US20150196406A1 - Method and apparatus for repairing vascular abnormalities and/or other body lumen abnormalities using an endoluminal approach and a flowable forming material - Google Patents

Abstract

A method for repairing an abnormality in the wall of a body lumen, the method comprising:

• • isolating the abnormality in the wall of the body lumen from flow in the body lumen;
  • positioning flowable forming material adjacent to the abnormality in the wall of the body lumen; and
  • transforming the flowable forming material into a substantially stationary state so as to repair the abnormality in the wall of the body lumen.

Apparatus for repairing an abnormality in the wall of a body lumen, the apparatus comprising:

• • a supply of flowable forming material;
  • zone isolation apparatus for isolating the abnormality in the wall of the body lumen from flow in the body lumen; and
  • positioning apparatus for positioning the flowable forming material adjacent to the abnormality in the wall of the body lumen so as to repair the abnormality in the wall of the body lumen.

Description

REFERENCE TO PENDING PRIOR PATENT APPLICATIONS
• This patent application claims benefit of:
• (i) pending prior U.S. Provisional Patent Application Ser. No. 61/189,670, filed Aug. 21, 2008 by Howard Riina et al. for METHOD AND APPARATUS FOR ACCESSING THE SIDE WALL OF A VASCULAR STRUCTURE OR OTHER BODY LUMEN, ORGAN OR TUBULAR STRUCTURE WHILE SIMULTANEOUSLY PROVIDING ZONE ISOLATION AND BYPASS CAPABILITY (Attorney's Docket No. CORN-0615 PROV); and
• (ii) pending prior U.S. Provisional Patent Application Ser. No. 61/131,584, filed Jun. 10, 2008 by Howard Riina et al. for INJECTABLE MOLD (Attorney's Docket No. CORN-13 PROV).
• The two above-identified patent applications are hereby incorporated herein by reference.
FIELD OF THE INVENTION
• This invention relates to medical procedures and apparatus in general, and more particularly to medical procedures and apparatus for accessing the wall of a vascular structure or other body lumen.
BACKGROUND OF THE INVENTION
• Medical technologies are now expanding so that curative therapies may now be applied directly to the wall of a vascular structure or other body lumen (e.g., tubular structure or organ) within the human body. In most situations it will be necessary to access the inside (or other portion) of the wall of a vascular structure or other body lumen in order to provide therapy to a patient. By way of example but not limitation, it may be necessary to treat an aneurysm formed in the wall of an artery (e.g., a lateral aneurysm such as a saccular aneurysm, a fusiform aneurysm such as a typical abdominal aortic aneurysm), or to treat a lesion formed on the wall of a vascular structure (e.g., an artery or vein) or other tubular or hollow structure. As used herein, the term “vascular structure” is intended to encompass any tubular or hollow structure of the vasculature (e.g., an artery, a vein, a blood chamber, etc.), and the term “body lumen” is intended to encompass any tubular or hollow structure, including the gastrointestinal or genitourinary tracts, the lymph system, an air passageway, the interior of a hollow organ, a passageway through a body structure, etc. As used herein, the term “wall” of a vascular structure or other body lumen is intended to encompass the inside surface of the wall and/or any other portion of the wall, including aneurysms, lesions, etc. which may be formed in or on the wall.
• Additionally, in many situations it may be desirable to isolate a segment of the vascular structure (or other body lumen) from the remainder of the vascular structure (or other body lumen). By way of example but not limitation, a particular therapy applied to the inside of the wall of a vascular structure may create debris which should be localized and prevented from flowing downstream from the site of the therapy.
• Furthermore, in many situations it may become necessary to apply therapy to the inside of the wall of a vascular structure (or other body lumen) without interrupting the flow of blood (or other fluids) through the vascular structure (or other body lumen).
• Thus, there is a substantial need for a novel method and apparatus for accessing the wall of a vascular structure or other body lumen while simultaneously providing “zone isolation” and simultaneously providing fluid bypass capability. Ideally, pressure and fluid (presence or absence) should be controllable within the isolation zone, thereby facilitating the use of medical instruments (including cutting instruments, biopsy instruments, closure instruments, endoscopic visualization, etc.), vacuum, electrical energy (e.g., electrosurgery), adhesives and/or other therapies which may be difficult to apply in a zone where blood or any other biologic fluid or substance is present and/or flowing.
SUMMARY OF THE INVENTION
• The present invention provides a novel method and apparatus for accessing the wall of a vascular structure or other body lumen while simultaneously providing zone isolation and simultaneously providing fluid bypass capability.
• In one preferred form of the invention, the novel method and apparatus permits pressure and fluid (presence or absence) to be controllable within the isolation zone, thereby facilitating the use of medical instruments (including cutting instruments, biopsy instruments, closure instruments, material delivery systems, endoscopes, etc.), vacuum, electrical energy (e.g., electrosurgery), adhesives and/or other therapies (e.g., agents promoting thrombus, gene therapeutic agents, etc.) which may be difficult to apply in a zone where blood or another biologic fluid or substance is present and/or flowing.
• More particularly, the present invention comprises the provision and use of an access system comprising an erectable proximal isolation barrier (e.g., a balloon, a superelastic shape memory alloy ring, etc.), an erectable distal isolation barrier (e.g., a balloon, a superelastic shape memory alloy ring, etc.), and a bypass channel extending between the proximal isolation barrier and the distal isolation barrier, such that when the access system is erected in a body lumen, the access system can isolate a segment of the body lumen from the remainder of the body lumen, while still permitting a fluid to flow independently through the isolated segment of the body lumen. Additionally, the access system preferably comprises a working catheter extending through the proximal isolation barrier and providing access (e.g., for instruments, etc.) to the wall of the isolated segment of the body lumen. Furthermore, the access system can be configured so as to be mountable on a guidewire, so that the access system can be delivered over a guidewire to a desired position within a body lumen.
• In one preferred form of the present invention, there is provided apparatus for accessing the wall of a body lumen while simultaneously providing zone isolation and fluid bypass capability, the apparatus comprising:
• an erectable proximal isolation barrier capable of making a sealing engagement with the wall of the body lumen;
