MX2007016204A - Anti-clotting indwelling catheter - Google Patents

Abstract

A catheter for providing blood flow includes a wall defining at least one lumen extending between a distal end and a proximal end. The distal end portion of the cathet is deformable to selectively open and close one or more ports in the wall to allow bloo 5 flow into or out of the lumen of the catheter.

Description

INTERNAL ANTICOAGULANT RESIDENCY CATHETER DESCRIPTION OF THE INVENTION Patients with end-stage renal disease (ESRD) should routinely receive dialysis treatments in order to live. Internal residence catheters are a useful dialysis access method for hemodialysis because they reduce the number of venous penetrations necessary for repeated dialysis. Central venous catheters for chronic dialysis (CVCD) are the main long-term dialysis access for more than 25% of patients with ESRD or hemodialysis. In a standard direct-flow dialysis system, the CVCD must provide a first route for blood removal and a second route for blood return at a rate of at least 300 ml / min. A CVCD for a standard direct-flow dialysis system can be formed by inserting two separate catheters into the jugular vein in a manner that forms a tunnel over the clavicle. In this arrangement, the tips of the catheter rest near the joint of the superior vena cava with the right atrium. The tip of the blood removal catheter, or arterial catheter, is placed 3-4 cm above the tip of the blood return catheter downstream, or venous catheter, to avoid mixing clean blood with blood entering the blood. arterial catheter.

As an alternative to the separate catheter for the standard direct-flow dialysis system, a single-body catheter with two separate lumens can be used for dialysis access. In this arrangement, the tip of the arterial lumen is placed 3-4 cm above the tip of the venous lumen. Similar to the standard direct-flow arrangement, this arrangement also prevents the mixing of clean blood with blood entering the arterial lumen. As yet another alternative, dialysis can also be performed by using a single catheter with a single lumen. In this case, the dialysis machine distributes a quantity of untreated blood and then returns the treated blood in alternative cycles. Blood enters and exits the lumen of the catheter through lumens or holes in the catheter. The design of these lumens is highly variable, and similar concepts are used in single and double lumen catheters. A first example is a lumen of the catheter that has a simple port at the tip for the entry or exit of the blood. A second example is a lumen of the catheter having a blood exchange port, located on the side of the lumen body towards its distant tip. Another example is a lumen of the catheter having multiple blood exchange ports axially positioned around the lumen body side toward its distant tip. While all Previous CVCD designs work, there is room for improvement in the field, and there are problems with all current port designs for dialysis catheters. Arterial catheter lumens that contain only one blood exchange port, regardless of their location, risk obstruction of the lumen by the neighboring venous walls, by the coagulation of blood in the exchange port and by the growth of a fibrin cover around the distal end of the lumen and the exchange port. Lumens of the venous catheter that contain only one blood exchange port, regardless of their location, run the risk of obstruction by the blood coagulating in the exchange port and by the growth of a fibrin envelope around the distal end of the catheter. Lumen and the exchange port. The obstruction of the blood exchange port prevents the desired blood exchange rate of at least 300 ml / min from occurring. The degree of obstruction can return to ineffective internal residence catheters for dialysis access. Therefore, when this level of obstruction occurs, internal residence catheters should be replaced. Arterial catheter lumens that contain multiple blood exchange ports around the distant end of the catheter reduce the occurrence of venous obstruction. However, the presence of multiple lumens increases the risk of obstruction by the blood that coagulates because multiple ports will allow blood to flow into the lumen when they are inactive, which can flush the anticoagulant solution. The decreased presence of anticoagulant solution at the distal end of the catheter increases the amount of blood that coagulates in the lumen and lumen. The obstruction of the blood exchange ports prevents the desired blood exchange rate of at least 300 ml / min from occurring. The degree of obstruction can return to ineffective internal residence catheters for dialysis access. Therefore, when that level of obstruction occurs, internal residence catheters should be replaced. Thus, there is a general need in the industry to provide methods and devices for the prevention of obstructions in the catheter blood exchange ports and around the distal end of the catheters. It is desired that these methods and devices avoid lumen obstructions due to coagulation and boxing of the fibrous cap of the catheter tip, as well as maintaining the anticoagulant blocking solution of the catheter within the lumen during inactive periods between dialysis.

The present invention is directed to an internal residence catheter. More particularly, but not exclusively, one aspect relates to an internal residence catheter adapted to prevent coagulation and coating of the distal end of the catheter. One application of the catheter includes non-exclusive use as a dialysis catheter (CVCD). Other applications are also contemplated. Another aspect relates to a catheter with a lumen for blood flow that includes a deformable wall portion to provide a path for blood flow in a first configuration and substantially closes the path when in a second configuration. The expansion of the catheter walls will also be free of any fibrous covering that begins to form around the tip of the catheter. A further aspect relates to a catheter with a lumen for blood flow that includes a wall portion that deforms to open and close one or more ports in the wall portion by axially displacing a distal portion of the catheter that includes one or more lumens relative to a proximal portion of the catheter. A further aspect relates to a catheter with a lumen for blood flow that includes a wall portion that deforms to open and close one or more lumens in the wall portion by radially deforming a distal portion of the catheter including one or more lumens. A further aspect relates to a catheter with a lumen for blood flow that includes a wall portion that deforms to open one or more ports in the wall portion by axially and radially displacing a distal end of the catheter relative to each other. to a proximal portion of the catheter. Yet another aspect relates to a catheter with a lumen for blood flow that includes a wall portion that has a first shape to provide a port for blood flow and a second form that substantially closes the port to prevent flow through the port. the luminary. Another aspect relates to a catheter with a lumen for blood flow that includes one or more ports that open by reducing the length of at least a portion of the catheter that includes one or more ports. A further aspect relates to a catheter that includes a self-closing port that retains a catheter locking solution in a catheter lumen when closed and allows blood flow through the passage when it is opened. In another aspect, a catheter includes an elongated body that defines a pair of lumens, each for the flow of fluid through them. Each of the lumens extends between a distant and proximal end and includes a port at the far end thereof in communication with the lumen. The catheter also includes a pair of end caps at the distal ends of the respective lumens and an activation mechanism at the proximal ends of the lumens. Each of the end caps is coupled to the activation mechanism with at least one activation member extending into a wall along the respective lumen. The activation mechanism can be operated to independently and remotely move each of the end caps with the respective activation member toward and away from the respective lumen port between closed and open conditions to allow fluid flow through the port respective. In another aspect, a catheter includes an elongate body that extends between a distal end and a proximal end. The body includes a wall defining at least one lumen for the flow of fluid therethrough and at least one port at the distal end of the elongate body in communication with at least one lumen. The catheter also includes an end cap at the distal end and an activation mechanism at the proximal end. The end cap is coupled to the activation mechanism with at least one activation member extending into the wall along of the lumen. The activation mechanism can be operated to remotely move the end cap away from the port in an open condition and allow fluid flow through the port and the activation mechanism can be further operated to remotely move the end cap towards the end Distant in a closed condition in sealing engagement with the body to prevent fluid flow through the port. In a further aspect, a catheter includes a body defining at least one lumen extending along a longitudinal axis of the body. The body extends between a distal portion that can be placed in a vascular structure of a patient and a proximal end that can be placed outside the patient with the distal portion in the vascular structure. The distal portion of the body includes a plurality of adjacent wall segments extending along it and located distantly from the lumen. The wall segments together have a size and shape that correspond substantially to a size and shape of the lumen transversely to the longitudinal axis. Adjacent wall segments define a port therebetween. Each of the ports includes a first closed condition formed by splice coupling of the part of the adjacent wall segments to prevent the flow of fluid between the lumen and the vascular structure through the lumbreras. The ports include a second open condition formed by deforming at least one of the wall segments to open at least one of the ports to allow fluid flow between the vascular structure and the lumen through the ports. Various means for opening and closing the catheter port are contemplated, including mechanical, pneumatic and hydraulic means. The closure means can be remotely activated so that the port can remain inside the patient while the port is opened and closed. These and other aspects are also discussed in the following. BRIEF DESCRIPTION OF THE DRAWINGS Figure 1 is a perspective view of a distal portion of a catheter with open ports according to one embodiment of the invention. Figure 2 is an elevation of the catheter of Figure 1 with the ports in a closed condition. Figure 3 is an elevation of the catheter of Figure 1 with the ports in an open condition. Figure 4 is a sectional view through the body of the catheter of Figure 1 taken transversely to its longitudinal axis.

