Patent Publication Number: US-2009222033-A1

Title: Percutaneous device and method for harvesting tubular body members

Description:
CROSS REFERENCE TO RELATED APPLICATION 
     This application is a continuation of U.S. application Ser. No. 10/618,456 filed on Jul. 11, 2003 and entitled “Percutaneous Device and Method for Harvesting Tubular Body Members”, which claims the benefit of Provisional Application No. 60/395,248, filed on Jul. 11, 2002 and entitled “Percutaneous Vein Harvesting Device and Method of Use” and is a continuation-in-part of U.S. application Ser. No. 10/444,773 entitled “Guide Wire Torque Device” filed on May 24, 2003. 
    
    
     FIELD OF THE INVENTION 
     The present invention relates to methods and devices for removing tubular body members, particularly blood vessels, from the body of a human or animal. 
     BACKGROUND OF THE INVENTION 
     Various tubular structures in the body (“tubular body members”) are sometimes removed, either for use somewhere else in the body or simply because removal is desired or necessary. As used herein, the terms “harvest,” “dissect” and “remove,” when used in connection with the removal of a tubular body member from the body, are synonymous. Tubular body members include blood vessels, such as arteries and veins, tendons, bile ducts and other structures. For example, the long sapheneous vein (LSV) located in subcutaneous fatty tissue in an anteromedial compartment of the lower leg and thigh is sometimes removed for use in (1) arterial bypass surgery, including coronary artery bypass, and peripheral arterial surgery bypasses, and (2) preparing an arteriovenus (AV) loop for dialysis. The length of the harvested LSV may vary from 20 cm to 100 cm. 
     Traditionally, the LSV has been removed by making a long incision along the leg from about the ankle to the groin, or by making a series of multiple, bridged incisions. Tissue (primarily fat) including the LSV is dissected from the leg through the incision(s) and the LSV is then dissecting from the surrounding tissue. While this procedure usually yields a usable LSV, the incision(s) is painful, is reported to suffer wound healing failures rates of up to 40% not infrequently mandating rehospitalization and considerable expense and discomfort, is a possible source of infection, takes a long time to heal, and leaves a long, noticeable scar. Further, the harvested vein must be extensively handled in order to remove the surrounding tissue. That can result in damage to the LSV and possible early failure after the LSV is used as a graft. 
     In an attempt to solve the problems caused by removal of the LSV via a long incision or multiple incisions in the leg, various endoscopic techniques have been developed. These techniques involve the insertion of an endoscopic camera into the leg near the LSV at the knee area. The area around the camera may be inflated with a gas such as carbon dioxide using a gas-release nozzle positioned in an endoscopic dissection tool inserted along with the endoscopic camera—the gas is usually injected through a separate device requiring a separate incision. The endoscopic dissection tool is used to dissect the fatty tissue around the LSV and vein branches by gently using the pointed tip of the endoscopic dissection tool, the carbon dioxide gas flow and additional endoscopic dissection tools. After separating the LSV and vein branches from the fatty tissue, the dissection tools are withdrawn and an endoscopic clipper is used to clip the various branches. Once that is completed a cutting tool (typically cauterizing scissors) is inserted through the endoscope. The cutting tool is manipulated to divide and cauterize the clipped branches of the vein. As used herein, the term “divide” when used in relation to a tubular body member means to cut entirely through the tubular body member. 
     After the LSV is dissected and the branches are clipped and divided as described above, incisions to expose the vein are made through the skin at the distal and proximal ends of the leg. The vein is ligated in continuity and then divided with a pair of scissors. The dissected LSV is then pulled out of the body. 
     While these endoscopic procedures reduce scarring, pain, wound-related complications and risk of infection as compared to the previously described open incision method, the endoscopic technique is both difficult to learn and to use. An endoscopic procedure can also damage the vein due to over manipulation and potential mishandling of the endoscopic tools. Additionally, endoscopic equipment used in these procedures is expensive to buy and use. 
     SUMMARY OF THE INVENTION 
     A method according to the invention improves upon the prior art methods for removing a tubular body member from the body and generally comprises the steps of (1) creating openings in the body through which the tubular body member can be accessed at a proximal end and a distal end, (2) sufficiently straightening the tubular body member to utilize a cutting tool according to the invention, (3) using a cutting tool to dissect a section of body tissue (wherein the tubular body member is inside the dissected section) between the proximal end and the distal end, and (4) removing the dissected section of tissue including the tubular body member from the body. Once the body tissue is removed from the body, the tubular body member is dissected from the body tissue using any suitable method. 
