US 6,530,878 B2Grant
Method for vascular occlusive therapy
Issue Date:2003-03-11
•10 Claims
•5 Drawing Sheets
Abstract
A method for treating a blood vessel in a wall forming a gastrointestinal tract of a body of a mammal. At least one nonaqueous solution is introduced from the gastrointestinal tract into the vessel. A nonbiodegradable solid is formed in the vessel in the vicinity of a portion of the vessel from the least one nonaqueous solution to create an occlusion in the vessel and thus terminate blood flow to the vessel distal of the occlusion.
Metadata
Assignee
- Scimed Life Systems, Inc.
Inventors
- David E. Silverman
- Alan Stein
Application Information
Application Number:US 09/853,060
Filing Date:2001-05-10
Priority Date:1998-12-11
Art Unit:7
Classifications
IPC:
A61F 200
Field of Search:
600 29600 30424436424423424422424502604507604 13604 96623920623 1623 11623 12
Patent Drawings (5 sheets)
Description
[0002] This application is a continuation application of U.S. patent application Ser. No. 09/412,105 filed Oct. 4, 1999, now U.S. Pat. No. 6,234,955, which is a continuation-in-part of U.S. patent application Ser. No. 09/232,056 filed Jan. 15, 1999, now U.S. Pat. No. 6,238,335, and claims priority to U.S. provisional patent application Serial No. 60/111,884 filed Dec. 11, 1998, the entire contents of each of which are incorporated herein by this reference.
[0003] This invention pertains to the treatment of blood vessels and, more particularly, to the treatment of dilated veins.
[0004] Blood vessels, and specifically veins, in the gastrointestinal tract of a body can often become enlarged. For example, a vein which becomes enlarged and lengthened is known as a varix. Such varices can occur in the wall of the gastrointestinal tract, for example in the vicinity of the lower esophageal sphincter. A dilated vein at the margin of the anus or nearby within the rectum is known as a hemorrhoid. An erosion in the mucous membrane of the gastrointestinal tract is known as an ulcer. Bleeding from ulcers can be either from veins or arteries. Varices, hemorrhoids and ulcers are more suspectable to undesirable bleeding than normal vessels.
[0005] Sclerotherapy is used to treat bleeding of esophageal varices. However, rebleeding is still common in patients receiving sclerotherapy. In addition, the injection of sclerosing agents induces various local and systemic complications. Ligation was developed in an attempt to provide an endoscopic therapy that would be at least as effective as sclerotherapy but have fewer complications. Unfortunately, relatively large vessels can be difficult to ligate. In addition, the ligation procedure can cause tears in the vessel. Hemorrhoids have been treated in the same manner as varices, but these treatment techniques suffer from the same disadvantages discussed above.
[0006] For patients with severely bleeding ulcers, surgery may be required to cauterize the vasculature in the vicinity of the ulcer. Unfortunately, surgical intervention is a major operation with all attendant morbidities, mortality and risk of failure requiring further surgery.
[0007] As can be seen from the foregoing, there is a need for a new and improved method for treating varices, hemorrhoids and gastric ulcers.
[0008] In general, it is an object of the present invention to provide a minimally invasive method for injecting a material into a vessel in the gastrointestinal system of the body to substantially occlude the vessel.
[0009] Another object of the invention is to provide a method of the above character in which the injected material is a nonbiodegradable material.
[0010] Another object of the invention is to provide a method of the above character in which the material is injected as at least one solution and thereafter forms a solid.
[0011] Another object of the invention is to provide a method of the above character in which the at least one solution includes a solution from which a nonbiodegradable solid precipitates.
[0012] Another object of the invention is to provide a method of the above character in which the solution includes a biocompatible polymer and a biocompatible solvent.
[0013] Additional objects and features of the invention will appear from the following description from which the preferred embodiments are set forth in detail in conjunction with the accompanying drawings.
[0014] FIG. 1 is a perspective view of an apparatus for use in the method for treating vessels of the present invention.
[0015] FIG. 2 is a cross-sectional view of a portion of the apparatus of FIG. 1 taken along the line 2—2 of FIG. 1.
[0016] FIG. 3 is an enlarged side view of the distal portion of the apparatus of FIG. 1 taken along the line 3—3 of FIG. 1.
[0017] FIG. 4 is an enlarged side view, similar to FIG. 3, of the distal portion of another embodiment of the apparatus for use in the method for treating vessels of the present invention.
[0018] FIG. 5 is a cross-sectional view of a proximal portion of the apparatus of FIG. 1 taken along the line 5—5 of FIG. 1.
[0019] FIG. 6 is a schematic view of the apparatus of FIG. 1 practicing the method of the present invention for treating varices in the vicinity of the esophageal sphincter.
[0020] FIG. 7 is an enlarged view of a portion of the esophagus and cardia of FIG. 6, taken along the line 7—7 of FIG. 6, showing the method step of FIG. 6.
[0021] FIG. 8 is a cross-sectional view of a treated varix in the area of the esophagus and cardia taken along the line 8—8 of FIG. 7.
[0022] FIG. 9 is an enlarged view, similar to FIG. 7, of a portion of the esophagus and cardia showing the apparatus of FIG. 1 practicing the method of the present invention for treating ulcers in the cardia.
[0023] FIG. 10 is a cross-sectional view of a treated ulcer in the cardia taken along the line 10—10 of FIG. 9.
[0024] FIG. 11 is a schematic view of a step of method of the present invention for treating hemorrhoids in the anal canal.
[0025] FIG. 12 is a cross-sectional view of a treated hemorrhoid in the anal canal taken along the line 12—12 of FIG. 11.
[0026] In general, a method for treating a blood vessel in a wall forming a gastrointestinal tract of a body of a mammal is provided. At least one nonaqueous solution is introduced from the gastrointestinal tract into the vessel. A nonbiodegradable solid is formed in the vessel in the vicinity of a portion of the vessel from the least one nonaqueous solution to create an occlusion in the vessel and thus terminate blood flow to the vessel distal of the occlusion.
[0027] The method of the present invention can be performed with an apparatus of the type shown in FIG. 1. Apparatus or medical device 21 shown therein includes a probe member or probe 22 having an optical viewing device 23. A needle assembly 26 is slidably carried by probe 22. Treatment device 21 further includes a supply assembly 27 mounted to the proximal end portion of needle assembly 26.
[0028] A conventional or other suitable gastroscope or endoscope can be used for probe 22. The exemplary probe 22 shown in FIG. 1 is an Olympus CF Type 40L/I endoscope made by Olympus Corporation of Tokyo Japan. Probe 22 includes a flexible elongate tubular member or insertion tube 31 having proximal and distal extremities 31aand 31band a distal face 32. Insertion tube 31 has been sectioned in FIG. 1 so that only a portion of proximal extremity 31aand distal extremity 31bis shown. A handle means or assembly is coupled to proximal extremity 31aof the insertion tube 31 and includes a conventional handle 33. The tubular insertion tube 31 is provided with a plurality of bores or passageways extending from proximal extremity 31ato distal extremity 31b. A plurality of five such passageways, including a central passageway 36, are shown in FIG. 2.
[0029] An optical viewing device 23 is formed integral with conventional probe 22 and has an optical element or objective lens 37 carried by the central passageway 36 of insertion tube 31. The lens 37 has a field of view at distal face 32 which permits the operator to view forwardly of insertion tube distal extremity 31b. Optical viewing device 37 further includes an eye piece 41 mounted on the proximal end of handle 33. Second and third illumination passageways 42 are provided in insertion tube 31 peripherally of central passageway 36 for carrying respective light fiber assemblies or light guides 43. A connection cable 46, a portion of which is shown in FIG. 1, extends from handle 33 to a conventional light source 47. First and send light guides 43 extend through insertion tube 31 and cable 46 for providing illumination forwardly of insertion tube 31.
[0030] A working passageway or channel 51 is further provided in insertion tube 31 and extends to a side port 52 formed in handle 33. An additional passageway 56 extends through insertion tube 31 and can be used as an air and/or water outlet. Insertion tube 31 is flexible so as to facilitate its insertion and advancement through a body and is provided with a bendable distal end for selectively directing distal face 32 in a desired direction. A plurality of finger operable controls 57 are provided on handle 33 for, among other things, operating the bendable distal end of insertion tube 31 and the supply and removal of fluids through the insertion tube 31.
