Abstract: A surgical method for reducing insulin resistance comprises cryolipolysis of mesenteric fat in a controlled manner to avoid tissue ablative temperatures. Cryolipolysis is carried out in stages based on evaluating reduction in volumes of mesenteric fat and fasting glucose levels.

Abstract: An endovascular near critical fluid based cryoablation catheter for creating an elongated lengthwise-continuous lesion in tissue can comprise an elongated shaft, a flexible distal tissue treatment section, and a distal tip. A plurality of flexible tubes can extend through the distal treatment section to transport a near critical fluid to and from the distal tip. The distal treatment section can also include a flexible fluid-sealed cover or barrier layer surrounding the delivery tubes. The cover and tubes can collectively define a space which is filled with a fluidic thermally conductive media. The thermally conductive media, fluid delivery tubes, and the cover can be arranged such that a flow of the near critical fluid through the tube bundle transfers heat between a target tissue and the distal treatment section of the catheter thereby creating the elongated lengthwise-continuous lesion in the tissue.

Abstract: A multimodality or hybrid ablation system includes an ablation apparatus for creating a lesion in target tissue. The ablation apparatus has an ablation shaft including a handle, a first portion, an ablation portion, distal tip, at least one ablation energy delivery lumen, at least one ablation energy return lumen, and a stylet lumen that extends substantially along a length of the ablation shaft from the handle to at least the ablation portion. The ablation apparatus also includes a stylet that is capable of being inserted into the stylet lumen where the stylet is made of a shape-memory material. A plurality of electrodes are arranged on the ablation portion for measuring or verifying tissue contact with the tissue and applying a pulsed electric field. Optionally, the pulsed electric field may be applied after or in parallel with freezing the target tissue.

Abstract: An endovascular near critical fluid based cryoablation catheter for creating an elongated lengthwise-continuous lesion in tissue can comprise an elongated shaft, a flexible distal tissue treatment section, and a distal tip. A plurality of flexible tubes can extend through the distal treatment section to transport a near critical fluid to and from the distal tip. The distal treatment section can also include a flexible fluid-sealed cover or barrier layer surrounding the delivery tubes. The cover and tubes can collectively define a space which is filled with a fluidic thermally conductive media. The thermally conductive media, fluid delivery tubes, and the cover can be arranged such that a flow of the near critical fluid through the tube bundle transfers heat between a target tissue and the distal treatment section of the catheter thereby creating the elongated lengthwise-continuous lesion in the tissue.

Abstract: An ablation apparatus for creating a lesion in target tissue, the ablation apparatus including a handle, an elongate shaft extending from the handle to a distal tip, where the shaft includes a first portion, an ablation portion distal to the first portion and having an outer sheath, and at least one ablation energy element disposed within the outer sheath, where a space is formed between the at least one ablation energy element and the outer sheath. The ablation apparatus further includes a thermally conductive liner disposed within the space.

Abstract: Embodiments described herein are directed to a system for providing alternating freeze and thaw cycles. The system includes a controller, a vessel for holding a working fluid, a pressure generator, a cooler, a cooler heat exchanger, a heater, a heater heat exchanger, a check valve, and a treatment instrument. In some embodiments, the treatment instrument includes a distal end, a proximal end, a connecting portion adjacent to the proximal end, a needle element adjacent the distal end, a handle portion disposed between the proximal and distal end, and a depth-limiting element to limit an injection depth of the needle element.

Abstract: Embodiments described herein are directed to a system for providing alternating freeze and thaw cycles. The system includes a controller, a vessel for holding a working fluid, a pressure generator, a cooler, a cooler heat exchanger, a heater, a heater heat exchanger, a check valve, and a treatment instrument. In some embodiments, the treatment instrument includes a distal end, a proximal end, a connecting portion adjacent to the proximal end, a needle element adjacent the distal end, a handle portion disposed between the proximal and distal end, and a depth-limiting element to limit an injection depth of the needle element.

Abstract: An endovascular near critical fluid based cryoablation catheter for creating an elongated lengthwise-continuous lesion in tissue can comprise an elongated shaft, a flexible distal tissue treatment section, and a distal tip. A plurality of flexible tubes can extend through the distal treatment section to transport a near critical fluid to and from the distal tip. The distal treatment section can also include a flexible fluid-sealed cover or barrier layer surrounding the delivery tubes. The cover and tubes can collectively define a space which is filled with a fluidic thermally conductive media. The thermally conductive media, fluid delivery tubes, and the cover can be arranged such that a flow of the near critical fluid through the tube bundle transfers heat between a target tissue and the distal treatment section of the catheter thereby creating the elongated lengthwise-continuous lesion in the tissue.

Abstract: An ablation apparatus for creating a lesion in target tissue has a handle, an elongate shaft extending from the handle and a distal ablation portion. The distal ablation portion includes a cryogen flow manifold defining a plurality of fluid pathways between an insert body and a sleeve. Cryogen is circulated through the plurality of fluid pathways to create the lesion in the target tissue.

Abstract: A multimodality or hybrid ablation system includes an ablation apparatus for creating a lesion in target tissue. The ablation apparatus has an ablation shaft including a handle, a first portion, an ablation portion, distal tip, at least one ablation energy delivery lumen, at least one ablation energy return lumen, and a stylet lumen that extends substantially along a length of the ablation shaft from the handle to at least the ablation portion. The ablation apparatus also includes a stylet that is capable of being inserted into the stylet lumen where the stylet is made of a shape-memory material. A plurality of electrodes are arranged on the ablation portion for measuring or verifying tissue contact with the tissue and applying a pulsed electric field. Optionally, the pulsed electric field may be applied after, contemporaneously, or for only a portion that the cryo-modality is applied to the target tissue.