     One device according to the invention is a percutaneous harvesting device (PHD) for the harvesting of tubular body members from a body. The PHD includes (1) an endovascular component (EVC) for passing inside of the tubular body member to be removed, and (2) a perivascular cutting tool (PVT) that is inserted over the EVC and is used to cut a length of body tissue that includes the tubular body member. 
     In one preferred embodiment, the EVC comprises a guide wire and an endovascular guide (EVG) surrounding the guide wire. The EVG is preferably a catheter made from a soft material (preferably plastic) suitable for passing through the selected tubular body member without damage to the intimal surface of the tubular body member. The EVG may have a tapered end, or nose, to assist in introducing it into the tubular body member and may include one or more structures, such as grooves or rings, for securing the tubular body member to the EVG. Alternatively, the tubular body member can be secured to a specially designed, nozzle nosed, torque device with an external structure (such as an annular ridge or chevron) on the torque device, preferably positioned at the base of the nozzle. The nozzle is designed to fit partially inside the lumen of the tubular body member and to retain the tubular body member, preferably by a suture at the external structure for ligating the tubular body member to the torque device. The torque device is then tightened onto the guide wire at the proximal end and the distal end, thus the tubular body member is firmly fixed to the guide wire via the torque device. 
     The PVT is preferably cylindrical and has a diameter (or width) greater than the diameter of the tubular body member. The PVT surrounds the tubular body member and cuts through the body tissue surrounding the tubular body member thus dissecting from the body an essentially cylindrical section of body tissue (mostly fat in the case of the LSV) with the tubular body member inside the body tissue. If the tubular body member is a blood vessel, the blade cuts the branches of the blood vessel, thus isolating the blood vessel and enabling it to be removed without tearing. The dissected section of body tissue is removed from the body and the tubular body member is separated from the surrounding tissue in the dissected section. 
     In one preferred embodiment, the PVT includes a cutting head and a body section. The cutting head preferably has an annular leading edge that forms an annular cutting blade. 
     The body section of the PVT is preferably a plastic tube having an attachment structure (preferably threads) at one end for attaching to the cutting head. Optionally, the body section includes an outer surface (or exterior) having a helical thread or other device on the outer surface to assist in the movement of the cutting tool through the body. 
     The PVT optionally is used in conjunction with a handle that can attach to an end of the body section of the PVT. The handle, and hence the PVT, is preferably turned by a user, such as a surgeon, to advance the PVT through a body to dissect the tubular body member. The handle may be an elongated shaft with one end that is connected to the body section of the PVT. Optionally, a handgrip can be attached to the handle for easier operation. Optionally, the PVT can be fitted with a power source, such as a battery pack and appropriate drive equipment to rotate or vibrate the PVT thus assisting in the dissection of the tubular body member with less resistance. 
     Thus, a PHD according to various aspects of the invention provides a less invasive and quicker way of removing tubular vessels such as the long sapheneous vein (LSV) from a body. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       Aspects of the present invention will be appreciated with reference to the description of the invention when made with reference to the accompanying drawings and wherein: 
         FIG. 1  is a side view of a preferred embodiment of a perivascular harvesting device; 
         FIG. 2  is a cross-sectional, side view of an embodiment of an endovascular component of the percutaneous harvesting device of  FIG. 1 ; 
         FIG. 3  is a cross-sectional, side view of an alternate embodiment of an endovascular component; 
         FIG. 3   a  is an end view of an alternate embodiment of an endovascular component; 
         FIG. 4  is a cross sectional view of a perivascular cutting tool; 
         FIGS. 5   a - 5   b  are views of an embodiment of a cutting head for use with a perivascular cutting tool; 
         FIG. 6   a  is a side view of an alternative embodiment of a perivascular cutting tool; 
         FIG. 6   b  is a cross-sectional, side view of the perivascular cutting tool shown in  FIG. 6   a;    
         FIGS. 7   a - 7   b  are views of an alternative cutting head for use with the perivascular cutting tool of  FIGS. 6   a - 6   b;    
         FIGS. 8   a - 8   c  are views of a connector for use with the cutting head of  FIGS. 6   a - 6   b  and  7   a - 7   b;    
         FIG. 9  is a view of a cutting tool according to the invention that includes an optional handle and an optional hand grip; 
         FIG. 10  is a view of a percutaneous harvesting device according to the invention in use; 
         FIG. 11  is a flow diagram of a method using a device according to the invention. 