• an erectable distal isolation barrier capable of making a sealing engagement with the wall of the body lumen;
• a bypass channel secured to, and extending between, the proximal isolation barrier and the distal isolation barrier, the bypass channel comprising a lumen communicating with the region proximal to the proximal isolation barrier and with the region distal to the distal isolation barrier; and
• a working catheter passing through the proximal isolation barrier and terminating short of the distal isolation barrier, the working catheter providing a central lumen for providing access to the wall of the body lumen between the proximal isolation barrier and the distal isolation barrier.
• In another preferred form of the present invention, there is provided a method for accessing the wall of a body lumen while simultaneously providing zone isolation and fluid bypass capability, the method comprising:
• providing an access system comprising:
• • an erectable proximal isolation barrier capable of making a sealing engagement with the wall of the body lumen;
  • an erectable distal isolation barrier capable of making a sealing engagement with the wall of the body lumen;
  • a bypass channel secured to, and extending between, the proximal isolation barrier and the distal isolation barrier, the bypass channel comprising a lumen communicating with the region proximal to the proximal isolation barrier and with the region distal to the distal isolation barrier; and
  • a working catheter passing through the proximal isolation barrier and terminating short of the distal isolation barrier, the working catheter providing a central lumen for providing access to the wall of the body lumen between the proximal isolation barrier and the distal isolation barrier;
• deploying the access system within the body lumen;
• erecting the distal isolation barrier and the proximal isolation barrier; and
• accessing the wall of the body lumen through the working catheter.
• As noted above, the present invention provides a novel method and apparatus for accessing the wall of a vascular structure or other body lumen while simultaneously providing zone isolation and fluid bypass capability. In the following description, the present invention may sometimes hereinafter be discussed in the context of application to a vascular structure, however, it should be appreciated that this is done solely for the sake of clarity of illustration and should not be considered as limiting the scope of the present invention. Thus, the present invention may also be used in conjunction with body lumens other than vascular structures, e.g., the gastrointestinal or genitourinary tract, the lymph system, an air passageway, the interior of a hollow organ, a passageway through a body structure, etc.
• In another preferred form of the present invention, there is provided a method for repairing an abnormality in the wall of a body lumen, the method comprising:
• isolating the abnormality in the wall of the body lumen from flow in the body lumen;
• positioning flowable forming material adjacent to the abnormality in the wall of the body lumen; and
• transforming the flowable forming material into a substantially stationary state so as to repair the abnormality in the wall of the body lumen.
• In another preferred form of the present invention, there is provided apparatus for repairing an abnormality in the wall of a body lumen, the apparatus comprising:
• a supply of flowable forming material;
• zone isolation apparatus for isolating the abnormality in the wall of the body lumen from flow in the body lumen; and
• positioning apparatus for positioning the flowable forming material adjacent to the abnormality in the wall of the body lumen so as to repair the abnormality in the wall of the body lumen.
BRIEF DESCRIPTION OF THE DRAWINGS
• These and other objects and features of the present invention will be more fully disclosed or rendered obvious by the following detailed description of the preferred embodiments of the invention, which is to be considered together with the accompanying drawings wherein like numbers refer to like parts and further wherein:
• FIG. 1 is a schematic perspective view showing the access system of the present invention deployed within a vascular structure;
• FIG. 2 is a schematic side view showing the access system ofFIG. 1 deployed within a vascular structure, wherein the vascular structure includes an aneurysm;
• FIG. 3 is a schematic end view, as seen from the distal end, showing the access system ofFIG. 1 deployed within the vascular structure shown inFIG. 2;
• FIG. 4 is a schematic perspective view showing an alternative form of an access system deployed within a vascular structure;
• FIG. 5 is a schematic side view showing the access system ofFIG. 4 deployed within a vascular structure, wherein the vascular structure includes an aneurysm;
• FIG. 6 is a schematic perspective view showing an alternative form of an access system;
• FIG. 7 is a schematic end view of the access system shown inFIG. 6;
• FIG. 8 is a schematic sectional view taken along line A-A ofFIG. 7;
• FIG. 9 is a schematic enlarged view of the segment labeled B inFIG. 8;
• FIG. 10 is a schematic perspective view showing an alternative form of an access system;
• FIG. 11 is a schematic end view of the access system shown inFIG. 10;
• FIG. 12 is a schematic sectional view taken along line C-C ofFIG. 11;
• FIGS. 13,14,14A and15-20 illustrate a delivery catheter which may used to deploy the access system of the present invention at a procedure site within a vascular structure;
• FIGS. 21-26 are schematic views showing one approach for repairing a lateral aneurysm using an endoluminal approach and a flowable forming material;
• FIGS. 27-32 are schematic views showing another approach for repairing a lateral aneurysm using an endoluminal approach and a flowable forming material;
• FIGS. 33-38 are schematic views showing still another approach for repairing a lateral aneurysm using an endoluminal approach and a flowable forming material;
• FIGS. 39-44 are schematic views showing an approach for repairing a fusiform aneurysm using an endoluminal approach and a flowable forming material;
• FIGS. 45-50 are schematic views showing another approach for repairing a fusiform aneurysm using an endoluminal approach and a flowable forming material;
• FIGS. 51-56 are schematic views showing still another approach for repairing a fusiform aneurysm using an endoluminal approach and a flowable forming material;
• FIGS. 57-63 are schematic views showing another approach for repairing a lateral aneurysm using an endoluminal approach and a flowable forming material;
• FIG. 64 is a schematic view showing an approach for repairing an abnormality in a body lumen using an endoluminal approach and a flowable forming material; and
• FIGS. 65-68 are schematic views showing various constructions for a mold structure which may be used in conjunction with the present invention.
DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTSMethod and Apparatus for Accessing the Wall of a Vascular Structure or Other Body Lumen while Simultaneously Providing Zone Isolation and Fluid Bypass Capability
