Multi-lumen catheter

Abstract

To provide devices and methods of use thereof for improving access and navigation of vascular bifurcations and other multiple tortuous pathways.SOLUTION: A medical device includes: an elongate catheter body defining a proximal segment, a distal segment, and a first lumen through the catheter body; a tube attached to the distal segment of the catheter body, the tube defining a proximal end, a distal end, and a second lumen through the tube. The proximal end of the tube is attached to the catheter body at a first joint. The distal end of the tube is attached to the catheter body at a second joint. A portion of the tube extending between the first and second joints is movable with respect to the catheter body.SELECTED DRAWING: Figure 2

Description

[Technical field]

[0001] FIELD OF THE DISCLOSURE The present disclosure relates to intravascular medical devices and methods of use thereof. [Background technology]

[0002] Various types of catheters are used for intravascular delivery of medical devices such as stents or angioplasty balloons. Various catheter systems have been developed. Typically, a guidewire is introduced into the blood vessel. The catheter is then advanced through the vascular system to the treatment site. The distal end of the catheter is then positioned at the treatment site. The catheter is advanced over the guidewire so as to be positioned. and / or guidewires, stents, grafts, angioplasty balloons, atelec The device transports any of a variety of medical devices, including MRI devices, and others, in close proximity to the treatment site. It can be used to position the

[0003] The success of many minimally invasive medical procedures relies on the delivery of such medical devices to such target tissue areas. Therapy relies on the ability to precisely position the catheter within the target vasculature to access bifurcations. And when it is necessary to navigate this precise placement can become complicated. The present disclosure provides a method for accessing and guiding such vessel bifurcations and other multiple tortuous pathways. The present invention provides a device and method for improving navigation. Summary of the Invention

[0004] The present invention advantageously comprises a catheter through the proximal segment, the distal segment and the catheter body. an elongate catheter body defining a first lumen through which the catheter is inserted; and a distal segment of the catheter body. a tube attached to the proximal end, a distal end, and a second lumen extending therethrough; a tube defining a catheter body; and a proximal end of the tube being joined to the catheter body at a first junction. and the distal end of the tube is attached to the catheter body at a second joint, and the first and A portion of the tube extending between the first and second joints is movable relative to the catheter body. The Company provides medical devices.

[0005] The first joint includes a first cap concentrically mounted onto the proximal end of the tube. The first cap is attached to the catheter body. The second joint is attached to the distal end of the tube. The catheter may include a second cap concentrically attached onto the end, the second cap being At least one of the first and second joints may be attached to the terminating body by a heat shrink tape. The catheter body may include a tube attached to the catheter body by tubing. At least one of the first and second joints is formed by attaching the tube to the catheter body with an adhesive. The tube may be constructed at least in part from a polymer. Preferably, at least one of the first and second joints is a joint that connects a portion of the tube to the catheter body. Attachment of the tube to the catheter body by fusing the tube to a portion of the catheter body. The first lumen does not have to be concentric with the second lumen.

[0006] The medical device further comprises a deflection element attached to a distal segment of the catheter body. the deflection element may be an arcuate surface aligned adjacent to the first lumen. The arcuate surface may define an arc between 45 degrees and 135 degrees.

[0007] The deflection element has a first opening substantially coaxial with the first lumen and a first aperture. and a second opening that is generally perpendicular, the arcuate surface extending between the first and second openings. There may be.

[0008] The deflection element defines a third aperture generally perpendicular to each of the first and second apertures. The deflecting element may be radiopaque and / or may be The deflection element may be movable relative to the catheter body. It may be movable along the axis.

[0009] The present disclosure provides a catheter comprising a proximal segment, a distal segment, and a first loop through the catheter body. an elongated catheter body defining a distal portion and a distal segment attached to the distal portion of the catheter body; A tube having a second lumen passing therethrough that is not concentric with the first lumen. a tube and a deflection element attached to the distal segment of the catheter body. the deflection defining an arcuate surface aligned adjacent to the distal end of the first lumen. and wherein the arcuate surface defines an arc of between 45 degrees and about 135 degrees. provide.