         FIG. 12  is a view of an alternate embodiment of a perivascular cutting tool, which has an automatic advancement device. 
     
    
    
     DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS 
     In the following descriptions, the present invention is frequently discussed using the example of the removal of a blood vessel, such as the LSV, from the body. However, the devices and methods of the invention can be used to harvest any tubular body member from a body for any purpose. 
     Turning now to the drawing figures where the purpose is to describe preferred embodiments of the invention and not to limit same, a preferred embodiment of one device of the invention is percutaneous harvesting device (PHD)  100 , illustrated in  FIG. 1 . PHD  100  is used percutaneously for dissecting a tubular body structure, such as a blood vessel, by cutting through a length of body tissue that includes the tubular body member, thus freeing the body tissue including the tubular body member from the body. 
     PHD  100  includes an endovascular component (EVC)  102  for insertion into the blood vessel to be removed, and a perivascular cutting tool (PCT)  104  for traveling subcutaneously and coaxially outside of and along the length of the blood vessel in which EVC  102  has been inserted. Cutting tool  104  is for cutting tissue surrounding the blood vessel. 
     EVC  102  may be any structure or structures suitable for sufficiently straightening the blood vessel so that the blood vessel can be dissected from the body using a PVT according to the invention. Referring to  FIG. 2 , in one embodiment EVC  102  comprises a guide wire  202  and an outer tube, or endovascular guide (EVG),  204  surrounding guide wire  202 , although it is possible that the EVC could be a single tubular member threaded through the vein. In the preferred method of using EVC  102 , guide wire  202  is first inserted into the blood vessel and EVG  204  is then inserted over guide wire  202  and threaded through the blood vessel. 
     Guide wire  202  is any suitable medical guide wire that can be used in a procedure according to the invention, and guide wire  202  preferably has a hydrophilic coating and a straight floppy tip  214  to help provide maneuverability through the blood vessel. U.S. Provisional Application 60/475,666 to Opie and Joyce, filed on Jun. 3, 2003 and entitled “Improved Medical Guide Wires” discusses exemplary guide wires and is herein incorporated in its entirety by reference. Suitable guide wires include those having a diameter between 0.010″-0.038″ and having about a 2-5 cm long floppy tip. The guide wire is long enough to pass through and extend outside of each divided end of the blood vessel and is preferably about 40% longer than the section of blood vessel to be removed. If used to remove an LSV, the guide wire is usually about 230-260 cm in length. 
     EVG  204  is preferably a flexible tubular plastic catheter and includes a central lumen  210  through which guide wire  202  is positioned when EVC  102  is positioned in the vein. EVG  204  optionally includes a tapered nose  206  that allows for easier introduction of EVG  204  into a blood vessel and easier passage through the blood vessel, and any structure suitable for this purpose may be used. Tapered nose  206  preferably is between about 3 and 4.5 cm in length and tapers to a tip  206 A that is about 1.5 mm in diameter. EVG  204  can be soft enough to allow a suture to be secured to the EVG  204  in order to secure an end of a blood vessel thereto to facilitate removal. Alternatively the suture can be applied to a guide wire torque device to secure the blood vessel as described herein. A guide wire torque device (or simply “wire torque device” or “torque device”) is a device that mechanically grips and secures a guide wire. Suitable wire torque devices are disclosed in copending application Ser. No. 10/444,776 filed on May 24, 2003 and entitled “Guide Wire Torque Device” by Opie and Joyce, the disclosure of which is herein incorporated in its entirety by reference. 
     Typically, EVG  204  is 10% to 20% longer than the section of blood vessel to be removed because both ends of EVG  102  need to be exposed outside of the respective divided ends of the blood vessel. The outside diameter of the EVG depends on the size of the blood vessel because the EVG must be of a suitable size to pass through the blood vessel without damaging it. In a preferred embodiment, the EVG has a diameter of 3-4 mm. 
     In one embodiment, a series of grooves  212  are formed around the circumference of each end of EVC  102 . Grooves  212  are for securing the blood vessel to EVC  102 , preferably at each end of EVC  102  and preferably through the use of suture ligatures. In this embodiment the grooves are preferably about 0.5 mm deep and are spaced about 1.0 centimeter apart. 