• Looking first atFIGS. 1-3, there is shown anaccess system5 formed in accordance with the present invention.Access system5 generally comprises an erectableproximal isolation barrier10 and an erectabledistal isolation barrier15 for disposition within the lumen of a vascular structure or other body lumen. Erectableproximal isolation barrier10 and erectabledistal isolation barrier15 are formed so that they can (i) initially assume a diametrically-reduced configuration so as to facilitate insertion ofaccess system5 to a site where a procedure (e.g., therapy, diagnosis, exploration, etc.) is to be conducted, and (ii) thereafter assume a diametrically-expanded configuration once at the procedure site so as to form a fluid-tight (occlusive) seal against the wall of the vascular structure, whereby to isolate a segment of the vascular structure from the remainder of the vascular structure, e.g., while a procedure is performed. In one preferred form of the invention,proximal isolation barrier10 anddistal isolation barrier15 have a peripheral surface texture to help ensure that the barriers will maintain their position in the vascular structure once deployed. By way of example but not limitation, such peripheral surface texturing may comprise dimpling, circumferential ribbing, etc. In this respect it will be appreciated that the proximal and distal isolation barriers should remain in place when systolic pressure is present on the outer surfaces of each of the isolation barriers and atmospheric pressure is present within the isolated segment of the vascular structure. Furthermore, erectableproximal isolation barrier10 and erectabledistal isolation barrier15 are formed so that they may be collapsed when desired so as to facilitate removal ofaccess system5 from the vascular structure, e.g., at the conclusion of the procedure. By way of example but not limitation, erectableproximal isolation barrier10 and erectabledistal isolation barrier15 may be formed by inflatable/deflatable balloons, compressible/expandable superelastic shape memory alloy (e.g., Nitinol) rings, etc. As a result of this construction, whenaccess system5 has been deployed at a desired point in a vascular structure or other body lumen, and erectableproximal isolation barrier10 and erectabledistal isolation barrier15 have been expanded to their sealing condition,access system5 can isolate a segment of the vascular structure (i.e., the portion located between erectedproximal isolation barrier10 and erected distal isolation barrier15) from the remainder of the vascular structure, e.g., while a procedure is performed. This can be important in a variety of situations, e.g., where the procedure may dislodge debris which could harm downstream tissue.
• Access system5 is preferably constructed so that erectableproximal isolation barrier10 and erectabledistal isolation barrier15 may be diametrically-expanded and diametrically-reduced independently of one another. In other words,access system5 is preferably constructed so thatproximal isolation barrier10 may be diametrically-expanded or diametrically-reduced regardless of the condition ofdistal isolation barrier15, and vice-versa.
• Where erectableproximal isolation barrier10 and erectabledistal isolation barrier15 are formed out of an inflatable/deflatable balloon,access system5 also comprises channels for delivering fluid (a liquid or a gas) for inflating/deflating the balloons. By way of example but not limitation, achannel16 may be provided for inflating the balloon of erectableproximal isolation barrier10 and achannel17 may be provided for inflating the balloon of erectabledistal isolation barrier15.
• Access system5 further comprises abypass channel20 secured to, and extending between and through,proximal isolation barrier10 anddistal isolation barrier15.Bypass channel20 comprises a central lumen25 (FIG. 3) which opens proximal toproximal isolation barrier10 and distal todistal isolation barrier15, whereby to permit flow from one side ofaccess system5 to the other side ofaccess system5. As a result of this construction, whenaccess system5 is deployed in a vascular structure so as to isolate a segment of the vascular structure from the remainder of the vascular structure,access system5 can still permit blood to flow uninterrupted through thebypass channel20 which traverses the isolated segment of the vascular structure. This can be important in a variety of situations, e.g., such as where continued blood flow is important for the oxygenation of downstream tissues.
• In one embodiment, the upstream isolation barrier may be configured so as to channel blood flow intobypass channel20. Thus, for example, inFIG. 1,proximal isolation barrier10 may be configured so as to channel blood flow intobypass channel20. By way of example but not limitation, the upstream side ofproximal isolation barrier10 may be formed with a concave (e.g., funnel-shaped) surface surrounding the entrance to bypasschannel20.
• Thus it will be seen thataccess system5 provides both zone isolation (viaproximal isolation barrier10 and distal isolation barrier15) and distal perfusion (via bypass channel20). These features can be important in a variety of situations where zone isolation and distal perfusion are both desirable and/or necessary, e.g., where vascular trauma needs to be temporarily stabilized while the patient is transported to another site for further treatment, where an aneurysm (e.g., abdominal or thoracic, iliac or femoral, etc.) is bleeding and/or threatening to rupture, or actually has ruptured, etc. Furthermore, it should be appreciated thataccess system5 may be used on both the arterial and venous sides of the circulation system.
• Access system5 further comprises a workingcatheter30 which passes throughproximal isolation barrier10 and provides access (e.g., for medical instruments including but not limited to cutting instruments, biopsy instruments, closure instruments, material delivery systems, endoscopes, etc., including for the delivery of adhesives and/or agents for promoting thrombus, gene therapeutic agents, etc.) to the wall of the isolated length of the vascular structure. Preferably, workingcatheter30 can slide forward and backward throughproximal isolation barrier10 such that workingcatheter30 can be positioned anywhere betweenproximal isolation barrier10 anddistal isolation barrier15. Additionally,access system5 is preferably configured so that workingcatheter30 can be rotated in order that thedistal tip33 of workingcatheter30 can access substantially the entire circumference of the isolated vessel.
• Access system5 is preferably configured so as to be mountable on aguidewire35, so thataccess system5 may be delivered to a desired position within the vascular structure. By way of example but not limitation,access system5 may comprise aguidewire channel40 mounted toproximal isolation barrier10 and/or working catheter30 (e.g., proximal toproximal isolation barrier10, as shown inFIG. 1), such thatguidewire35 may be received withinbypass channel20 andguidewire channel40, whereby to permit controlled delivery ofaccess system5 to a desired location within a vascular structure.