Figure 5 is a longitudinal sectional view of one embodiment of the activation mechanism for opening and closing the catheter of Figure 1. Figure 6 is a longitudinal sectional view of another embodiment of the activation mechanism. Figure 7 is a sectional view through line 7-7 of Figure 6. Figure 8 is a longitudinal elevational view seen in partial section of another embodiment of the activation mechanism. Figure 9 is an elevation view of a cube member comprising a portion of the activation mechanism of Figure 8. Figure 10 is a perspective view of another embodiment of the activation mechanism and its position when the ports are in a closed condition. Figure 11 is a perspective view of the activation mechanism of Figure 10 and its position with the ports in an open condition. Figure 12 is an elevation view of a distal portion of another embodiment of the catheter with its lumens in a closed condition. Figure 13 is an elevational view of the catheter of Figure 12 with its ports in an open condition. Figure 14 is a sectional view through the line 14-14 of Figure 13. Figure 15 is a perspective view of a distal portion of another embodiment of the catheter with its lumens in a closed condition. Figure 16 is the distal portion of the catheter of Figure 15 with its ports in an open position. Figure 17 is a perspective view of a distal portion of another embodiment of the catheter with its lumens in a closed condition. Figure 18 is the distal portion of the catheter of Figure 17 with its ports in an open position. Figure 19 is a sectional view along line 19-19 of Figure 17. Figure 20 is a sectional view along line 20-20 of Figure 17. Figure 21 is a view in section along line 21-21 of Figure 18. Figure 22 is a plan view of a portion remote from another embodiment of the catheter with its lumens in a closed condition. Figure 23 is a sectional view along line 23-23 of Figure 22. Figure 24 is a sectional view along line 24-24 of Figure 22. Figure 25 is a view in perspective of a portion of another mode of the catheter with its lumen in an open condition. Figure 26 is a sectional view of the portion of the catheter in Figure 25. Figure 27 is a plan view of a catheter assembly showing another embodiment of the activation mechanism. For purposes of promoting an understanding of the principles of the invention, reference will now be made to the modalities illustrated in the drawings and specific language will be used to describe them. However, it will be understood that no limitation of the scope of the invention is therefore intended. Any further alterations and modifications of the principles of the invention as illustrated or described herein are contemplated as being normally presented to one of skill in the art to which the invention relates. The present invention provides a catheter with at least one port adjacent to a distal end of the catheter that can be selectively opened and closed. At least one port may be opened or closed while there is at least one port located in a vascular structure of a patient, such as a vein or artery. One application of the catheter contemplates that it is used in dialysis procedures, although other applications of internal residence they are also contemplated. At least one port will be in the closed position between the dialysis procedures to prevent blood from flowing through the port and to prevent coagulation within the tip of the catheter. With at least one closed port, the catheter can be injected with anticoagulant solution and the solution is retained within the lumen of the catheter. It is contemplated that at least one port allows fluid egress easier than the fluid entry when closed. In this way, the concentration of anticoagulant within the lumen of the catheter can be maintained at a certain level for many days or even weeks when at least one port is closed. During dialysis, at least one port is opened by deforming the wall adjacent to at least one port to allow blood to enter through the port and into the lumen of the catheter. It is contemplated that the opening of at least one port may lift the distal end of the catheter from the surface of the neighboring blood vessel, preventing occlusion of at least one port by a wall surface of the blood vessel structure. In addition, the opening of at least one port can be released from any fibrous cover that forms around the distal end of the catheter adjacent to at least one port. Repeated opening and closing of at least one port can provide a measure to prevent the formation of a fibrous covering around the distal end of the catheter. The catheter can be formed from any suitable biocompatible material, including silicone, polyurethane, polyurethane-polycarbonate copolymer, or any other plastic or polymeric material. The catheter may also include an antibacterial coating. The catheter may also be treated with an anti-infection agent, such as methylene blue, for example. The catheter can be of any size suitable for placement in a blood vessel structure, which include sizes ranging from 8 to 15 French. Other sizes are also contemplated. The outer wall surface of the catheter may be cylindrical, D-shaped, double-D shaped, or divided, for example. The catheter may also include a single lumen or multiple lumens. With reference to Figures 1-3, a distal portion of a catheter 10 is shown which includes a body 12 and a distal end 14. One or more ports 16 are provided adjacent to the distal end 14, and extend through the wall 18 of the body 12 in communication with a lumen 20. The distal end 14 can be closed with an integral tip or cap to prevent fluid flow through it. In the illustrated embodiment, each port 16 is a slit or elongated gill that is it extends generally parallel to the longitudinal axis 13 of the body 12. Other embodiments contemplate other configurations for ports 16, including slits extending transversely to the longitudinal axis 13 of the body 12 and round openings with valve members that open and close. In Figures 1-3, three ports 16 are provided in the wall 18 which extend along the longitudinal axis of the body 12 and radially separate on the body 12 at approximately 120 degrees apart from each other. Other embodiments contemplate one or more louvres 16, which include two louvres, four louvres, or five or more louvres. It is further contemplated that the ports may be uniformly separated or separated non-uniformly over the body 12. In the illustrated embodiment, each port 16 includes a distal end spaced at a distance Ll from the distal end 14 and extends along the axis 13. by a length L2 to a proximal end of the port 16. in a specific embodiment, the length Ll is 5 millimeters and the length L2 is 15 millimeters. It should be understood, however, that other distances for Ll and L2 are also contemplated, which vary from plus 0 millimeters to 20 or more millimeters. The body 12 is comprised of a material with sufficient flexibility at least adjacent the end 12 Distant to facilitate manipulation of the wall 18 to open and close the ports 16. In Figure 2, the body 12 is in a first configuration or condition where the ports 16 are closed. It is contemplated that in the closed condition, the wall 18 substantially seals the ports 16 to prevent fluid flow out or into the lumen 20 through the ports 16 under a low pressure gradient. During the injection of the catheter, sufficient pressure is generated to cause the blocking solution to exit the closed ports. In Figures 1 and 3, the wall 18 has been manipulated to open one or more of the ports 16 to provide fluid communication between the lumen 20 and an exterior of the body 12. Manipulation of the wall 18 may include displacing or deforming adjacent portions of the wall 18 along the port 16. The deformed wall portions may provide a round or bulbous shape along the ports 16. In one embodiment, the ports 16 are opened by deforming the wall 18 at length of the ports 16 to reduce the length L2 to the length L3. One or more portions of the wall 18 along the ports 16 may extend or radially separate from an adjacent wall portion to open the ports 16. The deformed portions of the wall 18 may be released from any fibrous cover formed around the same. . Besides, the deformation of the wall 18 can provide ports 16 of sufficient size to accommodate any required blood flow through the lumen 20. When the ports 16 are closed, the wall portions 18 along the ports 16 butt together with each other. each length of each port 16 and with sufficient force to prevent the ingress and egress of fluid through the wall 18 between the lumen 20 and the blood vessel structure, and allows the egress of fluid only under a moderately positive pressure such as when The catheter is filled with a blocking solution. It is further contemplated that an activation assembly may be provided to facilitate opening and closing the ports 16, and to maintain the ports 16 in their open and closed conditions. The activation assembly may include an actuator adjacent a proximal end portion of the catheter 10 so that the actuator is positioned outside the patient's body and can be easily accessed by the surgeon. The activation assembly may further include one or more activation members coupled to the actuator and extend along the catheter to an adjacent location of the ports 16. The activation members can be moved or operated with the actuator to manipulate the actuator. wall 18 and open or close the louvers 16 as desired.

