connection between the junction element20and the catheter10.

Other embodiments can be considered in the framework of the invention.

According to different embodiments, the junction element20can comprise different shapes so as to provide a first function of a seal between the vessel41and the vessel42, in particular when a treatment solution is injected into the vessel42. An interest is to maintain the distal end13of the catheter10in contact with the anastomosis of the vessel42. The maintaining of the contact ensures that the solution SOL1does not flow back into the vessel41.

FIG. 6Ashows an example of a shape wherein the junction element20has an S-shaped profile. This shape allows for a good introduction of the junction element20into the vein of Marshall42while still offering a curved surface making it possible to hug the shape of the anastomosis43.

FIG. 6Bshows another example of a shape of a profile of the junction element20. In this case, the junction element20has a circumference that decreases linearly. The appendix20has a substantially conical shape. This shape allows for a good adaptation of the junction element20in the vein of Marshall42. The diameter and the position of the anastomosis of the vein of Marshall is subject to substantial anatomical variations. This solution therefore makes it possible to obtain an end that can be adapted to different anastomosis morphologies.

FIG. 6Cshows another alternative shape of the profile of the appendix20. This “hyperbole” shape makes it possible to provide the introduction of the distal portion of the catheter20. It makes it possible to introduce a more substantial portion of the appendix into the vein of Marshall42than in the cases ofFIGS. 6A and 6B. This embodiment is for example adapted if the vein of Marshall42has a complex, enlarged or abnormal anatomy.

According to an alternative embodiment, the junction element20comprises a portion25intended to penetrate into the vessel42having a contact surface with the vessel42extending over 1 mm to 2 cm, preferably 3 mm to 1 cm.

According to an embodiment, the junction element20has an outer diameter that is smaller than the outer diameter of the catheter10over a length of 1 mm to 2 cm, preferably from 3 mm to 1 cm.

According to an embodiment, the junction element20comprises a rounded end. This embodiment makes it possible to not damage or tear a body tissue during the passage thereof in the vessels.

According to an embodiment, the junction element20is made from a flexible material. It can, according to an example, be deformable in such a way as to adapt to the geometry of the anastomosis43of the vein of Marshall42. It can be made from a plastic or elastic material. According to an embodiment, it is comprised of a polymer material or a silicone.

According to an embodiment, the material of the junction element20comprises an elasticity that is greater than a predefined threshold. The threshold is defined for example according to a % of the elasticity of the tissues present on the surface of the vessels in the myocardium, for example that of the coronary sinus. According to an embodiment, the elasticity of the junction element20is substantially close to the average elasticity of the tissues of the myocardium.

According to an embodiment, the material of the junction element20comprises a ductibility that allows for a slight deformation in order to ensure a sealed contact by cooperating with the geometry of an anastomosis.

According to another embodiment, the junction element20is made from a hard material in order to favor the introduction thereof.

Lumen of the Catheter

According to an example, the lumen LU1is coaxial to the catheter10. An advantage is to be able to pass, for example, a guide that ensures the stability of the catheter10in a vessel41, for example a blood vessel of the vein type such as the coronary sinus. Once the catheter10is positioned and stabilized, the guide can be withdrawn in such a way as to introduce in a second step the solution SOL1.

According to an embodiment, the catheter can be deflected. The deflection is controlled by a proximal handle. The catheter can be, for example, guided using a proximal handle, this is referred to as a catheter rendered deflectable.

The catheter10is compatible with different types of guides that can circulate in a lumen of which the diameter is suitable for the passage thereof.

According to an embodiment, a guide can, indeed, be adapted in the objective to stabilize the catheter10.

According to an embodiment, the diameter of the distal opening17formed by the connection element20can be adapted to the introduction of a treatment solution SOL1of the alcohol type, to a revelator and/or to the passage of a guide.

When a revelator or a marker is introduced, it makes it possible to improve the visibility of the positioning of the catheter10by means of a medical imaging system, such as an X-ray imaging system. By way of example, the first lumen LU1can be used to diffuse a volume of iodine within a vessel41. An advantage is to improve the positioning of the catheter10in such a way that the channel22of the appendix is precisely facing the outlet opening out of the vessel42or inside the vessel42, such as shown in the zone43,FIG. 3A.