[0010] The deflection element has a first opening substantially coaxial with the first lumen and a first aperture. and a second opening that is generally perpendicular, the arcuate surface extending between the first and second openings. The deflection element may include a third deflection element substantially perpendicular to each of the first and second apertures. The deflecting element may define an opening. The deflecting element may be radiopaque and / or The deflection element may be movable relative to the catheter body. At least a portion of the tube is movable along the longitudinal axis of the catheter. It may be movable independently of the body.

[0011] A more complete understanding of the present disclosure, and its attendant advantages and features, may be obtained from the following detailed description. The disclosure will be more readily understood when considered in conjunction with the accompanying drawings, in which: [Brief description of the drawings]

[0012] [Figure 1] 1 illustrates an example of a medical device constructed according to the principles of the present disclosure. [Diagram 2] FIG. 2 is a detailed view showing a distal segment of the medical device of FIG. 1. [Diagram 3] FIG. 2 is a side view of a distal segment of the medical device of FIG. 1. [Figure 4] 2 is another view of the distal segment of the medical device of FIG. 1. [Diagram 5] FIG. 2 is a distal end view of the medical device of FIG. 1. [Figure 6] FIG. 2 is a proximal end view of the medical device of FIG. 1. [Figure 7] 1 is a side view of an example of a medical device constructed in accordance with the principles of the present disclosure, showing a curved configuration. [Figure 8] 8 is a perspective view of the example medical device shown in FIG. 7 in a bent configuration. [Figure 9] 8 is a front view of the example medical device shown in FIG. 7 in a bent configuration. [Figure 10] 1 illustrates another example of a medical device constructed in accordance with the principles of the present disclosure. [Figure 11] 1 illustrates another example of a medical device constructed in accordance with the principles of the present disclosure. [Figure 12] FIG. 12 is a side view of a distal segment of the medical device of FIG. [Figure 13] 12 is a cross-sectional view of a distal segment of the medical device of FIG. 11. [Figure 14A] 12A-12C show examples of deflection elements of the medical device of FIG. 11. [Figure 14B]12A-12C show examples of deflection elements of the medical device of FIG. 11. [Figure 15] 1 illustrates another example of a deflection element of a medical device constructed in accordance with the principles of the present disclosure. [Figure 16] FIG. 12 is a proximal end view of the medical device of FIG. [Figure 17] FIG. 12 is a distal end view of the medical device of FIG. [Figure 18] 12 is another view showing a distal segment of the medical device of FIG. 11. [Figure 19] 12 is yet another view showing a distal segment of the medical device of FIG. 11. [Figure 20] 16 shows a medical device including the deflection element of FIG. 15 constructed in accordance with the principles of the present disclosure. [Figure 21] 21 is another view showing a distal segment of the medical device of FIG. 20. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0013] The present disclosure provides intravascular medical devices and methods of use thereof. In particular, the present disclosure provides Multiple guidewires that can be steered independently and / or along different segments of the vasculature. Multi-lumen, operable to facilitate treatment with ears or other auxiliary devices Provide a medical device.

[0014] Referring now to the drawings, FIGS. 1-9 show a method for manufacturing a semiconductor device in accordance with the principles and advantages disclosed herein. An example of an intravascular medical device, such as a catheter, 10 is shown. In interventional cardiology, to evaluate and / or treat blockages or other vascular disorders or conditions one or more other devices as disclosed herein, such as those used to The catheter is a minimally invasive device that can be introduced and operated intravenously in conjunction with a catheter chair. The device 10 is generally introduced and operated from outside the patient, routed through the vascular system, and evaluated. The length, flexibility and torque transmission are sufficient to be positioned close to the area to be evaluated or treated. The catheter body 12 generally comprises a hub 14 and a catheter body 12 having a catheter extension. a proximal segment 14 that may connect to and / or terminate at a hub 16; and a distal segment The catheter body 12 further includes a catheter 16 extending therethrough and The distal segment 18 includes or defines a first lumen 20 that exits at the distal segment 18 and a second lumen 2 0, in the distal segment 18, a guidewire is passed and / or a catheter is inserted. The body 12 has a diameter sufficient to introduce one or more fluids through it.