     In another embodiment, grooves  212  (shown in  FIG. 2 ) may be replaced by a series of rings  302  (shown in  FIG. 2 ). In this embodiment, rings  302  are about 2.0 mm wide and are spaced about 1.0 cm apart. The blood vessel to be removed can be attached to rings  302  via sutures or clips. In addition to grooves  212  and rings  302 , any other structure that allows a blood vessel to be attached to EVC  102  may be used, or EVC  102  may not include any such structure. Any such structures for attaching a blood vessel to EVC  102 , if used, can be positioned at any suitable location on the EVC. In two known embodiments such structures are located on the EVG about 25-40 cm from each end of an EVG 80-150 cm in length, and 65-80 cm from each end of an EVG 230 cm in length. Alternatively, these structures may be replaced by structures on torque devices positioned at either end of the EVG, wherein the tubular body member can be secured to the structure on each torque device. 
     Presently, the most preferred embodiment of EVC  102  includes a guide wire with a hydrophilic coating and a single floppy tip and an EVG made of PVC or similar, suitable plastic, approximately 4 mm in diameter and having a central lumen of about 1-1.3 mm in diameter, wherein the EVG is threaded over the guide wire. 
     An alternate EVC  340  is shown in  FIG. 3A . EVC  340  comprises an inner core  350  covered by an exterior covering  360 . Inner core  350  provides both strength and flexibility to EVC  340 , and is preferably made from a flexible or semi-flexible polymer plastic. However, any material that provides for a firm but semi-flexible inner core can be used. In one embodiment, the inner core is 2-3 mm in diameter. Any diameter can be used, however, as long as EVC  340  is properly sized to be threaded through the blood vessel to be removed. 
     The preferred embodiment of exterior covering  360  is deformable and deforms in response to pressure from a suture or clip (such as a C-clip) in order to secure an end of a blood vessel to EVC  340  without significant slippage. The exterior covering can be made from foamed plastic, silastic or silicone rubber, although any suitable bio-compatible material can be used. In one embodiment, exterior covering  360  is 0.5 to 1.0 mm thick, although other thickness can be used with the maximum thickness controlled by the overall thickness of EVC  340 , which needs to be properly sized to fit inside a blood vessel and is typically 3-4 mm in diameter if used in the removal of the LSV. 
     Exterior covering  360  may be co-extensive with inner core  350  or it may cover only part of an area of the inner core  350 . In one embodiment the exterior covering  360  may cover from 25 to 40 cm from one end of inner core  350  for a shorter EVC  340 , or 65-80 cm from one end of inner core  350  for a longer EVC  340 . EVC  340  may also include a nose or cone having dimensions the same as or similar to those of previously described structure  206 . 
     The PHD further includes a perivascular cutting tool (PVT)  104 . PVT  104  includes a body section  402  coupled to a cutting head  404 . As used herein, unless otherwise stated, “coupled” means attached in any manner suitable for the PVT to be used in the manner described herein. 
     Body section  402  is any suitable structure for use in a method according to the invention and is preferably a hollow tubular structure having a first end  401 , a second end  403 , a passage  406  extending therethrough and an optional driving helix  408  positioned on annular wall  410 . Body section  402  is preferably an extruded, semi-flexible polycarbonate (such as General Electric Lexan 12) piece flexible enough to be suitable for the particular application in which it is to be used. Body section  402  supports cutting head  404  and preferably helps to substantially center the cutting head  404  around the blood vessel being removed during the cutting procedure. Body section  402 , in one embodiment, has an exterior diameter of 15 mm and an internal diameter of 10 mm and is approximately 100 cm in length, and in this embodiment wall  410  is preferably about 3 mm thick. Body section  402  may have different dimensions, however, the dimensions depending upon such factors as the application for which the PVT will be used and the amount of surrounding tissue to be removed with the blood vessel. The outer surface of wall  410  is preferably coated with a low-friction material, such as TEFLON, to reduce friction during use, or may be coated with a hydrophilic coating such as polyurethane. 
     Driving helix  408  is optional and is preferably a 2 mm high, clockwise, helical thread positioned on (i.e., formed in or attached to) the outer surface of wall  410  of body section  402 . Helix  408  assists in advancing PCT  104  through the body, and any structure positioned on wall  410  suitable for performing this function may be used, assuming such a structure is used at all. For example, other sizes and types of threads may be used, or a series of longitudinally-extending grooves may be positioned on in the outer surface of wall  410 , and the grooves may be slightly twisted to provide gripping ability. 