• In one preferred form of use, and looking now atFIGS. 1-3,access system5 may be used to isolate, bypass and access the wall of a vascular structure. By way of example but not limitation,access system5 may be used to isolate, bypass and access alateral aneurysm45 formed in the wall of avascular structure50. In this case, guidewire35 is first deployed downvascular structure50. Then accesssystem5, withproximal isolation barrier10 anddistal isolation barrier15 set in their diametrically-reduced condition, is advanced over the guidewire to a point adjacent tolateral aneurysm45. Next,proximal isolation barrier10 anddistal isolation barrier15 are set in their diametrically-expanded condition, so as to conform to, and seal against, the wall of the vascular structure and thereby create anisolation zone55 which encompasseslateral aneurysm45. However, it will be appreciated that blood is still able to flow past the isolation zone (e.g., fromflow zone60 to flow zone65) viabypass channel20. To the extent that the proximal end of workingcatheter30 is open to the atmosphere, blood in the isolation zone may flow out of the isolation zone via the working catheter and be replaced with air. Alternatively, the working catheter may be used to introduce another fluid (e.g., saline) into the isolation zone. At this point, instruments may be advanced through workingcatheter30 so as to access, and provide therapy to,lateral aneurysm45. Such instruments may include, but are not limited to, cutting instruments, biopsy instruments, closure instruments, material delivery systems, endoscopes, etc. At the conclusion of the procedure,proximal isolation barrier10 anddistal isolation barrier15 are set in their diametrically-reduced condition, and then accesssystem5 is withdrawn alongguidewire35. Finally, guidewire35 is removed fromvascular structure50.
• Any debris created inisolation zone55 during the procedure may be removed by withdrawing blood/debris fromisolation zone55. In one form of the invention, blood/debris evacuation may be effected by applying suction via workingcatheter30 while bothproximal isolation barrier10 anddistal isolation barrier15 remain erected. In another form of the invention, blood/debris evacuation may be effected by first returningproximal isolation barrier10 to its diametrically-reduced configuration while retainingdistal isolation barrier15 in its diametrically-expanded configuration, then removing blood/debris via suction, and then returningdistal isolation barrier15 to its diametrically-reduced configuration so thataccess system5 may be removed from the vascular structure. This latter approach may be particularly applicable to angioplasty in the coronary and/or carotid arteries.
• FIGS. 4 and 5 show an alternative form ofaccess system5. The access system shown inFIGS. 4 and 5 is substantially the same as the access system shown inFIGS. 1-3, except thatguidewire channel40 extends parallel to, but spaced from,bypass channel20 andbypass channel20 is positioned diametrically outboard so as to sit proximate to the wall of the vascular structure.
• If desired, workingcatheter30 may be made detachable from the remainder ofaccess system5. This feature can be advantageous where longer term isolation of a vascular region is desired, e.g., for aneurysm embolization, since it allows the relatively large-bore working catheter to be removed, leaving only the zone isolation apparatus and fluid bypass apparatus present in the body lumen.
• As noted above,proximal isolation barrier10 anddistal isolation barrier15 are designed so as to be able to assume a diametrically-expanded configuration or a diametrically-reduced configuration. As also noted above,proximal isolation barrier10 anddistal isolation barrier15 may comprise an inflatable/deflatable balloon or a compressible/expandable ring, etc. In this respect it should be appreciated that whereproximal isolation barrier10 anddistal isolation barrier15 comprise an inflatable/deflatable balloon, the balloon may extend across substantially the entire diameter of the vascular structure. Alternatively, the balloon may extend only about the periphery of the diameter of the vascular structure, and amembrane67 may extend across the interior of the balloon, such as is shown inFIG. 3. A similar construction may be used whereproximal isolation barrier10 anddistal isolation barrier15 comprise a compressible/expandable ring, e.g., such as one formed from a superelastic shape memory alloy. Again, a membrane may extend across the interior of the ring.
• FIGS. 6-9 show an alternative form ofaccess system5. The access system shown inFIGS. 6-9 is substantially the same as the access system shown inFIGS. 1-3 except thatproximal isolation barrier10 anddistal isolation barrier15 comprisemulti-segmented balloons70, and workingcatheter30 includes anopening75 connected to the lumen of workingcatheter30. The use of thesemulti-segmented balloons70 to formproximal isolation barrier10 anddistal isolation barrier15 provide a wider, more stable barrier without restricting blood flow throughbypass channel20. As seen inFIG. 9,channels80 may be provided between adjacent balloons so that the interior of the balloons are in communication with one another.
• FIGS. 10-12 show an alternative form ofaccess system5. The access system shown inFIGS. 10-12 is substantially the same as the access system shown inFIGS. 6-9 except thatchannels80 may be replaced withholes85 so that the interior of the balloons are in communication with one another.
Deployment
• Access system5 may be deployed in a vascular structure or other body lumen using a delivery catheter. More particularly, and looking next atFIGS. 13,14,14A and15-20, adelivery catheter100 comprising adelivery sheath103 may be provided for advancingaccess system5 to a procedure site within a vascular structure (or other body lumen), and for erectingaccess system5 in the manner previously discussed. Furthermore,delivery catheter100 may be used for advancing instruments down to the procedure site and/or removing debris from the procedure site (e.g., a fusiformaortic aneurysm104 of the type shown inFIG. 14A), again in the manner previously discussed. Finally,delivery catheter100 may be used to collapseaccess system5 and remove it from the vascular structure (or other body lumen). In the case whereaccess system5 comprises inflatable/deflatable balloons in its proximal isolation barrier and/ordistal isolation barrier15,delivery catheter100 may contain one or morefluid supply tubes105 for inflating/deflating the balloons. It should be appreciated thatdelivery sheath103 ofdelivery catheter100 may also perform the function of an introducer sheath, in the sense that it can be secured to the exterior tissue of the patient once the delivery catheter is properly positioned. Ahemostatic valve110, with aside port115, is preferably located on the proximal end of the delivery catheter to prevent the loss of blood through the catheter while still allowing the insertion ofaccess system5.
Anatomical Applications
