US20050049615A1 - Methods for treating chronic obstructive pulmonary disease - Google Patents

Abstract

The methods and devices disclosed altering gaseous flow within a lung to improve the expiration cycle of individuals having Chronic Obstructive Pulmonary Disease.

Description

CROSS-REFERENCE TO RELATED APPLICATIONS
• This application is a continuation of U.S. patent application Ser. No. 10/633,902, filed Aug. 4, 2003, which is a continuation of U.S. patent application Ser. No. 09/633,651 filed Aug. 7, 2000 now U.S. Pat. No. 6,692,494, which claims the benefit under 35 U.S.C. § 119(e) of U.S. Provisional Patent Application No. 60/147,528 filed Aug. 5, 1999 and 60/176,141 filed Jan. 14, 2000, all of which are incorporated in their entirety.
FIELD OF THE INVENTION
• The invention relates to methods and devices to allow expired air able to pass out of the lung tissue to facilitate both the exchange of oxygen ultimately into the blood and/or to decompress hyper-inflated lungs. The invention also directed to methods and devices to altering gaseous flow within a lung to improve the expiration cycle of an individual, particularly individuals having Chronic Obstructive Pulmonary Disease (COPD).
BACKGROUND OF THE INVENTION
• The term “Chronic Obstructive Pulmonary Disease” (COPD) is generally used to describe the disorders of emphysema and chronic bronchitis. Previously, COPD was also known as Chronic Obstructive Lung Disease (COLD), Chronic Airflow Obstruction (CAO), or Chronic Airflow Limitation (CAL). Some also consider certain types of asthma to fall under the definition of COPD. Emphysema is characterized by an enlargement of air spaces inside the lung. Hence, Emphysema is an anatomic definition and it can only be presumed in a living patient. Chronic bronchitis is characterized by excessive mucus production in the bronchial tree. Chronic bronchitis is a clinical definition and denotes those individuals who meet criteria defining the disease. It is not uncommon for an individual to suffer from both disorders.
• In 1995, the American Lung Association (ALA) estimated that between 15-16 million Americans suffered from COPD. The ALA estimated that COPD was the fourth-ranking cause of death in the U.S. The ALA estimates that the rates of emphysema is 7.6 per thousand population, and the rate for chronic bronchitis is 55.7 per thousand population.
• Those inflicted with COPD face disabilities due to the limited pulmonary functions. Usually, individuals afflicted by COPD also face loss in muscle strength and an inability to perform common daily activities. Often, those patients desiring treatment for COPD seek a physician at a point where the disease is advanced. Since the damage to the lungs is irreversible, there is little hope of recovery. Most times, the physician cannot reverse the effects of the disease but can only offer treatment and advice to halt the progression of the disease.
• To understand the detrimental effects of COPD, the workings of the lungs requires a cursory discussion. The primary function of the lungs is to permit the exchange of two gasses by removing carbon dioxide from venous blood and replacing it with oxygen. Thus, to facilitate this exchange, the lungs provide a blood gas interface. The oxygen and carbon dioxide move between the gas (air) and blood by diffusion. This diffusion is possible since the blood is delivered to one side of the blood-gas interface via small blood vessels (capillaries). The capillaries are wrapped around numerous air sacs called alveoli which function as the blood-gas interface. A typical human lung contains about 300 million alveoli.
• The air is brought to the other side of this blood-gas interface by a natural respiratory airway, hereafter referred to as a natural airway or airway, consisting of branching tubes which become narrower, shorter, and more numerous as they penetrate deeper into the lung. Specifically, the airway begins with the trachea which branches into the left and right bronchi which divide into lobar, then segmental bronchi. Ultimately, the branching continues down to the terminal bronchioles which lead to the alveoli. Plates of cartilage may be found as part of the walls throughout most of the airway from the trachea to the bronchi. The cartilage plates become less prevalent as the airways branch. Eventually, in the last generations of the bronchi, the cartilage plates are found only at the branching points. The bronchi and bronchioles may be distinguished as the bronchi lie proximal to the last plate of cartilage found along the airway, while the bronchiole lies distal to the last plate of cartilage. The bronchioles are the smallest airways that do not contain alveoli. The function of the bronchi and bronchioles is to provide conducting air ways that lead inspired air to the gas-blood interface. However, these conducting airways do not take part in gas exchange because they do not contain alveoli. Rather, the gas exchange takes place in the alveoli which are found in the distal most end of the airways.
• The mechanics of breathing include the lungs, the rib cage, the diaphragm and abdominal wall. During inspiration, inspiratory muscles contract increasing the volume of the chest cavity. As a result of the expansion of the chest cavity, the pleural pressure, the pressure within the chest cavity, becomes sub-atmospheric with respect to the pressure at the airway openings. Consequently, air flows into the lungs causing the lungs to expand. During unforced expiration, the expiratory muscles relax and the lungs begin to recoil and reduce in size. The lungs recoil because they contain elastic fibers that allow for expansion, as the lungs inflate, and relaxation, as the lungs deflate, with each breath. This characteristic is called elastic recoil. The recoil of the lungs causes alveolar pressure to exceed the pressure at airway openings causing air to flow out of the lungs and deflate the lungs. If the lungs' ability to recoil is damaged, the lungs cannot contract and reduce in size from their inflated state. As a result, the lungs cannot evacuate all of the inspired air.
• Emphysema is characterized by irreversible damage to the alveolar walls. The air spaces distal to the terminal bronchiole become enlarged with destruction of their walls which deteriorate due to a bio-chemical breakdown. As discussed above, the lung is elastic, primarily due to elastic fibers and tissues called elastin found in the airways and air sacs. If these fibers and tissues become weak the elastic recoil ability of the lungs decreases. The loss of elastic recoil contributes to more air to entering the air sacs than can exit preventing the lungs from reducing in size from their inflated state. Also, the bio-chemical breakdown of the walls of the alveolar walls causes a loss of radial support for airways which results in a narrowing of the airways on expiration.
• Chronic bronchitis is characterized by excessive mucus production in the bronchial tree. Usually there is a general increase in bulk (hypertrophy) of the large bronchi and chronic inflammatory changes in the small airways. Excessive amounts of mucus are found in the airways and semisolid plugs of this mucus may occlude some small bronchi. Also, the small airways are usually narrowed and show inflammatory changes.
• In COPD, a reduction in airflow arises as a result of 1) partial airway occlusion by excess secretions, 2) airway narrowing secondary to smooth muscle contraction, bronchial wall edema and inflation of the airways, and 3) reduction in both lung elasticity and tethering forces exerted on the airways which maintain patency of the lumen. As a result of the COPD, the airways close prematurely at an abnormally high lung volume. As mentioned above, in an emphysematous lung there is a decrease of lung parenchyma as there are larger and fewer air sacs. Thus, there is a decrease in the amount of parenchymal tissue which radially supports the airways. This loss of radial traction allows the airway to collapse more easily. As lung recoil decreases and airway closure occur at higher lung volumes, the residual volume of gas in the lung increases. Consequently, this increased residual gas volume interferes with the ability of the lung to draw in additional gas during inspiration. As a result, a person with advanced COPD can only take short shallow breaths.
• One aspect of an emphysematous lung is that the flow of air between neighboring air sacs, known as collateral ventilation, is much more prevalent as compared to a normal lung. Yet, while the resistance to collateral ventilation may be decreased in an emphysematous lung the decreased resistance does not assist the patient in breathing due to the inability of the gasses to enter and exit the lungs as a whole.
• Currently, although there is no cure for COPD, treatment includes bronchodilator drugs, and lung reduction surgery. The bronchodilator drugs relax and widen the air passages thereby reducing the residual volume and increasing gas flow permitting more oxygen to enter the lungs. Yet, bronchodilator drugs are only effective for a short period of time and require repeated application. Moreover, the bronchodilator drugs are only effective in a certain percentage of the population of those diagnosed with COPD. In some cases, patients suffering from COPD are given supplemental oxygen to assist in breathing. Unfortunately, aside from the impracticalities of needing to maintain and transport a source of oxygen for everyday activities, the oxygen is only partially functional and does not eliminate the effects of the COPD. Moreover, patients requiring a supplemental source of oxygen are usually never able to return to functioning without the oxygen.
• Lung volume reduction surgery is a procedure which removes portions of the lung that are over-inflated. The improvement to the patient occurs as a portion of the lung that remains has relatively better elastic recoil which allows for reduced airway obstruction. The reduced lung volume also improves the efficiency of the respiratory muscles. However, lung reduction surgery is an extremely traumatic procedure which involves opening the chest and thoracic cavity to remove a portion of the lung. As such, the procedure involves an extended recovery period. Hence, the long term benefits of this surgery are still being evaluated. In any case, it is thought that lung reduction surgery is sought in those cases of emphysema where only a portion of the lung is emphysematous as opposed to the case where the entire lung is emphysematous. In cases where the lung is only partially emphysematous, removal of a portion of emphysematous lung increases the cavity area in which the non-diseased parenchyma may expand and contract. If the entire lung were emphysematous, the parenchyma is less elastic and cannot expand to take advantage of an increased area within the lung cavity.
• Both bronchodilator drugs and lung reduction surgery fail to capitalize on the increased collateral ventilation taking place in the diseased lung. There remains a need for a medical procedure that can alleviate some of the problems caused by COPD. There is also a need for a medical procedure that alleviates some of the problems caused by COPD irrespective of whether a portion of the lung, or the entire lung is emphysematous. The production and maintenance of collateral openings through an airway wall which allows expired air to pass directly out of the lung tissue responsible for gas exchange. These collateral openings ultimately decompress hyper inflated lungs and/or facilitate an exchange of oxygen into the blood.
SUMMARY OF THE INVENTION
• This invention relates to devices and methods for altering gaseous flow in a diseased lung. In particular, the inventive method includes the act of improving gaseous flow within a diseased lung by the step of altering the gaseous flow within the lung. A variation of the inventive method includes the act of selecting a site for collateral ventilation of the diseased lung and creating at least one collateral channel at the site. The term “channel” is intended to include an opening, cut, slit, tear, puncture, or any other conceivable artificially created opening. A further aspect of the invention is to locate a site within a portion of a natural airway of the respiratory system of the patient having the diseased lung. The portion of the natural airway selected for the creation of the collateral channels may be, for example, the bronchi, the upper lobe, the middle lobe, the lower lobe, segmental bronchi and the bronchioles.
• A variation of the invention includes selecting a site for creating a collateral channel by visually examining areas of collateral ventilation. One variation includes visually examining the lung with a fiber optic line. Another example includes the use of non-invasive imaging such as x-ray, ultrasound, Doppler, acoustic, MRI, PET computed tomography (CT) scans or other imaging. The invention further includes methods and devices for determining the degree of collateral ventilation by forcing gas through an airway and into air sacs, reducing pressure in the airway, and determining the reduction in diameter of the airway resulting from the reduction in pressure. The invention further includes methods and devices for determining the degree of collateral ventilation by forcing a volume of gas within the lung near to the airway and measuring pressure, flow, or the return volume of gas within the airway. The invention also includes methods and devices for occluding a section the airway and determining the degree of collateral ventilation between the occluded section of the airway and the air sacs.