     As PVT  104  is turned, driving helix  408  grips the body tissue through which it is passing and helps to advance PVT  104  forward, and/or helps to prevent PVT  104  from slipping backward during a procedure. In one embodiment, driving helix  408  is dimensioned such that for every 360.degree. rotation of body portion  402 , PVT  104  would advance 3.0 centimeters if there were no slippage, with a preferred range of 2-3 cm of advancement for every 360.degree. rotation of body portion  402 . 
     Cutting head  404  is designed to cut the body tissue surrounding the blood vessel and to cut blood vessel branches, thus dissecting the body tissue from the body so that the body tissue including the blood vessel can be removed. Cutting head  404  is preferably metal (most preferably carbon steel or stainless steel). Referring to  FIGS. 5   a  and  5   b,  cutting head  404  has, in one embodiment, a generally wedge-shaped front  501  (as seen in side view), approximately in the shape of a truncated cone. The shape of front  501  assists in the movement of PVT  104  inside the body by pushing tissue outward from PVT  104  as cutting head  404  advances. While cutting head  404  with front  501  is illustrated, cutting head  404  can be any suitable shape for use on the PVT. 
     Cutting head  404  includes an attachment end  504 . Attachment end  504 , in one embodiment, has threads  506  that threadingly engage first end  401  of body portion  402 , although cutting head  404  can be connected to body section  402  by any method or structure that provides a secure connection. Preferably, cutting head  404  is removable from body section  402 , so that it may be disposed of (if desired), while body section  402  can be sterilized and reused (if desired). 
     Cutting head  404  includes a leading edge forming an annular blade  508 . Alternatively, the cutting blade may not be annular or on the leading edge, although this is preferred. With annular blade  508  at the leading edge of PVT  104  the force required to advance PVT  104  through the body tissue is less than the force that would be required if the blade was behind the leading edge. Further, the annular blade provides 360 degrees of cutting surface, which also reduces the amount of force that must be applied to advance the PVT relative a cutting surface of less than 360.degree. Annular blade  508  is, in one embodiment, non-serrated, although a serrated annular blade can also be used. 
     Cutting head  404  also includes, in one embodiment, and with reference to the cross-sectional view of  FIG. 5   b,  an internal funnel-shaped section  510  coupled to internal cylindrical section  512 . Internal funnel-shaped section  510  compresses tissue dissected by the cutting blade. In this respect, as PVT  104  advances, the dissected tissue is forced into section  510  by the forward movement of PVT  104 . In section  510  the body tissue is compressed from a first diameter essentially equal to diameter  511 , down to a second diameter essentially equal to diameter  513 . The compression of the body tissue helps keep the PVT  104  essentially centered around the blood vessel to be removed, which helps to prevent the blood vessel from being cut by cutting blade  508 . 
     In one embodiment first diameter  511 , i.e., the diameter of annular blade  508 , is 15 mm and second diameter  513 , i.e., the diameter of the internal cylindrical section  512 , is 10 mm. The length of internal funnel section  510  is, in one embodiment 10 mm, and is preferably in the range of 5 to 15 mm. 
     In another embodiment, and with reference to  FIGS. 6   a  and  6   b,  an articulated PVT  600  is shown. Articulated PVT  600  has an articulated (i.e., jointed) cutting head  602  that is able to move and pivot independent from body portion  402  and any structure suitable for allowing cutting head  602  to pivot may be used. The articulation allows for easier movement of the articulated PVT  600  around structures such as the knee. In one embodiment, articulated cutting head  602  can pivot up to 15 degrees, although any suitable pivoting range may be utilized. Unless otherwise stated, the preferred size, shape, materials and configuration of cutting head  602  are the same as previously described for cutting head  404 . Articulated PVT  600  also includes a body section  402  (previously described) and an articulated connection section  601 . Articulated cutting head  602  is coupled to connection section  601 , as best seen in  FIG. 6   b.    
     Referring to  FIGS. 7   a - 7   b,  articulated cutting head  602  includes a blade portion  702  having a leading edge forming an annular cutting blade  704  and a coupling section  706 . Coupling section  706  includes an annular rim  708  and a channel  710  formed in rim  708 . Similar to cutting head  404 , articulated cutting head  602  includes an internal funnel section  712  coupled to an internal cylindrical section  714 . Internal funnel section  712  compresses tissue dissected by annular cutting blade  704 . The advancement of articulated PVT  600  forces tissue to the cylindrical section  714 . The compression of the body tissue helps keep articulated PVT  600  essentially centered around the blood vessel to be removed in order to assist in preventing the blood vessel from being cut by cutting blade  704 . 