• It should be appreciated thataccess system5 can be used to provide a wide range of therapies to vascular structures, e.g., aneurysm therapy, lesion therapy, infusion therapy, gene therapy, photodynamic therapy, etc.Access system5 may also be used to repair tears, flaps and leaks in a vascular structure.
• Furthermore, it should be also be appreciated that the present invention can be used to access structures other than vascular structures, e.g., the esophagus, stomach, small or large bowel, ureter, bladder, urethra, bronchus, bile duct, ear, nose, fallopian tube, other tubular or hollow structures within the human body, etc. In essence, the present invention can be advantageously used in substantially any body lumen where isolation, access and/or fluid bypass are desired. Additionally, it should be appreciated that the zone which is isolated between the proximal and distal isolation barriers could be of varying lengths, and of various diameters as well. Furthermore, many different catheter shapes and sizes may be utilized.
• Without limiting the breadth and scope of the present invention, it is anticipated that the present invention is particularly well suited for treating fusiform aneurysms in the aorta and the larger peripheral blood vessels.
• Furthermore, without limiting the breadth and scope of the present invention, it is anticipated that the present invention is particularly well suited for treating vascular trauma in a variety of situations where zone isolation and distal perfusion are both desirable and/or necessary, e.g., where vascular trauma needs to be temporarily stabilized while the patient is transported to another site for further treatment.
Method and Apparatus for Repairing Vascular Abnormalities and/or Other Body Lumen Abnormalities Using an Endoluminal Approach and a Flowable Forming Material
• In the foregoing description, there is disclosed a novel method and apparatus for endoluminally accessing the wall of a vascular structure or other body lumen while simultaneously providing zone isolation and fluid bypass capability.
• Significantly, this novel method and apparatus for endoluminally accessing the wall of a vascular structure or other body lumen can be used in conjunction with another novel method and apparatus in order to endoluminally repair vascular abnormalities and/or other body lumen abnormalities. More particularly, in another aspect of the present invention, there is provided a novel method and apparatus for repairing vascular abnormalities and/or other body lumen abnormalities using an endoluminal approach and a flowable forming material.
• Looking next atFIGS. 21-26,vascular structure50 is shown havinglateral aneurysm45. As is well known, such a lateral aneurysm can present a substantial risk to the patient, since the aneurysm may enlarge and rupture if it is left untreated. To this end, it is generally desirable to block the flow of blood into the aneurysm so as to prevent the aneurysm from enlarging and rupturing. In some circumstances this may be accomplished by placing a clip across the neck of the aneurysm (i.e., via an invasive surgical approach), or by performing a repair with a graft (in the case of an abdominal aortic aneurysm). However, in other circumstances, it may be difficult to reach the aneurysm in order to apply the clip, e.g., where the aneurysm is located deep within the brain or in the case of trauma where no facilities are available in the field to perform a repair. In these situations, and others, it could be desirable to close off the aneurysm using an endoluminal approach. In this respect it should be appreciated that such an endoluminal approach can substantially reduce morbidity, since it eliminates the need to open the skull and avoids trauma to intervening tissue.
• To this end, the present invention provides a novel method and apparatus for closing off an aneurysm using an endoluminal approach. More particularly, the present invention provides a method and apparatus for accessing an aneurysm via an endoluminal approach and then filling the aneurysm with a flowable forming material so as to close off the aneurysm from blood flow. Significantly, the present invention may also be used to endoluminally repair other vascular abnormalities and/or to repair other body lumen abnormalities such as vascular tears, flaps, and perforations using an endoluminal approach and a flowable forming material.
• And significantly, the present invention may be facilitated using theaforementioned access system5.
• In accordance with one preferred form of the present invention, an aneurysm in a vascular structure may be repaired in the following manner. First, and still looking now atFIGS. 21-26, theaforementioned access system5 is introduced into thevascular structure50 and advanced along that vascular structure until erectableproximal isolation barrier10 and erectabledistal isolation barrier15 straddle the neck of theaneurysm45. Thenproximal isolation barrier10 anddistal isolation barrier15 are erected so as to isolate the segment of the vascular structure which is disposed betweenproximal isolation barrier10 and distal isolation barrier15 (i.e., isolation zone55) from the remainder of the vascular structure. However, as this occurs, and as discussed previously,bypass channel20 maintains fluid flow from one side of the isolation zone to the other side of the isolation zone. This is significant, since it permits uninterrupted oxygenation of downstream tissue, and hence permits procedure time to be increased without risk of oxygen deprivation to downstream tissue. The blood contained within isolation zone55 (and aneurysm45) may then be removed via opening75 of workingcatheter30 and replaced by another fluid, e.g., air, saline, etc. SeeFIG. 21. Next, asupply catheter205 is advanced down workingcatheter30 so that thedistal end210 ofsupply catheter205 emerges from opening75 and is disposed adjacent to, or within,aneurysm45. SeeFIG. 22. Then a flowable formingmaterial215 is flowed out ofdistal end210 ofsupply catheter205 and intoaneurysm45. The flow of flowable forming material is continued untilaneurysm45 is, preferably, substantially completely filled with flowable formingmaterial215. SeeFIGS. 23-25. This flowable formingmaterial215 occupies the interior space ofaneurysm45 and prevents blood from flowing back into the aneurysm. Thereafter, after flowable formingmaterial215 has assumed its substantially stationary state,access system5 is removed fromvascular structure50, allowing blood to return to the neck ofaneurysm45. However, since the aneurysm has been filled with flowable formingmaterial215, blood is unable to re-enter the aneurysm. Thus, the risk of subsequent aneurysm enlargement and rupture is significantly reduced.
• It should be appreciated that inasmuch asaccess system5 simultaneously provides both zone isolation capability and fluid bypass capability,access system5 can be maintained invascular structure50 for substantial periods of time while flowable formingmaterial215 is deployed in position and assumes its substantially stationary state, thereby increasing the possibility of better repair and expanding the range of compositions which may be used for flowable formingmaterial215.