[0031] Needle assembly 26 can be of any conventional type such as a modified sclerotherapy needle similar to the Bard® Flexitip™ needle manufactured by C.R. Bard, Inc. of Billerica, Md. Needle assembly 26 includes a needle member or needle 61 having a proximal end portion 61aand a distal end portion 61band an optional sleeve member or sleeve 62 having a proximal end portion 62aand a distal end portion 62b. Sleeve 62 is made from any suitable material such as plastic and has a lumen extending longitudinally therethrough for receiving the needle 61. The sleeve 62 and the needle 61 are slidable relative to each other in a longitudinal direction. Needle 61 and sleeve 62 can be slidably disposed within working channel 51 and side port 62 of insertion tube 31 and each have a length so that when distal end portions 61band 62bare extending from distal extremity 31bof the insertion tube 31 or otherwise in the vicinity of distal face 32, proximal end portions 61aand 62aare accessible at side port 52.
[0032] The hollow needle 61 has a passage 63 extending longitudinally therethrough from proximal end portion 61ato distal end portion 61b. The modified needle distal end portion 61bis made from any suitable material such as stainless steel and has a size ranging from 16 to 28 gauge and preferably ranging from 23 to 26 gauge. As shown most clearly in FIG. 3, the distal end portion 61bhas a cylindrical wall 66 for forming internal passage 63 and also has a sharpened or beveled distal end 67 formed in part by a tapered end surface 68. At least one opening 71 is provided in distal end portion 61 and can include or consist of an opening 71aprovided in tapered end surface 68. As an alternative to or in addition to opening 71a, at least one and as shown a plurality of openings 71 can be provided in cylindrical wall 66. A plurality of two openings 71band two additional openings 71care provided in wall 66. Openings 71bare diametrically disposed relative to each other, so as to be 180° apart, and openings 71care also diametrically disposed relative to each other but offset 90° from openings 71b. The openings 71care spaced longitudinally behind the openings 71b. Openings 71band 71ccan be any suitable shape or size and are shown as being elongate or oblong in shape. It should be appreciated that a needle distal end portion 61bhaving only openings 71bor openings 71ccan be provided and be within the scope of the present invention. In one embodiment of needle 61, tapered surface 68 is closed and openings 71 provided only in cylindrical wall 66.
[0033] Another embodiment of the modified distal end portion of the needle 61 is shown in FIG. 4. Distal end portion 61b′ therein has a sharpened or pointed distal end 76 which is generally conical in shape. No opening 71 is provided in the closed pointed end 76. A plurality of three circumferentially-disposed openings 71dare provided in cylindrical wall 66 proximal of pointed end 76. Openings 71dare circumferentially spaced apart at separation angles of approximately 120°. A second set of three openings 71eextend through cylindrical wall 66 proximal of openings 71d. Openings 71eare also circumferentially spaced apart at separation angles of approximately 120°. The openings 71eare angularly offset about the centerline of distal end portion 61b′ relative to the opening 71d.
[0034] A fluid connector 81 is secured to proximal end portion 61aof needle 61 and a gripping member or grip 82 is secured to the proximal end portion 62aof the sleeve 62 (see FIG. 1). Fluid connector 81 includes first and second luer fitting portions 83 and 84, or any other suitable fitting portions, which communicate with passage 63 in needle 61. First luer fitting portion 83 is capped in FIG. 1. Fluid connector 81 and grip 82 are longitudinally movable relative to each other so as to cause relative longitudinal movement between needle 61 and sleeve 62. More specifically, grip 82 can be slid forwardly and rearwardly on proximal end portion 61aof the needle 61 relative to fluid connector 81. Movement of grip 82 forwardly relative to fluid connector 81 causes distal end portion 62bof sleeve 62 to extend fully over distal end portion 61bof the needle 61 so that the needle has fully retracted within sleeve 62. Conversely, movement of grip 82 rearwardly relative to fluid connector 81 causes sleeve distal end portion 62bto retract relative to needle distal end portion 61bso as to expose the needle distal end portion 61b.
[0035] The handle means of treatment device 21 includes supply assembly 27 coupled to proximal extremity 31aof insertion tube 31 (see FIG. 1). More specifically, supply assembly 27 is secured to the proximal extremity of needle assembly 26. The supply assembly 27 is included within the means of treatment device 21 for introducing a liquid or solution through passage 63 of needle 61 and out one or more of the openings 71 provided in the needle distal end portion 61b. Supply assembly 27 comprises a conventional syringe or first syringe 91 having a reservoir or barrel 92 provided with any suitable fitting portion such as luer fitting portion 93 at the forward end thereof and a plunger 94 for dispelling liquid within barrel 92 through luer fitting portion 93. The supply assembly 27 optionally includes second and third reservoirs in the form of second and third syringes 96 and 97. The second syringe 96 is filled with dimethyl sulfoxide (DMSO) or any other suitable liquid. The third syringe 97 is filled with a saline solution or any other suitable aqueous or physiologic solution.
[0036] A manifold assembly or manifold 98 is provided for coupling syringes 91, 96 and 97 to fluid connector 81. In one embodiment, the manifold 98 has a plurality of three stop cocks 101-103 and a plurality of at least two and as shown a plurality of four ports or luer fitting portions. A first luer fitting portion 104 cooperatively mates with the forward luer fitting portion 93 of syringe 91. A second luer fitting portion 106 cooperatively mates with second luer fitting portion 84 of the fluid connector 81. Third and fourth luer fitting portions 107 and 108 are additionally provided. The third luer fitting portion 107 is connected by a tube 109, a portion of which is shown in FIG. 1, to second syringe 96 and the fourth luer fitting portion 108 is connected by a tube 110, a portion of which is shown in FIG. 1, to third syringe 97. The stop cocks 101-103 operate in a conventional manner to direct fluid flow between the luer fitting portions 104 and 106-108. In a further embodiment of the invention (not shown), syringe 91 can be secured directly to fluid connector 81 or the proximal end portion 61aof needle 61. It should be appreciated that manifold 98 can alternatively be provided with less than or greater than four luer fitting portions or be of any other configuration for coordinating fluid flow from a plurality of syringes or other fluid reservoirs.
[0037] Supply assembly 27 further includes an optional delivery device or gun 111 for supplying a plurality of discrete preselected amounts of the fluid within barrel 92 to needle 61 (see FIGS. 1 and 5). Gun 111 has a cylindrical housing 112 made from plastic or any other suitable material for receiving syringe barrel 92. Housing 112 is formed from a base portion 113 and a cover portion 114 pivotally secured to the base portion 113 by hinge 116. A latch 117 is pivotally coupled to the cover portion 114 for engaging base portion 113 and thereby locking the cover portion 114 in a closed position. Housing 112 has a forward opening 118 for receiving luer fitting portion 93 of the syringe 91. A handle 126 made from plastic or any other suitable material depends from base portion 113. The handle 126 has an internal cavity 127. First and second spaced-apart reinforcing members 128 and 129 extend downwardly from the base portion 113 at the front and rear of handle 126. The reinforcing members 128 and 129 are longitudinally aligned and each provided with a bore 132 extending longitudinally therethrough and opening into internal cavity 127. A rod 136 made from plastic or any other suitable material is slidably disposed within bores 132. The rod 136 has a paddle 137 extending upwardly from the rear thereof perpendicularly to the longitudinal axis of the rod. Paddle 137 is adapted to engage the end of syringe plunger 94. A ring 138 sized for receiving a finger of a human hand extends rearwardly from paddle 137 for facilitating the pulling of rod 136 rearwardly in bores 132.