In Figure 4, a cross section of the body 12 taken transversely to the longitudinal axis 13 is shown to illustrate one embodiment of the activation member 24. The wall 18 extends over the lumen 20 and closes it from the exterior of the body 12. A number of passages 22 are formed in the wall 18 and each is of a size to receive an activation member 24 therethrough. Although three activation members 24 are shown, it is also contemplated that one, two or four or more activation members 24 may be provided. The activation members 24 extend from a distal end thereof adjacent to the distal end 14 of the catheter 10 at a proximal end coupled to an actuator, as discussed further in the following. In the illustrated embodiment, the activation members 24 extend through respective ones of the elongated portions 26 of the wall 18. The elongated portions 26 project toward the lumen 20 from the surface 30 of the interior of the wall 18, and provide a region of wall thickness increased to accommodate the insertion of the activation members 24 into the wall 18. The activation members 24 may be in the form of a wire, chain, cable, tendon, rod, connection, spring or bar, example. The activation members 24 may be formed of stainless steel, titanium, polymer, shape recovery material, or other suitable material. The members 24 of activation may be coated with anti-bacterial agents and / or lubricant material to facilitate movement in the wall 18. In other embodiments, it is contemplated that one or more activation members 24 may extend through the lumen 20. The activation members 24 They extend closely to a location adjacent the remote end 14 and engage an actuator at their proximal ends. It is contemplated that the distal ends of the activation members 24 may be placed close to the ports 16, remote from the ports 16, or along the ports 16. The actuator is positioned along a proximal portion of the catheter 10 and is placed outside the patient's body so that the distal portion of the catheter 10 can be manipulated remotely with the actuator mechanism to selectively open and close the ports 16. In locations where the activation members 24 enter and / or exit the catheter body, the Locations can be selected and treated to prevent fluid leakage and infection. One embodiment of an actuator comprising an activation mechanism with activation members 24 is shown in Figure 5 with a longitudinal cross section through the actuator 50. The actuator 50 is placed on the body 12 of the catheter and includes a hub 62 that can be coupled with a locking mechanism 52 Sliding The hub 62 includes a passage 64 centered to receive a portion of the sliding lock mechanism 52 and the body 12 of the catheter. The hub 62 further includes a distal tapered portion 68, and is fixedly secured to the body 12 of the catheter. The sliding lock mechanism 52 includes a proximal portion 54 which can be manually held or clamped with a tool to facilitate movement of the sliding locking mechanism 50 axially relative to the body 12 of the catheter and the hub 62. The sliding lock mechanism 52 it also includes a distal portion 56 extending to the hub passage 64 and around the body 12 of the catheter. The distal portion 56 includes a coupling member 60 at a distal end thereof for engagement with the proximal ends 25 of the activation members 24. A number of locking surfaces 58 is formed along the length of the remote portion 56 between the locking member 66 and the proximal portion 54. The hub 62 includes the locking member 66 for engaging the surfaces 58 with sufficient force in any of a number of positions along the locking surface 58 and maintaining the sliding locking mechanisms 52 in the corresponding position relative to the hub 62. The locking member 66 is sufficiently resilient, so that the block member 66 can move along the blocking surface 58 for adjusting a positioning of the sliding locking mechanism 52 relative to the hub 62. The wall 18 of the catheter 10 can be manipulated by moving the sliding locking mechanism 52, and thus, the activation, near and adjacent members 24. axially relative to the hub 60 and the body 12 of the catheter. The activation members 24 pull the portions of the wall 18 adjacent the ports 16 to open the ports 16. The ports 16 can be closed by moving the sliding lock mechanism 52, and thus, the activation, remote and control members 24. axially relative to the hub 62 and the body 12 of the catheter. The locking member 66 engages the sliding lock mechanism 52 to hold the port 16 in any of the open and closed positions until sufficient force is applied to axially move the sliding lock mechanism 52 relative to the hub 62. The mechanism of activation may further include one or more springs or other biasing members to facilitate maintenance of the ports 16 in any of the open or closed positions. Another embodiment of an actuator 150 that can be used with the catheter activation mechanism 10 is shown in Figures 6 and 7. The actuator 150 includes a hub 162 and a sliding lock mechanism 152. The sliding lock mechanism 152 includes a portion 154 next to be held by the user, and a distal portion 156 extending to the passage 166 of the hub 162. The activation members 24 are secured to the distant portion 156. The hub 162 includes locking surfaces formed by a pair of receptacles 170 formed therein in communication with the passage 166. The block members 158 extend from the remote portion 156 and toward the corresponding portions of the receptacles 170. The receptacles 170 include each a proximal displacement portion 172 and a distal displacement portion 174. In order to place and maintain the ports 16 in a closed position, the sliding lock mechanism 152 is advanced distantly in the hub 162 and rotated to place the locking members 158 in the remote displacement portions 174. In order to place and maintain the ports 16 in an open position, the sliding lock mechanism 152 is closely drawn from the hub 162 and rotated to place the locking members 158 in proximal shifting portions 172. The positioning of the locking members 158 in the displacement portions prevents axial movement of the sliding locking mechanism 152 relative to the hub 162. It is also contemplated that displacement portions for the receptacle 170 may be provided between the displacement portions 172, 174. next and distant to provide variability in the degree of opening of the ports 16 and changes in the physical properties of the catheter body 12 and the activation members 24 over time. The other embodiment of the actuator 250 for an activation mechanism for the catheter 10 is shown in Figures 8 and 9. The actuator 250 includes a hub 262 and a sliding lock mechanism 252. The sliding lock mechanism 252 includes one or more locking members 254 extending therefrom. The activation members 24 are secured to the sliding lock mechanism 252 and can be moved therewith. The hub 262 includes a pair of opposite end portions 263 that can be attached to the body 12 of the catheter. The hub 262 further includes a pair of opposed slotted ports 264 and a pair of opposed side walls 265 that extend between the opposed slotted ports 264. At least one receptacle 266 extends through at least one of the side walls 265. The receptacle 266 includes a displacement portion 268 at a proximal end thereof. The sliding lock mechanism 252 is positioned between the side walls 265 and can move therebetween axially along the body 12 of the catheter. The locking mechanism 254 extends into the receptacle 266 and can be moved along the same with the movement of the sliding lock mechanism 252 to be placed on the displacement portion 268 for securing the ports 16 in an open condition. A second remote displacement receptacle portion (not shown) can be provided to secure the ports 16 in a closed condition, and the displacement portions can be provided along the length of the receptacle 266 to accommodate variation in opening of the ports 16 and the physical properties of the catheter body 12 and the activation members 24. Another embodiment of the actuator 350 is shown in Figures 10 and 11. In Figures 10 and 11, the proximal end of the catheter 10 is