     Referring to  FIGS. 8   a - 8   c,  preferred connection section  601  comprises two parts, a first connection section  802  and a second connection section  804 . Each connection section  802  and  804  has threads  806  and when connection sections  802  and  804  are joined, threads  806  form an essentially continuous thread that can be used to threadingly connect section  601  to body portion  402 . Connection sections  802  and  804 , when joined, form a cup  808  between connection sections  802  and  804 . 
     Cup  808  includes a lip  810  that engages and retains annular rim  708  of articulated cutting head  602  and enables cutting head  602  to pivot. Each lip  810  includes a stud  812 . When cup section  808  is coupled to coupling section  706 , each stud  812  is aligned with and positioned inside of a channel section  710 . In one embodiment there are two channel sections  710 , each of which has a stud  812  positioned therein when cutting head  602  is coupled to connecting section  601 . This prevents the articulated cutting head  602  from rotating continuously about a center axis, while still allowing the articulated cutting head  602  to pivot freely. If the cutting head  602  were allowed to continuously rotate, then the twisting motion that may be used to advance articulated PVT  600  inside the body could be translated into merely a spinning of articulated cutting head  602 . 
     Once the articulated cutting head  602  is coupled to the articulated connection section  601 , articulated cutting head  602  and articulated connection section  601  together act like a ball and socket joint wherein section  706  is analogous to the ball and cup section  808  is analogous to the socket. The articulation assists in the advancement of PVT  104  through the body. For example, articulated cutting head  602  allows PCT  600  to more easily maneuver around structures in the body, such as the knee joint. 
     Moving PVT  104  or  600  through the subcutaneous body tissue requires a certain amount of torque and/or pressure to force a PVT through the body tissue surrounding the blood vessel. To assist in advancing a PVT, an optional torque handle (or simply “handle”)  902  can be attached to PCT  104  or  600  opposite the cutting head. Torque handle  902  is designed to fit into an adult human hand and is preferably a rod or tube made from extruded plastic (Lexan 12, high density polyethylene, acetal, Nylon, ABS are all plastics that could be used) and includes a connector  904  to connect to the PVT  104  and a shaft  906 . In one embodiment connector  904  comprises threads on the rod or tube that threadingly connect to the PVT. Optionally a handgrip  908  can be attached to or formed in handle  902  to further assist in operation of the PVT. 
     A surgeon or other medical worker would first attach torque handle  902  to the PVT  104  or  600 . This is done using connector  904 , which connects to the end of PVT  104  or  600  opposite the cutting head, preferably by a threaded connection. Once connected and the PVT is inserted into the body, the surgeon twists and pushes the shaft  906 . This causes the PVT to rotate and move forward. Cutting head  404  or  602  cuts the body tissue and the blood vessel and surrounding tissue is pressed through the body portion  402  as the PVT is advanced. Driving helix  408 , if used, helps move the PVT forward and prevents the PVT from backing out of the body. To remove the PVT, the user would either advance it entirely out of the body or turn it in the opposite direction while pulling on the torque handle  902  to back it out of the body. Handgrip  908  can also be used to help in twisting the torque handle  902 . Torque handle  902  and handgrip  908  can be made from a plastic such as polycarbonate, although any strong rigid material can be used. 
     Referring now to  FIG. 10 , EVC  102  is shown positioned in a blood vessel  1002  to be removed. When EVC  102  is inserted into vessel  1002 , blood vessel  1002  collapses around the endovascular guide  102  as the blood in blood vessel  1002  is pushed outward through branches  1004 . As seen in  FIG. 10 , blood vessel  1002  can be secured to EVC  102  using a suture  1006  to secure to a structure  212  formed on EVG  204  or to the torque device as previously discussed. Alternatively, blood vessel  1002  may be secured to a wire torques device at one end or both ends. Typically, both ends of the blood vessel  1002  to be removed are secured to EVC  102  or to respective torque devices to help straighten blood vessel  1002  to be removed. 