[0038] Rod 136 and paddle 137 are included within the finger operable means of gun 111 for causing incremental relative movement between barrel 92 and plunger 94 of the syringe 91. A trigger 141 extends from an opening 142 at the front of handle 126 below rod 136. The trigger is slidably disposed in a direction parallel to the longitudinal axis of rod 136 between first and second spaced-apart guides 143 provided in internal cavity 127. Trigger 141 moves between a first or fully extended position to a second or fully retracted position. A lever 146 is pivotally coupled to handle 126 by means of a pin 147. The lever 146 has a first end portion 146awhich extends behind trigger 141 and a second end portion 146bhaving a wedge-like shape for engaging one of a plurality of longitudinally spaced-apart notches formed in the bottom of rod 136. When trigger 141 is pulled rearwardly by the finger of a human hand, the trigger engages lever first end portion 146ato cause the lever 146 to pivot about pin 147 from a first or home position to a second or operational position. Lever second end portion 146bmoves forwardly during this half-stroke to engage one of notches 148 and cause the rod 136 to move forwardly relative to housing 112. The paddle 137 follows rod 136 and incrementally pushes plunger 94 into barrel 92 for each pull of trigger 141.
[0039] A fixed stop 151 is provided in handle 126 for limiting the rearward movement of trigger 141 and thus determining the incremental amount of fluid within barrel 92 dispelled from the syringe 91 with each pull of trigger 141. The rearward travel of trigger 141 can be selectively limited by means of one or more additional pins or stops 152, one of which is shown in FIG. 5. Adjustable limit pin 152 is slidably mounted within handle 126 for movement from a first position out of the path of trigger 141 to a second position within the path of the trigger 141 so as to selectively limit the rearward stroke of trigger 141 when engaged and placed in its second position.
[0040] A coil spring 156 or any other suitable biasing number having one end coupled to a pin 157 mounted within handle 126 and a second end secured to the second end portion 146bof lever 146 is provided. Spring 156 urges lever 146 back to its home position, out of engagement with notches 148, when the finger pressure on trigger 141 is released. Spring 156 causes lever first end portion 146ato push trigger 141 outwardly from opening 142 to its home position.
[0041] A finger operable adjustment mechanism 166 is connected to needle proximal end portion 61aand sleeve proximal end portion 62afor causing longitudinal relative movement between the needle 61 and the sleeve 62. The adjustment mechanism 166 can be of any suitable type for use with any suitable needle assembly having a needle and sleeve which are adjustable relative to each other. One embodiment of such an adjustment mechanism 166 is carried by gun 111. As shown in FIG. 1, such adjustment mechanism 166 has a first or forward post 167 and a second or rear post 168 extending upwardly from the top of cover portion 114. The longitudinally spaced-apart posts 167 and 168 extend perpendicularly to barrels 92. A slidable member or slide bar 171 is slidably mounted in a bore (not shown) provided in forward post 167 for forward and rearward movement in a direction parallel to barrel 92. A thumb screw 172 having an enlarged head 172ais slidably disposed in a bore (not shown) provided in rear post 168. Screw head 172aabuts rear post 168 and the other end of screw 172 is threadably received within the back end of slide bar 171. Counterclockwise rotation of thumb screw 172 relative to rear post 168 causes slide bar 171 to move rearwardly toward forward post 167, while clockwise rotation of the thumb screw 172 results in the slide bar 171 moving forwardly away from post 167. An L-shaped coupler 173 is pivotally coupled to the forward end of slide bar 171 by means of a pin 174. The coupler 173 has first and second spaced-apart arms 176 forming a slot 178 therebetween for receiving the central portion of grip 82. A screw 179 extends between the arms 176 for locking the arms to grip 82 and thus longitudinally locking sleeve 62 relative to needle 61.
[0042] Treatment device 21 can be used in the body of a mammal for any suitable procedure such as the treatment of a vessel, preferably a blood vessel, in the upper portion of the gastrointestinal tract. In one such procedure, device 21 is utilized for the treatment of an esophageal varices. A portion of a human body 184 is shown in FIGS. 6-8 and has an internal cavity in the form of esophagus 186 extending through a lower esophageal sphincter 187 to a stomach 188. Such cavity is accessible by a natural body opening in the form of mouth 192 and is defined by a wall 193. Esophagus 186 is part of the gastrointestinal tract of body 184 that extends from mouth 192 to an anus (see FIG. 11).
[0043] The esophageal mucosa 196 serves as the inner layer of the intraluminal wall 193 in the esophagus 186 and the gastric mucosa 197 serves as the inner layer of the intramural wall 193 in the stomach 188. The esophageal mucosa and the gastric mucosa meet at the squamous columnar junction 198. Wall 193 further includes a muscle layer comprising layer of circular muscle 201 extending beneath mucosa layers 196 and 197 and layer of longitudinal muscle 202 beneath circular muscle 201. The muscle layers 201 and 202 each extend around the esophagus 186 and the stomach 188. Wall 193 further includes a submucosal space 203, that is any space located between mucosa layer 196 or 197 and circular muscle layer 201 created by the separation of layer 196 or 197 from muscle layer 201. The wall 193 has a depth or thickness which includes at least mucosa layers 196 or 197, muscle layers 201 and 202 and the submucosal space 203. The phreno-esophageal ligament 204 and diaphragm 206 extend around the esophagus 186 above the lower esophageal sphincter 187.
[0044] A plurality of vessels 207 such as veins, arteries or lymphatic vessels extend through wall 193. At least some of the vessels have an abnormally dilated and enlarged portion in the form of a varix 208 that protrudes from wall 193 (see FIGS. 7 and 8). Each of the varices 208 has proximal and distal portions 208aand 208band, as shown, are in the vicinity of the lower esophageal sphincter 187. The term in the vicinity of the lower esophageal sphincter is defined herein to include at least the lower third of the esophagus, the squamous columnar junction 198, and the gastric cardia or upper portion of the stomach 188.
[0045] In a method of the present invention, at least one nonaqueous solution is introduced into the vessel or blood vessel 207 to form an occlusion in the blood vessel and thus terminate blood flow to the vessel distal of the occlusion. Although any suitable material can be used with the method of the present invention, an inert, nonresorbable material is preferred. One such material comprises at least one solution which when introduced into the body forms a nonbiodegradable solid. As used herein, a solid means any substance that does not flow perceptibly under moderate stress, has a definite capacity for resisting forces which tend to deform it (such as compression, tension and strain) and under ordinary conditions retains a definite size and shape; such a solid includes, without limitation, spongy and/or porous substances. One such embodiment of the at least one solution is first and second solutions which when combined in the body form the nonbiodegradable solid. Another such embodiment is a nonaqueous solution which can be introduced into the body as a liquid and from which a solid thereafter precipitates. A preferred embodiment of such a nonaqueous solution is a solution of a biocompatible polymer and a biompatible solvent which can optionally include a contrast agent for facilitating visualization of the solution in the body.
[0046] A particularly preferred augmenting or bulking solution is a composition comprising from about 2.5 to about 8.0 weight percent of a biocompatible polymer, from about 52 to about 87.5 weight percent of a biocompatible solvent and optionally from about 10 to about 40 weight percent of a biocompatible contrast agent having a preferred average particle size of about 10 μm or less. It should be appreciated that any percents stated herein which include a contrast agent would be proportionally adjusted when the contrast agent is not utilized. Any contrast agent is preferably a water insoluble biocompatible contrast agent. The weight percent of the polymer, contrast agent and biocompatible solvent is based on the total weight of the complete composition. In a preferred embodiment, the water insoluble, biocompatible contrast agent is selected from the group consisting of barium sulfate, tantalum powder and tantalum oxide. In still a further preferred embodiment, the biocompatible solvent is dimethylsulfoxide (DMSO), ethanol, ethyl lactate or acetone.
[0047] The term “biocompatible polymer” refers to polymers which, in the amounts employed, are non-toxic, chemically inert, and substantially non-immunogenic when used internally in the patient and which are substantially insoluble in physiologic liquids. Suitable biocompatible polymers include, by way of example, cellulose acetates (including cellulose diacetate), ethylene vinyl alcohol copolymers, hydrogels (e.g., acrylics), poly(C1-C6) acrylates, acrylate copolymers, polyalkyl alkacrylates wherein the alkyl and alk groups independently contain one to six carbon atoms, polyacrylonitrile, polyvinylacetate, cellulose acetate butyrate, nitrocellulose, copolymers of urethane/carbonate, copolymers of styrene/maleic acid, and mixtures thereof. Copolymers of urethane/carbonate include polycarbonates that are diol terminated which are then reacted with a diisocyanate such as methylene bisphenyl diisocyanate to provide for the urethane/carbonate copolymers. Likewise, copolymers of styrene/maleic acid refer to copolymers having a ratio of styrene to maleic acid of from about 7:3 to about 3:7. Preferably, the biocompatible polymer is also non-inflammatory when employed in situ. The particular biocompatible polymer employed is not critical and is selected relative to the viscosity of the resulting polymer solution, the solubility of the biocompatible polymer in the biocompatible solvent, and the like. Such factors are well within the skill of the art.