shown with a cuff 40 that can be placed below the level of the skin to help maintain the catheter in the patient and prevent leakage around the catheter 10. The proximal end of catheter 10 further includes a luer lock fitting 42. The actuator 350 includes a tube member 352 through which the activation member 24 extends. The tube member 352 extends transversely from one side of a portion 43 remote from the fitting 42. The portion of the tube member 352 closest to the hub 43 includes a plastic material, such as silicone rubber, therein to serve as a seal around the activation member 24. The activation member 24 extends through the tube member 352 and the plastic material for the end member 26 elongated at the end next to the activation member 24. The end member 26 is attached to the tube member 352 and ensures that the activation member 24 moves with the expansion and compression of the tube member 352. The tube member 352 includes an accordion-like shape along its length with a wall that bends on itself to allow expansion and contraction of the length of the tube member 352. The tube member 352 can be gummed or sealed at each end to prevent contamination. Figures 12-14 illustrate several views of a distal portion of a catheter according to another embodiment. The catheter 410 includes a body 412 of the catheter with a central lumen 420. The distal end 413 of the body 412 is sealed with a cap 414, which may be integral with the body 412 or a separate member sealingly coupled thereto. Body 412 includes a wall 418 that extends around lumen 420. Wall 418 includes one or more ports 416, which may be slits or elongated gills as discussed above with respect to catheter 10. Wall 418 also includes an inflation lumen 422 formed therein for distribution of a fluid, such as saline, air, gas or other fluid suitable for inflating an elongation member 428. The elongation member 428 is placed in the lumen 420, and shown in a reduced size configuration in Figure 12 and a elongated configuration in Figures 13 and 14. The elongation member 428 may be in the form of a balloon, bag, bubble, diaphragm or other device capable of opening and closing the ports 416 as it is lengthened and reduced. The end cap 414 and the distal end 413 define a cavity 424 therebetween. The inflation lumen 422 is in fluid communication with the cavity 424 to distribute fluid thereto. An inflation tube or rod 426 extends through lumen 420 from the remote end 413. The rod 426 includes an internal passage in fluid communication with the cavity 424 and the elongation member 428. Accordingly, the fluid can be moved through the inflation lumen 422 into the cavity 424 and through the rod 426 towards the elongation member 428 to elongate and selectively reduce the elongation member 428. One or more arms 430 extend between the elongation member 428 and an interior surface 419 of the wall 418 in the wall portions 432 adjacent the ports 416. As shown in Figure 14, an arm 430 is provided between each port 416. When the elongation member 428 is elongated, the arms 430 are pushed externally to radially deform the wall portions 432 of the wall 418 and effect the separation of the adjacent wall portions 432 and open each port 416.

In the illustrated embodiment, three arms 430, three ports 416 and three wall portions 432 are provided between adjacent ports of ports 416. Arms 430 separate wall portions 432 of elongated elongation member 428 to provide a path for flow blood flow through the open ports 416 and over the elongated elongation member 428 in the lumen 420. When the fluid is removed from the elongation member 428, its size is reduced and the arms 430 pull the wall portions 432 in alignment with the 412 of the catheter, the ports 416 close to prevent flow therethrough. To effect a positive force between the adjacent sides of the wall portions 432 for sealingly closing the ports 416, a negative pressure can be imparted to the elongation member 428, the wall portions 432 being removed radially internally in contact with each other. Other configurations for the ports 416 are also contemplated, including a single port 416 with a pair of wall portions 432 positioned adjacent to the sides thereof. In another embodiment, a pair of ports 416 is provided on opposite sides of the body 412, and a pair of wall portions 432 are centrally spaced between the opposing ports 416. In an additional embodiment, four or more ports 416 with a corresponding number of portions of wall placed between adjacent louvers are contemplated. Any or all of the wall portions of the embodiments may be provided with an arm extending between the wall portion and the elongation member. Other configurations are also contemplated to distribute the fluid to elongate the elongation member 428. For example, one or more of the arms 430 may include a passage for distributing the fluid to the elongation member 428. In another embodiment, the elongation member 428 is in direct fluid communication with the elongation lumen 422. The catheter embodiment in Figures 12-14 uses pneumatic or hydraulic means to manipulate the wall 418 of the catheter 410 to selectively open and close the ports 416. When the ports 416 are closed, blood flow is prevented from entering the lumen 420 and a blocking solution can be retained in lumen 420 to avoid coagulation. Other variations for rod 426 and arms 430 are also contemplated. For example, the rod 426 may include a bellows, accordion type, or other suitable configuration that can expand and compress axially, or be moved axially in another way to reposition the rod 426 in the lumen 420. The arms 430 can include a structure in the form of wire or another connected pivotally to the rod 426 and the wall portions 432. When the rod 426 is in a first axial configuration and is positioned relative to the wall portions 432, the arms 430 are angled between the rod 426 and the wall portions 432 to maintain the ports 416 in a closed condition. When the rod 426 moves to a second axial configuration, the ends of the arms 430 connected to the rod 426 move with it, and as the arms are oriented more orthogonally to the rod 426, the arms 430 are pushed radially and externally onto the arms. wall portions 432 for opening the ports 416. In yet another embodiment, the arms 430 expand along their axes between the rod 426 and the wall portions 432 to move the wall portions 432 away from each other to open the ports 416. The arms 430 can collapse along their axes to move the wall portions 432 toward each other and close the ports 416. In this embodiment, the rod 426 may not be expandable and / or non-movable. In one form, arms 430 include an accordion or bellows-like configuration along its length. In another form, arms 430 include a balloon-like configuration and can be expanded at least axially, and can also expand radially. Figures 15 and 16 show a distal portion of another embodiment of the catheter. In Figure 15, the luminaries Distances of the catheter are in the closed condition, and in Figure 16, the distant lumens are in an open condition. The catheter 510 includes a catheter body 512 with a central lumen 520 defined by a first wall 518. The distal end 513 of the first wall 518 can be opened to allow fluid to flow therethrough, and can be closed to prevent the flow of fluid through it. The first wall 518 includes one or more ports 516, which may be slits or elongated gills extending to the distal end 513. Adjacent louvers 516 are separated by wall portions 519 extending therebetween. A second wall 522 extends through the lumen 520 and forms a second lumen 524. The second lumen 524 opens at the remote end 526 of the second wall 522. The second wall 522 includes a number of end members 528 that normally deviate to the closed position to prevent fluid flow from entering second lumen 524. Fluid pressure at second lumen 524 causes end members 528 to move away from each other and separate, allowing discharge fluid from lumen 524 through the distant 526 end. Other modalities contemplate that the 524 lumen is not used for blood flow. Still other embodiments contemplate that the 510 catheter be provided without lumen 524.