Advantageously, the injection of iodine by the coaxial lumen LU1makes it possible to carry out a venography of the coronary sinus in order to locate the vein of Marshall42. This step can be carried out prior to the positioning of the junction element20with respect to the anastomosis43, i.e. at the ostium of the vessel42and of the vessel41. Then, the injection of alcohol into said vein42can be conducted with complete safety by a visual assistance conducted using an imaging system.

According to an embodiment, the first lumen LU1is adapted to receive an internal lumen LU2for the passage of an angioplasty balloon. According to an example, the lumen LU2can be considered as a catheter of small diameter that can be introduced into the lumen LU1in order to penetrate more distally in a vessel of low caliber.

According to another embodiment, the lumen LU1is adapted to the passage of an angioplasty balloon.

According to an embodiment, the catheter10has a diameter comprised between 6 and 9 F allowing it to have at least one central lumen LU1but also according to another embodiment two lumens LU1and LU3.FIG. 4shows an embodiment wherein the catheter10comprises two lumens LU1and LU3. A guide G1is introduced into the lumen LU3in such a way as to guide the catheter10and to maintain the catheter10in a stabilized position during the introduction of the solution SOL1into the lumen LU1.

According to an embodiment, the device1of the invention comprises a sheath of a larger diameter than that of the catheter10. Advantageously, the sheath allows for the guiding of the catheter10to the coronary sinus when it entails a treatment of the vein of Marshall. According to an embodiment, the sheath is an interventional cardiology sheath.

An advantage of the device1of the invention is to make it possible to ensure several functions with a single device. The function of guiding, the function of introducing a revelator such as iodine and the introducing of a treatment solution of a vessel, such as alcohol.

According to an embodiment, the invention relates to a lumen comprising an appendix20intended to be made secure within the catheter10into the coaxial lumen LU1.FIG. 3Bshows such a lumen LU2comprising an appendix20. The lumen LU2can be, for example, positioned within the catheter10before the introduction thereof.

According to an embodiment, the catheter1comprises one or more collection electrodes arranged within the lumen LU1. The electrode is arranged in such a way as to have a conductive portion protruding with respect to the opening17of the distal end of the appendix20.

According to an embodiment, the catheter10comprises electrodes on the distal surface of the body of the catheter making it possible to record the electrical activity in the vessel41.

According to an embodiment, the catheter can be deflected. The deflection is controlled by a proximal handle. The catheter can be, for example, guided using a proximal handle. This is referred to as a catheter rendered deflectable and therefore able to be oriented in order to facilitate the introduction into the coronary sinus then into the ostium of the vein of Marshall.

An advantage is to measure an electrical conductivity of a zone located in the vein of Marshall, in particular at the anastomosis43. The electrode can be introduced from the proximal opening and be positioned for example by means of a guide at the distal end17of the appendix20.

According to another example, the appendix20is made from a deformable material and can be compressed during the introduction thereof by the proximal end of the catheter10to arrive up to the distal end of the catheter10where it is hooked to the distal end of the catheter10.

According to another aspect, the invention relates to a method of treatment of the vein of Marshall.

The method comprises:an introduction of a device1of the invention into the coronary sinus;an introduction of a solution of the revelator type, for example iodine, so as to improve the contrast of images acquired by an imaging system, said solution being introduced by the first lumen LU1;a positioning of the catheter10in such a way as to position the distal outlet17of the junction element20at the anastomosis43of the vein of Marshall42;a control of the positioning of the outlet17so that it opens out at the anastomosis of the vein of Marshall42;an introduction of a treatment solution SOL1into the first lumen LU1so that it is conveyed into the anastomosis zone43and inside the vein of Marshall42.

According to an embodiment, the treatment solution SOL is an alcohol solution. According to an embodiment, a test liquid, such as an iodine solution, is introduced prior to the treatment solution SOL1into the first lumen LU1so as to verify the seal of the contact between the appendix20and the wall of the coronary sinus41, the wall of the vessel42or the zone forming the anastomosis of the vein of Marshall (vessel42).

According to an embodiment, an introduction of an internal lumen LU2into the first lumen LU1makes it possible to deliver the solution of the revelator type as an alternative of its conveyance by the central lumen LU1. In a second step, it is withdrawn so as to release the first lumen LU1so that the treatment solution SOL is introduced.