[0048] The polymers of polyacrylonitrile, polyvinylacetate, poly(C1-C6) acrylates, acrylate copolymers, polyalkyl alkacrylates wherein the alkyl and alk groups independently contain one to six carbon atoms, cellulose acetate butyrate, nitrocellulose, copolymers of urethane/carbonate, copolymers of styrene/maleic acid and mixtures thereof typically will have a molecular weight of at least about 50,000 and more preferably from about 75,000 to about 300,000.
[0049] Preferred biocompatible polymers include cellulose diacetate and ethylene vinyl alcohol copolymer. In one embodiment, the cellulose diacetate has an acetyl content of from about 31 to about 40 weight percent. Cellulose diacetate polymers are either commercially available or can be prepared by art recognized procedures. In a preferred embodiment, the number average molecular weight, as determined by gel permeation chromatography, of the cellulose diacetate composition is from about 25,000 to about 100,000 more preferably from about 50,000 to about 75,000 and still more preferably from about 58,000 to 64,000. The weight average molecular weight of the cellulose diacetate composition, as determined by gel permeation chromatography, is preferably from about 50,000 to 200,000 and more preferably from about 100,000 to about 180,000. As is apparent to one skilled in the art, with all other factors being equal, cellulose diacetate polymers having a lower molecular weight will impart a lower viscosity to the composition as compared to higher molecular weight polymers. Accordingly, adjustment of the viscosity of the composition can be readily achieved by mere adjustment of the molecular weight of the polymer composition.
[0050] Ethylene vinyl alcohol copolymers comprise residues of both ethylene and vinyl alcohol monomers. Small amounts (e.g., less than 5 mole percent) of additional monomers can be included in the polymer structure or grafted thereon provided such additional monomers do not alter the implanting properties of the composition. Such additional monomers include, by way of example only, maleic anhydride, styrene, propylene, acrylic acid, vinyl acetate and the like.
[0051] Ethylene vinyl alcohol copolymers are either commercially available or can be prepared by art recognized procedures. Preferably, the ethylene vinyl alcohol copolymer composition is selected such that a solution of 8 weight-volume percent of the ethylene vinyl alcohol copolymer in DMSO has a viscosity equal to or less than 60 centipoise at 20° C. and more preferably 40 centipoise or less at 20° C. As is apparent to one skilled in the art, with all other factors being equal, copolymers having a lower molecular weight will impart a lower viscosity to the composition as compared to higher molecular weight copolymers. Accordingly, adjustment of the viscosity of the composition as necessary for catheter delivery can be readily achieved by mere adjustment of the molecular weight of the copolymer composition.
[0052] As is also apparent, the ratio of ethylene to vinyl alcohol in the copolymer affects the overall hydrophobicity/hydrophilicity of the composition which, in turn, affects the relative water solubility/insolubility of the composition as well as the rate of precipitation of the copolymer in an aqueous solution. In a particularly preferred embodiment, the copolymers employed herein comprise a mole percent of ethylene of from about 25 to about 60 and a mole percent of vinyl alcohol of from about 40 to about 75, more preferably a mole percent of ethylene of from about 40 to about 60 and a mole percent of vinyl alcohol of from about 40 to about 60.
[0053] The term “contrast agent” refers to a biocompatible (non-toxic) radiopaque material capable of being monitored during injection into a mammalian subject by, for example, radiography. The contrast agent can be either water soluble or water insoluble. Examples of water soluble contrast agents include metrizamide, iopamidol, iothalamate sodium, iodomide sodium, and meglumine. The term “water insoluble contrast agent” refers to contrast agents which are insoluble in water (i.e., has a water solubility of less than 0.01 milligrams per milliliter at 20° C.) and include tantalum, tantalum oxide and barium sulfate, each of which is commercially available in the proper form for in vivo use and preferably having a particle size of 10 μm or less. Other water insoluble contrast agents include gold, tungsten and platinum powders. Methods for preparing such water insoluble biocompatible contrast agents having an average particle size of about 10 μm or less are described below. Preferably, the contrast agent is water insoluble (i.e., has a water solubility of less than 0.01 mg/ml at 20° C.)
[0054] The term “biocompatible solvent” refers to an organic material liquid at least at body temperature of the mammal in which the biocompatible polymer is soluble and, in the amounts used, is substantially non-toxic. Suitable biocompatible solvents include, by way of example, dimethylsulfoxide, analogues/homologues of dimethylsulfoxide, ethanol, ethyl lactate, acetone, and the like. Aqueous mixtures with the biocompatible solvent can also be employed provided that the amount of water employed is sufficiently small that the dissolved polymer precipitates upon injection into a human body. Preferably, the biocompatible solvent is ethyl lactate or dimethylsulfoxide.
[0055] The term “encapsulation” as used relative to the contrast agent being encapsulated in the precipitate is not meant to infer any physical entrapment of the contrast agent within the precipitate much as a capsule encapsulates a medicament. Rather, this term is used to mean that an integral coherent precipitate forms which does not separate into individual components, for example into a copolymer component and a contrast agent component.
[0056] The compositions employed in the methods of this invention are prepared by conventional methods whereby each of the components is added and the resulting composition mixed together until the overall composition is substantially homogeneous. For example, sufficient amounts of the selected polymer are added to the biocompatible solvent to achieve the effective concentration for the complete composition. Preferably, the composition will comprise from about 2.5 to about 8.0 weight percent of the polymer based on the total weight of the composition and more preferably from about 4 to about 5.2 weight percent. If necessary, gentle heating and stirring can be used to effect dissolution of the polymer into the biocompatible solvent, e.g., 12 hours at 50° C.
[0057] Sufficient amounts of the contrast agent are then optionally added to the biocompatible solvent to achieve the effective concentration for the complete composition. Preferably, the composition will comprise from about 10 to about 40 weight percent of the contrast agent and more preferably from about 20 to about 40 weight percent and even more preferably about 30 to about 35 weight percent. When the contrast agent is not soluble in the biocompatible solvent, stirring is employed to effect homogeneity of the resulting suspension. In order to enhance formation of the suspension, the particle size of the contrast agent is preferably maintained at about 10 μm or less and more preferably at from about 1 to about 5 μm (e.g., an average size of about 2 μm). In one preferred embodiment, the appropriate particle size of the contrast agent is prepared, for example, by fractionation. In such an embodiment, a water insoluble contrast agent such as tantalum having an average particle size of less than about 20 microns is added to an organic liquid such as ethanol (absolute) preferably in a clean environment. Agitation of the resulting suspension followed by settling for approximately 40 seconds permits the larger particles to settle faster. Removal of the upper portion of the organic liquid followed by separation of the liquid from the particles results in a reduction of the particle size which is confirmed under an optical microscope. The process is optionally repeated until a desired average particle size is reached.
[0058] The particular order of addition of components to the biocompatible solvent is not critical and stirring of the resulting suspension is conducted as necessary to achieve homogeneity of the composition. Preferably, mixing/stirring of the composition is conducted under an anhydrous atmosphere at ambient pressure. The resulting composition is heat sterilized and then stored preferably in sealed amber bottles or vials until needed.
[0059] Each of the polymers recited herein is commercially available but can also be prepared by methods well known in the art. For example, polymers are typically prepared by conventional techniques such as radical, thermal, UV, gamma irradiation, or electron beam induced polymerization employing, as necessary, a polymerization catalyst or polymerization initiator to provide for the polymer composition. The specific manner of polymerization is not critical and the polymerization techniques employed do not form a part of this invention. In order to maintain solubility in the biocompatible solvent, the polymers described herein are preferably not cross-linked.