The second wall 522 further includes an elongation member 530 formed around it closely to the end members 528. The elongation member 530 is received in the lumen 520, and has a collapsed or reduced size configuration, as shown in Figure 15, and an elongated or expanded configuration, as shown in Figure 16. The second wall 522 can including an inflation lumen (not shown) in fluid communication with the interior of the elongation member 530 for distribution and removal of the fluid from the elongation member 530. The fluid may be saline, air, gas, or other suitable fluid, to inflate or elongate the elongation member 530. The extension member 530 may be in the form of a balloon, bag, bubble, diaphragm or other device capable of opening and closing the ports 516 as it is lengthened or reduced. When in the unexpanded condition of Figure 15, the adjacent ones of the wall portions 519 abut one another so that the ports 516 are closed. Fluid flowing to the second lumen 524 may exit lumen 524 to through the distal end opening of the second wall 522 with the proviso that the fluid pressure is sufficient to open the distal end 526 when separating the end members 528. If the influx of fluid into the lumen 520 is desired, the fluid may distributed to the extension member 530 to cause it to elongate or expand. As it expands, it acts on the wall portions 519 to deform radially 518 and cause the ports 516 to open as the wall portion 519 is separated. The arms 532 can be provided between the elongation member 530 and the wall portions 519 to facilitate radial deformation of the wall 518, ensure active closure of the ports 516 and prevent separation of the wall portions 518 of the elongation member 530 . The arms 532 connect the wall portions 519 to the elongation member 530. In one embodiment, there is zero void space between the elongation member 530 and the wall portions 519, and the fluid flow is directed through the ports 516 open close to the remote end 513. The arms 532 are provided with sufficient resilience to encompass the different radii of curvature between the distal ends of the wall portions 519 and the elongate elongation member 530. In another embodiment, the arms 532 maintain the separation between the inner surface of the wall 518 and the elongation member 530, facilitate the flow of fluid through the distal end opening of the first wall 518 and also through the ports 516 between the adjacent wall portions 519 In the illustrated embodiment, the arms 532 are they extend distally from the respective wall portions 519 and in contact with the elongation member 530. It is also contemplated that one or more of the arms 532 may be located within the lumen 520, and may include any configuration as discussed above with respect to the arms 430. In the illustrated embodiment, three arms 532, three ports 516 are provided. and three wall portions 519 between adjacent ones of the ports 516. The wall portions 519 may or may not be separated from the elongate elongation member 530. When the elongation member 530 is lengthened, the open ports 516 provide a path for blood flow therethrough and around the elongate elongation member 530 to the lumen 520. When the fluid is removed from the elongation member 530, its The size is reduced and the wall portions 519 collapse in alignment and splice coupling with each other, closing the ports 516 to prevent flow therethrough. In one embodiment, arms 532 can be coupled to elongation member 530 and wall portions 519 to pull wall portions 519 toward the closed condition. The spleens 532 can ensure a positive closure of the ports 516 when the elongation member 530 is in its reduced size configuration. In another embodiment, the wall portions 519 are naturally diverted by a mobile joint connection with the wall 518 towards the closed condition. In a further embodiment, the arms 532 can be secured to the distal ends of the wall portion 519 at one end of each of the arms 532 and include an opposite end that mounts or floats along the elongation member 530 as expands and collapses. In yet another embodiment, the arms 532 may extend along their axes between the elongation member 530 and the wall portions 519 to move the wall portions 519 away from each other to open the ports 516 as the fluid is distributed to the walls. arms 532. The arms 532 can be collapsible along their axes to move the wall portions 519 toward each other and close the ports 516. In this embodiment, the extension portion 530 can be non-expandable or non-stretchable. In one form, the arms 532 include an accordion or bellows-like configuration along its length. In another form, arms 532 include a balloon-like configuration and are at least axially expandable, and may also expand radially. Other configurations for the ports 516 are also contemplated, including a single port 516 with a pair of wall portions 519 positioned adjacent the sides thereof. In another modality, a pair of ports 516 are provided on opposite sides of body 512, and a pair of wall portions 519 are centrally spaced between opposite ports 516. In a further embodiment, four or more ports 516 with a corresponding number of wall portions are placed between the adjacent ports. For any of the embodiments, one or more arms 532 may be provided between the elongation member and one or more wall portions, or arms 532 are not provided. The catheter embodiment in Figures 15-16 uses pneumatic or hydraulic means to manipulate the wall 518 of the catheter 510 for selectively opening and closing the ports 516. When the ports 516 are closed, blood flow between the lumen 520 and a blocking solution is prevented from being retained in the lumen 520 to prevent coagulation. The blocking solution can also be maintained in lumen 524 to prevent coagulation. Figures 17-21 show a distal portion of another embodiment of catheter 610. In Figure 17, the distal ports of catheter 610 are in a closed condition, and in Figure 18, distal ports are in an open condition. The catheter 610 includes a body 612 of the catheter by a first lumen 620 defined by a first wall 618. The distal end 613 of the first wall 618 is closed, and one or more ports 616 are formed in the first wall 618 in communication with the first lumen 620. The adjacent ones of the ports 616 are separated by the first wall portions 619 that extend between them. The ports 616 can be opened by deforming the wall portions 619 to allow fluid to flow through them, and they can be closed to prevent ingress or egress of fluid from the lumen 620. One or more ports 616 can be slits or elongated gills extending along the first wall 618 to a location near the distant end 613. The body 612 also includes a second wall 622 that extends around the second lumen 624. The second lumen 624 is closed at the far end 626 of the second wall 622. The second wall 622 includes a number of ports 628 separated by the portions 637. of wall between them. The ports 628 are normally biased to the closed position to prevent fluid flow therethrough. The pressure from the fluid in the second lumen 624 causes the wall portions 637 to move away from each other and separate to open the ports 628 allowing fluid to enter and exit from the lumen 624 through the ports 628. A common wall portion 625 extends between and separates the lumens 620, 624. In the illustrated embodiments, the first and second walls 618, 622 form lumens 620, 624 in form of D. Other modalities contemplate other forms for the lumens 620, 624, that include circular, oval, polygonal and irregular forms, for example. Other embodiments do not contemplate any common wall portion between lumens 620, 624. In fact, each of the lumens is circumscribed by a separate wall. The separated walls can be separated or divided one from the other at least along the distal portion of the catheter 610. In another form, the walls can be coupled together and can even be divided to allow the walls to separate one from the other. the other if desired. The first wall 618 includes a first elongation member 629, and the second wall 622 includes a second elongation member 630. The elongation members 629, 630 can be received in the respective lumens 620, 624 and have a reduced collapsed size configuration, as shown in Figure 17, and an elongated or expanded configuration, as shown in Figure 18. At least one of the first and second walls 618, 622 or the common wall 625 may include an inflation lumen 635 in fluid communication with the interior of the elongation members 629, 630 for distribution and removal of fluid from the members 629, 630 elongation. The fluid may be saline, air, gas or other fluid suitable to inflate or elongate the members 629, 630 of lengthening The inflation lumen 635 may be provided in communication with the