     After endovascular guide  102  is inserted through blood vessel  1002 , PVT  104  is passed along endovascular guide  102  such that endovascular guide  102  and blood vessel  1002  it is inserted into is inside PVT  104 . As PVT  104  moves along endovascular guide  102  branches  1004  are severed by annular blade  508 , which is on the leading edge of PVT  104 . The diameter of annular blade  508  determines the length of branches  1004  left on removed blood vessel  1002 . Cut blood vessel  102  and surrounding tissue passes to body section  402 . 
     Referring to  FIGS. 10 and 11 , a preferred harvesting method shall be described. In this preferred harvesting (or removal) procedure, a PHD having either PVT  104  or PVT  600  may be utilized to remove an LSV. First, the LSV is accessed and divided at a proximal end (step  1102 ) and a distal end (step  1104 ). Next, a guide wire  202  is fed through the LSV and is exposed outside of the body at the proximal end and the distal end. EVG  204  is then advanced over guide wire  202  and into the LSV from the proximal end to the distal end and is exposed at each end (Steps  1105  and  1106 ). 
     To secure the guide wire a wire torque device (the wire torque devices are not shown) is preferably placed on the guide wire at the proximal end outside of the LSV and another guide wire torque device is placed on the guide wire at the distal end outside of the LSV. The LSV is secured at both the proximal end and the distal end to either the EVG or a wire torque device, and the EVG is secured to a wire torque device at the proximal end and to a wire torque device at the distal end. (Step  1108 ). 
     The guide wire, catheter and LSV are then pulled straight by applying force to the distal end and the proximal end of each, preferably by pulling on the wire torque devices. As used throughout this application with respect to straightening a tubular body member, the word “straight” means sufficiently straight to utilize a cutting tool according to the invention, and is not limited to a perfectly straight configuration. 
     Once the LSV is sufficiently straightened to remove it using a PVT as described herein, a PVT is utilized to dissect body tissue including the LSV from the body. The PVT is positioned so that the guide wire and EVG are inside the PVT and the LSV is preferably approximately axially-aligned with the cavity of the cutting head. (Step  1110 ). Ideally, the passage of the PVT is coaxially aligned with the LSV, although the alignment need not be coaxial, the LSV must simply be positioned so that it is not cut by the cutting blade. 
     The PVT is then advanced along the accessed length of the tubular body member, cutting through the body tissue surrounding the LSV and the LSV branches, thereby separating the body tissue and LSV from the body. (Step  1112 ). Once separated, the tissue including the LSV is removed from the body, which may be accomplished by simply by withdrawing the EVG with the LSV and surrounding tissue out of one of the incisions. (Step  1114 ). After being removed, the LSV is dissected from the surrounding body tissue and the vein can be flushed and the branches tied off. (Step  1116 ). 
     A drain, optionally positioned in the PVT, can be placed into the wound created by the PVT. The PVT is then removed leaving the drain in the leg precisely where the body tissue had been. (Step  1118 ). The drain would then be in place to remove blood and clots from the wound. Exemplary drains are disclosed in U.S. Provisional Application 60/476,663 filed on Jun. 5, 2003 and entitled “Improved Surgical Drains,” to Opie and Joyce, the disclosure of which is herein incorporated in its entirety by reference. 
     In an alternative embodiment, manual operation of the PVT is replaced or augmented by an electromechanical operation using an automated device. For example, and with reference to  FIG. 12 , the perivascular cutting tool  104  is coupled to an automatic advancement device  1202 . Automatic advancement device  1202  applies a twisting motion, vibration or other suitable force to the PVT to assist in advancing the PVT through the body and may be any device suitable for this purpose. In one embodiment, automatic advancement device  1202  comprises a low speed, high torque motor  1204  that couples to either the PVT or to a torque handle. Motor  1204  would use gears  1206 , belts or any other method of connecting a motor to a shaft to transfer driving force to the PVT. Preferably, automatic advancement device  1202  comprises a variable speed motor to vary the torque an/or force applied to the PVT to control the speed of the PVT. In one embodiment, automatic advancement device  1202  includes an opening  1208  for the passage of an endovascular guide wire. 
     In addition to, or as an alternative to, twisting PVT  104  or  600 , automatic advancement device  1202  may also vibrate or otherwise manipulate PVT  104  or  600  to assist in moving it through the body. Such a movement could be provided, for example, by an ultrasonic vibrator. 
     Having now described preferred embodiments of the invention; modifications and variations that do not depart from the spirit of the present invention may be made. The invention is thus not limited to the preferred embodiments, but is instead set forth in the following claims and legal equivalents thereof.