[0060] In another particularly preferred embodiment of the nonaqueous solution, the biocompatible polymer composition can be replaced with a biocompatible prepolymer composition containing a biocompatible prepolymer. In this embodiment, the composition comprises a biocompatible prepolymer, an optional biocompatible water insoluble contrast agent preferably having an average particle size of about 10 μm or less and, optionally, a biocompatible solvent.
[0061] The term “biocompatible prepolymer” refers to materials which polymerize in situ to form a polymer and which, in the amounts employed, are non-toxic, chemically inert, and substantially non-immunogenic when used internally in the patient and which are substantially insoluble in physiologic liquids. Such a composition is introduced into the body as a mixture of reactive chemicals and thereafter forms a biocompatible polymer within the body. Suitable biocompatible prepolymers include, by way of example, cyanoacrylates, hydroxyethyl methacrylate, silicon prepolymers, and the like. The prepolymer can either be a monomer or a reactive oligomer. Preferably, the biocompatible prepolymer is also non-inflammatory when employed in situ.
[0062] Prepolymer compositions can be prepared by adding sufficient amounts of the optional contrast agent to the solution (e.g., liquid prepolymer) to achieve the effective concentration for the complete polymer composition. Preferably, the prepolymer composition will comprise from about 10 to about 40 weight percent of the contrast agent and more preferably from about 20 to about 40 weight percent and even more preferably about 30 weight percent. When the contrast agent is not soluble in the biocompatible prepolymer composition, stirring is employed to effect homogeneity of the resulting suspension. In order to enhance formation of the suspension, the particle size of the contrast agent is preferably maintained at about 10 μm or less and more preferably at from about 1 to about 5 μm (e.g., an average size of about 2 μm).
[0063] When the prepolymer is liquid (as in the case of polyurethanes), the use of a biocompatible solvent is not absolutely necessary but may be preferred to provide for an appropriate viscosity in the nonaqueous solution. Preferably, when employed, the biocompatible solvent will comprise from about 10 to about 50 weight percent of the biocompatible prepolymer composition based on the total weight of the prepolymer composition. When a biocompatible solvent is employed, the prepolymeric composition typically comprises from about 90 to about 50 weight percent of the prepolymer based on the total weight of the composition.
[0064] In a particularly preferred embodiment, the prepolymer is cyanoacrylate which is preferably employed in the absence of a biocompatible solvent. When so employed, the cyanoacrylate adhesive is selected to have a viscosity of from about 5 to about 20 centipoise at 20° C.
[0065] The particular order of addition of components is not critical and stirring of the resulting suspension is conducted as necessary to achieve homogeneity of the composition. Preferably, mixing/stirring of the composition is conducted under an anhydrous atmosphere at ambient pressure. The resulting composition is sterilized and then stored preferably in sealed amber bottles or vials until needed.
[0066] Specific embodiments of nonaqueous solutions suitable for use in the apparatus and methods of the invention are described in U.S. Pat. No. 5,667,767 dated Sep. 16, 1997, U.S. Pat. No. 5,580,568 dated Dec. 3, 1996 and U.S. Pat. No. 5,695,480 dated Dec. 9, 1997 and International Publication Number WO 97/45131 having an International Publication Date of Dec. 4, 1997, the entire contents of which are incorporated herein by this reference.
[0067] In operation and use of treatment device 21 in the method of the present invention, syringe 91 is filled with the nonaqueous solution in preparation of the procedure. The syringe 91 is loaded into gun 111 by opening cover portion 114 to permit placement of barrel 92 within housing 112. Ring 138 is grasped to pull rod 136 rearwardly relative to housing 112 so that paddle 137 is disposed behind the retracted plunger 94. Cover portion 114 is closed and secured to base portion 113 by means of latch 117. The physician thereafter pulls trigger 141 as necessary to cause paddle 137 to engage the rear of plunger 94.
[0068] Although the method of the present invention permits supply assembly 27 to be attached to needle assembly 26 after needle 61 and sleeve 62 have been disposed in working channel 51 of probe 22, the method alternatively permits the supply assembly 26 to be attached to the needle assembly prior to such disposition of the needle assembly within probe 22. In either case, attachment is accomplished by coupling first luer fitting portion 104 of manifold 98 to luer fitting portion 93 of syringe 91 and second luer fitting portion 106 of the manifold to the first luer fitting portion 83 of fluid connector 81. Coupler 173 is pivoted downwardly so that first and second arms 176 thereof engage grip 82 and screw 179 is tightened to secure the grip 82 in the slot 178 between arms 176. Thumb screw 172 is rotated in a counterclockwise direction relative to rear post 191 to ensure that needle 61 is fully retracted within sleeve 62. Thereafter, saline solution syringe 97 is coupled by means of tube 110 to third luer fitting portion 107 of the manifold 98 and DMSO syringe 96 is coupled by means of tube 109 to fourth luer fitting portion 108 of the manifold.
[0069] Probe 22 is prepared by connecting light cable 46 to light source 47 and attaching the proper eyepiece 41 to handle 33. In addition, all other conventional attachments are applied to the probe 22.
[0070] After the patient has been appropriately sedated or anesthetized, probe distal extremity 31bis introduced through mouth 187 into esophagus 191. In this regard, probe handle 33 is grasped by the physician to introduce distal extremity 31bof probe 22 into mouth 187 and advance the insertion tube 31 down esophagus 191 to the vicinity of the varix 207. Optical viewing device 23 facilities such advancement by the physician of insertion tube 31. Insertion tube 31 has a length so that when distal extremity 31bis in the vicinity of the varix 207, proximal extremity 31ais outside of body 184.
[0071] Distal end portions 61band 62bof needle assembly 26 are now inserted through side port 52 of insertion tube 31 and advanced until such distal end portions of needle 61 and sleeve 62 are in the vicinity of insertion tube distal extremity 31b. Needle 61 and sleeve 62 are each movable from a first position in which distal end portions 61band 62bare each retracted within insertion tube 31 and thus recessed within working channel 51 to a second position in which the distal end portions 61band 62bextend distally beyond the end of insertion tube 31. The needle and sleeve each have a sufficient length so that the physician holding gun 111 can extend both the needle and the sleeve distally from distal extremity 31ba significant distance, should that be desired.
[0072] A portion of the procedure for treating varices 207 is shown in FIGS. 6 and 7. Under the guidance of optical viewing device 23, insertion tube distal extremity 31bis maneuvered to a position above the varix 207 to be treated. The physician retracts sleeve 62 relative to needle 61 by means of adjustment mechanism 166 so that needle distal end portion 61bextends beyond sleeve distal end portion 62ba selected amount of at least 2 millimeters and preferably ranging from 2 to 15 millimeters. Such amount of extension can be easily determined for example by correlating such extension as a function of the rotation of thumb screw 172 and properly calibrating the position of thumb screw 172 relative to rear post 168 in this regard. The retraction of needle 61 relative to sleeve 62 can occur either within working channel 51 or after the needle 61 and sleeve 62 have been extended from insertion tube distal extremity 31b.
[0073] The physician optionally cleanses needle passage 63 with DMSO from syringe 96. DMSO cleansing can be determined by observing a slight amount of DMSO being dispelled from needle distal end portion 61b. The DMSO is then removed from passage 63 by withdrawing the plunger of syringe 96 or by any other suitable means. The cleansing of the passage with DMSO inhibits premature precipitation within syringe 91 of the biocompatible polymer in the nonaqueous solution from the DMSO in the nonaqueous solution. Needle passage 63 is next primed with the nonaqueous solution carried by syringe 91 until such solution is available at the openings 71 in needle distal end portion 61b. For simplicity, the operation of conventional stop cocks 101-103 for directing appropriate fluids to and from needle passage 63 will not be discussed in connection with the procedure.