interiors of one or more of the members 629, 630 to provide a path for the distribution of fluid thereto and the removal thereof to selectively elongate and reduce the size of the members 629, 630 elongation. The inflation lumen 635 may extend between and communicate with each of the interiors of the elongation members 629, 630 so that the elongation members 629, 630 may be simultaneously lengthened or simultaneously reduced in size. Other modalities contemplate a separate inflation lumen in communication with the respective ones of the elongation members 629, 630. Inflation lumen 635 is shown on common wall 625. Other embodiments contemplate one or more inflation lumens in the first wall 618 and / or the second wall 622. The elongation members 629, 630 may be in the form of a balloon, bag, bubble, diaphragm or other device capable of opening and closing the ports 616, 628 as it is lengthened or reduced. When in the unexpanded condition of Figure 17, the adjacent ones of the wall portions 619, 637 abut one another so that the ports 616, 628 are closed. The fluid may be distributed to the elongation member 629 to cause it to lengthen or expand. As it expands, it acts on the wall portions 619 to radially deform the first wall 618 and cause the ports 616 to open when the wall portions 619 are separated. Similarly, the fluid may be distributed to the elongation member 630 to cause it to elongate or expand. As it expands, it acts on the wall portions 637 to radially deform the second wall 622 and cause the ports 628 to open when the wall portions 637 separate from each other. Pneumatic or hydraulic means can be used to manipulate the elongation members 629, 630 to selectively open and close the ports 616, 628. When the ports 616, 628 are closed, blood flow is prevented from entering the 620, 624 lumens and a Blocking solution can be retained in lumens 620, 624 to avoid coagulation. A method for manufacturing the catheter 610 contemplates forming the body 612 so that the distal ends of the lumens 620, 624 are initially opened. The elongation members 629, 630 are inserted in a collapsed condition through the respective one of the distal end openings. A shutter is then placed in each of the distal end openings. The obturator material and the catheter body are then re-flowed or otherwise sealed to seal the elongation members in the respective lumens. A pin or other device Orifice formation is inserted through the wall or walls to form a passage between the interior of the elongation member and one or more inflation lumens. The hole is then capped or sealed to seal the elongation lumen and elongation members. The arms 632, 633 may be provided in the wall portions 619, 637 along the respective ports 616, 628. The arms 632, 633 may include shape recovery properties to facilitate closing the ports 616, 628 after releasing the deformation force on the wall portions 619, 637. The arms 632, 633 can be integrated into the wall portions 619, 637 and have the shape of a wire or other folding member that moves with the wall portion 619, 637 when deformed to open the ports. The shape recovery properties of the arms 632, 633 hold the ports 616, 628 in a positively closed condition to allow containment of the blocking solution or other fluid in the lumens 620, 624. Various shapes for the arms 632, 633 are contemplated, which include spring steel, nitinol, or other suitable material. Other embodiments contemplate that the wall portions 619, 637 are made of material with shape recovery properties to effect positive closure of the ports. When the elongation members 629, 630 are elongate, the open ports 616, 628 provide a path for blood flow through them and around the elongate elongation members 629, 630. When the fluid is removed from the elongation members 629, 630 its size is reduced and the wall portions 619, 637 collapse in alignment and in splice engagement with each other, closing the ports 616, 628 to prevent flow through the walls. the same. The arms 632, 633 can ensure a positive closure of the ports 616, 628 when the elongation members 629, 630 are in a small size configuration. In another embodiment, the wall portions 619, 637 are naturally diverted to the closed position by a movable joint connection with the walls 618, 622 or by the material properties of the wall portions 619, 637. Other configurations for the ports 616, 628 are also contemplated, which include a single port between a pair of adjacent wall portions. In another embodiment, a pair of ports is provided on opposite sides of the respective wall portions. In a further embodiment, four or more ports are provided in the respective wall portions with a corresponding number of wall portions between the adjacent ports. For any of the modalities, the wall portions may have the same number of ports, or may have a different number of luminaries. The ports can also extend non-longitudinally in the respective walls. With reference to Figures 22-24, there is shown a distal portion of a portion 710 of the lumen of a catheter 700 that includes a body 712 and a distal portion 714. One or more ports 716 are provided along the remote portion 714, and extend through the wall 718 of the body 712 in communication with a lumen 720. The remote portion 714 may be closed with a tip or cover 719 integral in its distant end to avoid the flow of fluid through it. In the illustrated embodiment, each port 716 is an elongated slit or gill that extends generally parallel to the longitudinal axis 713 of the body 712. It should be understood that a second portion 710 of the lumen of the catheter 700 could be provided adjacent to the 710 part of the lumen. which is similar to lumen 710. Taken together, lumen portions 710 provide separate flow paths for fluid ingress and fluid egress. Other modalities contemplate that the lumen 720 could be divided into multiple separate lumens. Three ports 716 are provided in the wall 718 extending radially through the portion 714 distant approximately 90 degrees apart from the central port 716a. Other modalities contemplate one or more luminaires 716, which include two luminaries, four luminaries or five or more luminaries. It is further contemplated that the ports may be uniformly separated or separated non-uniformly over the remote portion 714. The distal portion 714 may be formed of a material with sufficient flexibility so that the wall segments 722, 724, 726 between the ports 716 may flex or deform to open and close the ports 716. In Figure 22, the remote portion 714 is in a first configuration or condition where the ports 716 are closed. It is contemplated that. in the closed condition, the wall 718 substantially seals the ports 716 to prevent fluid flow out or into the lumen 720 through the ports 716. In Figure 24, the wall 18 has been manipulated to open one or more of the ports 716 to provide fluid communication between the lumen 720 and an exterior of the body 712 through the ports 716. Manipulation of the wall 718 may include displacing or deforming the adjacent wall segments 722, 724, 726 along the the ports 716. In one embodiment, the ports 716 are opened by deforming the wall segments 722, 724, 726 along the ports 716 to reduce the length of the remote portion 714 from a first undeformed length to a deformed length. more short. One or more 722, 724, 726 wall segments at length of the ports 716 can expand or separate from an adjacent wall segment 722, 724, 726 to open the ports 716. The deformed portions of the wall segments 722, 724, 726 can be released from any fibrous cover formed on the wall 718 In addition, the deformation of the wall segments 722, 724, 726 can provide the ports 716 with sufficient size to accommodate any required blood flow through the lumen 720. When the ports 716 are closed, the segments 722, 724, 726 wall along the ports 716 are joined together along the entire length of each port 716 and with sufficient force to prevent the ingress and egress of fluid through the ports 716 between the lumen 720 and the structure of blood vessels. In addition, it is contemplated that an activation mechanism may be provided to facilitate opening and closing the ports 716, and maintaining the ports 716 in their open and closed conditions. The activation mechanism may include an actuator adjacent a proximal end portion of the catheter 700, such that the actuator is positioned outside the patient's body and can be easily accessed by the surgeon. The trigger mechanism may further include one or more actuator members 730 coupled to the actuator and extending along the catheter to a location adjacent to the ports 716. One or more members Activation 730 can be moved or operated with the actuator to manipulate the wall segments 722, 724, 726 and open or close the ports 716 as desired. In Figures 22-24, the activation member 730 is placed in a lumen 732 along a side wall 734 of the body 712. The round wall 736 extends between opposite sides of the side wall 734, and may include members of additional activation, but not in the illustrated modality. The activation member 730 may be in the form of a wire integrated in or surrounded by the side wall 734, or which may be placed in a lumen formed in the side wall 734. Such a lumen for receiving the activation member 730 could be formed by a loop of stainless steel or nitinol flat wire. The activation member 730 may also be formed of stainless steel, nitinol or any suitable material. The activation member 730 extends through the remote portion 714 between the wall segments 722, 724, 726 to the distant cover 719. The activation member 730 may be wrapped in the lid 719 to prevent it from pulling on the lid 719. The ports 716 positively close as the activation member 730 moves away from the lid 719, pulling the distant portion 714 and forcing the segments apart. 