[0015] The catheter body 12 may be constructed from a metal, a polymer, or a combination of a polymer and a metal. Examples of materials that may be used include stainless steel. (SST), nickel titanium (nitinol) or polymers. Examples of metals include superelastic nickel titanium, shape memory nickel titanium, Ti-Ni, Nickel titanium, about 55-60% Ni by weight, Ni-Ti-Hf, Ni-Ti-Pd, Ni- Mn-Ga, 300~400 series, e.g. 304, 316, 402, 440 series SAE grades of stainless steel (SST), MP35N, and 17-7 precipitation in Hardened (PH) stainless steel, other spring steel, or other high tensile strength material, or other biocompatible material Composite metal materials are included.

[0016] The catheter body 12 has an axial torque transmission for pushability, kink resistance, and rotational response. and / or bending flexibility as measured by the torque to failure along its length. One or more cut patterns on the inside to provide a gradual transition in sex may include a plurality of tube components.

[0017] Modulation of flexibility / stiffness over the length of the catheter body 12 can be accomplished in several ways. For example, the flexibility / rigidity of the tubular components of the catheter body 12 may vary depending on the spiral The parameters of the spiral cut pattern (pitch, number of interruptions) were changed, and the spiral cut pattern Additionally, the spiral cut pattern may be controlled by transitioning between The cross-sectional diameter of the lumen is maintained when the tubular module is bent or curved. The spiral cut sections with different cut patterns are The spiral cut pattern may be distributed along the length of the catheter body 1. 2 may be continuous or discontinuous along the length of the device. There are 1, 2, 3, 4, 5, 6, 7, ... n spiral cuts along the The spiral cut sections may be continuous or interrupted. In the example, there may be a constant cut pattern, but the cut pattern may be different between different parts of the tubular module. In this case, the cut pattern may vary, for example in pitch.

[0018] One or more sections of the catheter body 12 may also include a variable pitch pattern within a particular section. Each spiral cut portion may have a size in the range of, for example, about 0.05 mm to about 10 mm. Within a certain pitch, for example pitch 0.1mm, 0.2mm, 0.3mm, 0.4mm , 0.5mm, 0.6mm, 0.7mm, 0.8mm, 0.9mm, 1.0mm, 1.5 mm, 2.0mm, 2.5mm, 3.0mm, 3.5mm, 4.0mm, others available The pitch may also vary within each section. The pitch of the different spiral cut sections may be , may be the same or different compared to other portions of the catheter body 12. Alternatively, the catheter body 12 may have a spiral caliber that varies continuously along the length of the catheter. The spiral may be formed from tubular modules having a spiral pattern within the module. The orientation or handedness of the cut portion may also vary within the spiral cut portion.

[0019] One or more portions of the catheter body 12 may be cut according to the cut pattern of the catheter body 12. The catheter body 12 is provided with a tubular component that is adapted to protect the catheter components and to extend distally through the tubular component of the catheter body 12. Transport of additional tool devices, such as guidewires and balloons, to the desired location. It can be covered with a lining that facilitates the installation of the outer and / or inner lining. The tubing may be formed from a polymer, for example a polymeric tubular structure in which the tube wall is co-extruded. and heat shrinking the tubular structure or dip coating the tubular structure with one of the layers of It can be made by coating the tube wall with a coating process. The polymer jacket material is nylon, polyether block amide, PTFE (polyethylene glycol) (fluoroethylene), FEP (fluorinated ethylene propylene), PFA (perfluoroethylene) fluoroalkoxyalkane), PET (polyethylene terephthalate) or PEEK ( Further, the distal tube portion 120 (also The catheter 100 is made of a hydrophilic polymer to enhance lubricity and tracking. The coating may be coated with a hydrophilic polymer coating, but is not limited to the hydrophilic polymer coating. However, it may contain polyelectrolyte polymers and / or non-ionic hydrophilic polymers. The polyelectrolyte polymers include poly(acrylamide-co-acrylic acid) salts, poly Poly(methacrylamide-co-acrylic acid) salts, Poly(acrylamide-co-methacrylic and non-ionic hydrophilic polymers include poly(lactams), e.g. For example, polyvinylpyrollidone (PVP), Polyurethanes, homopolymers and copolymers of acrylic and methacrylic acid, polyvinyl chloride, Polyvinyl alcohol, polyvinyl ether, sinapic anhydride copolymer (snapic anhydride based copolymer), polyester, hydroxypropyl It may be propyl cellulose, heparin, dextran, polypeptides, etc.