[0074] The nonaqueous solution is injected into blood vessel 207 in the vicinity of the varix 208 to be treated and preferably proximal or upstream of the varix 208. The physician positions insertion tube distal extremity 31bin the esophagus and causes sharpened end 67 of needle 61 to penetrate wall 188 and thus extend into the blood vessel 207 by moving the needle 61 and sleeve 62 closer to side port 52. The field of view of optical viewing device 23 permits the physician to observe the penetration of blood vessel 207. Although the needle 61 and sleeve 62 can penetrate the wall 188 at any angle, it is preferred that the angle of penetration relative to wall 188 be less than 90° and more preferably less than 40°. The physician pulls trigger 141 to cause the desired preselected amount of nonaqueous solution to be introduced through needle 61 extending through probe 22. The openings 71 in needle distal end portion 61bare positioned in wall 193 so that the nonaqueous solution is introduced into the blood vessel. The optional contrast agent within the nonaqueous solution permits the viewing of the nonaqueous solution by means of fluoroscopy. In addition, the introduction of the nonaqueous solution into wall 188 can be monitored transabdominally or transesophageally by ultrasound. The rate of injection of the nonaqueous solution into blood vessel 207 can range from 0.1 cc per minute to 10 cc per minute. The amount of nonaqueous solution so injected into the blood vessel 207 can range from 0.05 to 10 cc and preferably range from 0.25 to 3 cc.
[0075] Once the nonaqueous solution has been introduced into the blood vessel 207, the biocompatible polymer of the nonaqueous solution precipitates to form one or more discrete deposits or solid implants 213 in the blood vessel (see FIGS. 7 and 8). The amount of nonaqueous solution injected into wall 188 for each implant can range from 0.05 cc to 10 cc. Although only a single implant 213 is shown as being created in blood vessel 207, a plurality of implants 213 can be created in the blood vessel. The one or more implants 213 are formed in the vicinity of each varix 208 and preferably in the proximal portion 208aof the varix 208 or in the vessel 207 proximal of the varix 208. However, an implant 213 can also be formed in varix distal portion 208b. Each implant 213 substantially conforms to the shape of the blood vessel 208. Implants 213 which merge with adjacent implants in blood vessel 207 are within the scope of the present invention. It is preferable that each implant 213 be sized and shaped to completely occlude the blood vessel 207 and thus preclude blood flow past the implant 213 (see FIG. 8).
[0076] A saline or other aqueous or physiologic solution can optionally be introduced into the blood vessel 207 after the introduction of the nonaqueous solution in the blood vessel 207 to facilitate dispersion of the DMSO or other biocompatible solvent present in the nonaqueous solution.
[0077] The occlusion of the blood vessel caused by the implant 213 terminates blood flow beyond the implant and thus ceases any bleeding of the varix 208 beyond the implant. The cessation of blood flow beyond the implant eventually causes the varix 208 to atrophy and disappear. The procedure of the invention can optionally be performed in combination with ligatures, sclerosing agents, tissue glues and clotting agents.
[0078] The method of the present invention is broad enough to cover the treatment of vessels in any internal wall of the body. In a further example, the method of the invention can be utilized to treat ulcers in the gastrointestinal tract and more specifically to treat ulcers in the cardia (see FIGS. 9 and 10). Ulcer 221 has a crater 222 formed in the gastric mucosa and has a blood vessel 207 such as blood vessel 223 having an exposed portion 223a. The vessel 223 has an opening 224 in the exposed portion through which the blood 226 of the vessel is flowing. Any suitable device such as treatment device 21 can be utilized in such procedure.
[0079] The method of the present invention for treating ulcers is substantially similar to the method described above for treating varices. In general, and as more specifically described above, probe distal extremity 31bis introduced through mouth 198 into esophagus 191 and distal end portions 61band 62bof needle assembly 26 advanced through insertion tube 31 until such distal end portions are in the vicinity of insertion tube distal extremity 31b. Under the guidance of optical viewing device 23, insertion tube distal extremity 31bis maneuvered to a position above the ulcer 221 to be treated. After optionally cleansing needle passage 63 with DMSO, the needle passage is primed with any suitable solution such as the nonaqueous solution discussed above.
[0080] The nonaqueous solution is injected by the physician into vessel 223 in the vicinity of the exposed portion 223aand preferably proximal or upstream of the opening 224. The physician positions insertion tube distal extremity 31bin the cardia and causes sharpened end 67 of needle 61 to penetrate vessel 223 by moving the needle 61 and sleeve 62 closer to side port 52. The field of view of optical viewing device 23 permits the physician to observe the penetration of vessel 223. The physician pulls trigger 141 to cause the desired preselected amount of nonaqueous solution to be introduced through needle 61 and the one or more of openings 71 disposed in the vessel 223. The optional contrast agent within the nonaqueous solution permits the viewing of the nonaqueous solution by means of fluoroscopy. In addition, the introduction of the nonaqueous solution into the vessel 223 can be monitored transabdominally or transesophageally by ultrasound. The rate of injection of the nonaqueous solution into vessel 223 can range from 0.1 cc per minute to 10 cc per minute. The amount of nonaqueous solution so injected into the vessel 223 can range from 0.05 to 10 cc and preferably range from 0.25 to 3 cc.
[0081] Once the nonaqueous solution has been introduced into the vessel 223, the biocompatible polymer of the nonaqueous solution precipitates to form one or more discrete deposits or solid implants 227 in the vessel (see FIGS. 9 and 10). The amount of nonaqueous solution injected into ulcer 221 for each implant can range from 0.05 cc to 10 cc. First and second implants 227aand 227bare shown in vessel 223 in FIG. 10. It is preferable that at least one of the implants 227abe formed upstream of the opening 224. The second implant 227bin FIG. 10 is formed downstream of the opening 224 to inhibit any retrograde blood flow from the opening. Although only two implants 227 are shown as being created in vessel 223, one or a plurality of implants 227 can be created in the vessel. Each implant 227 is sized and shaped in a manner similar to implants 213 discussed above with respect to varices 208. More specifically, it is preferable that each implant 227 be sized and shaped to completely occlude the vessel 223 and thus preclude blood flow past the implant 227 (see FIG. 10). A saline or other aqueous or physiologic solution can optionally be introduced into the vessel 223 for facilitating the dispersion of the DMSO or other biocompatible solvent present in the nonaqueous solution.
[0082] The occlusion of vessel 223 caused by the implant 227 terminates blood flow beyond the implant and thus ceases any bleeding of the ulcer 221 beyond the implant. The cessation of blood flow beyond the implant 227 eventually causes the portion of vessel 223 distal of the implant to atrophy. The procedure of the invention can be used with used with cauterizing and/or clotting agents.
[0083] Additional implants 228 can be formed in the wall 193 forming stomach 188 for creating a tamponade to inhibit blood flow from opening 224. Several of such implants 228 are shown in muscle layers 201 and 202 in FIG. 10. The implants 228 are substantially similar to the implants described above and can be formed in the manner described above. It should be appreciated that implants 228 for the tamponade can be formed in all or any of the layers forming wall 193.
[0084] Other supply and/or injection assemblies, such as any of those described in copending U.S. patent application Ser. No. 09/232,056 filed Jan. 15, 1999, can be used with probe 22 and needle assembly 26 in the methods of the invention for treating vessels 207 in the upper gastrointestinal tract. In addition, such methods are not limited to the transesophageal or intraesophageal methods described above. The methods herein can also be performed by surgical procedures such as a laparotomy, thoracotomy, laparoscopy or thoracoscopy.
[0085] In a further specific method of the present invention, the method can be used to treat one or more vessels such as hemorrhoids 231 located in the lower portion of the gastrointestinal tract (see FIGS. 11 and 12). Such lower portion of the gastrointestinal tract includes the anal canal or rectum 232 and opens to the outside of body 184 at the anus 233. The inner layer of the rectal wall 236 forming rectum 232 is mucosal layer 237. A layer of muscle extends around the rectum 232 and also forms part of rectal wall 236. Such muscle layer comprises circular muscle layer 241 extending beneath mucosal layer 237 and longitudinal muscle layer 242 extending beneath muscle layer 241. Body 184 further includes the anal sphincter 246 having the sphincter ani internus 247 and the sphincter ani externus 248. The sphincter ani internus 247 forms the terminus of circular muscle layer 241 at anus 233. The sphincter ani externus 248 comprises a deep external sphincter 251, the superficial external sphincter 252 and the subcutaneous external sphincter 253. For purposes of this application, rectal wall 236 and thus the wall of the gastrointestinal tract of body 184 includes both the sphincter ani internus 247 and the sphincter ani externus 248. Hemorrhoids 231 are formed from a plurality of blood vessels 256 having enlarged portions 256aand can be internal or external of rectal wall 236.