722, 724, 726 wall in splice coupling with each other. Since segments 722, 724, 726 of The wall substantially occupies the entire cross-sectional area of the remote portion 714, more surface area is provided along and between the adjacent wall segments 722, 724, 726 to form a positive seal than would be provided if the lumen 720 it will be carried through the remote portion 714 in the same size and shape as provided in the body 712. The ports 716 are opened by tensioning the activation member 730, compressing the remote portion 714 between the cover 719 and the body 712. Other embodiments contemplate that the ports are normally closed by the properties of the material and the configuration of the wall segments 722, 724, 726 and opened in response to the fluid pressure, for exe. In addition, the wall segments 722, 724, 726 may include tapered portions 729 at the proximal ends thereof that internally taper toward the ports 716 to facilitate fluid flow thereto from lumen 720 without abrupt profile changes . In Figures 25-26, another embodiment of the catheter 800 is shown. The catheter 800 includes a portion 810 of the lumen having a body 812 formed by a wall 818 that extends over a lumen 820. The lumen 820 opens at one end Distant from the body 812 to form a port 816 for ingress and / or egress of the fluid flow. It should be understood that the catheter 800 may include one or other portions 810 of the more lumen that can provide additional lumens for fluid intake or discharge. In addition, the catheter 800 includes an end cap 830 associated with the body 812 and movable relative thereto from an open position, as shown in FIG. 25, to a closed position. The port 816 can be opened by deforming the catheter 800 from its closed position by moving the end cap 830 away from its closed position to the open position. In the open position, the cap 830 is separated from the distal end 822, which results in a change in the length of the catheter 800, so that the port 816 opens to allow fluid to pass from or into the lumen 820. The cap 830 The end portion is coupled to the body 812 with one or more activation members 834 that extend between the body 812 and the end cap 830. The activation members 834 may be in the form of a wire in the wall 818 or adjacent the junction of the linear portion 819 and the round convex portion 821. Each activation member 824 can be placed in a lumen formed in the wall 818. Such a lumen for receiving the respective activation member 834 could be formed by a loop of stainless steel or nitinol flat wire. The activation members 834 may also be formed of stainless steel, nitinol or any suitable material. Activation member 834 can be located in other locations around the wall 818, and part 810 of the lumen may include one, two or three or more activation members 834. The end cap 830 can be moved to the closed position from the open position by axially and closely displacing the end cap 830 to the port 816 along the longitudinal axis 811 and in sealing engagement with the body 812. The activation members 834 can coupling to an activation mechanism to allow movement of the activation members 834, and thus the end cap 830, closely along the axis 811 to the closed position. To open the port 816, the actuating members 834 move distally with the actuator mechanism to displace the cap 830 distally along the axis 811 and relative to the port 816 and the body 812. The end cap 830 may include a portion 832 next tapered which can facilitate reception through port 816 to lumen 820. Tapered portion 832 can also allow cover 830 to self-center relative to port 816 and provide seal engagement with wall 818 Referring now to Figure 27, there is shown an example of an activation mechanism 900 that can be employed with catheters 700, 800 or other catheter embodiments discussed herein. Catheters 700, 800 include lumen portions 710, 810 that are coupled together in a bucket 902 next. The proximal hub 902 can include a Y shape that separates the two lumen parts for connection to fluid sources or other equipment at the connectors 904, 906. In one embodiment, one of the lumen portions 710, 810 can be designated for providing fluid flow to the patient's body and the other portion 710, 810 of the lumen can be designed to receive fluid flow from the patient's body, as indicated by arrow 908, 910. The activation members 730, 834 parts 710, 810 of the lumen may be coupled with an actuator adjacent the hub 902. The actuator may include first and second slide buttons 912, 914. Each slide button engages one or more of the activation members 730, 834 of the portion 710, 810 of the respective lumen. The sliding buttons 912, 914 allow the movement of the activation members 710, 810 of the respective lumen along the wall of the lumen part. The separate sliding buttons 912, 914 can be moved axially in either the near or distant direction, as desired, to effect the corresponding independently and remotely activated movement of the remote portion 714 or the end cap 830, depending on the part 710, 810 of the lumen used with the mechanism 900 actuator. Such movement allows the selective opening and closing of one or more parts to allow the flow of fluid therethrough.

While the invention has been illustrated and described in detail in the drawings and description above, the same will be considered as illustrative and not restrictive in character. For example, for any modality, catheter activation mechanisms are contemplated which include micro-motors or other automatic or mechanical systems for opening and closing the fluid flow ports. It is desired to protect all changes and modifications that come within the spirit of the invention.

Claims (36)

1. CLAIMS 1. A catheter, characterized in that it comprises: a body defining at least one lumen extending along a longitudinal axis of the body, the lumen for the passage of fluid flow through it, the body extends between a distal portion that can be placed in a vascular structure of a patient and a proximal end that can be placed outside the patient with the distal portion in the vascular structure, the distal portion of the body includes a plurality of adjacent wall segments that are extending along the same and located distantly from the lumen, the wall segments together have a size and shape that correspond substantially to a size and shape of the lumen transversely to the longitudinal axis, where the adjacent segments of the wall define a lumen between them, each of the ports includes a first closed condition formed by splice coupling of the ady wall segments. In order to prevent the flow of fluid between the lumen and the vascular structure through the lumens, the lumens include a second open condition formed by deforming at least one of the wall segments to open at least one of the lumens to allow the flow of fluid between the vascular structure and the lumen through the lumens.
2. 2. The catheter in accordance with the claim 1, characterized in that the body includes an activation member in a wall of the body, the activation member extends through the portion and is secured in a cover located distantly from the distal portion.
3. 3. The catheter in accordance with the claim 2, characterized in that the activation member is a wire and the wire includes a distant end wound on the cover.
4. 4. The catheter in accordance with the claim 2, characterized in that in the closed condition the activating member tightens the body and deflects the adjacent wall segments in splice coupling.
5. 5. The catheter according to claim 2, characterized in that in the open condition the activation member compresses the wall segments between the cap and the body of the catheter.