• InFIGS. 21-26 discussed above, andFIGS. 27-32,33-38,39-44,45-50,51-56 and57-63 which are hereinafter discussed, the boundary of flowable formingmaterial215 is generally shown to have a “wavy” boundary line. These are schematic views which are intended to indicate that the boundary line offlowable forming material215 may or may not have a uniform, highly regular character, depending upon a variety of factors, e.g., the nature of the flowable forming material, the presence or absence of a mold structure (see below), the face of such a mold structure, etc. Thus, it should be understood that the use of a “wavy” boundary line in the drawings is not intended to necessarily indicate a non-uniform boundary line forflowable forming material215. In point of fact, where flowable formingmaterial215 is intended to abut active blood flow, it is generally desired that flowable formingmaterial215 have a uniform, highly regular character in order to preserve laminar blood flow.
• Flowable forming material215 preferably comprises a bi-state material, having (i) a flowable state prior to disposition within the aneurysm, and (ii) a substantially stationary state after disposition within the aneurysm. In its flowable state,flowable forming material215 may comprise a liquid, a foam, a gel, etc.Flowable forming material215 may comprise a polymer which is cured in situ, an adhesive which hardens in situ, thrombus, fibrin glue, or any other material consistent with the present invention.
• By way of example but not limitation,flowable forming material215 may comprise a permanent, non-resorbable material. Some candidate permanent, non-resorbable materials are as follows:
• (1) a hybrid inorganic/organic-hydraulic cement/polyurethane resin (expands slightly during cure), including:
• • (a) a solid, rigid molded matrix;
  • (b) a foaming during cure to produce an open-cell, microcellular, rigid foam; and
  • (c) a syntactic foam containing pre-formed resorbable gelatin microspheres containing an active ingredient, such as an antibiotic;
• (2) an organic polymer ambient temperature cure resin, including:
• • (a) methyl methacrylate (MMA) liquid monomer catalyzed with peroxide initiator—this material can cure at body temperature within several minutes to several hours, depending upon catalyst type and amount, and has been successfully applied to knee replacement surgery, etc.—some available options include:
    • (i) a solid, rigid molded poly(methyl methacrylate [PMMA] matrix;
    • (ii) a syntactic foam containing pre-formed resorbable gelatin microspheres containing an active ingredient, such as an antibiotic; and
    • (iii) an Oakes Foamer-produced pre-formed MMA liquid monomer foam injection to produce rigid, closed cell foam matrix—this material can expand slightly during cure within the body; and
  • (b) polyurethane (non-resorbable) liquid pre-polymer blended and mixed with co-reactant polyol/catalyst component immediately prior to injection-molding into in-vivo mold cavity—this material can cure at body temperature within several minutes to several hours, depending upon catalyst type and amount, and biocompatible, non-resorbable polyurethane (PUR) monomers and catalysts are available that produce a soft, elastomeric-to-hard, rigid, cured PUR matrix—some available options include:
    • (i) a solid, rigid molded matrix;
    • (ii) a foaming during cure to produce an open-cell, microcellular, rigid foam—this non-resorbable foam matrix can be made to contain active components, such as antibiotics, that leach out at a controlled, adjustable rate;
    • (iii) a syntactic foam containing pre-formed resorbable gelatin microspheres that are filled with an active ingredient, such as an antibiotic
• as the gelatin capsule walls are resorbed into the body, the active ingredient becomes leached out in a controlled-release process that can be adjusted in rate and amount; and
• • • (iv) an Oakes Foamer-produced pre-formed PUR liquid monomer foam injection to produce rigid, closed cell foam matrix—this material can expand slightly during cure within the body.
• By way of further example but not limitation,flowable forming material215 may comprise a resorbable material. Some candidate resorbable materials are as follows:
• (1) a resorbable organic polymer ambient temperature cure resin—some available options include:
• • (a) a bioresorbable polyurethane (contains biodegradable chain segments) liquid pre-polymer blended and mixed with co-reactant polyol/catalyst component immediately prior to injection-molding into in-vivo mold cavity—this material cures at body temperature within several minutes to several hours, depending upon catalyst type and amount, and biocompatible, resorbable polyurethane (PUR) monomers and catalysts are available that produce soft, elastomeric-to-hard, rigid, cured PUR matrix—resorbable polyurethane polymer chain segments can be polylactic acid (PLA), polyglutaric acid (PGA), polyethylene oxide (PEO), polycaprolactone (PCL), polyvinyl alcohol (PVOH) and polyethylene/vinyl alcohol (EVOH) segments with tailorable resorption rates, varying from 15 days to 6 months, depending upon chain segment type and amount—some options include:
    • (i) a solid, rigid molded matrix;
    • (ii) a foaming during cure to produce an open-cell, microcellular, rigid foam—this in-vivo resorbable foam matrix can be made to contain active components, such as antibiotics, that are released into the body at a controlled, adjustable rate as the matrix is resorbed;
    • (iii) a syntactic foam containing pre-formed resorbable gelatin microspheres that are filled with an active ingredient, such as an antibiotic—as resorbable polymer matrix and resorbable gelatin capsule walls are resorbed into the body, the active ingredient becomes leached out in a controlled-release process that can be adjusted in rate and amount; and
    • (iv) an Oakes Foamer-produced pre-formed PUR liquid monomer foam injection to produce rigid, resorbable closed cell foam matrix—this material can expand slightly during cure within body; and
  • (b) resorbable hydroxyethylmethacrylate ester (HEMAE) liquid monomer (this material contains biodegradable ester linkages, such as PLA, PCL and PGA linkages, attached to methacrylate monomer unit) catalyzed with peroxide initiator—this material can cure at body temperature within several minutes to several hours, depending upon catalyst type and amount—this material can undergo gradual bioresorption in-vivo—attached ester linkages can be functional groups, such as an antibiotic, that are released as ester linkage is hydrolyzed in-vivo—some options include:
    • (i) a solid, rigid molded poly(HEMAE) matrix;
    • (ii) a syntactic foam containing pre-formed resorbable gelatin microspheres containing an active ingredient, such as antibiotic; and
    • (iii) an Oakes Foamer-produced pre-formed MMA liquid monomer foam injection to produce rigid, closed cell foam matrix—this material can expand slightly during cure within body.
• In one preferred form of the invention,flowable forming material215 comprises spider silk.