[0086] In the method of the present invention for treating hemorrhoids 231, a solution is introduced into the vessels or blood vessels 256 forming the hemorrhoids to occlude blood flow to the enlarged portion 256aof the hemorrhoid. One preferred apparatus for introducing the solution into hemorrhoids 231 is a conventional syringe 261 having a barrel 262 filled with any suitable solution such as the nonaqueous solution discussed above. A conventional elongate needle 263 is connected to syringe 261 for delivering the solution from barrel 262 into the hemorrhoid. Tubular needle 263 can be of a conventional type and, as such, provided with a single opening at the distal end thereof. Alternatively, needle 263 can be similar to any of the needles described above.
[0087] The nonaqueous solution is injected by the physician into blood vessel 256 in the vicinity of the enlarged portion 256aand preferably proximal of the enlarged portion 256a. In this regard, the physician introduces the needle 263 through anus 233 and into rectum 232 and thereafter causes the sharpened end of needle 263 to penetrate blood vessel 256. The physician pushes down on the syringe plunger to cause the desired preselected amount of nonaqueous solution to be introduced through the needle into the blood vessel. The optional contrast agent within the nonaqueous solution permits the viewing of the nonaqueous solution by means of fluoroscopy. The rate of injection of the nonaqueous solution into blood vessel 256 can range from 0.1 cc per minute to 10 cc per minute. The amount of nonaqueous solution so injected into the blood vessel 256 can range from 0.05 to 10 cc and preferably range from 0.25 to 3 cc.
[0088] Once the nonaqueous solution has been introduced into the blood vessel 256, the biocompatible polymer of the nonaqueous solution precipitates to form one or more discrete deposits or solid implants 266 in the hemorrhoid 231 (see FIGS. 11 and 12). The amount of nonaqueous solution injected into the hemorrhoid 231 for each implant can range from 0.05 cc to 10 cc. Although only a single implant 266 is shown as being created in the hemorrhoid 231, a plurality of implants 266 can be created in the hemorrhoid. The one or more implants 266 are formed in the vicinity of enlarged portion 256aand preferably proximal of the enlarged portion 256aof the hemorrhoid 231. Each implant 266 is sized and shaped in a manner similar to implants 213 discussed above with respect to varices 208. More specifically, it is preferable that each implant 266 be sized and shaped to completely occlude the blood vessel 256 and thus preclude blood flow past the implant 266 (see FIG. 12). A saline or other aqueous or physiologic solution can optionally be introduced into the blood vessel 256 for facilitating the dispersion of the DMSO or other biocompatible solvent present in the nonaqueous solution.
[0089] The occlusion of blood vessel 256 caused by the implant 266 terminates blood flow beyond the implant and thus ceases any bleeding of the hemorrhoid 231 beyond the implant. Such cessation of blood flow eventually causes the hemorrhoid 231 to atrophy and disappear. The procedure hereof for treating hemorrhoids can be used in combination with ligatures.
[0090] Other apparatus can be utilized for treating hemorrhoids 231 in accordance with the method of the present invention. For example, apparatus of the type disclosed in U.S. patent application Ser. No. 09/286,245, the entire contents of which are incorporated herein by this reference, can also be utilized in the method hereof.
[0091] The needle assembly of the present invention can have other configurations. For example, the needles disclosed herein can be provided with a plurality of lumens or passages extending longitudinally therethrough for permitting multiple liquids to be separately carried by the needle. In a further alternative embodiment, a plurality of needles can be introduced through the working channels of any suitable probe such as probe 22 or otherwise utilized in the methods disclosed herein. Each of such needles can be used to perform one or more of the steps of the invention. For example, separate needles can be provided for the introduction of the nonaqueous solution, for the introduction of the DMSO or other biocompatible solvent and for the introduction of the saline solution or other physiologic or aqueous solution.
[0092] In addition, although the method and apparatus of the invention have been described as utilizing a biocompatible polymer and a biocompatible solvent, the method and apparatus can be modified as necessary when other solutions such as those containing prepolymers are utilized. It should be appreciated that the syringes or other reservoirs described herein can be manually operated, as shown, or automated. For example, a conventional single-speed, multi-speed, programmable or other syringe pump can be used for automation. Further, in procedures where no saline or similar solution is utilized, the saline solution syringe and the related saline solution fluid flow hardware need not be provided in the treatment device.
[0093] It should be appreciated that the implants of the present invention can be used as delivery vehicles for other materials such as radioisotopes, chemotherapeutic agents, anti-inflammatory agents and/or antibiotics. The optional contrast agent in the implants permits the implants to be monitored after completion of the procedure described above. Thus the stability of the implant and its configuration can be observed over time. Further procedures can be performed to supplement previously formed implants.
[0094] From the foregoing, it can be seen that a minimally invasive method for injecting a material into a vessel of the gastrointestinal tract of a body to substantially occlude the vessel has been provided. The injected material can be a nonbiodegradable material and, preferably, can be at least one solution which forms a solid in the vessel. The at least one solution can include a solution from which a nonbiodegradable solid precipitates. The solution is preferably a biocompatible polymer and a biocompatible solvent.
Claims
What is claimed is:
1. A method for treating a vessel in a wall of a body of a mammal comprising the step of forming at least one implant in the wall in the vicinity of the vessel to create a tamponade and thus inhibit blood flow in the vessel distal of the tamponade.
2. The method of claim 1 wherein the forming step includes the step of forming a plurality of implants in the wall in the vicinity of the vessel to create the tamponade.
3. The method of claim 1 wherein the at least one implant is a nonbiodegradable implant.
4. The method of claim 1 wherein the at least one implant is a biocompatible polymer.
5. The method of claim 1 wherein the forming step includes the step of introducing at least one nonaqueous solution into the wall.
6. The method of claim 5 wherein the at least one nonaqueous solution is a solution of a biocompatible polymer and a biocompatible solvent and wherein the forming step further includes the step of precipitating a biocompatible polymer from the solution to form the at least one implant.
7. The method of claim 6 wherein the solution of the biocompatible polymer and the biocompatible solvent has a composition comprising from about 2.5 to about 8.0 weight percent of a biocompatible polymer, from about 10 to about 40 weight percent of water insoluble biocompatible contrast agent and from about 52 to about 87.5 weight percent of a biocompatible solvent.
8. The method of claim 6 wherein the solution of the biocompatible polymer and the biocompatible solvent has a composition comprising from about 2.5 to about 8.0 weight percent of a biocompatible polymer, from about 10 to about 40 weight percent of a water soluble biocompatible contrast agent and from about 52 to about 87.5 weight percent of a biocompatible solvent.
9. The method of claim 5 wherein the introducing step includes the steps of extending a needle into the wall and supplying the at least one solution through the needle into the wall.
10. The method of claim 1 wherein the forming step includes the step of introducing a solution into the wall and precipitating a material from the solution to form the at least one implant.
