Abstract:
An improved catheter device includes an elongate shaft having a distal portion adapted to be disposed with the abdominal aorta and a plurality of expandable members disposed thereon. One expandable member is dimensioned and configured so that it rests within the iliac bifurcation when expanded. At least two expandable members are spaced apart from the one expandable member and configured to selectively occlude blood flow to different abdominal/pelvic arteries when expanded. Preferably, the distal-most and the proximal-most expandable members are spaced apart at a distance more than 20 cm and less than 40 cm (and most preferably on the order of 30 cm). The expandable members are preferably realized by four inflatable balloons controlled by fluidic pressure supplied thereto via corresponding inflation lumens in the shaft. The catheter device can be fixated within the abdominal aorta and manipulated in order to quickly and efficiently identify and isolate a hemorrhage flowing from an abdominal artery. In another aspect, the catheter device can be used in treating an abdominal aortic aneurysm.

Description:
BACKGROUND OF THE INVENTION  
       [0001]     1. Field of the Invention  
         [0002]     This invention relates broadly to occlusion catheter devices and associated methods for vascular applications. More particularly, this invention relates to aortic occlusion catheter devices and associated methods.  
         [0003]     2. State of the Art  
         [0004]     Hemorrhagic shock is typically the result of penetrating injuries such as caused by traffic accidents and gunshot wounds. When a patient is suffering from hemorrhagic shock, cardiac function is unimpaired and the cause of the shock is blood loss. Treatment of hemorrhagic shock consists of volume replacement and hemostasis. In many trauma situations, it may be difficult to isolate the injury that is the cause of the loss of blood. In these situations, maintaining blood flow to the heart, neck and lungs while temporarily blocking the flow of blood through the aorta may be necessary to stabilize the patient and provide time for interventional treatment.  
         [0005]     An example of such treatment is described in U.S. Pat. No. 5,820,593 wherein an aortic balloon catheter is inserted into the femoral artery and guided into position in the aorta of the patient. The balloon catheter includes two balloons, a distal balloon and a proximal balloon. The distal balloon is positioned in the ascending aorta just above the aortic valve. The proximal balloon is positioned in the descending aorta below the brachiocephalic trunk. When only the proximal balloon is inflated, a supply of blood is delivered to the arteries of the head and heart while blocking the flow of blood below the thorax, thereby providing hemostasis in severe hemorrhage below the thorax. However, these prior art devices and treatments require opening the intra-abdominal cavity and manually inspecting the arteries of the intra-abdominal cavity (many of which are hidden behind the organs therein) in order to identify the root cause of the hemorrhage. Once the cause of the hemorrhage is identified, the injured artery is clamped upstream from the injury. These steps are typically time consuming and can be problematic, especially when there is severe bleeding. In these cases, the lack of blood flowing below the thorax can result in renal failure or damage to other parts of the body that rely on blood flowing below the thorax.  
         [0006]     Thus, there remains a need in the art to provide devices and treatments that provide for quick identification and isolation of an injured artery below the thorax, thereby stabilizing the patient and providing time for interventional treatment.  
       SUMMARY OF THE INVENTION  
       [0007]     It is therefore an object of the invention to provide a surgical device (and corresponding method of treatment) that enables quick identification and isolation of a hemorrhaging artery in the abdomen/pelvis (e.g., below the thorax), thereby allowing the attending physician to stabilize the patient and provide time for interventional treatment.  
         [0008]     It is another object of the invention to provide a surgical device (and corresponding method of treatment) that enables quick identification and isolation of a hemorrhaging artery in the abdomen/pelvis without requiring that the abdominal cavity be opened for inspection and clamping.  
         [0009]     It is a further object of the invention to provide a surgical device (and corresponding method of treatment) that selectively occludes the arteries flowing from the abdominal aorta in a manner that stabilizes the blood pressure of the patient while maintaining blood flow through arteries that are upstream from the hemorrhage.  
         [0010]     It is also an object of the invention to provide a surgical device (and corresponding method of treatment) that is quickly and effectively located (e.g., secured in place) in the abdominal aorta of the patient.  
         [0011]     In accord with these objects, which will be discussed in detail below, an improved catheter device for accessing the abdominal aorta of a patient includes an elongate hollow catheter shaft which is advanceable though the arterial system of the patient. The catheter shaft has a proximal portion that extends out from the patient and a distal portion adapted to be disposed within the abdominal aorta of the patient. A plurality of expandable members are disposed on the distal portion. One expandable member is dimensioned and configured so that it rests within the iliac bifurcation of the abdominal aorta when expanded so as to secure the catheter and minimize catheter movement within the abdominal aorta of the patient. At least two other expandable members are spaced apart from the one expandable member and configured to selectively occlude blood flow to different arteries that extend from the abdominal aorta when expanded. Preferably, the distal-most and the proximal-most expandable members are spaced apart at a distance of more than 20 cm and less than 40 cm (and most preferably on the order of 30 cm).  