• An important, but not necessarily critical, portion of the invention is the step of avoiding blood vessels or determining the location of blood vessels to avoid them. It is typically important to avoid intrapulmonary blood vessels during the creation of the collateral channels to prevent those vessels from rupturing. Thus, it is preferable to avoid intrapulmonary or bronchial blood vessels during the creation of the collateral channels. Such avoidance may be accomplished, for example by the use of non-invasive imaging such as radiography, computed tomography (CT) imaging, ultrasound imaging, Doppler imaging, acoustical detection of blood vessels, pulse oxymetry technology, or thermal detection or locating. The avoidance may also be accomplished using Doppler effect, for example transmission of a signal which travels through tissue and other bodily fluids and is reflected by changes in density that exist between different body tissue/fluids. If the signal is reflected from tissue/fluid that is moving relative to the sensor, then the reflected signal is phase shifted from the original signal thereby allowing for detection. The invention includes devices having at least one sensor for the above described imaging methods. In variations of the invention having multiple sensors, the sensors may be arranged in a linear pattern or in an array pattern. Also, the invention may have a mark to serve as a reference point while the device is remotely viewed.
• The invention may include adding an agent to the lungs for improving the imaging. For example, a gas may be inserted into the lungs to provide contrast to identify hyperinflation of the lungs during an x-ray or other non-invasive imaging. For example,¹³³Xe (Xenon 133) may be used as the agent. Also, a contrast agent may help in identifying blood vessels during CT scans. Another example includes inserting a fluid in the lungs to couple an ultrasound sensor to the wall of an airway.
• Another variation of the act of looking for blood vessels includes insertion of a probe into a wall of the natural airway for the detection of a blood vessel. Such a probe may, for example, detect the presence of a blood vessel upon encountering blood such as when the probe is inserted into a vessel. The probe may also use ultrasonic detection to determine the location of a vessel. For example, ultrasound may be used to determine changes in composition of the tissue beyond the airway wall for determination of the location of a vessel. A probe may, for example, use low frequency radio energy to induce heat at a point and determine the presence of a vessel by measuring a change in temperature due to the conduction of heat by the blood flowing within the vessel. Another variation is that the probe could detect changes in impedance given a pre-arranged discharge of current through the bloodstream. It is also contemplated that the probe is used, for example, purposely to find the blood vessel, so that an alternative site may be selected at a safe distance from the vessel.
• Another variation of the invention is via the delamination of the blood vessel and the wall of an airway. This delamination may occur in many ways. For instance, the airway may be expanded until the vessel separates from the wall of the airway. Or, a vacuum may be applied within the interior of the airway using, for example, two occlusive balloons or the like to isolate a portion of the airway and apply a vacuum. The vacuum between the balloons constricts the diameter of the airway by collapsing the walls of the airway until the exterior walls separate from any blood vessel.
• The invention may also include providing a remotely detectable signal to indicate the presence or absence of any blood vessels at the target site. The invention also includes methods and devices for marking a desired site for the creation of a collateral channel.
• The invention also includes the act of creating one or more collateral channels within the respiratory system of the individual. The collateral channels may have a cross sectional area anywhere between 0.196 mm²to 254 mm². Any subset of narrower ranges is also contemplated. The collateral channels may also extend anywhere from immediately beyond the epithelial layer of the natural airway to 10 cm or more beyond the epithelial layer. The channel or channels should be created such that the total area of the channel(s) created is sufficient to adequately decompress a hyperinflated lung. The channel may be, for example, in the shape of a hole, slit, skive, or cut flap. The channel may be formed by the removal of any portion of the airway wall; e.g., a circumferential or arc-shaped ring of material may be removed to form the channel. Such an excised periphery may be for example, perpendicular or at angled with respect to the axis of the airway.
• Another variation of the invention involves creation of a collateral channel by creating an incision in a natural airway and using a blunt member to push the vessel away from the path of a collateral channel. Another variation of forming the collateral channel is, for example, by use of a mechanical process such as dilation, cutting, piercing, or bursting. For example, a balloon may be used to expand an incision made in the natural airway or the natural airway itself until a collateral channel is opened. Or, a mechanical cutter or piercing tool could be used to open and create the collateral channel. Another variation for creating a collateral channel includes making an incision in the natural airway and placing the wall of the airway in tension, then advancing a blunt instrument into the incision.
• Also, it is anticipated that along with any method of creating a collateral channel any loose material or waste generated by the creation of the collateral channel is optionally removed from the airway.
• Another variation for creating the collateral channel is the creation of the airway using electric energy, for example radio frequency. Or, for example, ultrasonic energy, a laser, microwave energy, chemicals, or cryo-ablative energy may be used to form a collateral channel as well. A feature of these methods often includes creation of a hemostasis in the event that any blood vessel is punctured. For example, use of RF energy provides a hemostasis given a puncture of a vessel by using heat to seal the vessel. Similarly, an ultrasonic scalpel also provides an area of hemostasis in case the vessel is punctured. It is understood that any combination of different methods may be used for forming a single or multiple collateral channels. A variation of the invention includes a limiter for limiting the depth of a collateral channel.
• A variation of the inventive device includes a device that detects motion within tissue using Doppler measurements. The device may include a flexible member having a transducer assembly that is adapted to generate a source signal and receive a reflected signal. The inventive device may also comprise a hole-making assembly that is adapted to making collateral channels within tissue. The transducer assembly may include an acoustic lens which enables the transmission and detection of a signal over a tip of the device. The hole-making assembly may be an RF device and use portions of the tip of the device as RF electrodes, or the hole-making assembly may use ultrasound energy to make the hole.
• Another variation of the invention includes the act of inserting an implant or conduit within a collateral channel to maintain the patency of the channel over time during the expiration cycle of the lung. A conduit could, for example, have distal and proximal ends with a wall defining a lumen extending between the ends. The conduit could have, for example, a porous wall permitting the exchange of gasses through the wall. The conduit may, for example, be comprised of a material such as elastomers, polymers, metals, metal alloys, shape memory alloys, shape memory polymers, or any combination thereof. A variation of the invention includes an expandable conduit, either one that is self-expanding, or one that expands in diameter in relation to any applied radial, or axial force. For example, the conduit may be expanded into an opening of the natural airway upon the inflation of a balloon. A variation of the conduit may include the use of flanges or anchors to facilitate placement of the device within an airway. Another variation of the conduit includes placing a one-way valve within the conduit. Another variation includes using a self cleaning mechanism within the conduit to clear accumulating debris.
• The inventive conduit may be, for example, removable or permanent. Also, another variation of the device includes a means for inserting the conduit within a collateral channel. The conduit may be constructed to allow for passage of gasses through its wall, for example, the conduit may have a wall consisting of a braid. A variation of the conduit may be located through an opening in a wall of an airway and engage both an inside and outside of the wall. Another variation of the conduit includes a distal end having a porous member and a proximal end having a grommet member which engages an opening in a wall of the natural airway. Yet another variation of the implant, for example, comprises an expandable conduit-like apparatus which could bridge an opening within a wall of a natural airway. Another variation includes the conduit-like apparatus having a cutting portion exterior to the device wherein expansion of the device pierces the wall of the natural airway and creates a collateral channel.
• An aspect of the invention is that conduits of varying cross-sectional areas may be placed in various sections of the lung to optimize the effect of the collateral channels.
• Another variation of the invention includes the application of a cyano-acrylate, fibrin or other bio-compatible adhesive to maintain the patency of a collateral channel. The adhesive may be used with or without the conduit described above. For example, the adhesive may be deposited within the collateral channel to maintain patency of the channel or to create a cast implant of the channel. The inventive act further includes the act of delivering medications such as steroids which have been shown to inhibit the healing process, bronchodilators, or other such drugs which aid in breathing, fighting infection, or recovery from the procedure. The steroids inhibit inflammation and then promote the stabilization of the created channel.
• Another variation of the inventive process includes promoting the flow of gasses through under-utilized parenchymal inter-conduits, or bypassing restricted airways. It is also contemplated that the gaseous flow may be altered by, for example, making separate inspiratory and expiratory paths. Also, relieving pressure on the external wall of a natural airway may be accomplished to assist the natural airway by maintaining patency during the expiration cycle of the lung. Yet another variation includes creating collateral channels parallel to existing airflow paths, or the existing airflow paths may be increased in cross-sectional area.
• The invention further includes a device for altering gaseous flow in a diseased lung comprising a locator for locating a site for collateral ventilation of the lung, and optionally, a creating means for opening at least one collateral channel at the site. It is contemplated that the device includes a means for locating a blood vessel as described above. Also, as stated above, the device may use a mechanical, electrical, laser, ultrasonic, microwave, or chemical process for creating a collateral channel. Another variation of the device includes a means for coagulating blood upon the entry of the device into a blood vessel. Yet another variation of the device includes the means for locating and the means for creating are the same. The device may further include a means for simultaneously creating a plurality of collateral channels.
• Another variation of the implant includes conduits constructed from materials that oppose the constriction of the natural airway over time during the expiration cycle of the lung. Yet another variation of the implant includes a device which expands as the pressure in the lung decreases during the expiration cycle.
• The invention further includes a modified respiratory airway having an artificially created channel allowing gaseous communication between an exterior of the airway and an interior of the airway.
• The invention may include an endoscope or a bronchoscope configured to select sites and create collateral channels at those sites. An endoscope or a bronchoscope may also be configured to deploy conduits within the collateral channels. Another variation of the invention includes sizing the device to fit within the working channel of a bronchoscope.
• The invention also includes methods for evaluating an individual having a diseased lung for a procedure to create collateral channels within an airway of the individual. The invention further includes the method of determining the effectiveness of the procedure.
• The invention further includes the act teaching any of the methods described above.
• The invention further includes the method of sterilizing any of the devices or kits described above.
BRIEF DESCRIPTION OF THE DRAWINGS
• FIG. 1A-1C illustrates various states of the natural airways and the blood-gas interface.
• FIGS. 1D-1G illustrate devices and methods for determining the degree of collateral ventilation within a lung.
• FIG. 2A illustrates a natural airway with a collateral channel in relation to a blood vessel.
• FIGS. 2B-2K illustrate methods of avoiding blood vessel prior to the creation of a collateral channel.