• If desired, a mold structure can be erected withinisolation zone55 so as to restrain the flow offlowable forming material215 while the forming material is still in its flowable state (and before the material transforms to its substantially stationary state). To this end, and looking now atFIGS. 27-31, there is shown amold structure220 for restraining the flow offlowable forming material215 while the material transforms to its substantially stationary state.Mold structure220 may be configured to line some or all ofisolation zone55, but in any case it lines at least the neck of the aneurysm. InFIGS. 27-31,mold structure220 is configured to line substantially the entire periphery ofisolation zone55. In one preferred form of the invention,mold structure220 is delivered toisolation zone55 viaaccess system5, and is thereafter selectively detachable from the access system so that the mold structure can be left invascular structure50 upon withdrawal ofaccess system5. SeeFIG. 32. In another form of the invention,mold structure220 may be permanently secured to accesssystem5 so that the mold structure is withdrawn fromvascular structure50 upon withdrawal of the access system. In either case,mold structure220 forms a barrier about the neck ofaneurysm45 so as to preventflowable forming material215 from extravascating out of the body ofaneurysm45.
• In one form of the invention,mold structure220 preferably comprises a substantially continuous film such as is shown inFIGS. 27-32. In this form of the invention,distal end210 ofsupply catheter205 is preferably formed with a needle-like profile which permits the supply catheter to puncture throughmold structure220 so as to be able to deliverflowable forming material215 into the interior ofaneurysm45. Alternatively,mold structure220 can be formed with an opening therein which permitsdistal end210 ofsupply catheter205 to deliver flowable forming material into the interior ofaneurysm45. Furthermore, wheremold structure220 is to be left in place at the conclusion of the procedure,flowable forming material215 andmold structure220 can be configured to adhere to one another.
• In another form of the invention, and looking now atFIGS. 33-38,mold structure220 may comprise a mesh. This mesh has a porosity which is sufficiently small vis-à-vis the flow characteristics offlowable forming material215 that the mesh restrains the flowable forming material within the aneurysm. Again,distal end210 ofsupply catheter205 is preferably formed with a needle-like profile which permits the supply catheter to puncture throughmold structure220 so as to be able to deliverflowable forming material215 into the interior ofaneurysm45. Alternatively,mold structure220 can be formed with an opening therein which permitsdistal end210 ofsupply catheter205 to deliver flowable forming material into the interior ofaneurysm45. And again, wheremold structure220 is to be left in place at the conclusion of the procedure,flowable forming material215 andmold structure220 can be configured to adhere to one another.
• FIGS. 21-26,27-32 and33-38 all show the present invention being used in the context of repairing a lateral aneurysm. However, it is also possible to use the present invention to treat a fusiform aneurysm. See, for example,FIGS. 39-44, where the aneurysm is filled with flowable formingmaterial215 without using a mold structure;FIGS. 45-50, where the aneurysm is filled with flowable formingmaterial215 using a film-type mold structure220, andFIGS. 51-56 where the aneurysm is filled with flowable formingmaterial215 using a mesh-type mold structure220. Where the present invention is used to treat a fusiform aneurysm without the provision of a mold structure, it may be necessary to rotate workingcatheter30 about its longitudinal axis so as to enablesupply catheter205 to deliverflowable forming material215 to all aspects of the aneurysm. Where the present invention is used to treat a fusiform aneurysm with the provision of amold structure220, it may not be necessary to rotate workingcatheter30 so as to enablesupply catheter205 to deliverflowable forming material215 to all aspects of the aneurysm, although it may still be desirable to provide this option.
• If desired, theflowable forming material215 can be limited to the region of the aneurysm (e.g., as is shown inFIGS. 21-26,27-32,33-38,39-44,45-50 and51-56), or it can be allowed to flow into a portion of the lumen ofvascular structure50 in order to provide a flange at the base of the solidified formingmaterial215. See, for example,FIGS. 57-63, which show aflange225 formed integral with the solidifiedmaterial filling aneurysm45. In this respect it should be appreciated thatflange225 can be formed with or without a mold structure, e.g., a partial circumferential mold structure can be provided to constrainflowable forming material215 so as to formflange225 or the flowable forming material can be dispensed in a controlled manner so as to formflange225. Again,FIGS. 57-63 show this concept in the context of a lateral aneurysm; however, is should be appreciated that this same concept may be applied to fusiform aneurysms as well.
• In the foregoing description, the present invention is discussed in the context of repairing an aneurysm in a vascular structure. However, it should be appreciated that the present invention may also be used to repair other types of vascular abnormalities (e.g., a blood vessel wall which is reduced in thickness or strength due to disease, trauma, therapeutic intervention such as an angioplasty, device failure such as leaks and/or migration of an abdominal aortic aneurysm (AAA) graft, etc.) and/or abnormalities in other body lumens (e.g., an intestinal wall which is reduced in thickness or strength due to disease or injury). Thus, for example,FIG. 64 shows abody lumen50A which hasflowable forming material215 lining the wall ofbody lumen50A. Also shown are aproximal isolation barrier10, adistal isolation barrier15 and amold structure220.
• It should be appreciated thatmold structure220 can be provided with various configurations other than the simple continuous film configuration shown inFIGS. 27-32 and/or the simple mesh configuration shown inFIGS. 33-38. Thus, for example,mold structure220 can be formed with longitudinally-extending ribs230 (FIGS. 65 and 66), circumferentially-extending ribs230 (FIGS. 67 and 68), and/or other configurations. If desired, whereproximal isolation barrier10 anddistal isolation barrier15 comprise inflatable balloon structures, the longitudinally-extending ribs230 (FIGS. 65 and 66) and/or the circumferentially-extending ribs230 (FIGS. 67 and 68) can also comprise balloons, which may or may not be in fluid communication with one or more of the balloons which formproximal isolation barrier10 anddistal isolation barrier15.
Modifications
• While the present invention has been described in terms of certain exemplary preferred embodiments, it will be readily understood and appreciated by one of ordinary skill in the art that it is not so limited, and that many additions, deletions and modifications may be made to the preferred embodiments discussed