         [0012]     The improved catheter device of the present invention can be quickly fixated within the abdominal aorta and manipulated in order to efficiently identify and isolate a hemorrhage flowing from an abdominal artery. In addition, the improved catheter device can be used in treating an abdominal aortic aneurysm.  
         [0013]     According to a preferred embodiment of the invention, the expandable members are realized by four inflatable balloons controlled by fluidic pressure supplied thereto via corresponding inflation lumens in the elongate catheter shaft. The balloons are independently inflatable to a diameter of at least 2.5 cm, and the catheter shaft has an external diameter in a range between 7 and 9 french with a total length of at least 80 cm.  
         [0014]     Additional objects and advantages of the invention will become apparent to those skilled in the art upon reference to the detailed description taken in conjunction with the provided figures. 
     
    
     BRIEF DESCRIPTION OF THE DRAWINGS  
       [0015]      FIG. 1  is a schematic illustration of the principle arteries of the human body.  
         [0016]      FIG. 2A  is a side view of an illustrative embodiment of a catheter device in accordance with the present invention.  
         [0017]      FIG. 2B  is a cross-sectional view of the catheter shaft of the catheter device of  FIG. 2A .  
         [0018]      FIG. 3  is a schematic illustration showing the advancement and placement of the catheter device of  FIGS. 2A and 2B  into the abdominal aorta via the subclavian artery during treatment for hemorrhagic shock in accordance with the present invention.  
         [0019]      FIG. 4  is a schematic illustration showing the advancement and placement of the catheter device of  FIGS. 2A and 2B  into the abdominal aorta via the femoral artery during treatment for hemorrhagic shock in accordance with the present invention.  
         [0020]      FIG. 5  is a schematic illustration showing the placement of the catheter device of  FIGS. 2A and 2B  into the abdominal aorta during open surgery of an abdominal aortic aneurysm in accordance with the present invention.  
         [0021]      FIG. 6  is a schematic illustration showing the placement of the catheter device of  FIGS. 2A and 2B  into the abdominal aorta during catheter-based surgery of an abdominal aortic aneurysm in accordance with the present invention.  
     
    
     DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS  
       [0022]     The descriptive terms “downstream” and “upstream”, when used herein in relation to the patient&#39;s vasculature, relate to the direction of normal blood flow and to the direction opposite normal blood flow, respectively, i.e., “upstream” is closer to the heart in the arterial system.  
         [0023]     In addition, the terms “proximal” and “distal”, when used in relation to instruments used in a surgical procedure refer to directions closer and farther away, respectively, from that end of the instrument which is held or manipulated by the operator performing the procedure.  
         [0024]     The principle arteries of the human body are shown in  FIG. 1 . During systole, oxygenated blood leaves the heart  8  and enters the aorta  10 . The aorta  10  includes the ascending aorta  12 , the aortic arch  14 , and the descending aorta  22 . The aortic arch  14  leads to the brachiocephalic trunk  16 , the left common carotid artery  18 , and the left subclavian artery  20 . The brachiocephalic trunk  16  branches into the right common carotid artery  24  and the right subclavian artery  26 . The right and left subclavian arteries  26 ,  20  give rise to the right vertebral artery  28  and the left vertebral artery  34 , respectively in addition to the right axillary artery  26  and the left axillary artery  36 , respectively. The descending aorta  22  starts after the aortic arch  14  and ends at the iliac bifurcation  40 , which is a branch that splits into the two common iliac arteries  42  that go to the legs.  
         [0025]     The descending aorta  22 , by convention, is subdivided into the thoracic aorta  44  and the abdominal aorta  46 . The thoracic aorta  44  runs from the aortic arch  14  to the diaphragm and gives off numerous branches that supply oxygenated blood to the chest cage and the organs within the chest. The abdominal aorta  46  begins at the diaphragm as a continuation of the thoracic aorta  44  and runs down to the iliac bifurcation  40 . The abdominal aorta supplies oxygenated blood to all of the abdominal and pelvic organs and the legs.  
         [0026]     The abdominal aorta  46  leads to the celiac artery  48 , the superior mesenteric and renal arteries  50 , and the inferior mesenteric artery  52 . The celiac artery  48  is a short thick branch of artery about an inch in length that divides into three branches, the gastric, hepatic, and splenic arteries. The celiac artery  48  supplies blood to the intestines, spleen, and liver. The superior mesenteric artery supplies blood to the intestines, and the renal arteries supply blood to the kidneys. The inferior mesenteric artery  52  supplies blood to the colon and the rectum.  