• FIGS. 2B-2E illustrate various methods for delaminating an airway from a blood vessel.
• FIG. 2F illustrates the use of a probe to determine a site for creating a collateral channel.
• FIGS. 2G-2K illustrate the use of sensors to determine a site for creating a collateral channel.
• FIGS. 3A-3I illustrate methods of and devices for creating a collateral opening within a natural airway.
• FIGS. 3J-3K illustrate a method of folding epithelial tissue through a collateral channel.
• FIG. 4 illustrates a device and method for simultaneously creating numerous collateral channels or deployment of numerous probes.
• FIGS. 5A-5V illustrate various configuration of implantable conduits.
• FIGS. 6A-6D illustrate devices for detecting blood vessels within tissue.
• FIGS. 6E-6O illustrates various devices for detecting blood vessels within tissue where the devices also include hole-making assemblies.
• FIGS. 6P-6V illustrate various electrode configurations for the hole-making assemblies of the device.
• FIGS. 7A-7B illustrate devices and methods for creating a collateral channel with a device having a hole-making assembly and also preserving the tissue surrounding the collateral channel.
• FIGS. 7C-7D illustrate additional electrode configurations for use with a device of the present invention where the structure of the electrodes limits the possible depth of a collateral channel formed by the electrode.
• FIGS. 8A-8U illustrate variations of conduits of the present invention.
• FIGS. 9A-9I illustrate variations of methods and devices for deployment of conduits of the present invention.
DETAILED DESCRIPTION OF THE INVENTION
• Prior to considering the invention, simplified illustrations of various states of a natural airway and a blood gas interface found at a distal end of those airways are provided inFIGS. 1A-1C.FIG. 1A shows anatural airway100 which eventually branches to ablood gas interface102.FIG. 1B illustrates anairway100 andblood gas interface102 in an individual having COPD. Theobstructions104 impair the passage of gas between theairways100 and theinterface102.FIG. 1C illustrates a portion of an emphysematous lung where theblood gas interface102 expands due to the loss of theinterface walls106 which have deteriorated due to a biochemical breakdown of thewalls106. Also depicted is aconstriction108 of theairway100. It is generally understood that there is usually a combination of the phenomena depicted inFIGS. 1A-1C. More usually, the states of the lung depicted inFIGS. 1B and 1C are often found in the same lung.
• The following illustrations are examples of the invention described herein. It is contemplated that combinations of aspects of specific embodiments or combinations of the specific embodiments themselves are within the scope of this disclosure.
• As will be explained in greater detail below, central to this invention in all of its aspects is the production and maintenance of collateral openings or channels through the airway wall so that expired air is able to pass directly out of the lung tissue and into the airways to ultimately facilitate exchange of oxygen into the blood and/or decompress hyper inflated lungs. The term ‘lung tissue’ is intended to include the tissue involved with gas exchange, including but not limited to, gas exchange membranes, alveolar walls, parenchyma and/or other such tissue. To accomplish the exchange of oxygen, the collateral channels allow fluid communication between an airway and lung tissue. Therefore, gaseous flow is improved within the lung by altering or redirecting the gaseous flow within the lung, or entirely within the lung.FIG. 1D illustrate a schematic of alung118 to demonstrate a principle of the invention described herein. As shown, acollateral channel112 placeslung tissue116 in fluid communication withairways100 allowing expired air to directly pass out of theairways100. As shown, constrictedairways108 may ordinarily prevent air from exiting thelung tissue116. In the example illustrated inFIG. 1D,conduits200 may be placed in thecollateral channels112 to assist in maintaining the patency of thecollateral channels112. Therefore, it is not necessary to pierce the pleura to improve gaseous flow within the lungs. While the invention is not limited to the number of collateral channels which may be created, it is preferable that 1 or 2 channels are placed per lobe of the lung. For example, the preferred number of channels is 2-12 channels per individual patient.
• Accordingly, since the invention is used to improve the function of the lungs, a variation of the inventive device may include an endoscope or a bronchoscope configured to locate a site for creating a collateral channel and create the collateral channel. Another variation includes sizing the inventive device to fit within a working channel of an endoscope or a bronchoscope. For the sake of brevity, hereafter, any reference made to an endoscope includes the term bronchoscope.
• The invention includes assessing the degree of the collateral ventilation taking place in an area of a lung to select a site for creation of a collateral channel. The invention may include locating a site for creation of a collateral channel by visually examining an airway for dynamic collapse. One method of visual examination includes the use of a fiber optic line or camera which may be advanced into the lungs and through the airways. Other variations of visually examining the lung to determine the location of a site for the creation of the collateral channel using non-invasive imaging, including but not limited to radiography, computer tomography, ultrasound, Doppler, and acoustic imaging. Such imaging methods may also be used to determine the amount of collateral channels to be created.
• Also contemplated in the invention is the addition of various agents to assist during imaging of the airways or lungs. One example includes the use of a non-harmful gas, such as Xenon, to enhance the visibility of hyperinflated portions of the lung during radiological imaging. Another example includes the use of inserting a fluid in the lungs to provide an improved sound transmission medium between the device and the tissue in variations of the invention using ultrasound, acoustic, or other imaging.
• Another variation of the invention includes methods and devices for triggering a collapse of the airway to determine the degree of collateral ventilation in the lung. One example includes forcing a fluid, such as a gas, air, oxygen, etc., through the airway and into the air sacs. Next, to assess the patency of the airway, the pressure is reduced in the airway. One example of how pressure is reduced in the airway includes evacuating the air in a direction opposite to the air sacs. Constriction of the airway given a drop in pressure may be an indication of collateral ventilation of the lung in that region.
• FIG. 1E, illustrates a method anddevice212 for causing collapse of theairway wall100. Thedevice212 includes afluid delivery member214 located at a distal end of thedevice212. Thefluid delivery member214 is configured to deliver a volume of fluid through theairway100 and into an air sac (not shown). Thedevice212 may also comprise aprobe216 configured to collect data within the lung. Theprobe216 may also simply consist of a channel that transmits signals outside of the lung. Moreover, thefluid delivery member214 and theprobe216 may not be separate channels. Also, thedevice212 may, but does not necessarily, have anocclusion member218 designed to isolate a section of theairway100 between theocclusion member218 and the air sacs (not shown). Theocclusion member218, which forms a seal against theairway100 walls, may provide a partially closed system allowing a more effective search for collateral ventilation between the air sacs (not shown.) The device delivers a burst of fluid, through thefluid delivery member214 and subsequently uses theprobe216 to measure characteristics such as pressure, flow, or return volume to determine the degree of collateral ventilation. The term fluid is intended to include, air or a gas, such as oxygen, etc. For example, if the air sacs are diseased (as shown inFIG. 1C), the forced fluid will escape/disperse through another air sac due to the collateral ventilation of the air sacs. As a result, theprobe216 may fail to record any increase in pressure, volume, flow, or any other characteristic of the fluid at the site. Another variation of the invention includes using thefluid delivery member214 to add or remove fluid distally to the occluded segment and using theprobe216 to monitor flow or pressure changes in the area. For example, if after adding/removing fluid the pressure in the occluded segment fails to build/drop, the assumption may be made that the gas is being collaterally vented through diseased air sacs.
• FIG. 1F illustrates another variation of the invention. In this example, thedevice220 comprises a separatedprobe216 andgas delivery member214. In this variation, thefluid delivery member214 is configured to pass through a wall of theairway100 so that fluid may be directly forced into, or pulled out of anair sac102.
• FIG. 1G illustrates yet another variation of the invention. In this variation, thedevice222 may have at least onefluid exchange passageway224. Thedevice222 may force fluid into theairway100 via thepassageway224. Then, fluid can be pulled out via thepassageway224, thus decreasing pressure distally to thedevice222. The decrease in pressure permits fluid to flow out of theairway100 and away from the air sac (not shown). In this case, if the air sacs surrounding theairway100 are diseased and collateral ventilation is taking place, then theairway100 may collapse. A variation of the invention may include anexpandable member218, such as a balloon, to create a seal against theairway100 walls. Forming a seal may provide a partially closed system to search for collateral ventilation between air sacs (not shown.) As described above, observation of a collapsingairway100 may indicate a desired site for creation of a collateral channel.
• FIG. 2A illustrates ablood vessel110 on an outer wall of anairway100. In this figure, thecollateral channel112 created using this invention is located away from thevessel wall110. Such a positioning of thecollateral channel112 eliminates the risk of rupturing thevessel110 during formation of thecollateral channel112. As mentioned above, the term channel is intended to include an opening, cut, slit, tear, puncture, or any other conceivable artificially created opening.
• Of course, it is not the case that blood vessels are necessarily as conveniently located as is seen inFIG. 2A. Consequently, it may be desirable to move the vessels or to avoid them.FIG. 2B illustrates a first way of moving the nearby vessel.FIG. 2B shows the inflation of theairway100 using aballoon204 provided on adelivery device202. As shown inFIG. 2C, upon deflation of theballoon204, theairway100 and thevessel110 become delaminated thereby moving the vessel from the region just outside the exterior of the airway. Subsequent creation of a collateral channel using the inventive procedures will be less likely to hit the vessel.
• FIG. 2D demonstrates anotherdevice206 and method for delaminating anairway100 from avessel110. In this variation, the two balloons (204 &205) occlude theairway100. As shown inFIG. 2E, upon application of a vacuum, thevessel110 and theairway100 delaminate as theairway100 separates from thevessel110. It may be desirable to make a channel while the airway is contracted as shown inFIG. 2E.
• FIG. 2F illustrates the insertion of aprobe210 into a wall of theairway100. Although, theprobe210 is illustrated to be a singular probe, thedelivery device208 may be adapted to have multiple probes. As described above, theprobe210 may detect the presence of blood such as when the probe is inserted into a vessel. For example, theprobe210 could be configured to puncture a wall of theairway100, and detect the presence of blood. Optionally, theprobe210 could pull a vacuum to facilitate entry of blood into theprobe210. Theprobe210 may also use ultrasonic detection to determine the location of a vessel. For example, ultrasound may be used to determine changes in composition of the tissue beyond the airway wall for determination of the location of a vessel. Aprobe210 may, for example, use low frequency radio energy to induce heat at a point and determine the presence of a vessel by measuring a change in temperature due to the conduction away or removal of heat by the blood flowing within the vessel. Another variation is that theprobe210 could detect changes in impedance given a pre-arranged discharge of current through the bloodstream. If aprobe210 detects blood during its travel outside the airway, the user could select another spot for a collateral channel.
• Another variation of the invention includes methods and devices for determining whether a blood vessel is in proximity to a potential site. Making this determination prior to creating the channel is advantageous as the risk of puncturing a blood vessel is minimized. As mentioned above, non-invasive imaging may be used to locate blood vessels or to confirm the absence of a vessel at a site.FIG. 2G illustrates an example of this variation of thedevice226 having asingle sensor228. The device may be, but is not necessarily, steerable and rotatable such that thesensor228 can be placed in contact with any portion of theairway100 wall. In non-steerable variations, the device may be located to a site by the use of an endoscope. Thedevice226 may also be stiff so that thesensor228 may be placed in firm contact with a wall of theairway100. It is important that the device does not ‘wander’ causing the creation of a collateral channel at a distance from the area originally searched. Such an occurrence may compromise a blood vessel (e.g., puncture, rupture, or otherwise open the blood vessel) even though the step of detecting the location indicated the absence of a blood vessel. In those cases, a stiffer wall provides added benefits.