An advantage of the catheter10of the invention is to facilitate the chemical ablation of the zone comprising the anastomosis of the vein of Marshall and the vein itself. Indeed, the catheter10makes it possible to obtain a destruction of the muscular conduction tissue associated with the vein of Marshall. As specified hereinabove, the vein of Marshall and the muscular arborization thereof are involved in several ways in the process of atrial fibrillation.

The invention relates to the usage of the catheter for carrying out an alcoholization of the vein of Marshall. For this purpose, the catheter10is introduced into the anastomosis43of the vein of Marshall42, the distal appendix20is then oriented to cooperate with the wall of the coronary sinus at the anastomosis zone. The outlet of the channel23is then oriented with respect to the anastomosis43of the vein of Marshall42. The contact between the appendix and the wall of the vessel at the zone43provides the seal during the introduction of a volume of alcohol into the first lumen LU1in order to be introduced into the vein of Marshall42. Once the catheter10is positioned, a volume of alcohol is introduced into the lumen LU1. An alternative means is to use an angioplasty material with the aforementioned disadvantages of the prior art.

In a complementary and optional manner, a second volume of alcohol can be introduced within the vein of Marshall42from a device introduced into the first lumen LU1. This embodiment makes it possible to inject a volume of alcohol inside the vein42and so as to go beyond the zone directly in the vicinity of the anastomosis zone43. For example, the device introduced can be an angioplasty balloon.

FIG. 8shows a junction element20comprising at the distal end17of the channel22an opening provided on the periphery thereof with at least two electrodes210and211. According to an example, the electrodes210and211form a pair of electrodes, of which one reference electrode210and one working electrode211. The two electrodes210,211are for example, separated from one another by an electrical insulation213and212. In the case where the electrodes form an arc of a circle at the distal end of the channel22, the insulating portions213and212can also form a circular portion. The electrodes210and211can be extended inside the catheter10by at least one conductive element. The conductive elements can be guided, for example, within the catheter10by a lumen (not shown). The electric potential can thus be measured using a proximal connector of the catheter10.

According to an example, the proximal material forming the electrodes210,212can be a polished metal so as to not attack the tissues. It can alternatively be made from a polymer material into which a conductive powder is injected. Other conductive materials can be used according to other embodiments of the invention.

An advantage of this configuration is to measure the electric potential on a wall of a vessel41,42at the anastomosis zone43or directly on a portion of a wall of a vessel41or42. The catheter10being deformable from a proximal control, the catheter10can be oriented in such a way as to establish a contact between a wall of a vessel and the distal end thereof. An advantage is to be able to verify the electrical activity in the vessel41during a series of heartbeats. This verification makes it possible to validate or not the treatment to be conducted of said vessel41.

The junction element20comprises a profile215adapted to cooperate with the shape of the anastomosis zone43in such a way as to carry out a border that favors the seal of this zone with respect to the zones upstream and downstream from the vessel41when the catheter10is positioned. According to an embodiment, the junction element20comprises a positioning ring216that has a circumference of which the radius can be greater than that of the catheter10. An advantage of a positioning ring216is to form a sealed contact at the anastomosis zone43. Advantageously, the sealed contact forms a ring around the anastomosis of the vessel42. The positioning ring216thus makes it possible to secure the seal of the anastomosis zone43that has to be treated with a solution SOL1.

According to an embodiment, the positioning ring216is a lip that forms a rounded edge on the circumference of the distal end of the catheter10. The profile of the lip is convex in such a way as to favor firstly the contact of this part during the introduction of the junction element20in the anastomosis zone43in the direction of the vessel42. The positioning ring216can form a crown, of the collar type. According to an embodiment, the collar216is movable. In this case, it can be adapted to the geometry of the anastomosis zone43. Thus, an image carried out beforehand of the zone to be treated, for example by MRI or by a scanner, makes it possible to choose the junction element20when it is movable or makes it possible to choose the ring216when it is movable.

According to an embodiment, the positioning ring216is inflatable. The inflation is, for example, carried out using a lumen (not shown) internal to the catheter10. Thus, the inflation is preferably carried out remotely. According to an embodiment, a lateral opening on the wall of the catheter10makes it possible to convey a volume of liquid or gas to inflate the positioning ring216. When the positioning ring216is a balloon, the latter can be crimped in a groove of the catheter10, alternatively the balloon can be glued or thermobonded on the wall of the catheter10. The gluing can result from a melting of the material of the balloon in the body of the catheter.