         [0027]      FIGS. 2A and 2B  depict an aortic occlusion catheter device  100  in accordance with the present invention. The device  100  includes a hollow elongate catheter shaft  102  with four distally-mounted expandable occlusion balloons  104 A,  104 B,  104 C,  104 D. The four occlusion balloons are spaced apart along the distal portion of the shaft  102 . Preferably, the balloons are expandable to a maximum diameter of approximately 2.5 to 3 cm, and the spacing between adjacent balloons is regular at a distance of approximately 10 cm. In this configuration, there is a distance on the order of approximately 30 cm between the first balloon  104 A and the fourth balloon  104 D. These dimensions correspond to the configuration and spacing of the major arteries (e.g., the celiac artery  48 , renal arteries and superior mesenteric artery  50 , inferior mesenteric artery  52 , iliac bifurcation  40 ) of the abdominal aorta  46  as will become evident from the operation of the catheter device  100  as set forth below.  
         [0028]     The proximal end of the catheter device  100  is provided with a multi-port adapter  106 . The adapter  106  has four ports  108 A,  108 B,  108 C,  108 D and a main access port  110 . The first port  108 A is in fluid communication with the first balloon  104 A. The second port  108 B is in fluid communication with the second balloon  104 B. The third port  108 C is in fluid communication with the third balloon  104 C. The fourth port  108 D is in fluid communication with the fourth balloon  104 D. The main access port  110  is in fluid communication with a distal port  116  on the distal end of the catheter shaft  102 .  
         [0029]     As shown in  FIG. 2B , the hollow elongate catheter shaft  102  has a main inner lumen  112  and four inflation lumens  114 A,  114 B,  114 C,  114 D. The main lumen  112  extends in fluid communication between the main access port  110  and the distal port  116 . The first inflation lumen  11   4 A extends in fluid communication between the first port  108 A and the first balloon  104 A. The second inflation lumen  114 B extends in fluid communication between the second port  108 B and the second balloon  104 B. The third inflation lumen  114 C extends in fluid communication between the third port  108 C and the third balloon  104 C. The fourth inflation lumen  114 D extends in fluid communication between the fourth port  108 D and the fourth balloon  104 D. The four inflation lumens  114 A,  114 B,  114 C,  114 D allow for independent inflation and deflation of the four balloons  104 A,  104 B,  104 C,  104 D by pumping a fluid (such as a saline solution or air or other medium) into and from the balloons via the ports  108 A,  108 B,  108 C,  108 D, respectively.  
         [0030]     The main lumen  112  and the distal port  116  may be used to pass a wide variety of surgical devices (such as guide wires, angioscopes, irrigation lines, aortic grafts and the like) into the aorta of the patient. The catheter shaft  102  may also include an additional port and lumen (not shown) that are in fluid communication with one another. The port and lumen are also in fluid communication with an aperture (not shown) in the catheter shaft. The aperture is disposed upstream with respect to the four balloons  104 A,  104 B,  104 C,  104 D. These elements provide a manometer for measuring the upstream pressure within the aorta. A pressure monitor is attached the port to monitor the upstream pressure within the aorta.  
         [0031]     The catheter shaft  102  preferably has an external diameter between 7 and 9french such that it can be introduced into the left subclavian artery  20  (or possibly the left common carotid artery  18 , the brachiocephalic trunk  16 , the right common carotid artery  24 , or the right subclavian artery  26 ) and advanced through the aortic arch  14  and down into the abdominal aorta  46 . Alternatively, the catheter shaft  102  may be introduced into a femoral artery and advanced from below into the abdominal aorta  46 . The spacing of the four balloons  104 A,  104 B,  104 C,  104 D along the distal portion of the catheter shaft  102  allows the balloons to be positioned in the abdominal aorta  46 . This will generally require that the length of the catheter shaft  102  be at least 80 cm, and preferably about 90-100 cm. As described below in detail, the first balloon  104 A (or the last balloon  104 D) is inflated and located at the iliac bifurcation  40 , and thus acts to fix the position of the catheter device  100  in the abdominal aorta  46 . In this manner the first balloon  104 A (or the last balloon  104 D) secures the catheter device  100  and minimizes catheter movement within the abdominal aorta  46 . The other balloons are inflated and/or deflated as desired in order to maintain pressure in the abdominal aorta  46  and thus stabilize the patient.  