• Another variation of the invention includes inserting a fluid into the airway to provide a medium for thesensor228 couple to the wall of theairway100 to detect blood vessels. In those cases where fluid is not inserted, the device may use mucus found within the airway to directly couple thesensor228 to the wall of theairway100.
• FIG. 2H illustrates another variation of theinventive device230 having a plurality ofsensors228 arranged in an array pattern. Although not shown, the array could extend around the circumference of thedevice230.FIG. 2I illustrates yet another variation of the inventive device. In this example, thedevice232 comprises a plurality ofsensors228 arranged in a linear pattern. Although not shown, the pattern may also wind helically or in other patterns around the perimeter of thedevice232.
• FIG. 2J illustrates another variation of the invention. In this example, thedevice234 comprises asensor228 encapsulated by anexpandable member236 e.g., a balloon. Theexpandable member236 may be filled with a fluid or other substance that couples thesensor228 to an outer surface of theexpandable member236. Thesensor228 may be rotatable within theexpandable member236, or theentire device234 may be rotatable within theairway100. Another variation of thedevice234 includes amark238 which provides a reference for orientation of thedevice234 in theairway100. Themark238 is preferably remotely detectable and may be positioned on theexpandable member236.
• Another variation of the invention includes a means for marking the site. This variation of the device allows marking of the site after it is located. Accordingly, once marked, a previously selected site can be located without the need to re-examine the surrounding area for collateral ventilation, or the presence or absence of a blood vessel. The marking may be accomplished by the deposit of a remotely detectable marker, dye, or ink. Or, the marking may comprise making a physical mark on the surface of the airway to designate the site. Preferably, the mark is detectable by such imaging methods as radiography, computer tomography (CT) imaging, ultrasound imaging, doppler imaging, acoustical detection, or thermal detection or locating. Also, the mark may be detectable by direct visualization such as the case when a fiber optic cable is used.FIG. 2K illustrates an example of thedevice240 having asensor228 to locate a site and amarking lumen242 which may deposit an ink, dye, or other marker (not shown) on the site once located.
• Although not illustrated, the invention may include a user interface which provides feedback once an acceptable site is located. For example, once a site is located a visual or audible signal or image is transmitted to the user interface to alert the user of the location of a potential site. The signal could be triggered once a blood vessel is located so that the site is selected in another location. In another example, the signal may trigger so long as a blood vessel is not located.
• FIGS. 3A-3I depict various ways of providing openings in the airway wall which may be used as collateral air passageways.
• FIG. 3A illustrates anairway100 having a piercingmember300 and adilation member302. In this example, the piercingmember300 makes an incision (not shown) in theairway100 wall. Next, the piercingmember300 is advanced into the wall so that adilation member300 can expand the incision to thereby provide a collateral channel. In this example, thedilation member300 is depicted as a balloon. One variation of the invention includes filling a balloon with a heated fluid as the balloon dilates the tissue to form the collateral channel. Use of a heated balloon allows the transfer of heat to the collateral channel for modifying the healing response. However, it is also contemplated that the dilation member may be an expanding wedge (not shown) or other similar device.
• FIG. 3B shows acutting device304 and anairway100 having anopening306 cut from a wall. In this example, aflap308 is cut from the wall and is attached to an outside or an inside wall of theairway100. As will be mentioned below, the flap may be glued, using for instance, fibrin-based or cyano-acrylate-based glues or stapled to that wall.
• FIG. 3C illustrates acutter304 making anincision310 in a wall of theairway100.FIG. 3D illustrates one example of placing the walls of theairway100 in tension and inserting ablunt instrument314 into the incision. In this example, thedelivery device312 is flexible and may be shaped to the contour of anairway100 to provide support for theblunt instrument314 so that theinstrument314 can advance into the incision. Thedelivery device312 is also used to deliver ablunt instrument314 which expands the original incision. Theblunt instrument314 may have a hooked configuration as needed.
• FIG. 3E shows the use of aballoon320 to dilate a previously formed collateral channel in theairway wall100. This procedure may be used variously with other mechanical, chemical, cryo-energy or RF based penetration systems to expand the size of that previously-formed opening.
• FIG. 3F illustrates a variation of thedevice322 having anRF electrode324. This variation of the invention uses RF energy to create a collateral channel. Thedevice322 may be mono-polar or bi-polar. The RF energy throughout this invention is similar to that of a typical RF cutting probe operating between the 300 KHz-600 KHz range.
• FIG. 3G-3I illustrates additional variations of devices of the present invention used to create collateral channels. The devices may use RF energy, either monopolar or bipolar, or the devices may use light, infrared heat, or any of the other methods describe herein. In the variation ofFIG. 3G, thedevice328 has anelectrode324 located on a side of the device. This variation of thedevice328 automatically limits the depth of the collateral channel as the body of thedevice328 remains against anairway100 wall while theelectrode324 creates a channel.
• FIGS. 3H and 3I illustrates another variation of adevice330 of the present invention having anelectrode324 located on a front face of the device.FIG. 3I illustrates a perspective view of thedevice330 with an electrode on thefront face324. Thedevice330 may either have anelectrode324 disposed on a front surface of thedevice330 or the device may comprise a conductive material with an insulatinglayer332 covering thedevice330 and leaving anelectrode surface324 exposed. In the variations illustrated inFIGS. 3G-3I, the size of the electrode may be selected based upon the size of the desired collateral channel.
• The device of the present invention may also be configured to limit the depth of the collateral channel. In one example, the invention may include a shoulder or stop326 to limit the depth of the collateral channel. Another example includes graduated index markings on a proximal end of the device or on the distal end so long as they are remotely detectable. Also contemplated is the use of RF impedance measuring. In this example, the use of RF impedance may be used to determine when the device leaves the wall of the airway and enters the air sac or less dense lung tissue.
• The invention also includes creating a collateral channel by making a single or a series of incisions in an airway wall then folding back the cut tissue through the collateral channel. This procedure allows the surface epithelium which was previously on the inside of the airway wall to cover the walls of the newly formed collateral channel. As discussed herein, promoting growth of the epithelium over the walls of the collateral channel provides a beneficial healing response. The incision may be created by the use of heat or a mechanical surface. For example,FIG. 3J illustrates a section of anairway100 havingseveral incisions356 forming a number ofsections358 of airway wall tissue theairway100.FIG. 3K illustrates the sections orflaps358 of the airway wall folded through thecollateral channel112. Any number ofincisions358 may be made to form any number ofsections358 of airway wall tissue as desired. For example, a plus-shaped incision would result in four sections of tissue that may be folded through a channel. Thesections358 may be affixed with a suture material, an adhesive, or thesections358 may simply be inserted into surrounding tissue to remain folded through thecollateral channel112.
• Another variation of the device includes safety features such as probes to determine the presence of blood. If a probe indicates that a blood vessel is contacted or penetrated, a signal is sent which prevents the channel making device from causing further harm to the vessel. Such a feature minimizes the risk of inadvertently puncturing a blood vessel within the lungs.
• Although the examples depict mechanically forming a collateral opening, the invention is not limited to such. Alternative methods of forming the opening are contemplated in the use of RF energy, bi-polar, or single pole electrosurgical cutters, ultrasonic energy, laser, microwave, cryo-energy or chemicals.
• The present invention includes the use of a device which is able to detect the presence or absence of a blood vessel by placing a front portion of the device in contact with tissue. One variation of the invention includes the use of Doppler ultrasound to detect the presence of blood vessels within tissue. It is known that sound waves at ultrasonic frequencies travel through tissue and reflect off of objects where density gradients exist. In which case the reflected signal and the transmitted signal will have the same frequency. Alternatively, in the case where the signal is reflected from the blood cells moving through a blood vessel, the reflected signal will have a shift in frequency from the transmitted signal. This shift is known as a Doppler shift. Furthermore, the frequency of the signals may be changed from ultrasonic to a frequency that is detectable within the range of human hearing.
• The ultrasound Doppler operates at any frequency in the ultrasound range but preferably between 2 Mhz-30 Mhz. It is generally known that higher frequencies provide better the resolution while lower frequencies offer better penetration of tissue. In the present invention, because location of blood vessels does not require actual imaging, there may be a balance obtained between the need for resolution and for penetration of tissue. Accordingly, an intermediate frequency may be used (e.g., around 8 Mhz).
• FIG. 6A illustrates a variation of adevice600 adapted to determine the presence of blood vessels as previously mentioned. Thedevice600 includes a flexibleelongate member604 having atransducer assembly606, at least a portion of which is located adjacent to a distal end of theelongate member604. Although theelongate member604 is illustrated as having a lumen, theelongate member604 may also be selected to be solid, or theelongate member604 may have a support member (not shown) such as a braid to increase the strength and/or maneuverability of the device. Thetransducer assembly606 is adapted to generate a source signal and receive a reflected signal. It may use a single transducer or multiple transducers. For example, at least a first transducer may be used to generate a signal and at least a second transducer may be used to receive the signal.
• The transducer or transducers use may comprise a piezo-ceramic crystal. In the current invention, a single-crystal piezo (SCP) is preferred, but the invention does not exclude the use of other types of ferroelectric material such as poly-crystalline ceramic piezos, polymer piezos, or polymer composites. The substrate, typically made from piezoelectric single crystals (SCP) or ceramics such as PZT, PLZT, PMN, PMN-PT Also, the crystal may be a multi layer composite of a ceramic piezoelectric material. Piezoelectric polymers such as PVDF may also be used. The transducer or transducers used may be ceramic pieces coated with a conductive coating, such as gold. Other conductive coatings include sputtered metal, metals, or alloys, such as a member of the Platinum Group of the Periodic Table (Ru, Rh, Pd, Re, Os, Ir, and Pt) or gold. Titanium (Ti) is also especially suitable. For example, the transducer may befurther coated with a biocompatible layer such as Parylene or Parylene C. The transducer is then bonded on the lens. A coupling such as a biocompatible epoxy may be used to bond the transducer to the lens. Thetransducer assembly606 communicates with ananalyzing device602 adapted to recognize the reflected signal or measure the Doppler shift between the signals. As mentioned above, the source signal may be reflected by changes in density between tissue. In such a case, the reflected signal will have the same frequency as the transmitted signal. When the source signal is reflected from blood moving within the vessel, the reflected signal has a different frequency than that of the source signal. This Doppler effect permits determination of the presence or absence of a blood vessel within tissue. Although depicted as being external to thedevice600, it is contemplated that the analyzingdevice602 may alternatively be incorporated into thedevice600. The transducer assembly of the invention is intended to include any transducer assembly that allows for the observation of Doppler effect, e.g., ultrasound, light, sound etc. Thedevice600 illustrated inFIG. 6A includes atransducer assembly606 comprising anultrasound transducer608 and anacoustic lens610 that is adapted to refract and disperse a source signal over an outer surface of thelens610. Thelens610 is designed such that it interferes and redirects the signals in a desired direction. Thelens610 may be comprised of materials such as dimethyl pentene (plastic-TPX), aluminum, carbon aerogel, polycarbonate (e.g., lexan), polystyrene, etc. It also may be desirable to place an epoxy between thelens610 and thetransducer608. Preferably, the epoxy is thin and applied without air gaps or pockets. Also, the density/hardness of the epoxy should provide for transmission of the signal while minimizing any effect or change to the source signal. The configuration of thetransducer assembly606 permits thelens610 to disperse a signal over a substantial portion of the outer surface of thelens610. Thelens610 also is adapted to refract a reflected signal towards thetransducer608. Accordingly, given the above described configuration, thedevice600 ofFIG. 6A will be able to detect vessels with any part of thelens610 that contacts tissue (as illustrated by the line612-612.) Although thelens610 is illustrated as being hemispherical, as described below, thelens610 may have other shapes as well.