Abstract: A method of cooling a material including the steps of (i) providing a cryotherapy instrument, (ii) positioning a portion of the cryotherapy instrument adjacent the material to be cooled, and (iii) circulating a cryogenic fluid through the cryotherapy instrument under physical conditions near a critical point of a liquid-vapor system for the cryogenic fluid. The critical point defines a point in a phase diagram of the liquid-vapor system where molar volumes are substantially equivalent for liquid and gas, whereby vapor lock associated with cooling of the cryotherapy instrument is avoided.

Abstract: An endovascular near critical fluid based cryoablation catheter for creating an elongated lengthwise-continuous lesion in tissue can comprise an elongated shaft, a flexible distal tissue treatment section, and a distal tip. A plurality of flexible tubes can extend through the distal treatment section to transport a near critical fluid to and from the distal tip. The distal treatment section can also include a flexible fluid-sealed cover or barrier layer surrounding the delivery tubes. The cover and tubes can collectively define a space which is filled with a fluidic thermally conductive media. The thermally conductive media, fluid delivery tubes, and the cover can be arranged such that a flow of the near critical fluid through the tube bundle transfers heat between a target tissue and the distal treatment section of the catheter thereby creating the elongated lengthwise-continuous lesion in the tissue.

Abstract: A cryoablation apparatus for creating a lesion in a target tissue includes an expandable energy transfer region formed of a plurality of independent spline ablation members. Manipulation of a control member extending from a handle to the energy transfer region controllably adjusts the shape of the energy transfer region to contact complex anatomies. A service lumen extending through the length of apparatus can slidably receive an ancillary catheter such as a guide catheter or diagnostic catheter. The catheter has particular application to treating conditions of the heart. Related methods and systems are also described.

Abstract: An endoesophageal balloon and catheter for operation with a transesophageal echocardiography (TEE) probe includes an inflatable balloon body disposed over the ultrasound element of the TEE probe, a liquid inflow lumen in fluid communication with the balloon, and a liquid outflow lumen in fluid communication with the balloon. The balloon is inflated with an acoustically transmitting liquid.

Abstract: An ablation apparatus for creating a lesion in target tissue, the ablation apparatus including a handle, an elongate shaft extending from the handle to a distal tip, where the shaft includes a first portion, an ablation portion distal to the first portion and having an outer sheath, and at least one ablation energy element disposed within the outer sheath, where a space is formed between the at least one ablation energy element and the outer sheath. The ablation apparatus further includes a thermally conductive liner disposed within the space.

Abstract: An endovascular near critical fluid based cryoablation catheter for creating an elongated lengthwise-continuous lesion in tissue can comprise an elongated shaft, a flexible distal tissue treatment section, and a distal tip. A plurality of flexible tubes can extend through the distal treatment section to transport a near critical fluid to and from the distal tip. The distal treatment section can also include a flexible fluid-sealed cover or barrier layer surrounding the delivery tubes. The cover and tubes can collectively define a space which is filled with a fluidic thermally conductive media. The thermally conductive media, fluid delivery tubes, and the cover can be arranged such that a flow of the near critical fluid through the tube bundle transfers heat between a target tissue and the distal treatment section of the catheter thereby creating the elongated lengthwise-continuous lesion in the tissue.

Abstract: An endovascular near critical fluid based cryoablation catheter for creating an elongated lengthwise-continuous lesion in tissue can comprise an elongated shaft, a flexible distal tissue treatment section, and a distal tip. A plurality of flexible tubes can extend through the distal treatment section to transport a near critical fluid to and from the distal tip. The distal treatment section can also include a flexible fluid-sealed cover or barrier layer surrounding the delivery tubes. The cover and tubes can collectively define a space which is filled with a fluidic thermally conductive media. The thermally conductive media, fluid delivery tubes, and the cover can be arranged such that a flow of the near critical fluid through the tube bundle transfers heat between a target tissue and the distal treatment section of the catheter thereby creating the elongated lengthwise-continuous lesion in the tissue.

Abstract: A method of cooling a material including the steps of (i) providing a cryotherapy instrument, (ii) positioning a portion of the cryotherapy instrument adjacent the material to be cooled, and (iii) circulating a cryogenic fluid through the cryotherapy instrument under physical conditions near a critical point of a liquid-vapor system for the cryogenic fluid. The critical point defines a point in a phase diagram of the liquid-vapor system where molar volumes are substantially equivalent for liquid and gas, whereby vapor lock associated with cooling of the cryotherapy instrument is avoided.

Abstract: A device for freezing body tissue, the device having a main driving system capable of generating nitrogen under physical conditions near a critical point of a liquid-vapor system for the nitrogen. The critical point defines a point in a phase diagram of the liquid-vapor system where molar volumes are substantially equivalent for liquid and gas and the physical conditions include a pressure of about 33.5 atm.

Abstract: An endovascular near critical fluid based cryoablation catheter for creating an elongated lengthwise-continuous lesion in tissue comprises an elongated shaft, a flexible distal tissue treatment section, and a distal tip. A plurality of flexible tubes extend through the distal treatment section to transport a near critical fluid to and from the distal tip. The distal treatment section is controllably articulated to match the contour of an anatomical region to be treated. In embodiments the distal treatment section includes a superelastic material and assumes a pre-set shape when released from an outer sleeve member. When the catheter is activated, heat is transferred between a target tissue and the distal treatment section of the catheter thereby creating the elongated lengthwise-continuous lesion in the tissue.