         [0032]     The catheter shaft  102  may be formed of conventional polymers (e.g., polyethelene, polyvinyl chloride, PTFE, PEBAX® and the like. The occluding balloons may be formed of conventional polymer sheet material and the like as is well known in the art. The catheter shaft  102  and/or the occluding balloons  104 A,  104 B,  104 C,  104 D may incorporate radio-opaque material to facilitate advancement and placement of the catheter utilizing fluoroscopic imaging techniques.  
         [0033]      FIG. 3  illustrates the aortic catheter  100  with the occluding balloons  104 A,  104 B,  104 C,  104 D disposed with the patient&#39;s abdominal aorta  46 . The catheter shaft  102  is introduced into the left subclavian artery  20  and advanced through the aortic arch  14  and down into the abdominal aorta  46 . The first balloon  104 A is inflated (as shown) and then the catheter shaft  102  is moved distally such that the first balloon  104 A is positioned at the iliac bifurcation  40  as shown. In this manner, the first balloon  104 A, when inflated, fixes the position of the catheter device  100  in the abdominal aorta  46  and also occludes blood from flowing through the iliac bifurcation. This configuration enables quick and efficient fixation of the aortic catheter device  100 , which is advantageous in trauma situations where the patient is experiencing excessive internal bleeding.  
         [0034]     After the catheter device  100  is fixed in position (e.g., with the first balloon  104 A located at the iliac bifurcation  40 ), the other three balloons  104 B,  104 C,  104 D are inflated and/or deflated as desired in order to identify and isolate a hemorrhage flowing from an artery in the abdominal aorta  46  and thus stabilize the patient.  
         [0035]     More particularly, the second balloon  104 B may be inflated to occlude blood from flowing downstream with respect to the balloon  104 B. Because the second balloon  104 B is positioned upstream from the inferior mesenteric artery  52 , such occlusion blocks the flow of blood flowing through the inferior mesenteric artery  52 . Similarly, the third balloon  104 C may be inflated to occlude blood from flowing downstream with respect to the balloon  104 C. Because the third balloon  104 C is positioned upstream from the inferior mesenteric artery  52  and the superior mesenteric and renal arteries  50 , such occlusion blocks the flow of blood flowing through the inferior mesenteric artery  52  as well as the superior mesenteric and renal arteries  50 . Finally, the fourth balloon  104 D may be inflated to occlude blood from flowing downstream with respect to the balloon  104 D. Because the fourth balloon  104 D is positioned upstream from the inferior mesenteric artery  52 , the superior mesenteric and renal arteries  50  and the celiac artery  48 , such occlusion blocks the flow of blood flowing through the inferior mesenteric artery  52 , the superior mesenteric and renal arteries  50  as well as the celiac artery  48 .  
         [0036]     Note that when the fourth balloon  104 D is pressurized to a level that does not occlude the flow of blood downstream therefrom, blood is pumped into the celiac artery  48  during systole. When the third and fourth balloons  104 C,  104 D are pressurized to a level that does not occlude the flow of blood downstream therefrom, blood is pumped into the celiac artery  48  and into the superior mesenteric and renal arteries  50  during systole. When the second, third and fourth balloons  104 B,  104 C,  104 D are pressurized to a level that does not occlude the flow of blood downstream therefrom, blood is pumped into the celiac artery  48 , the superior mesenteric and renal arteries  50  and the inferior mesenteric artery  52  during systole. Finally, when the first, second, third and fourth balloons  104 A,  104 B,  104 C,  104 D are pressurized to a level that does not occlude the flow of blood downstream therefrom, blood is pumped into the celiac artery  48 , the superior mesenteric and renal arteries  50 , the inferior mesenteric artery  52  and the iliac arteries  42  during systole.  