• FIG. 6B illustrates another variation of thedevice614 having a hemispherical shapedultrasound transducer618 affixed to an end of a flexibleelongate member616. Thetransducer618 communicates with an analyzing device (not shown) to measure the Doppler effect to determine the location of a blood vessel.
• FIG. 6C illustrates another variation of thedevice620 including atransducer assembly622, at least a portion of which is located adjacent to a distal end of theelongate member628. Thetransducer assembly622 includes aflat ultrasound transducer626, and a cone or wedge-likeacoustic mirror624. Themirror624 is adapted to reflect the signal over an area 360° around the device. The angle α of the mirror may be varied to optimally direct the signal as needed.
• FIG. 6D illustrates a variation of adevice630 of the present invention further comprising a joint632 to articulate an end of the device either to make sufficient contact with an area of tissue to be inspected for the presence of a blood vessel, or to navigate within the body to access the area to be inspected.
• The variations of the invention described herein may also be adapted to use ultrasound energy, for example, high energy ultrasound, to produce openings in or marks on tissue. In such a case, the transducer assembly and acoustic lens also functions as a hole-making or site marking device. In this case, use of ultrasound in a low power operation permits the detection of a blood vessel and location of a site for a collateral channel. Using the same device and switching the operation of the device to a high power ultrasound permits the use of the ultrasound to create a collateral channel.
• FIG. 6E illustrates a variation of adevice632 comprising atransducer assembly634 connected to a flexibleelongate member636. In this example, thetransducer assembly634 comprises afirst transducer641, asecond transducer642, and anacoustic lens640. As mentioned above, in variations usingalternate transducers641,642, one transducer may transmit a signal while the other receives a signal. Also, bothtransducers641,642 may simultaneously transmit and receive signals. It is intended that any combination of using the transducers to send and receive signals is contemplated. Thedevice632 also includes a hole-makingassembly638 for creating a channel in tissue.FIG. 6E illustrates the hole-makingassembly638 as an RF wire-like member. As illustrated, thedevice632 is connected anRF generator644 as well as ananalyzing device646 which is adapted to measure the Doppler shift between the generated and reflected signals.
• FIG. 6F illustrates thedevice632 ofFIG. 6E where the hole-makingassembly638 is retracted within thedevice632, in this case within theelongated member636.
• FIG. 6G illustrates another variation of adevice648 where a hole-makingassembly650 is exterior to atransducer assembly606. The hole-makingassembly650 may be either an RF device or a mechanical device that simply cuts the tissue. For example, thehole making assembly650 can be a hypotube placed over thetransducer assembly606. In this variation of thedevice648, thetransducer assembly606 may be moveable within the hole-makingassembly650, or the hole-makingassembly650 may be moveable over thetransducer assembly606. In either case, thetransducer assembly606 may be advanced out of the hole-makingassembly650 to determine the presence of a blood vessel. If no blood vessel is found, thetransducer assembly606 may be withdrawn into the hole-makingassembly650 allowing the hole-makingassembly650 to create a channel in the tissue either by mechanically cutting the tissue, or by using RF energy to create the channel.FIG. 6H illustrates a view taken along theline6H inFIG. 6G.
• FIG. 6I illustrates another version of adevice652 of the present invention wherein the device has atransducer assembly654 with anopening658 through which a hole-makingassembly656 may extend.FIG. 6J illustrates the hole-makingassembly656 extended through thetransducer assembly654. The hole-makingassembly656 may comprise RF electrodes or needle-like members which puncture the tissue to create the channels.
• FIG. 6K illustrates a variation of adevice666 of the present invention where atip660 of the device has a conductive portion allowing the tip to serve as both an acoustic lens and an RF electrode. In such a case, thetip660 is connected to anRF generator644 for creating channels within tissue and atransducer662 is placed in communication with ananalyzing device646 that is adapted to measure the Doppler shift between generated and reflected signals. In this variation, thetip660 is separated from thetransducer662, but both thetip660 andtransducer662 are in acoustic communication through the use of aseparation medium664. Theseparation medium664 transmits signals between thetip660 and thetransducer662. The spacing of thetransducer662 from thetip660 serves to prevent heat or RF energy from damaging thetransducer662. It is intended that the spacing between thetransducer662 andtip662 shown in the figures is for illustration purposes only. Accordingly, the spacing may vary as needed. The separation medium must have acceptable ultrasound transmission properties and may also serve to provide additional thermal insulation as well. For example, an epoxy may be used for the separation medium.
• FIG. 6L illustrates a variation of adevice680 of the present invention wherein thetransducer assembly670 comprises atip672, anultrasound coupling medium674, atransducer676, and anextension member678. In this variation of the invention, thetip672 of the device serves as an acoustic lens and also has conductive areas (not shown) which serve as RF electrodes. As shown inFIG. 6M, thetip672 may extend from thedevice680 and separate from thetransducer676. Separation of thetip672 protects thetransducer676 from heat or RF energy as thetip672 creates a channel in tissue. Theextension member678 may serve as a conductor to connect thetip672 to an RF energy supply (not shown). When thetip672 of thedevice680 is being used in an ultrasound mode, thetip672 may be coupled to thetransducer676 via the use of anultrasound coupling medium674. Any standard type of ultrasound gel material may be used, also highly formable silicone may be used. It is desirable to use a fluid boundary layer (such as the gel) which may be permanent or temporary. In those cases where the boundary layer is temporary, subsequent applications of the boundary layer may be necessary.
• FIG. 6N illustrates another variation of adevice682 of the present invention having atip684 andtransducer686 that are separable from each other. Again, thetip684 may include conductive areas and serve as both an RF electrode (not shown) as well as an acoustic lens. As shown inFIG. 6N, thetip684 may be separable from thetransducer686 when creating a channel to protect thetransducer686 from heat or RF energy. Thetip684 may be placed in contact with thetransducer686 for operation in an ultrasound mode, or thedevice682 may contain aseparation medium688 which permits acoustic coupling of thetransducer686 with thetip684 when separated.
• FIGS. 6P-6U illustrate variations of RF electrode tip690 configurations for use with the present invention. As illustrated, the electrodes may be placed around a circumference of a tip, longitudinal along a tip, spirally along a tip, or a combination thereof. Theelectrodes692,694 may be used with a device having an acoustic lens or the electrodes may be employed solely as an RF hole-making device. While the variations illustrated inFIGS. 6P-6U show bipolar RF devices, the invention may also use a single electrode (monopolar.) The tip690 may contain afirst electrode692 separated from asecond electrode694 by an electrical insulator696 (e.g., ceramic, or plastic insulator). In variations of the device where electrodes are positioned on an acoustic lens, a sufficient amount of surface area of the lens must remain uncovered so that sufficient coupling remains for transmission of a signal between the lens and tissue.FIG. 6V illustrates a co-axial variation of a bi-polar RF tip having afirst electrode692, asecond electrode694, and aninsulator696.
• FIGS. 6W and 6X illustrates additional variations of the lens of the present invention.FIG. 6W illustrates adevice724 with anacoustic lens726 having an oblate spheroid shape.FIG. 6X illustrates adevice728 with anacoustic lens730 having a prolate spheroid shape.FIG. 6Y illustrates adevice732 having a conical-shapedacoustic lens734. These variations are only intended to illustrate variations of the lens. It is contemplated that the shape of a lens may not follow a mathematical description such as conical, prolate, oblate or hemispherical. The design of the shape relates to the distribution pattern of the signal over the lens. The shapes can affect the distribution pattern by making it wider or narrower as needed. In any case, the lens is of a shape that provides coverage over the front face of the device.
• FIG. 7A illustrates a variation of the invention where adevice700 includes a heat-sink member702. The heat-sink member702 may preserve surround tissue during creation of the collateral channel. Or, the heat-sink member702 may be a section of conductive material or a balloon. The heat-sink member702 may be in fluid communication with alumen704 that provides a fluid, such as saline, that conducts heat away from the area surrounding the channel.
• FIG. 7B illustrates another variation of adevice710 having afluid delivery assembly706 which assists in preserving surrounding tissue while a channel is being created. Thefluid delivery assembly706 may spray, mist, or otherwise apply fluid708 to the area surrounding the channel. For example, cooled saline may be applied to the area to prevent excessive heating of the target area.
• The invention includes the use of hole-making assembly on the side of the device with a transducer assembly on the tip of the device. For example,FIG. 7C illustrates a variation of anRF electrode712 for use with the present invention. Theelectrode712 may be a protrusion extending from aconductive member716 that is covered with an insulatingmaterial714. In this variation, theelectrode716 limits the depth of the channel due to the amount of material extending from theconductive member716. Theconductive member716 may be connected to a source of RF energy (not shown) or may use another heating element (not shown).FIG. 7D illustrates another variation of an electrode configuration. In this variation, the electrode comprises aspherical member718 extending from anelongate member722. Theelectrode718 is retractable through theelongate member722 by use of anactuator720. Theactuator720 may be conductive and connected to a source of RF energy to conduct energy through theelectrode718. Again, the design of theelectrode718 limits the depth of penetration of theelectrode718 while creating a channel in tissue. The electrodes described herein may also be used in conjunction with a device having a Doppler arrangement.
• Also, a variation of the invention contemplates the delivery of drugs or medicines to the area of the collateral opening. Also contemplated is the use of a fibrin, cyano-acrylate, or any other bio-compatible adhesive to maintain the patency of the opening. For example, the adhesive could be deposited within the collateral channel to maintain patency of the channel or to create a cast implant of the channel. The adhesive could also coat the channel, or glue a flap to the wall of the airway. Also, the use of a bioabsorbable material may promote the growth of epithelium on the walls of the conduit. For example, covering the walls of a channel with small intestine submucosa, or other bioabsorbable material, may promote epithelium growth with the bioabsorbable material eventually being absorbed into the body.
• FIG. 4 illustrates a variation of adevice400 having the ability to create multiple openings within the walls of thenatural airway100. The holes may be created by dilation, cutting, electrical energy, microwave energy, ultrasonic energy, laser, chemical, or any process as mentioned above. Thisdevice400 may also be used to deploy multiple probes to determine the location of a blood vessel (not shown) using one of the procedures mentioned above.