According to an embodiment, the diameter of the junction element20decreases beyond the positioning ring216. An advantage is to treat the anastomosis zone43without the catheter penetrating excessively into the vessel42. Thus, the treatment can be effective in the anastomosis zone and not only in the vessel42.

According to a protocol, the catheter10is positioned at the anastomosis zone43. An inflation of the positioning ring216is carried out and a treatment of the zone is carried out using the injection of a volume of solution SOL1at this level. Then in a second step, the positioning ring216is deflated and the catheter10penetrates into the vessel42in order to treat the inside of the vessel42with the solution SOL1. When successively the anastomosis zone43and the vessel42are treated, the catheter10is withdrawn.

FIG. 9shows a catheter10provided with a junction element20at the distal end thereof. An operator can then control the orientation of the catheter10in such a way as to carry out a sufficient curvature to position the junction element20with regards to the anastomosis zone43until coming into contact with the wall of the vessels41,42at the anastomosis zone43. In the example ofFIG. 9, the body of the catheter10is provided with electrodes19to measure the electrical activity in the vicinity of the anastomosis zone43. An interest is to verify the electrical conductivity of the vessel41downstream or upstream from the anastomosis zone43, according to how the catheter10entered the vessel41.

FIG. 10shows an example of a catheter10provided with a first lateral balloon50. The lateral balloon50is inflated from a first lateral opening of the catheter10and from a first lumen (not shown) arranged inside the catheter10and opening out onto said lateral opening. According to an alternative, the inflation is carried out from a first lumen outside the catheter10. The balloon50is inflated until a sealed border is formed between the zone downstream to the anastomosis zone43and the anastomosis zone43. The balloon50can be inflated until the vessel41is obstructed.

The first balloon50makes it possible to improve the seal of a portion of the vessel41with regards to the anastomosis zone43to be treated. The inflation of the first balloon50is carried out until the vessel41is slightly deformed, here visible on the portion411. The deformation of the vessel41makes it possible to improve the seal of the border formed due to the pressure exerted on the wall of the vessel41. Furthermore, the balloon50makes it possible to stabilize the positioning of the catheter10when the junction element20is bearing on the walls of the vessels in particular in the anastomosis zone43.

FIG. 11shows an example of a catheter10provided with a first lateral balloon50and a second lateral balloon51. The lateral balloon51is inflated from a second lateral opening of the catheter10and from a second lumen (not shown) arranged inside the catheter10. According to an alternative, the inflation can be carried out from a second lumen outside the catheter10. The balloon is inflated until a sealed border is formed between the upstream zone and the anastomosis zone43. The positioning of the second lateral opening of the catheter intended to inflate the second balloon51is preferably arranged upstream from the first opening in the proximal direction. Preferably, this second opening is arranged at substantially 180° from the first opening on the wall of the catheter10.

Thus, using two balloons50,51makes it possible to define a sealed zone at the anastomosis zone43on the one hand with respect to the downstream zone of the anastomosis zone43and on the other hand with respect to an upstream zone of the anastomosis zone43.

The second balloon51makes it possible to improve the seal of a portion of the vessel41with regards to the anastomosis zone43to be treated. Furthermore, the second balloon51makes it possible to stabilize the positioning of the catheter10when the junction element20is bearing on the walls of the vessels41,42, in particular in the anastomosis zone43. The balloons50,51can be fixed to the surface of catheter10.

According to a configuration, a portion of the outer wall of the catheter10forms a wall of the inflated volume. According to an example, the balloons are circumferential and form rings or toroids around the catheter10. This is particularly interesting for the balloon51so that it completely obstructs the vessel41downstream from the anastomosis zone43. According to another example, the balloons extend partially at the circumference of the body of the catheter10.

In the case ofFIG. 11, the portion410of the vessel41located upstream from the anastomosis zone43is deformed and the zone411of the vessel41located downstream from the anastomosis zone43is also deformed. This deformation aims to reinforce the seal of the treated zone comprising the anastomosis zone43. So as to finish with a slight deformation of the vessel, the balloon is inflated sufficiently in order to obtain this result.