         [0037]     As described above with respect to  FIG. 3 , the aortic catheter  100  of the present invention can be used to quickly identification and isolate a hemorrhage flowing from an artery in the abdominal aorta  46 . Preferably, this is accomplished as follows:  
         [0038]     i) introduce the catheter shaft into the left subclavian artery and advance it through the aortic arch and down into the abdominal aorta, and then inflate the first balloon  104 A and move the catheter device distally in order to locate the first balloon  104 A at the iliac bifurcation  40 ;  
         [0039]     ii) if need be, adjust the inflation level of the first balloon  104 A such that it blocks blood from flowing downstream through the iliac arteries;  
         [0040]     iii) monitor the aortic pressure at a position upstream from the four balloons  104 A,  104 B,  104 C,  104 D;  
         [0041]     iv) if the pressure is normal (i.e., an indication that the hemorrhage has been isolated in the iliac arteries or one or more vessels downstream therefrom), end the manipulation of the occlusion of the four balloons and continue monitoring the stability of the patient; surgical procedures are performed to identify and repair the injured artery, which typically requires opening up the abdominal cavity, locating the injured artery and then repairing the injured artery;  
         [0042]     v) if the pressure is low (i.e., an indication that the hemorrhage has not been isolated), adjust the inflation level of the fourth balloon  104 D such that it blocks blood from flowing downstream therefrom;  
         [0043]     vi) monitor the aortic pressure at a position upstream from the four balloons  104 A,  104 B,  104 C,  104 D;  
         [0044]     vii) if the pressure is low (i.e., an indication that the hemorrhage has not been isolated), it is probable that the source of the hemorrhage is upstream from the abdominal aorta  46  (e.g., within the thoracic aorta  44 , the aortic arch  14 , the ascending aorta  12  or vessels downstream therefrom); end the manipulation of the occlusion of the four balloons and continue monitoring the stability of the patient; surgical procedures are undertaken to identify and isolate the source of such bleeding utilizing other means.  
         [0045]     viii) if the pressure is normal, adjust the inflation level of the third balloon  104 C such that it blocks blood from flowing downstream, and adjust the inflation level of the fourth balloon  104 D such that it does not block blood from flowing downstream therefrom; this configuration allows blood to flow downstream into the celiac artery.  
         [0046]     ix) monitor the aortic pressure at a position upstream from the four balloons  104 A,  104 B,  104 C,  104 D;  
         [0047]     x) if the pressure is low (i.e., an indication that the hemorrhage is flowing from the celiac artery), adjust the inflation level of the fourth balloon  104 D such that it blocks blood from flowing downstream, thereby isolating the hemorrhage; end the manipulation of the occlusion of the four balloons and continue monitoring the stability of the patient; surgical procedures are performed to identify and repair the injured artery, which typically requires opening up the abdominal cavity, locating the injured artery and then repairing the injured artery;  
         [0048]     xi) if the pressure is normal, adjust the inflation level of the second balloon  104 B such that it blocks blood from flowing downstream, and adjust the inflation levels of the fourth balloon  104 D and third balloon  104 C such that they do not block blood from flowing downstream, if need be; this configuration allows blood to flow downstream into the renal arteries and upper mesenteric artery.  
         [0049]     xii) monitor the aortic pressure at a position upstream from the four balloons  104 A,  104 B,  104 C,  104 D;  
         [0050]     xiii) if the pressure is low (i.e., an indication that the hemorrhage is flowing from the renal arteries/upper mesenteric artery), adjust the inflation level of the third balloon  104 C such that it blocks blood from flowing downstream, thereby isolating the hemorrhage; end the manipulation of the occlusion of the four balloons and continue monitoring the stability of the patient; surgical treatment is then performed to identify and repair the injured artery, which typically requires opening up the abdominal cavity, locating the injured artery and then repairing the injured artery; and  
         [0051]     xiv) if the pressure is normal (i.e., an indication that the hemorrhage is flowing from the lower mesenteric artery), the inflation level of the second balloon  104 B is maintained such that it blocks blood from flowing downstream, thereby isolating the hemorrhage; end the manipulation of the occlusion of the four balloons and continue monitoring the stability of the patient; surgical treatment is then performed to identify and repair the injured artery, which typically requires opening up the abdominal cavity, locating the injured artery and then repairing the injured artery.  
         [0052]     The sequence of operations set forth in i)-xiv) directly above advantageously provides timely hemostasis, which is typically suitable for critically injured patients. However, it blocks blood flow through the upper arteries of the abdominal cavity (e.g., the celiac and renal arteries), thereby potentially impacting the normal function of the organs (e.g., the liver and/or kidney) that rely on the upper arteries of the abdominal cavity. Thus, in some circumstances (for example, where the blood pressure of the patient is not in a critical condition), an alternate sequence of operations may be used. For example, the balloons  104 B,  104 C,  104 D may be sequentially inflated/deflated in order to isolate the hemorrhage. This sequence of operations potentially minimizes the loss of blood flow through the upper arteries of the abdominal cavity (e.g., the celiac and renal arteries), and thus minimizes the potential impact to the normal function of the organs (e.g., the liver and/or kidney) that rely on the upper arteries of the abdominal cavity.  