6. 6. The catheter according to claim 2, characterized in that the activation member extends between the wall segments. The catheter according to claim 1, characterized in that the plurality of wall segments includes three wall segments. 8. The catheter according to claim 1, characterized in that the wall segments and the body each one defines a D-shaped cross section transversely to the longitudinal axis. The catheter according to claim 1, further characterized in that it comprises: a second body defining at least a second lumen for the passage of fluid flow therethrough, the second body extending between a second distant portion that it can be placed in the vascular structure of the patient and a second proximal end that can be placed outside the patient with the distal portion in the vascular structure, the second distal portion of the second body includes a plurality of adjacent wall segments extending the length thereof distantly from the second lumen and adjacent ones of the wall segments defining a port therebetween which can be moved between the open and closed positions with an activation member coupled to a proximal drive mechanism. A catheter, characterized in that it comprises: an elongated body extending between a distal end and a proximal end, the body includes a wall defining at least one lumen for fluid flow therethrough, where the body includes at least one port at the distal end of the elongate body in communication with at least one lumen, and further comprises an end cap at the distal end and a mechanism for activation at the proximal end, the end cap engages the activation mechanism with at least one activation member extending into the wall along the lumen, where the activation mechanism can be operated to remotely move the end cap away from the lumen in an open condition and allowing the flow of fluid through the port and the activation mechanism it can further be operated to remotely move the end cap to the distal end in a closed condition in sealing engagement with the body to prevent the flow of fluid through the port. The catheter according to claim 10, characterized in that the elongated body extends along a longitudinal axis and the end cap can be moved along the longitudinal axis between the open condition and the closed condition. The catheter according to claim 10, characterized in that the end cap includes a tapered proximal portion that can be placed in the lumen through the port in the closed condition. The catheter according to claim 10, characterized in that at least one activation member includes a first activation member along one side of the body and a second activation member along an opposite side of the body, each of the first and second activation member extends between and engages the end cap and activation mechanism. 14. The catheter according to claim 13, characterized in that the activation members each engage a sliding button of the activation mechanism. 15. The catheter according to claim 10, characterized in that the wall and the lumen each define a form D. 16. The catheter in accordance with the claim 10, further characterized in that it comprises: a second elongate body extending between a distal end and a proximal end, the second body includes a second wall defining at least a second lumen for blood flow therethrough, where the second body includes at least a second port at the distal end of the second elongated body in communication with at least one lumen, and further comprises a second end cap at the distal end and an activation mechanism is at the proximal end of the second body, the second end cap engages the activation mechanism with at least one second activation member extending in the second wall along the second lumen, where the activation mechanism can be operated to remotely move the second end cap away from the second. port in an open condition and allow fluid flow through the second port and the activation mechanism can be further operated to remotely move the second end cap to the distal end in a closed condition and in seal engagement with a second body elongated to prevent the flow of fluid through the second port. 1
7. 7. The catheter in accordance with the claim 16, characterized in that the activation members engage the respective first and second slide buttons of the activation mechanism, the slide buttons can be moved to move the respective activation member and the end cap between the open and closed conditions. 1
8. 8. The catheter in accordance with the claim 17, characterized in that the elongated bodies are joined in a hub at the proximal ends of the elongated bodies adjacent to the activation mechanism. 1
9. 9. A catheter, characterized in that it comprises: an elongated body defining a pair of lumens, each for the flow of fluid therethrough, each of the lumens extending between a distant end and a proximal end, where each of the lumens includes a port at the distant end thereof in communication with the lumen, and further comprises a pair of end caps in the distant ends of the respective lumens and an activation mechanism at the proximal ends of the lumens, each of the end caps engages the activation mechanism with at least one activation member extending into a wall along of the respective lumen, where the activation mechanism can be operated to move independently and remotely each of the end caps with the respective activation member remote from the respective lumen port to an open condition and allow the flow of fluid through the port, and where the activation mechanism can be operated to independently and remotely move each of the end caps toward the respective lumen port toward a closed condition in sealing engagement with the body to prevent fluid flow through the port of the respective lumen. The catheter according to claim 19, characterized in that the activation mechanism includes a pair of sliding buttons each associated with the respective one of the pair of lumens, each pair of sliding buttons is each coupled to the respective of at least one of the activation members and can be operated to move the respective end cap between the open and closed conditions. 21. A catheter, characterized in that it comprises: a body defining at least one lumen for the passage of blood flow therethrough, the body extending between a distant end that can be placed in a vascular structure of a patient and a proximal end that can be placed outside the patient with the distal end in the vascular structure, the body includes a wall having adjacent wall portions defining at least one port adjacent to the distal end, at least one port includes a first closed condition formed by splice coupling of the portions of wall to prevent blood flow through the lumen to the lumen, the port includes a second open condition formed by radially deforming at least one of the wall portions to open at least one port and allow fluid flow to through the lumen to the lumen, where the body wall defines at least one lumen and the body also comprises a second wall that defines a second lumen, the first and second lumens extend in a side-by-side relationship with each other. 22. The catheter in accordance with the claim 21, characterized in that the wall terminates at a distal first end and the second wall terminates at a second distal end, the first distal end is closely spaced from the second distal end. 23. The catheter in accordance with the claim 22, characterized in that the second wall includes at least one port in communication with the second lumen, at least one port of the second wall extends along the second wall and is located distantly from the first distal end. 24. The catheter in accordance with the claim 23, further characterized in that it comprises a first elongation member adjacent to at least one lumen and a second elongation member adjacent to the second lumen, the first elongation member can be elongated to deform the wall and open at least one lumen of the The wall and the second elongation member can be lengthened to deform the second wall and open at least one port of the second wall. 25. The catheter in accordance with the claim 21, further characterized in that it comprises a common wall between at least one lumen and the second lumen. 26. The catheter according to claim 21, characterized in that the lumens each include a D-shaped portion. 27. A catheter, characterized in that it comprises: a body defining at least one lumen for the passage of blood flow to Through it, the body extends between a distant end portion that can be placed in a vascular structure of a patient and a proximal end which can be placed outside the patient with the end portion distant in the vascular structure, the body includes at least one wall having adjacent wall portions defining at least one port in the far end portion in communication with minus one lumen, at least one port includes a first closed condition formed by splicing engagement of the wall portions to prevent blood flow through at least one port, where the body includes an adjacent elongation member at least to a port, the elongation member has a reduced size configuration when at least one port is in a closed condition and an elongation member can be elongated to an elongated configuration to deform at least one of the wall portions and place at least one port in an open condition to allow blood flow through at least one lumber, where the body wall defines at least one lumen and the body further comprises a second wall defining a second lumen, the first and second lumens extending in a side-by-side relationship with each other. 28. The catheter according to claim 27, further characterized in that it comprises a common wall between at least one lumen and the second lumen. 29. The catheter in accordance with the claim 27, characterized in that the lumens each include a D-shape at least along the remote end portion of the body. 30. The catheter according to claim 27, characterized in that the wall terminates at a distal first end and the second wall terminates at a second distal end, the first distal end is closely spaced from the second distal end. 31. The catheter according to claim 30, characterized in that the first and second distal ends are closed. 32. The catheter in accordance with the claim 31, characterized in that the second wall includes at least one port in communication with the second lumen, at least one port of the second wall extends along the second wall and is located distantly from the first distal end. 33. The catheter in accordance with the claim 32, further characterized in that it comprises a second elongation member in the second lumen, the second elongation member can be elongated to deform the second wall and place at least one port of the second wall in an open condition. 34. The catheter according to claim 33, characterized in that at least one member of Elongation is located between the first distant end and at least one lumen and the second elongation member are located between the second distant end and the second lumen. 35. The catheter in accordance with the claim 33, characterized in that the wall and the second wall each include an arm integrated therein adjacent to the respective ports, the arms include shape recovery properties to provide an active closure of the ports when the elongation members are in place. a small size configuration. 36. The catheter according to claim 33, characterized in that the body includes at least one information lumen in fluid communication with each of the elongation members.