Claims (32)

1. A method for repairing an abnormality in the wall of a body lumen, the method comprising:

isolating the abnormality in the wall of the body lumen from flow in the body lumen;

positioning flowable forming material adjacent to the abnormality in the wall of the body lumen; and

transforming the flowable forming material into a substantially stationary state so as to repair the abnormality in the wall of the body lumen.

2.-8. (canceled)

9. A method according toclaim 1 wherein the abnormality comprises one from the group consisting of a reduced wall thickness, a perforation, a tear and a flap.

10. A method according toclaim 9 wherein the flowable forming material is integrated with the wall of the body lumen so as to repair the abnormality.

11.-37. (canceled)

38. A method according toclaim 1 wherein the flowable forming material comprises a non-resorbable material.

39. A method according toclaim 38 wherein the flowable forming material comprises at least one selected from the group consisting of a hybrid inorganic/organic--hydraulic cement/polyurethane resin and an organic polymer ambient temperature cure resin.

40. A method according toclaim 39 wherein the flowable forming material comprises at least one selected from the group consisting of methyl methacrylate (MMA), polymethyl methacrylate [PMMA] and polyurethane.

41.-43. (canceled)

44. A method according toclaim 1 wherein the flowable forming material comprises polylactic acid (PLA).

45. A method according toclaim 1 wherein the flowable forming material comprises spider silk.

46.-49. (canceled)

50. A method according to claim46 wherein the mold structure comprises a mesh.

51. A method according toclaim 50 wherein the mesh is in the form of a cylinder.

52. (canceled)

53. A method according to claim46 wherein the mold structure comprises a partial circumferential configuration.

54. Apparatus for repairing an abnormality in the wall of a body lumen, the apparatus comprising:

a supply of flowable forming material;

zone isolation apparatus for isolating the abnormality in the wall of the body lumen from flow in the body lumen; and

positioning apparatus for positioning the flowable forming material adjacent to the abnormality in the wall of the body lumen so as to repair the abnormality in the wall of the body lumen.

55. Apparatus according toclaim 54 wherein the flowable forming material comprising a bi-state material having (i) a flowable state, and (ii) a substantially stationary state.

56. Apparatus according toclaim 54 wherein the flowable forming material comprises polylactic acid (PLA).

57. Apparatus according toclaim 54 wherein the flowable forming material comprises spider silk.

58. Apparatus according toclaim 54 wherein the zone isolation apparatus isolates the abnormality in the wall of the body lumen from flow in the body lumen while still allowing flow through the body lumen.

59. Apparatus according toclaim 58 wherein the zone isolation apparatus comprises:

an erectable proximal isolation barrier capable of making a sealing engagement with the wall of the body lumen;

an erectable distal isolation barrier capable of making a sealing engagement with the wall of the body lumen;

a bypass channel secured to, and extending between, the proximal isolation barrier and the distal isolation barrier, the bypass channel comprising a lumen communicating with the region proximal to the proximal isolation barrier and with the region distal to the distal isolation barrier; and

a working catheter passing through the proximal isolation barrier and terminating short of the distal isolation barrier, the working catheter providing a central lumen for providing access to the wall of the body lumen between the proximal isolation barrier and the distal isolation barrier.

60. Apparatus according toclaim 59 wherein the erectable proximal isolation barrier and the erectable distal isolation barrier are constructed so as to be capable of assuming a diametrically-reduced configuration and a diametrically-expanded configuration, and further wherein the erectable proximal isolation barrier and the erectable distal isolation barrier are in their diametrically-expanded configuration when making a sealing engagement with the wall of the body lumen.

61. Apparatus according toclaim 59 wherein at least one of the erectable proximal isolation barrier and the erectable distal isolation barrier comprises an upstream isolation barrier, and further wherein the upstream isolation barrier is configured to channel blood flow into the bypass channel.

62. Apparatus according toclaim 54 further comprising a mold structure configured to constrain the flowable forming material in the space between the wall of the body lumen and the mold structure.

63. Apparatus according toclaim 62 wherein the mold structure is penetrable.

64. Apparatus according toclaim 62 wherein the mold structure comprises a substantially continuous film.

65. Apparatus according toclaim 64 wherein the substantially continuous film is in the form of a cylinder.

66. Apparatus according toclaim 62 wherein the mold structure comprises a mesh.

67. Apparatus according toclaim 66 wherein the mesh is in the form of a cylinder.

68. Apparatus according toclaim 62 wherein the mold structure comprises a circumferential configuration.

69. Apparatus according toclaim 62 wherein the mold structure comprises a partial circumferential configuration.

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