         [0053]      FIG. 4  illustrates the aortic catheter  100  with the balloons  104 A,  104 B,  104 C,  104 D disposed with the patient&#39;s abdominal aorta  46 . The catheter shaft  102  is introduced into the femoral artery and advanced through the iliac bifurcation  40  such that four balloons  104 A,  104 B,  104 C,  104 D are positioned in the abdominal aorta  46 . The fourth balloon  104 D is inflated (as shown) and then the catheter shaft  102  is moved proximally such that the fourth balloon  104 D is positioned at the iliac bifurcation  40  as shown. In this manner, the fourth balloon  104 D, when inflated, fixes the position of the catheter device  100  in the abdominal aorta  46  and also occludes blood from flowing through the iliac bifurcation. This configuration enables quick and efficient fixation of the aortic catheter device  100 , which is advantageous in trauma situations where the patient is experiencing excessive internal bleeding.  
         [0054]     After the catheter device  100  is fixed in position (e.g., with the fourth balloon  104 D located at the iliac bifurcation  40 ), the other three balloons  104 A,  104 B,  104 C are inflated and/or deflated as desired in order to identify and isolate a hemorrhage flowing from an artery in the abdominal aorta  46  and thus stabilize the patient.  
         [0055]     More particularly, the third balloon  104 C may be inflated to occlude blood from flowing downstream with respect to the balloon  104 C. Because the third balloon  104 C is positioned upstream from the inferior mesenteric artery  52 , such occlusion blocks the flow of blood flowing through the inferior mesenteric artery  52 . Similarly, the second balloon  104 B may be inflated to occlude blood from flowing downstream with respect to the balloon  104 B. Because the second balloon  104 B is positioned upstream from the inferior mesenteric artery  52  and the superior mesenteric and renal arteries  50 , such occlusion blocks the flow of blood flowing through the inferior mesenteric artery  52  as well as the superior mesenteric and renal arteries  50 . Finally, the first balloon  104 A may be inflated to occlude blood from flowing downstream with respect to the balloon  104 A. Because the first balloon  104 A is positioned upstream from the inferior mesenteric artery  52 , the superior mesenteric and renal arteries  50  and the celiac artery  48 , such occlusion blocks the flow of blood flowing through the inferior mesenteric artery  52 , the superior mesenteric and renal arteries  50  as well as the celiac artery  48 .  
         [0056]     Note that when the first balloon  104 A is pressurized to a level that does not occlude the flow of blood downstream therefrom, blood is pumped into the celiac artery  48  during systole. When the first and second balloons  104 A,  104 B are pressurized to a level that does not occlude the flow of blood downstream therefrom, blood is pumped into the celiac artery  48  and into the superior mesenteric and renal arteries  50  during systole. When the first, second and third balloons  104 A,  104 B,  104 C are pressurized to a level that does not occlude the flow of blood downstream therefrom, blood is pumped into the celiac artery  48 , the superior mesenteric and renal arteries  50  and the inferior mesenteric artery  52  during systole. Finally, when the first, second, third and fourth balloons  104 A,  104 B,  104 C,  104 D are pressurized to a level that does not occlude the flow of blood downstream therefrom, blood is pumped into the celiac artery  48 , the superior mesenteric and renal arteries  50 , the inferior mesenteric artery  52  and the iliac arteries  42  during systole.  
         [0057]     As described above with respect to  FIG. 4 , the aortic catheter  100  of the present invention can be used to quickly identification and isolate a hemorrhage flowing from an artery in the abdominal aorta  46 . Preferably, this is accomplished as follows:  
         [0058]     i) introduce the catheter shaft into the renal artery and advance it up into the abdominal aorta, and then inflate the fourth balloon  104 D and move the catheter device proximally in order to locate the fourth balloon  104 D at the iliac bifurcation  40 ;  
         [0059]     ii) if need be, adjust the inflation level of the fourth balloon  104 D such that it blocks blood from flowing downstream through the iliac arteries;  
         [0060]     iii) monitor the aortic pressure at a position upstream from the four balloons  104 A,  104 B,  104 C,  104 D;  
         [0061]     iv) if the pressure is normal (i.e., an indication that the hemorrhage has been isolated in the iliac arteries or one or more vessels downstream therefrom), end the manipulation of the occlusion of the four balloons and continue monitoring the stability of the patient; surgical procedures are performed to identify and repair the injured artery, which typically requires opening up the abdominal cavity, locating the injured artery and then repairing the injured artery;  
         [0062]     v) if the pressure is low (i.e., an indication that the hemorrhage has not been isolated), adjust the inflation level of the first balloon  104 A such that it blocks blood from flowing downstream therefrom;  
         [0063]     vi) monitor the aortic pressure at a position upstream from the four balloons  104 A,  104 B,  104 C,  104 D;  
         [0064]     vii) if the pressure is low (i.e., an indication that the hemorrhage has not been isolated), it is probable that the source of the hemorrhage is upstream from the abdominal aorta  46  (e.g., within the thoracic aorta  44 , the aortic arch  14 , the ascending aorta  12  or vessels downstream therefrom); end the manipulation of the occlusion of the four balloons and continue monitoring the stability of the patient; surgical procedures are undertaken to identify and isolate the source of such bleeding utilizing other means.  