[0020] A lubricious coating may be provided on the catheter body 12 to facilitate movement of the device 10 through the blood vessel. A coating or film of, for example, High molecular weight vinyl polymers, polyalkylene glycols, and alkoxypolyethylene glycols Silicone or hydrogel polymers such as polymeric meshwork or the like; or It can be composed of a non-crosslinked hydrogel, for example polyethylene oxide (PEO). The coatings and liners disclosed herein are suitable for use in a dip coating process. or by spraying the coating onto the exterior and interior surfaces of the tube. It is possible to do so.

[0021] An additional feature of the device 10 and catheter body 12 is the "MODULAR VAS U.S. Patent Application Serial No. 15 / 726,024, entitled "CULAR CATHETER" (U.S. Patent Publication No. 2018 / 0093070), which is incorporated herein by reference in its entirety. , the entire contents of which are incorporated by reference.

[0022] The device 10 includes a secondary lumen coupled to the distal segment 18 of the catheter body 12. The secondary lumen assembly 22 may include a guidewire. or other instrument / auxiliary device through a lumen 26. The tube or tube segment 24 may include a tube or tube segment that defines a 24 may be constructed similarly to the catheter body 12 and / or Tube segment 24 may have certain characteristics and properties similar to those of tube segment 12. The catheter segments 24 are not concentric or coaxial with the catheter body 12, but instead are in a side-by-side configuration. It may be attached to the exterior surface of the catheter body 12 so as to be

[0023] The tube segment 24 has some degree of rotational freedom, movement, and Partially bonded to the catheter body 12 to allow bending and / or displacement. For example, the tube segment 24 may be tubularly joined to form the proximal junction 28. The proximal portion of the tube segment 24 may be coupled to the catheter body 12 and the distal portion may be coupled to the catheter body 12. To form a joint 30, the distal portion of the tube segment 24 is joined to the catheter body 12. The tube segment between the proximal and distal junctions 28, 30 may be A substantial portion of the remaining portion of the catheter 24 may be free to be secured to the catheter body, and / or Or it may be unattached thereto.

[0024] The proximal and distal joints 28, 30 are adapted for a variety of different attachment modalities. For example, each of the joints 28, 30 may include one or more of the following: The connector 20 may include a preformed molded cap that receives a portion of the connector 24 therein. The joints 28, 30 may be sheaths and / or heat sinks surrounding the ends of the tube segments 24. The joints 28, 30 may be formed from shrink tubing and / or may be made of adhesive, heat resistant, or the like. For example, the proximal joint and The distal joints 28, 30 are connected to the joints 28, 30 or the tubes that make up the tube segment 24. The outer polymer layer of the catheter-shaped component may be constructed from a metal such as Nitinol. The conductor may be formed by melting or fusing the conductor to the body 12 .

[0025] The secondary lumen assembly 22 is partially attached to the catheter body 12 along its length. A conventional offset dual lumen catheter that is substantially and / or completely attached to the Provides improved rotational and torque transmission characteristics compared to conventional stents. While in tortuous anatomy, such conventional devices are difficult to insert into the primary lumen / catheter. When attempting to rotate the catheter around its longitudinal axis, the distal segment This can result in offset, incongruent and / or asymmetric bending. Such inharmonic bending and rotation creates a device with a specific rotational orientation at a precise location. Difficulty for physicians trying to access the chair and manipulate or align the device In contrast, device 10 may substantially increase the length of tube segment 24 and Due to the degree of freedom of movement between the distal segment 18 of the catheter body 12, e.g., FIG. As shown in FIG. 9, the curved shape can be bent and more quickly assumed into a contoured curved shape. The section between the tube segment 24 and the distal segment 18 of the catheter body 12 Due to the spontaneous attachment, the two components shift relative to each other and The vehicle can follow the path of least resistance when turning around one or more curves. .