• FIG. 5A illustrates an implant orconduit500 placed within anatural airway100. As shown, theairway100 has a portion of its wall removed, thereby providing acollateral opening112 within theairway100. Theimplant500 typically has a porous structure which allows gasses to pass between the airway and thechannels112 and into the lung. Moreover, the structure of theinsert500 also maintains patency of theairway100 and thechannel112.
• Any variation of a conduit described herein may comprise a barrier layer which is impermeable to tissue. This aspect of the invention prevents tissue in-growth from occluding the channel. The barrier layer may extend between the ends of the body or the barrier layer may extend over a single portion or discrete portions of the body of the conduit.
• FIG. 5B illustrates anconduit500 having an expandable structure within anairway100. Usually, theconduit500 has a porous wall that allows the passage of gasses through the wall. Theconduit500 is delivered via adelivery device502 which may also contain an expandable member (not shown) which expands theconduit500. As shown inFIG. 5C, the conduit may have piercingmembers504 attached on an outer surface which enable theconduit500 to create an incision within theairway100.
• FIG. 5C illustrates theconduit500 after being expanded by anexpandable member506, e.g. a balloon device, an expandable mechanical basket, or an expandable wedge. In this example, theconduit500 expands through the walls of theairway100 atsections508. In this variation, theconduit500 is lodged within the walls of theairway100.
• FIG. 5D illustrates a grommet-like insert503 where the lumen of theinsert503 extends longitudinally through the collateral channel. In this example, an expandingmember501, e.g., a balloon, an expanding mechanical basket, or the like is used to secure theconduit503 within the collateral channel.
• Although not illustrated, the invention includes conduits having a length to diameter ratio approximately 1:1. However, this ratio may be varied as required. The cross-section of an implant may be circular, oval, rectangular, eliptical, or any other multi-faceted or curved shape as required. The cross-sectional area of animplant500 may be between 0.196 mm²to 254 mm².
• The conduit may also be any device capable of maintaining a patent opening, e.g., a plug, that is temporarily used as a conduit and then removed after the channel has healed in an open position. In another variation the plug may be a solid plug without an opening that is either bio-absorbable or removable. In such a case, the plug may be placed within an opening in tissue and allow the tissue to heal forming a collateral channel with the plug being ultimately absorbed into the body or removed from the body.
• Another variation of the conduit is illustrated inFIG. 5E. In this example theconduit510 comprises acone514 with agrommet512 for attachment to a wall of theairway100. Thecone514 may be porous or haveother openings516 to facilitate the passage of gas through the collateral channel. In the event that the distal opening of the cone become occluded, the porous cone permits the continued exchange of gasses between the collateral channel and the natural airway.
• Another variation of the conduit is illustrated inFIG. 5F. For example, theconduit518 may be configured in a ‘t-shape’ with aportion520 of the conduit extending through the collateral channel. Again, theconduit518 may be constructed to have a porous wall to allow gas exchange through the wall. The conduit may be configured in a variety of shapes so long as a portion of the conduit extends through the collateral channel. The portion may be formed into a particular shape, such as the ‘t-shape’ described above, or, the portion may be hinged so that it may be deployed within the channel. In such a case, a portion of a wall of the conduit may have a hinge allowing the wall of the conduit to swivel into a channel.
• Yet another variation of the conduit is found inFIG. 5G. In this example, theconduit522 is constructed with a geometry that reduces the chance that theconduit522 will migrate within theairway100.
• FIG. 5H illustrates an example of aconduit524 having an asymmetrical profile. Theconduit524 may have aflange526 at either or both ends of thebody528. Although not shown, theflange526 may have a cone-like profile to facilitate placement within an airway. As illustrated inFIG. 51, the asymmetrical profile of theconduit524 assists in preventing obstruction of the airway.
• FIG. 5J illustrate a variation of theconduit530 having a self-cleaning mechanism. In this example, the self cleaning mechanism is a floatingball bearing532. The ends of theconduit530 have a reduceddiameter534 which prevents the bearing532 from escaping. As gas passes through theconduit530, the bearing532 moves about theconduit530 clearing it of debris. The shape of thebearing532 and the size and shape of the reduceddiameter534 may be varied to optimize the self-cleaning effect of the device.
• FIGS. 5K and 5L illustrate another variations of a self-expandingconduit536. In this example, as shown inFIG. 5K, theconduit536 may be constructed from aflat material538 having a spring or springs540. As shown inFIG. 5L, theconduit536 is formed by rolling the assembly. Thespring540 provides an expanding force against thematerial538. Theconduit536 may also be constructed so that theflat material538 is resilient thus eliminating the need forsprings540.
• FIG. 5M illustrates another variation of anexpandable conduit542 constructed from a braided material. Theconduit542 may be constructed so that the diameter is dependent upon the length of thedevice542. For example, the diameter of thedevice542 may decrease as the length is stretched, and the diameter may increase as the length of thedevice542 is compressed. Such a construction being similar to a ‘finger cuff’ toy.
• FIGS. 5N-5P illustrate another variation of a grommet-type conduit.FIG. 5N illustrates aconduit544 having expandable ends546. In one variation theends546 of thedevice544 may flare outwards as illustrated inFIG. 5O.FIG. 5P illustrates another variation of thedevice544 in which the ends546 compress in length to expand in diameter.
• FIGS. 5Q and 5R illustrate variations of a conduit having an anchor. InFIG. 5Q, theconduit548 has ananchor550 at a distal end of ahollow plug540. Theanchor550 may be tapered to facilitate entry into theairway100 wall or may have another design as required. Theanchor550 also containsventilation openings552 to facilitate gas exchange through the device.FIG. 5R illustrates another variation of the device.
• FIG. 5S illustrates a variation of aconduit561 havingflanges563 at either end to assist in placement of the conduit within an airway wall (not shown). The ends of theconduit565 may be tapered to ease placement through a collateral channel. The conduit has anopening565 to facilitate passage of air. To simplify construction, theconduit561 may be constructed from a biocompatible material, such as stainless steel, or plastic.
• FIG. 5T illustrates a variation of the invention having multiple openings for gas flow. Theconduit560 has a firsthollow end564 which can extend through a wall of theairway100 and a secondhollow end566 which can remain parallel to theairway100. This example also includes anopening562 which allows gas to flow through theairway100.
• FIG. 5U illustrates a variation of the device having a one-way valve570. Thevalve570 allows theconduit568 to permit exhaust of the air sac but prevents theconduit568 from serving as another entrance of gas to the air-sac. Thevalve570 may be placed at ends of the conduit or within a lumen of the conduit. Thevalve570 may also be used as bacterial in-flow protection for the lungs.
• FIG. 5V illustrates another variation of aconduit572. In this variation, theconduit572 may be a sponge material, or constructed of anopen cell material574, which allows air flow through the material. Or, theconduit572 may havelumens576 which allow flow through theconduit572. To assist theconduit572 in remaining within a channel, the conduit material may be selected such that it expands as it absorbs moisture. Also, the sponge material/open cell material may be bio-absorbable to allow for temporary placement of theconduit572.
• FIGS. 8A-8F illustrate another variation of aconduit800 of the present invention. Theconduit800 has acenter section802 havingextension members804 located at either end of thecenter section802. Thecenter section802 illustrated is tubular but may be of any other shape as needed for the particular application. The conduit of the invention has a passageway extending between the ends of the conduit suited for the passage of air. The variation of theconduit800 illustrated inFIG. 8A has acenter section802 comprising a mesh formed from a plurality ofribs806.FIGS. 8A and 8B illustrate theconduit800 in a reduced profile whileFIGS. 8C and 8D illustrate theconduit800 in an expanded profile after expansion of thecenter section802 of theconduit800. As shown inFIGS. 8E and 8F, eachfree end808 of eachextension member804 is unattached to thecenter section802 and is bendable about the respective end of thecenter section802 to which it is attached. Accordingly, once aconduit800 is placed within a collateral channel (not shown), theextension members804 are bent about the end of thecenter section802 and form a cuff or grommet which assists in keeping theconduit800 within a collateral channel. Accordingly, the cross section and number ofextension members804 located about either end of theconduit800 may be selected as necessary to assist in placement and securing of theconduit800 within a channel.
• The conduits described herein may have a fluid-tight covering, as discussed below, about the center section, the extension members, or the entire conduit. Also, the conduit may be designed to limit a length of the center section to less than twice the square root of a cross sectional area of the center section when the center section is in the expanded profile.
• FIG. 8G-8I illustrates another variation of aconduit812 for use with the invention. In this variation, theconduit812 is formed from a rolled sheet ofmaterial810. The rolledsheet810 may be heat treated to preserve the shape of theconduit812 or thesheet810 may simply be rolled to form theconduit812. In those cases where the sheet ofmaterial810 comprises a shape-memory alloy, it is desirable to process the material810 so that it exhibits super-elastic properties at or above body temperature.
• FIG. 8G illustrates a variation ofextension members820 for use with a conduit (not shown) of the present invention. In this variation, theextension members820 have anattachment822 betweenadjacent extension members820.FIG. 8H illustrates theextension members820 as the conduit (not shown) is expanded and theextension members820 are bent on the conduit. Theattachment822 assists in preventing theextension members820 from deviating from a preferred position. As illustrated inFIG. 8I, theconduit826 may have cut or weakenedsections824 to facilitate expansion of theconduit826 and bending of the extension members in a desired manner (as shown by the section of828).
• FIGS. 8J-8K illustrate various additional cross sectional designs of conduits.FIG. 8J illustrates apossible conduit design830 havingextension members834 attached to acenter section832.FIGS. 8K and 8L illustrate additional variations of conduit designs. As illustrated inFIGS. 8K and 8L, theextension members840,846 andcenter sections838,844 are designed to form a diamond pattern upon expansion of the conduit.FIG. 8K further illustrates a variation of anextension member840 having anopening841 to facilitate tissue in-growth and thereby secures placement of the conduit.FIG. 8M illustrates an expandedconduit848 having the diamond pattern referred to above. Theconduit848 also contains a fluid-tight barrier851 on thecenter section850 of theconduit848. Although not illustrated, fluid-tight barrier may be placed throughout a conduit. Another feature of the variation ofFIG. 8M is that the extension members have a diamond pattern construction, this construction assists in maintaining alignment of the extension members allowing for a preferred aligned expansion of the extension members.
• FIGS. 8N-8O illustrate another variation of aconduit860 of the present invention. In this variation, theconduit design854 may haveextension members856 at only one end of theconduit860. In this variation, the center section of the conduit may comprise abody portion858. Theconduit860 may have a covering about a portion of theconduit860. The covering may extend throughout the length of theconduit860 or it may be limited to a portion of theconduit860. As illustrated inFIG. 8O, when expanded, theconduit860 may form a reducedarea858 near theextension members856. As mentioned above, the conduitcross section854 may be designed such that the a diamond pattern is formed upon expansion of theconduit860, as illustrated inFIG. 8O.
• FIG. 8P illustrates a sheet ofmaterial810 havingextension members814 extending from either end of thesheet810. Although thesheet810 is illustrated to be solid, a conduit may be formed from a sheet having openings within the center section of the sheet.FIG. 8Q illustrates theconduit812 where the rolledsheet810 comprises acenter section818 of theconduit812 and theextension members814 from either end of thecenter section818. As illustrated inFIG. 8Q, thesheet810 may be overlapped for a reduced profile and expanded into an expanded profile.FIG. 8R illustrates afree end816 of eachextension member814 as having been bent away from a central axis of theconduit812. As with any variation of a conduit of the present invention, theextension members814 of theconduit812 may be bent away from a central axis of theconduit812 up to 180° with respect to the central axis. As mentioned above, the cross section and number ofextension members814 located about either end of theconduit810 may be selected as necessary to assist in placement and securing of theconduit810 within a channel.