         [0065]     viii) if the pressure is normal, adjust the inflation level of the second balloon  104 B such that it blocks blood from flowing downstream, and adjust the inflation level of the first balloon  104 A such that it does not block blood from flowing downstream therefrom; this configuration allows blood to flow downstream into the celiac artery.  
         [0066]     ix) monitor the aortic pressure at a position upstream from the four balloons  104 A,  104 B,  104 C,  104 D;  
         [0067]     x) if the pressure is low (i.e., an indication that the hemorrhage is flowing from the celiac artery), adjust the inflation level of the first balloon  104 A such that it blocks blood from flowing downstream, thereby isolating the hemorrhage; end the manipulation of the occlusion of the four balloons and continue monitoring the stability of the patient; surgical procedures are performed to identify and repair the injured artery, which typically requires opening up the abdominal cavity, locating the injured artery and then repairing the injured artery;  
         [0068]     xi) if the pressure is normal, adjust the inflation level of the third balloon  104 C such that it blocks blood from flowing downstream, and adjust the inflation levels of the first balloon  104 A and second balloon  104 B such that they do not block blood from flowing downstream, if need be; this configuration allows blood to flow downstream into the renal arteries and upper mesenteric artery.  
         [0069]     xii) monitor the aortic pressure at a position upstream from the four balloons  104 A,  104 B,  104 C,  104 D;  
         [0070]     xiii) if the pressure is low (i.e., an indication that the hemorrhage is flowing from the renal arteries/upper mesenteric artery), adjust the inflation level of the second balloon  104 B such that it blocks blood from flowing downstream, thereby isolating the hemorrhage; end the manipulation of the occlusion of the four balloons and continue monitoring the stability of the patient; surgical treatment is then performed to identify and repair the injured artery, which typically requires opening up the abdominal cavity, locating the injured artery and then repairing the injured artery; and  
         [0071]     xiv). if the pressure is normal (i.e., an indication that the hemorrhage is flowing from the lower mesenteric artery), the inflation level of the third balloon  104 C is maintained such that it blocks blood from flowing downstream, thereby isolating the hemorrhage; end the manipulation of the occlusion of the four balloons and continue monitoring the stability of the patient; surgical treatment is then performed to identify and repair the injured artery, which typically requires opening up the abdominal cavity, locating the injured artery and then repairing the injured artery.  
         [0072]     The sequence of operations set forth in i)-xiv) directly above advantageously provides timely hemostasis, which is typically suitable for critically injured patients. However, it blocks blood flow through the upper arteries of the abdominal cavity (e.g., the celiac and renal arteries), thereby potentially impacting the normal function of the organs (e.g., the liver and/or kidney) that rely on the upper arteries of the abdominal cavity. Thus, in some circumstances (for example, where the blood pressure of the patient is not in a critical condition), an alternate sequence of operations may be used. For example, the balloons  104 C,  104 B,  104 A may be sequentially inflated/deflated in order to isolate the hemorrhage. This sequence of operations potentially minimizes the loss of blood flow through the upper arteries of the abdominal cavity (e.g., the celiac and renal arteries), and thus minimizes the potential impact to the normal function of the organs (e.g., the liver and/or kidney) that rely on the upper arteries of the abdominal cavity.  
         [0073]     Advantageously, the aortic occlusion device  100  of the present invention can be fixated within the abdominal aorta and manipulated in order to quickly and efficiently identify and isolate a hemorrhage flowing from an artery in the abdominal aorta, and thus stabilize the patient. Such operations are beneficial in trauma situations where the patient is experiencing excessive internal bleeding and quick stabilization provides time for interventional treatment.  