[0026] In another example, the device may be configured without the intervening tube segment 24, as shown in FIG. a proximal joint that is fixed and / or attached to the distal segment 18 of the catheter body 12; The distal junctions 28, 30 may include a guidewire (not shown) or or other devices through the lumens / openings at the proximal and distal junctions 28, 30. The guidewire may be routed and exit at the distal end 36. As such, it has the same degree of freedom of movement relative to the catheter body 12 and thus its Independent movement, bending and rotation are permitted.

[0027] Next, referring to FIG. 11 to FIG. 21, the guidewire GW and / or other auxiliary devices The catheter body 12 and lumen 20 are offset at a substantial angle away from the longitudinal axis LA. Distal to and / or beyond the exit of lumen 20, which may help direct or otherwise steer 1, having a deflection element 32 coupled to or adjacent to the catheter body 12. An additional example of a vise 10 is shown. Such an angled exit is similar to that of lumen 2. The guidewire GW may be at an angle α of about 45 degrees to about 135 degrees from the longitudinal axis LA of the guidewire GW. or other equipment / auxiliary devices, represented by "100" and generally labeled as "100" This can facilitate placement within a side branch or other vascular pathway to which the catheter is attached.

[0028] As shown in FIGS. 14A-14B, the deflection element 32 has a proximal end 34 and a distal end 36. and a guidewire or auxiliary instrument / device is moved away from the longitudinal axis of the catheter body 12. and a ramp face or contoured surface 38 that deflects the light. The contoured surface 38 may be rounded or arcuate to provide the desired angular deflection. 14B, the cross-sectional side view of the axial direction ... An arc may be defined.

[0029] Deflecting element 32 may be used to guide a guidewire or other instrument adjacent to and through lumen 20. into a first opening or guidewire entrance 41a, which is generally coaxial therewith, and into contoured surface 38. extending from the contoured surface 38 to help direct or guide the or an inlet to border the contoured surface 38 and extend outwardly from the device 10. 41a toward a second opening or guidewire exit 41b that is generally perpendicular to , may include or define side walls 39a, 39b. and the second openings 41a, 41b form a continuous open area across the deflection element 32. The catheter is constructed with an additional wall or other structure to prevent a guidewire or other interventional device from forming a deflection path through which the device 10 can traverse and exit the device 10; and / or assembled.

[0030] As shown in FIGS. 18 and 19, the catheter body 12 includes a guide wire 32 for the deflection element 32. defines an opening 41d adjacent and / or flush with the ear exit opening 41b; The opening 41d may be configured to allow the guidewire to pass through the catheter at an angle away from the longitudinal axis. This increases the overall space available to exit the body 12. A guidewire is typically The distal end of the guidewire typically has a stiffness that varies along its length. The larger exit window formed by openings 41b and 41d is more flexible than the proximal portion of the The stiffer portion of the guidewire is more likely to withstand sharper turns than the stiffer portion of the guidewire. or exit the catheter body 12 without the need for bending. The larger exit port allows the catheter body 12 to be moved or pulled back from the guidewire. This facilitates easier relative motion between the device 10 and the guidewire when the device is in place.