Patent Citations (35)
| Patent | Date | Inventor | Cited By |
|---|---|---|---|
| US3094122(A) | 1963-06-01 | Gauthier et al. | Applicant |
| US3204634(A) | 1965-09-01 | Koehn | Applicant |
| US4271827(A) | 1981-06-01 | Angelchik | Applicant |
| US4351333(A) | 1982-09-01 | Lazarus et al. | Applicant |
| US4424208(A) | 1984-01-01 | Wallace et al. | Applicant |
| US4582640(A) | 1986-04-01 | Smestad et al. | Applicant |
| US4773393(A) | 1988-09-01 | Haber et al. | Applicant |
| US4803075(A) | 1989-02-01 | Wallace et al. | Applicant |
| US4837285(A) | 1989-06-01 | Berg et al. | Applicant |
| US5007940(A) | 1991-04-01 | Berg | Applicant |
| US5067965(A) | 1991-11-01 | Ersek et al. | Applicant |
| US5116387(A) | 1992-05-01 | Berg | Applicant |
| US5158573(A) | 1992-10-01 | Berg | Applicant |
| US5204382(A) | 1993-04-01 | Wallace et al. | Applicant |
| US5258028(A) | 1993-11-01 | Ersek et al. | Applicant |
| US5301682(A) | 1994-04-01 | Debbas | Applicant |
| US5314473(A) | 1994-05-01 | Godin | Applicant |
| US5336263(A) | 1994-08-01 | Ersek et al. | Applicant |
| US5451406(A) | 1995-09-01 | Lawin et al. | Applicant |
| US5480644(A) | 1996-01-01 | Freed | Applicant |
| US5490984(A) | 1996-02-01 | Freed | Applicant |
| US5580568(A) | 1996-12-01 | Greff et al. | Applicant |
| US5667767(A) | 1997-09-01 | Greff et al. | Applicant |
| US5695480(A) | 1997-12-01 | Evans et al. | Applicant |
| US5755658(A) | 1998-05-01 | Wallace et al. | Applicant |
| US5785642(A) | 1998-07-01 | Wallace et al. | Applicant |
| US5792478(A) | 1998-08-01 | Lawin et al. | Applicant |
| US5830178(A) | 1998-11-01 | Jones et al. | Applicant |
| US5861036(A) | 1999-01-01 | Godin | Applicant |
| US6234955(B1) | 2001-05-01 | Silverman et al. | Examiner |
| WO97/19643 | 1997-06-01 | Applicant | |
| WO97/45131 | 1997-12-01 | Applicant | |
| WO98/01088 | 1998-01-01 | Applicant | |
| WO98/17200 | 1998-04-01 | Applicant | |
| WO98/17201 | 1998-04-01 | Applicant |
Non-Patent Literature (32)
- Society of Am. Gastrointestinal Endoscopic Surgeons, Los Angeles, CA, “Granting of Privileges for Laparascopic General Surgery”, (Mar. 1991), Am. Jrnl. of Surgery, vol. 161, pp. 324-325.Applicant
- Aye, R.W. et al., “Early Results With the Laparoscopic Hill Repair”, (May 1994), Am. Jrnl. of Surgery, vol. 167, pp. 542-546.Applicant
- Collard, J.M. et al., “Laparoscopic Antireflux Surgery/What is Real Progress?”, (1994), Annals of Surgery, vol. 220, No. 2, pp. 146-154.Applicant
- DeMeester, T.R. et al., “Nissen Fundoplication for Gastroesophageal Reflux Disease”, (1986), Annals of Surgery, vol. 204, No. 1, pp. 9-20.Applicant
- Donahue, P.E. et al., “The Floppy Nissen Fundoplication/Effective Long-term Control of Pathologic Reflux”, (Jun. 1985), Arch Surg, vol. 120, pp. 663-668.Applicant
- Ellis, Jr., F.H., “The Nissen Fundoplication”, (1992), Ann. Thorac. Surg., vol. 54, pp. 1231-1235.Applicant
- Grande, L. et al., “Value of Nissen fundoplication in patients with gastro-oesophageal reflux judged by long-term sympton control”, (1994), Brit. Jnl. of Surgery, vol. 81, pp. 548-550.Applicant
- Hill, L.D. et al., “Laparoscopic Hill Repair”, (Jan. 1994), Contemporary Surgery, vol. 44, No. 1, pp. 13-20.Applicant
- Hunter, J.G. et al., “A Physiologic Approach to Laparoscopic Fundoplication for Gastroesophageal Reflux Disease”, (1996), Annals of Surgery, vol. 223, No. 6, pp. 673-687.Applicant
- Ireland, A.C. et al., “Mechanisms underlying the antireflux action of fundoplication”, (1993), Gut, vol. 34, pp. 303-308.Applicant
- Johansson, J. et al., “Outcome 5 years after 360° fundoplication for gastro-oesophageal reflux disease”, (Jan. 1993), Brit. Jnl. of Surgery, vol. 80, pp. 46-49.Applicant
- Kauer, W.K.H. et al., “Mixed Reflux of Gastric and Duodenal Juices Is More Harmful to the Esophagus than Gastric Juice Alone/The Need for Surgical Therapy Re-Empasized”, (1995) Annals of Surgery, vol. 222, No. 4, pp. 525-533.Applicant
- Klingman, R.R. et al., “The Current Management of Gastroesophageal Reflux”, (1991), Adv. Surg., vol. 24, pp. 259-291.Applicant
- Little, A.G., “Mechanisms of Action of Antireflux Surgery: Theory and Fact”, (1992), World Jnl. of Surgery, vol. 16, pp. 320-325.Applicant
- Luostarinen, M., “Nissen Fundoplication for Reflux Esophagitis/Long-Term Clinical and Endoscopic Results in 109 of 127 Consecutive Patients”, (1993), Annals of Surgery, vol. 217, No. 4, pp. 329-337.Applicant
- Luostarinen, M. et al., “Fate of Nissen fundoplication after 20 years. A clinical, endoscopical, and functional analysis”, (1993), Gut, vol. 34, pp. 1015-1020.Applicant
- Malizia, A. et al., “Migration and Granulomatous Reaction After Periurethral injection of Polytef (Teflon)”, (Jun. 1984), JAMA, vol. 251, No. 24, pp. 3277-3281.Applicant
- Martin, C. et al., “Collis-Nissen Gastroplasty Fundoplication For Complicated Gastro-Oesophageal Reflux Disease”, (1992), Aust. N.Z. Jnl. Surg., vol. 62, pp. 126-129.Applicant
- O'Connor, K.W. et al., “Endoscopic placement of collagen at the lower esophageal sphincter to inhibit gastroesophagel reflux: a pilot study of 10 medically intractable patients”, (1988), Gastrointestinal Endoscopy, vol. 34, No. 2, pp. 106-112.Applicant
- O'Connor, K. W. et al., “An experiemtnal endoscopic technique for reversing gastroesophageal reflux in dogs by injecting inert material in the distal esophagus”, (1984) Gatrointestinal Endoscopy, vol. 30, No. 5, pp. 275-280.Applicant
- Ortiz, A. et al., “Conservative treatment versus antireflux surgery in Barrett's oesophagus: long-term results of a prospective study”, (1996), Brit. Jnl. of Surg., vol. 83, 274-278.Applicant
- Politano, V. et al., “Periurethral Teflon Injection for Urinary Incontinence”, (Feb. 1974) Jnl. Urology, vol. 111, pp. 180-183.Applicant
- Pope, C., “The Quality of Life Following Antireflux Surgery”, (1992), World Jnl. of Surgery, vol. 16 pp. 355-358.Applicant
- Schulman, C.C. et al., “Endoscopic injections of Teflon to treat urinary incontinence in women”, (Jan. 21, 1984), BMJ, vol. 228, p. 192.Applicant
- Shafik, A., “Intraesophageal Polytef injection for the treatment of reflux esophagitis”, (1996), Surgical Endoscopy, pp. 329-331.Applicant
- Shirazi, S.S. et al., “Long-term Follow-up for Treatment of Complicated Chronic Reflux Esophagitis”, (May 1987), Arch Surg, vol. 122, 548-552.Applicant
- Spechler, S.J. et al., “Comparison of Medical and Surgicl Therapy for Complicated Gastroesophageal Reflux Disease in Veterans”, (Mar. 19, 1992), NE Jnl. of Med, vol. 326, No. 12, pp. 786-792.Applicant
- Spechler, S.J. et al., “The Columnar-Lined Esophagus, Intestinal Metaplasia, and Norman Barrett”, (1996), Gastroenterology, vol. 110, pp. 614-621.Applicant
- Thor, K.B. et al., “A Long-Term Randomized Prospective Trial of the Nissen Procedure Versus a Modified Toupet Technique”, (Dec. 1989), Ann. Surg., vol. 210, No. 6, pp. 719-724.Applicant
- Vaezi, M.F. et al., “Synergism of Acid and duodenogastroesophageal reflux in complicated Barrett's esophagus”, (1995), Surgery, vol. 117, pp. 699-704.Applicant
- Walker, R.D. et al., “Injectable Bioglass as a Potential Substitute for Injectable Polytetrafluoroethylene”, (Aug. 1992), J. Urol., vol. 148, pp. 645-647.Applicant
- Waring, J.P. et al. “The Preoperative Evaluation of Patients Considered for Laparoscopic Antireflux Surgery”, (1995), Am. Jnl. Of Gastroenterolgy, vol. 90, No. 1, pp. 35-38.Applicant