• In those cases where theconduit812 ofFIG. 8Q comprises a non-shape memory alloy theconduit812 will be actively mechanically expanded. In those cases where theconduit812 is comprised of a shape memory alloy, such as a super-elastic alloy, theconduit812 may be pre-formed to assume a deployed shape which includes a grommet formed byextension members814 and an expandedcenter section818, such as the shape illustrated inFIG. 8R. Next, thesuper-elastic conduit812 may be restrained or even rolled into the shape illustrated inFIG. 8Q. Because theconduit812 is formed of a super-elastic material, no plastic deformation occurs. When thesuper-elastic conduit812 is then placed within a collateral channel, theconduit812 may naturally resume its pre-formed, deployed shape.
• FIG. 8S illustrates another variation of aconduit862 having afirst portion864 and asecond portion866 and apassageway868 extending therethrough. Thefirst portion864 may be a conduit design as described herein. In particular, thefirst portion864 is configured to secure theconduit862 to theairway wall100. Accordingly, thefirst portion864 may or may not have a center that is expandable. The walls of thefirst portion864 may be fluid-tight (either through design, or a fluid tight covering) to prevent tissue in-growth through the collateral channel. Alternatively, thefirst portion864 may be partially fluid-tight to facilitate tissue in-growth to improve retention of theconduit862 to theairway wall100. However, in the latter case, thefirst portion864 should be designed to minimize tissue in-growth within the channel to prevent substantial interference with airflow through theconduit864. As with thefirst portion864, the walls of thesecond portion866 of the conduit may or may not be fluid-tight. If thesecond portion866 is not fluid-tight, the larger area provides for improved airflow from lung tissue through thepassageway868 and into the airway. Thesecond portion866 may also be designed to be partially fluid-tight to encourage airflow through theconduit862 but reduce the probability of blockage of theconduit862.
• FIGS. 8T-8U illustrate another variation of aconduit870. For example, theconduit870 may be formed from a tube that is slit to form extension members at afirst portion872 andsecond portion876 with acenter section874 between the portions. Theconduit870 may be expanded as shown inFIG. 8U such that the first872 and second876 portions maintain thecenter portion874 in a collateral channel in an airway wall. Thecenter section874 may or may not be expandable.
• FIG. 8U illustrates thesecond portion876 of theconduit870 to expand in its center, however, theconduit870 may be designed in other configuration as well (e.g., expanded to have a larger diameter at an end opposite to thecenter section874.) However, a central aspect of this design is that thesecond portion870 provides a large area in the lung tissue to permit a larger volume of air to pass from the lung tissue into theconduit870. This design has an added benefit as thesecond portion876 cannot be easily blocked by flaps of parenchyma tissue. A simple variation of theconduit870 may be constructed from a metal tube, such as 316 stainless steel, titanium, titanium alloy, nitinol, etc. Alternatively, the conduit may be formed from a rigid or elastomeric material.
• The conduits described herein may be comprised of a metallic material (e.g., stainless steel), a shape memory alloy, a super-elastic alloy (e.g., a NiTi alloy), a shape memory polymer, a polymeric material or a combination thereof. The conduit may be designed such that its natural state is an expanded state and it is restrained into a reduced profile, or, the conduit may be expanded into its expanded state by a variety of devices (e.g., a balloon catheter.) The conduit described herein may be manufactured by a variety of manufacturing processes including but not limited to laser cutting, chemical etching, punching, stamping, etc.
• The conduits described herein may be coated with an elastomer, e.g., silicone, polyurethane, etc. The coatings may be applied, for example, by either dip coating, molding, or liquid injection molding (for silicone). Or, the coating may be a tube of a material and the tube is placed either over and/or within the conduit. The coating(s) may then be bonded, crimp, heated, melted, or shrink fit. The coatings may also placed on the conduit by either solvent swelling applications or by an extrusion process. Also, a coating of may be applied by either wrapping a sheet of PTFE about and/or within the conduit, or by placing a tube about and/or within the conduit and securing the tubes.
• As mentioned above, the number of and cross sectional area of the extension members on a conduit may be selected as needed for the particular application. Also, the extension members may be bent such that they anchor into the tissue thereby securing placement of the conduit. Or, the extension members or the center section may contain barbs or other similar configurations to better adhere to the tissue. Moreover, the orientation of the extension members may vary as well. For example, the extension members may be configured to be radially expanding from the center section, or they may be angled with respect to a central axis of the conduit. Another variation of the invention includes a radioactive conduit which inhibits or prevents the growth of tissue within the conduit.
• Although the conduits of the current invention have been described to contain expandable center sections, the invention is not necessarily limited as such. Instead, the design of the conduit may require extension members on the ends of a conduit with a non-expandable center section.
• FIGS. 9A-9D illustrate aconduit900 of the present invention. The deployment of theconduit900 is intended to show an example of a possible means of deployment only. Accordingly, the inventive conduit may be delivered at an angle via an articulating or jointed device, the conduit may be delivered on a device that is adapted to locate and create the collateral channel, or the conduit may be delivered on a device having other features as needed for the particular application.
• FIG. 9A illustrates theconduit900 being delivered to a collateral channel in anairway wall114 via a delivery device (e.g., aballoon catheter902.) Theconduit900 may be attached to thedelivery device902 using the natural resiliency of theconduit900. Or, in those cases where the conduit is spring loaded, theconduit900 restrained in a reduced profile and may be removably affixed to thedelivery device902 using an adhesive, or a removable sleeve such as a heat shrink tube. In this example, theballoon catheter902 has several balloons including adistal balloon904, aproximal balloon906, and a center balloon (not illustrated inFIG. 9A).FIG. 9B illustrates the inflation of the distal904 and proximal906 balloons to situate theextension members908. Accordingly, theextension members908 for a flange or collet about theairway wall114. Theballoons904,906 may be inflated simultaneously, or in a desired sequence. In any case, deployment of theballoons904,906 may serve to center theconduit900 in the collateral channel.
• FIG. 9C illustrates inflation of thecenter balloon912 which causes expansion of thecenter section910 of theconduit900. If theconduit900 is affixed to thedelivery device902, expansion of thecenter balloon912 causes release of theconduit900 by release of the adhesive or breaking of the heat shrink tubing (not shown). In any case, the means of attachment may be bioabsorbable and remain in the body, or may remain affixed to thedelivery device902 and is removed with removal of thedelivery device902.FIG. 9D illustrates theconduit900 affixed to theairway wall114 after thedelivery device902 is removed from the site. Another method of deploying a conduit includes restraining the conduit about a delivery device using a wire or string tied in a slip-knot or a series of slip-knots. When the conduit is delivered to a desired location, the proximal end of the wire or string may be pulled which releases the wire/string and deploys the conduit.FIGS. 9E and 9F illustrate possible ways to manipulate aconduit914 for placement in anairway wall114 using adelivery device916.FIG. 9E illustrates deployment of adelivery device916 to place aconduit914 within an opening in anairway wall114. Theconduit914 may be placed over a balloon918 (or other expandable section) of thedelivery device916.FIG. 9F illustrates deployment of theballoon918 to place and expand theconduit914. In the variation illustrated inFIGS. 9E and 9F, aballoon918 serves several functions. Theballoon918 first expands and starts bending theextension members920. Theballoon918 continues to center theconduit914 on the tissue and simultaneously begins to expand theconduit914 and secures the conduit to the tissue.
• FIGS. 9G and 9H illustrate additional variations of deployment devices. In these variations, thedeployment devices922,926 contain hourglass-shapedballoons924,928. The hour glass-shapedballoons924,928 contain aninterior profile923. For deployment of a conduit (not shown) of the present invention, the conduit is placed on theballoon924,928. As theballoon924,928 expands, the conduit expansion matches theinterior profile923 of theballoon924,928. Accordingly, the hour glass-shapedballoon924,928 may be used to set the angle and orientation of the expandable members of a conduit as well as the expansion of a center section of the conduit.
• FIG. 9I illustrates another variation of an hour glass shapedballoon delivery device930. This variation of the hour glass shapedballoon932 is designed to expand extension members (not shown) of a conduit (not shown) at aparticular angle934. The orientation of theballoon932 may be designed as needed to impart the desired angle to the extension members of the conduit. The balloons described herein may be constructed polyethylene terephthalate (PET) or any other material which is used in the construction of balloon catheters.
• The invention further includes methods of evaluating individuals having a diseased lung to assess inclusion of the individual for the procedure.
• The method comprises the steps of performing pulmonary function tests on the individual. The pulmonary function tests may obtain such values as FEV (forced expiratory volume), FVC (forced vital capacity), FEF_25%-75%(forced expiratory flow rate), PEFR (peak expiratory flow rate), FRC (functional residual capacity), RV (residual volume), TLC (total lung capacity), and/or flow/volume loops.
• FEV measures the volume of air exhaled over a pre-determined period of time by a forced expiration immediately after a full inspiration. FVC measures the total volume of air exhaled immediately after a full inspiration. FEF_25%-75%measures the rate of air flow during a forced expiration divided by the time in seconds for the middle half of expired volume. PEFR measures the maximum flow rate during a forced exhale starting from full inspiration. FRC is the volume of air remaining in the lungs after a full expiration. RV is the FRC minus the expiratory reserve volume. TLC is the total volume in the lungs at the end of a full inspiration. Flow/volume loops are graphical presentations of the percent of total volume expired (on the independent axis) versus the flow rate during a forced expiratory maneuver.
• The invention further comprises methods to determine the completion of the procedure. This variation of the invention comprises the step of performing pulmonary function tests as described above, creating collateral channels in the lungs, performing a post-procedure pulmonary function test, obtaining clinical information, comparing the results of the tests, evaluating the clinical information with the results of the test to determine the effectiveness of the procedure.
• Another method to determine the completion of the procedure includes checking the resistance of airflow upstream from a location of a collateral channel. The method includes making a collateral channel, checking airflow, measuring resistance to airflow, and repeating the procedure until acceptable resistance is obtained. Because the collateral channel allows for the release of trapped air, the resistance to airflow should decrease. A body plethysmograph or other suitable equipment used to measure in pulmonary medicine may be used to determine the resistance to airflow.
• A measurement of total lung volume may be used to determine when the lung is suitably deflated and therefore when enough collateral channels are created. Or, non-invasive imaging may be used to determine pre and post procedure lung volume or diaphragm position.
• An evaluation of the effectiveness of the procedure may also include creating a collateral channel then sealing the channel with a balloon catheter. The distal end of catheter is then opened for a measurement of the flow of trapped air through the catheter.
• This variation of the invention includes obtaining clinical information regarding the quality of life of the individual before and after any procedures, physical testing of the pulmonary system of the individual, and a general screening for pulmonary condition.
• The invention herein is described by examples and a desired way of practicing the invention is described. However, the invention as claimed herein is not limited to that specific description in any manner. Equivalence to the description as hereinafter claimed is considered to be within the scope of protection of this patent.