[0031] The stiffer portion of the guidewire passes through the catheter body 12 and through the catheter body. To further assist in routing out of 12, deflection elements 32 and / or routing elements 34 may be provided. The distal exit of the member 20 may include one or more flexible guidewires that may expand under the load of the guidewire. It may include soft or elastic edges. Instead of a distal component, the deflection element 32 and / or the distal exit of the lumen 20 may be , rather than simply a vertical side wall, a wall for the guidewire to cross as it exits the catheter body. It may include one or more rounded interior segments that provide a curved interior surface. For example, the guidewire shown in FIG. 15 has a vertical edge that the guidewire contacts as it exits the lumen 20. The edge or sidewall 41e may also include one or more elastic components, and and / or reduce friction with the guidewire and / or prevent kinking of the guidewire. In order to achieve this, the thickness, roundness, etc. may be altered.

[0032] The deflection element 32 is matably attached or coupled to the secondary lumen assembly 22. Such sized and shaped complementary surfaces or segments 40 may be included. In the illustrated example, surface 40 may define a rounded edge of tube segment 24. It is cylindrical to accommodate the shape of the

[0033] With continued reference to FIG. 15, the deflection element 32 has a third opening in its side wall 39b. Alternatively, the third opening 41c may define a guidewire exit 41c. , the deflection element is arranged in a plane other than the plane of the first opening 41b in the longitudinal direction of the lumen 20. The third opening 41c may allow the liquid to exit at an angle generally perpendicular to the adaxial direction. As described in detail in the present application, the present invention provides a method for preventing the guidewire from being dislodged from the device 1 while reducing the displacement of the guidewire. The device 10 is rotated about the aligned guidewire to pull back the guidewire. This makes it possible to

[0034] The device 10 allows a physician to view the location and orientation of the device 10 within a patient's vasculature. to aid in visualization of the patient and to allow the physician to use guidewires and / or other aids The ability to position the instrument / device through the lumen as desired and adjacent to the desired tissue For example, the catheter body 12 and / or the catheter body 14 may include one or more features that enhance Alternatively, the deflection element 32 may include one or more radiopaque markers, and The deflecting element 32 and / or the deflecting element 33 may be constructed from a radiopaque material. Alternatively, the catheter body 12 may include a deflection element 32 disposed within the catheter body 12 and / or the catheter lumen 12. one or more resilient, deformable members for allowing movement relative to the outlet of the member 20 and / or movable components, allowing the physician to A side branch or other auxiliary instrument / device may be provided away from the longitudinal axis of the catheter body 12. provides some longitudinal maneuverability for placement or orientation within other vascular channels. .

[0035] 20-21, an exemplary use of device 10 is shown. The device 10 may be routed into a primary blood vessel or vascular system pathway 100a. The insertion and routing of device 10 into blood vessel 100a is described herein. 2. Route the catheter through a second lumen assembly including a tube segment 24, as shown in FIG. The device 10 may be facilitated by crossing the first guide wire GW1. is located adjacent to or otherwise proximate to a secondary or side branch vascular pathway 100b. The second guide wire GW2 may be inserted into the first lumen of the catheter body 12. 20 to the deflection element 32. 4, so that the second opening or guidewire exit port 41b is substantially aligned with the secondary blood vessel 100b. Such registration and alignment may be achieved by one or more This may be accomplished by a medical imaging modality. Once the desired alignment is achieved, The second guidewire GW2 is routed through the deflection element 32 and The guidewire may be deflected by the guidewire exit 41b into the secondary vessel 100b. The device 10 then has a second guide wire extending from the device 10, as shown in FIG. The portion of the ear GW2 is aligned to the third opening 41c in the side wall 39b of the deflection element. The second guide wire GW2 is rotated about its longitudinal axis so as to extend outward from the The device 10 may then be routed into the secondary vessel 100b for subsequent use. While reducing the "pulling" or deflection on the second guidewire GW2, which remains guided Then, it may be pulled back out of the primary vessel 100a.

