METHODS FOR TREATING A HOLLOW ANATOMICAL STRUCTURE

• US 20110046617A1
• Filed: 11/09/2010
• Published: 02/24/2011
• Est. Priority Date: 07/21/2005
• Status: Active Grant

• Current Assignee: Tyco Healthcare Group LP (Medtronic Plc)
• Original Assignee: Tyco Healthcare Group LP (Medtronic Plc)
• Inventors: Thompson, Russell Blake, Esch, Brady David, Dhaka, Vijay Kumar, Sander, Fiona Maria
• Granted Patent: US 7,963,962 B2
• Time in Patent Office: Days
• US Class Current: 606/27
• CPC Class Codes: A61B 18/08 by means of electrically-heated probes
• CPC Class Codes: A61B 18/082 Probes or electrodes therefor
• CPC Class Codes: A61B 18/1492 having a flexible, catheter-like structure, e.g. for heart ablation A61B18/1477 takes precedence
• CPC Class Codes: A61B 18/20 using laser
• CPC Class Codes: A61B 18/24 with a catheter A61B18/26, A61B18/28 take precedence
• CPC Class Codes: A61B 2017/00026 Conductivity or impedance, e.g. of tissue
• CPC Class Codes: A61B 2017/00084 Temperature
• CPC Class Codes: A61B 2017/00119 alarm; indicating an abnormal situation
• CPC Class Codes: A61B 2017/00123 and automatic shutdown
• CPC Class Codes: A61B 2017/00132 Setting operation time of a device A61B2017/00123 takes precedence
• CPC Class Codes: A61B 2018/00636 Sensing and controlling the application of energy
• CPC Class Codes: A61B 2018/00666 using a threshold value
• CPC Class Codes: A61B 2018/00779 Power or energy
• CPC Class Codes: A61B 2018/00791 Temperature
• CPC Class Codes: A61B 2018/00827 Current
• CPC Class Codes: A61B 2018/046 in liquid form
• CPC Class Codes: A61B 2090/0811 for the position of a particular part of an instrument with respect to the rest of the instrument, e.g. position of the anvil of a stapling instrument
• CPC Class Codes: A61B 2090/3925 ultrasonic
• CPC Class Codes: A61B 2090/3937 Visible markers
• CPC Class Codes: A61B 2090/3945 Active visible markers, e.g. light emitting diodes
• CPC Class Codes: A61B 90/39 : Markers, e.g. radio-opaque or breast lesions markers

Abstract

A working end of a catheter includes at least one therapeutic element, such as a resistive heating element, usable to deliver energy for ligating, or reducing the diameter of, a hollow anatomical structure. In certain examples, the catheter includes a lumen to accommodate a guide wire or to allow fluid delivery. In certain embodiments, a balloon is inflated to place resistive element(s) into apposition with a hollow anatomical structure and to occlude the structure. Indexing devices and methods are also disclosed for successively treating portions of the hollow anatomical structure. In certain examples, marks along the catheter shaft provide visual verification to the physician of the relative position of the therapeutic element of the catheter. Embodiments of indexing devices may include pairs of rings and/or hinged arms that move a catheter a desired indexed position between successive treatments.

Claims

1. A method for performing a treatment inside a blood vessel having a lumen, the method comprising:

inserting an access sheath into the blood vessel, the access sheath comprising;

an internal portion for placement inside the blood vessel, an external portion for placement outside the blood vessel, a passage therethrough, and a reference location visible to the naked eye during treatment, that is located on the external portion of the access sheath;

inserting an elongate member into the blood vessel through the passage in the access sheath, the elongate member comprising;

a distal section comprising an electrically driven heating element, a proximal section several times longer than the distal section, and index markings marked at regular intervals along the proximal section, the heating element being insulated to prevent electrical contact with tissue;

advancing the heating element to a first treatment segment of the blood vessel;

adjusting the relative position of the elongate member and the access sheath such that a first index marking is viewable in or near the reference location;

applying energy to the blood vessel with the heating element while the heating element remains stationary in the first treatment segment to reduce the size of the blood vessel lumen to a desired degree in the first treatment segment;

moving the heating element along the blood vessel to one or more additional sequential treatment segments of the blood vessel wherein each additional sequential treatment segment comprises a new treatment portion and an overlap portion that overlaps with the preceding treatment segment, each sequential treatment segment indicated by at least one index marking marked on the elongate member;

adjusting the relative position of the elongate member and the access sheath such that the at least one index marking is viewable in or near the reference location; and

applying energy to the blood vessel with the heating element for additional dwell times that correspond to the one or more additional sequential treatment segments while the heating element remains stationary in each of the one or more additional sequential treatment segments, to thereby re-treat the blood vessel lumen in the overlap portion and treat the new treatment portion.

2. The method of claim 1, wherein adjusting the relative position of the elongate member and the access sheath comprises adjusting the sheath in relation to a small incision in the skin of a patient through which the access sheath is inserted.

3. The method of claim 2, wherein adjusting the sheath comprises moving the sheath toward the incision.

4. A method for treating a blood vessel comprising:

inserting an access sheath into the blood vessel, the access sheath comprising;

a distal portion, a proximal portion, a passage therethrough, and a reference location visible to the naked eye during treatment, that is located on the proximal portion of the access sheath;

inserting an elongate member into the blood vessel through the passage, the elongate member comprising;

a distal section comprising an energy element, a proximal section several times longer than the distal section, and index markings marked at regular intervals along the proximal section;

placing the energy element in a first treatment segment of the blood vessel;

applying energy to the blood vessel with the energy element while the energy element remains stationary in the first treatment segment;

moving the energy element along the blood vessel to one or more additional sequential treatment segments of the blood vessel wherein each additional sequential treatment segment comprises a new treatment portion, each sequential treatment segment indicated by at least one index marking marked on the elongate member;

aligning the elongate member relative to the access sheath until the at least one index marking is viewable in or near the reference location; and

applying energy to the blood vessel with the energy element for corresponding additional dwell times while the energy element remains stationary in each of the one or more additional sequential treatment segments.

5. The method of claim 4, wherein placing the energy element in a first treatment segment further comprises adjusting the sheath with relation to an incision in the skin of a patient through which the access sheath is inserted.

6. The method of claim 5, wherein adjusting the sheath comprises moving the sheath away from the incision.

7. A method comprising:

inserting an access sheath into a blood vessel, the access sheath comprising;

an internal portion, an external portion, a passage therethrough, and a reference location visible to the naked eye during treatment, the reference location having a proximal end and a distal end;

inserting an elongate member into the blood vessel through the passage, the elongate member comprising;

a distal section comprising a treating element, a proximal section, and index markings marked at regular intervals along the proximal section, the index markings each having a proximal end and a distal end;

placing the treating element in a first treatment segment of the blood vessel;

applying energy to the blood vessel with the treating element while the treating element remains stationary in the first treatment segment;

moving the treating element along the blood vessel to one or more additional sequential treatment segments of the blood vessel wherein each additional sequential treatment segment comprises a new treatment portion, each sequential treatment segment indicated by at least one index marking marked on the elongate member;

aligning the elongate member relative to the access sheath until the proximal end of the at least one index markings is substantially near the distal end of the reference location; and

applying energy to the blood vessel with the treating element for corresponding additional dwell times while the treating element remains stationary in each of the one or more additional sequential treatment segments.

8. The method of claim 7, wherein aligning the elongate member relative to the access sheath comprises adjusting the sheath with relation to an incision in the skin of a patient through which the access sheath is inserted.

9. The method of claim 8, wherein adjusting the sheath takes place prior to applying energy in the first treatment segment.