Claims (40)

1. A method of improving gaseous flow within a diseased lung comprising the step of altering the gaseous flow paths within the lung.

2. The method ofclaim 1 wherein the step of altering the gaseous flow comprises the steps of:

selecting at least one site for collateral ventilation of the lung, and

creating at least one collateral channel in at least one of the sites.

3. The method ofclaim 2 further comprising the step of locating the at least one site within a portion of a natural airway of the respiratory system prior to said selecting step.

4-5. (cancelled).

6. The method ofclaim 1 wherein said locating step comprises transmitting a first signal into an area of tissue, receiving a second signal, comparing said first and second signal for Doppler shifting.

7. The method ofclaim 6 wherein said comparing step comprises determining whether a blood vessel is present near said area of tissue.

8. The method ofclaim 3 wherein said locating step includes

(a) examining the lung using an imaging method selected from radiography, computer tomography, ultrasound, Doppler, MRI, PET and acoustic imaging to determine a location to alter the gaseous flow, and

(b) examining the lung using the non-invasive imaging method selected from radiography, computer tomography, ultrasound, doppler, MRI, PET and acoustic imaging to determine a number of collateral channels to be created.

9. The method ofclaim 8 further including the step of inserting a fluid into the airway to assist in ultrasound or doppler imaging.

10. The method ofclaim 3 further comprising the step of inserting an additive to enhance the visibility of the airway during the examining step.

11. The method ofclaim 3 wherein said locating step includes determining the degree of collateral ventilation between a plurality of air sacs of the lung in a region adjacent to the airway.

12-13. (cancelled).

14. The method ofclaim 11 wherein said step of determining the degree of collateral ventilation includes:

(a) occluding a segment of the airway;

(b) adding or removing gas distally of the occluded segment; and

(c) monitoring flow or pressure distally of the occluded segment.

15-26. (cancelled).

27. The method ofclaim 3 wherein the portion of the natural airway is selected from a group consisting of bronchi, upper lobe, middle lobe, lower lobe, segmental bronchi, and bronchioles.

28. The method ofclaim 27 wherein the step of selecting each of the sites comprises introducing a probe into a wall of the natural airway, and detecting the presence of a blood vessel.

29-33. (cancelled).

34. The method ofclaim 27 wherein the step of creating at least one collateral airway comprises mechanically forming the collateral channel.

35. The method ofclaim 34 wherein the at least one collateral channel is mechanically formed using a process selected from dilation, cutting, piercing, and bursting.

36. The method ofclaim 27 wherein the step of creating at least one collateral channel comprises electrically forming the collateral channel.

37-41. (cancelled).

42. The method ofclaim 27 wherein the channel comprises an opening in the wall of the airway.

43-47. (cancelled).

48. The method ofclaim 27 further comprising the step of applying a glue in proximity to the at least one site for collateral ventilation.

49. The method ofclaim 27 further comprising the step of delivering steroids to the lung.

50. The method ofclaim 27 wherein the step of creating the at least one collateral channel comprises making an incision in a wall of the natural airway, placing the wall of the natural airway in tension, advancing a blunt instrument into the incision.

51. (cancelled).

52. The method ofclaim 27 wherein the step of creating at least one collateral channel comprises inserting a conduit within a wall of the natural airway.

53. The method ofclaim 27 further comprising the step of inserting at least one conduit within each of the collateral channels.

54. (cancelled).

55. The method ofclaim 53 wherein the conduit is comprised of a material selected from the group consisting of elastomers, polymers, metals, metal alloys, shape memory alloys, and shape memory polymers.

56-57. (cancelled).

58. The method ofclaim 53 wherein the conduit is removable from the body.

59. The method ofclaim 1 where the altering step comprises collaterally ventilating the lung by forming at least one opening in a natural airway wall within said lung that is in fluid communication with lung tissue.

60. (cancelled).

61. The method ofclaim 59 further comprising the step of placing a bioabsorbable material in the opening to maintain patency of the opening.

62. (cancelled).

63. The method of claim65 wherein said preserving step comprises cooling the tissue adjacent to the opening.

64-66. (cancelled).

67. The method ofclaim 1 where the altering step comprises making an inspiratory path different from an expiratory path within the lung.

68-186. (cancelled)

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