         [0074]     In another aspect of the present invention, the aortic occlusion device  100  can be used in treating an abdominal aortic aneurysm, which is an abnormal ballooning of the abdominal aorta. In such applications, the distal portion of the aortic catheter  100  (with the balloons  104 A,  104 B,  104 C,  104 D) is located with the patient&#39;s abdominal aorta  46 . It may be introduced from above (e.g., into and through the subclavian artery or other artery extending from the aortic arch) as shown in  FIG. 5 , or introduced from below (e.g., into and through the femoral artery), and advanced into the abdominal aorta as described above. An incision is made into the abdominal cavity and the aneurysm  151  is exposed. One or more of the occlusion balloons of the device  100 , which are located upstream from the aneurysm  151 , are inflated to a level that occludes the flow of blood downstream, thereby effectively clamping the section of the abdominal aorta  46  that is upstream from the aneurysm  151 . The aneurysm  151  is opened and a graft  153  is inserted to bridge the normal aorta above the aneurysm to the normal aorta below the aneurysm. Alternatively, a bifurcated graft may be used to bridge the aorta  46  to the iliac arteries  42 . The lumbar arteries may be clamped to prevent back bleeding. A portion of the catheter shaft  102  together with one or more of the occlusion balloons may be disposed within the aneurysm (for example, the part of the catheter shaft supporting balloon  104 A as shown in  FIG. 5 ). In this case, before the graft  153  is affixed to the aorta, it may be placed around the outer diameter of that part of the catheter shaft that extends into the aneurysm  151 , and the inflatable balloon disposed within the graft  153 , if any, may be inflated to temporarily hold the graft  153  in place. In such applications, the four independently inflatable balloons  104 A,  104 B,  104 C,  104 D advantageously provide flexibility in occluding various parts of the abdominal aorta  46 . Moreover, the quick and efficient fixation of the catheter device  100  within the abdominal aorta can potentially provide time savings during surgery.  
         [0075]     In yet another aspect of the invention, the aortic occlusion device  100  can be used in a catheter-based treatment of an abdominal aortic aneurysm whereby a stent-graft is seated in the normal aorta above and below the aneurysm, thereby effectively isolating the aneurysm sac from the circulation. In this technique, the stent-graft provides a new normal-sized lumen to maintain blood flow. In such applications, the aortic catheter  100  (with the balloons  104 A,  104 B,  104 C,  104 D) is located with the patient&#39;s abdominal aorta  46 . It may be introduced from above (e.g., into and through the subclavian artery or other artery extending from the aortic arch) as shown in  FIG. 6 , or introduced from below (e.g., into and through the femoral artery), and advanced into the abdominal aorta as described above. Fluoroscopic imaging techniques are preferably used to locate the distal port  116  of the catheter shaft  102  at the desired position adjacent the aneurysm  151 . One or more of the occlusion balloons of the catheter device  100  (e.g., such as the first occlusion balloon  104 A as shown) may be inflated to a level that occludes the flow of blood, thereby effectively clamping the abdominal aorta section. The stent-graft  155  is then deployed though the distal port  116  of the catheter device  100 , and the catheter device  100  is removed. In such applications, the four independently inflatable balloons  104 A,  104 B,  104 C,  104 D advantageously provide flexibility in occluding various parts of the abdominal aorta  46 . Moreover, the quick and efficient fixation of the catheter device  100  within the abdominal aorta  46  can potentially provide time savings during surgery.  
         [0076]     There have been described and illustrated herein several embodiments of an aortic catheter device with multiple occluding elements and a method of operating the aortic catheter for treating hemorrhagic shock as well as an abdominal aortic aneurysm. While particular embodiments of the invention have been described, it is not intended that the invention be limited thereto, as it is intended that the invention be as broad in scope as the art will allow and that the specification be read likewise. Thus, while particular occluding balloons have been disclosed, it will be appreciated that other occluding elements, such as conical shaped expanding elements or cylindrical-shaped expanding elements, can be used as well. Moreover, the expandable size of such elements can also be controlled by mechanical means such as wires or the like. It is also contemplated that one or more of the occlusion elements can be controlled to partially occlude the aortic passageway. Such partial occlusion may be useful in providing pressure-controlled blood flow to an injured artery after surgically repairing the injured artery. In addition, while a particular configuration of the multi-lumen catheter shaft has been disclosed, it will be appreciated that other multi-lumen configurations, such as a sequence of concentric lumens formed about the inner guide lumen, can be used. Also, while particular configurations and sizes have been disclosed in reference to elements of the aortic catheter, it will be understood that the aortic catheter described herein can be readily adapted to other configurations and sizes. For example, the device can readily be adapted to include more than four (or less than four) occluding elements and supporting inflation lumens/ports. Also, the outside diameter of the device can readily be adapted to different sizes and distances such that the device is suitable for different size patients, such as a smaller diameter catheter for pediatric patients. Similarly, the distance between balloons can readily be adapted. For example, the distance between the distal-most balloon (e.g., first balloon  104 A) and the proximal-most balloon (e.g., the fourth balloon  104 D) may readily be adapted such that it is in the range between 20 and 40 cm. In another example, the distance separating the balloons may be adapted from that described herein such that the balloons are positioned upstream from different arterial groups with the abdominal aorta. It will therefore be appreciated by those skilled in the art that yet other modifications could be made to the provided invention without deviating from its spirit and scope as claimed.