[0036] It is to be understood that the present disclosure is not limited to what has been particularly shown and described hereinabove. It will be understood by those skilled in the art that this is not the case. Moreover, nothing to the contrary has been stated hereinbefore. It should be noted that, unless otherwise indicated, all of the accompanying drawings are not to scale. The stem components are readily understood by one of ordinary skill in the art having the benefit of the disclosure herein. So as not to obscure the disclosure with revealing details, appropriate explanations are provided that are relevant to an understanding of the embodiments of the disclosure. The drawings are represented by conventional symbols that show only certain details of the series. Any particular embodiment or illustration described in the document may be expressly shown in another illustration or embodiment. Although some features may be shown without limitation, the features and components of the examples disclosed herein may be used interchangeably. are not necessarily mutually exclusive, and thus would not depart from the scope and spirit of the present disclosure. It is understood that the above-mentioned embodiments may be included in various different combinations or configurations. In view of the teachings of the present application, the scope and spirit of the present disclosure should be limited only by the appended claims. Many changes and modifications are possible without departing from God.

Claims

1. A first lumen is defined through the proximal segment, the distal segment, and the catheter body. an elongated catheter body; A tube attached to the distal segment of the catheter body, the tube having a proximal end, a distal end a tube defining a distal end and a second lumen therethrough; Equipped with the proximal end of the tube is attached to the catheter body at a first joint; the distal end of the tube is attached to the catheter body at a second joint; The portion of the tube extending between the first and second joints is connected to the catheter body. movable relative to the body, Medical devices.

2. The first joint includes a first tubing member concentrically attached onto the proximal end of the tube. Including Chapp, the first cap is attached to the catheter body; The medical device of claim 1.

3. The second joint includes a second tubing member concentrically attached onto the distal end of the tube. Including Chapp, the second cap is attached to the catheter body; The medical device of claim 2.

4. At least one of the first and second joints is secured to the catheter by heat shrink tubing. The medical device of claim 1 including an attachment of the tube to a catheter body.

5. the tube being constructed at least in part from a polymer; At least one of the first and second joints is configured to connect a portion of the tube to the catheter. Attachment of the tube to the catheter body by fusing the tube to a portion of the catheter body. Including chimento, The medical device of claim 1.

6. At least one of the first and second joints is attached to the catheter body by an adhesive. The medical device of claim 1 , comprising an attachment of said tube.

7. 10. The medical device of claim 1, wherein the first lumen is not concentric with the second lumen. Vice.

8. a deflection element attached to the distal segment of the catheter body; The deflection element defines an arcuate surface aligned adjacent to the first lumen. The medical device of claim 1 .

9. The medical device of claim 8, wherein the arcuate surface defines an arc of between 45 degrees and 135 degrees.

10. The deflection element has a first opening that is substantially coaxial with the first lumen and a first a second opening generally perpendicular to the opening; the arcuate surface extends between the first and second openings; The medical device of claim 8.

11. The deflection element has a third aperture that is substantially perpendicular to each of the first and second apertures. The medical device of claim 10 , defining:

12. The medical device of claim 8 , wherein the deflecting element is radiopaque.

13. 10. The catheter of claim 8, wherein the deflection element is movable relative to the catheter body. medical devices.

14. the deflection element is movable along a longitudinal axis of the catheter body. The medical device of claim 8.

15. A first lumen is defined through the proximal segment, the distal segment, and the catheter body. an elongated catheter body; A tube attached to the distal segment of the catheter body, the first a tube defining a second lumen therethrough that is not concentric with the lumen; and a deflection element attached to the distal segment of the catheter body, A deflection element defining an arcuate surface aligned adjacent to the distal end of the first lumen. To Equipped with the arcuate surface defines an arc of between 45 degrees and about 135 degrees; Medical devices.

16. The deflection element has a first opening that is substantially coaxial with the first lumen and a first a second opening generally perpendicular to the opening; the arcuate surface extends between the first and second openings; 16. The medical device of claim 15.

17. The deflection element has a third aperture that is substantially perpendicular to each of the first and second apertures. The medical device of claim 15 , defining

18. The medical device of claim 15 , wherein the deflecting element is radiopaque.

19. 16. The catheter of claim 15, wherein the deflection element is movable relative to the catheter body. Medical devices.

20. the deflection element is movable along a longitudinal axis of the catheter body. The medical device of claim 15.

21. At least a portion of the tube is movable independently of the catheter body. The medical device of claim 15.

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