Compositions and methods for joining non-conjoined lumens

• US 8,216,259 B2
• Filed: 06/21/2007
• Issued: 07/10/2012
• Est. Priority Date: 06/21/2006
• Status: Expired due to Fees

• Current Assignee: Board of Trustees of the Leland Stanford Junior University (Stanford University)
• Original Assignee: Board of Trustees of the Leland Stanford Junior University (Stanford University)
• Inventors: Gurtner, Geoffrey C., Fuller, Gerald G., Longaker, Michael T., Rajadas, Jayakumar
• Primary Examiner(s): McDermott, Corrine M
• Assistant Examiner(s): ANDERSON, GREGORY A
• Application Number:
  US11/766,779
• Publication Number:
  US 20080045985A1
• Time in Patent Office: 1,846 Days
• Field of Search: 606/153, 606214-215, 606/154
• US Class Current: 606/153
• CPC Class Codes: A61B 17/00491 Surgical glue applicators surgical adhesives A61L24/00; two-component delivery syringes A61M5/19
• CPC Class Codes: A61B 17/04 for suturing wounds; Holders or packages for needles or suture materials suture materials A61L17/00
• CPC Class Codes: A61B 17/11 for performing anastomosis; Buttons for anastomosis
• CPC Class Codes: A61B 17/12022 Occluding by internal devices, e.g. balloons or releasable wires plugging an opening in the wall of an organ A61B17/0057; occluders for the cervical canal A61F6/146; vas deferens occluders A61F6/20
• CPC Class Codes: A61B 17/1204 temporary occlusion
• CPC Class Codes: A61B 17/12109 in a blood vessel
• CPC Class Codes: A61B 17/12186 liquid materials adapted to be injected
• CPC Class Codes: A61B 17/1219 expandable in contact with liquids
• CPC Class Codes: A61B 17/122 Clamps or clips , e.g. for the umbilical cord for the vas deferens A61F6/206
• CPC Class Codes: A61B 2017/1103 Approximator
• CPC Class Codes: A61B 2017/1107 for blood vessels

Abstract

Disclosed are compositions, methods, and kits for joining together non-conjoined lumens in a patient'"'"'s body including vascular lumens. More particularly, in various aspects, this invention provides compositions, methods, and kits for joining such non-conjoined lumens, including small lumens typically requiring microsurgical technique.

Claims

1. A method for joining at least two non-conjoined lumens in a patient which method comprises:

a) placing a biocompatible sol-gel composition in a liquid phase or a gel phase in at least the distal portion of at least one of the lumens by injection with a hypodermic needle and/or a syringe, wherein when the sol-gel composition is placed in the lumen in the liquid phase, a phase transition is induced wherein the liquid phase changes to the gel phase, and wherein the gel phase of the sol-gel composition provides structural support to said portion of the lumen to facilitate joining of the lumens;

b) aligning the lumens;

c) closing the aligned lumens to form a conduit; and

d) removing the sol-gel composition by inducing a phase transition of the sol-gel composition from the gel phase to the liquid phase thereby establishing flow through the conduit.

2. The method of claim 1, wherein the sol-gel composition is placed in the distal portion of each lumen to be joined.

3. The method of claim 1, wherein the sol-gel composition is placed in the distal portion of a first lumen in a manner in which the solid mass protrudes from the distal portion such that this protrusion can be used as a male mating functionality with the distal portion of the second lumen which acts as a female mating functionality.

4. The method of claim 1, wherein the sol-gel composition is sterile.

5. The method of claim 1, wherein the sol-gel composition is a phase-reversible sol-gel.

6. The method of claim 1, wherein the sol-gel composition further comprises a biologically active agent.

7. The method of claim 6, wherein the biologically active agent is selected from among one or more of:

an antithrombotic moiety, an anti-anginal moiety, an anti-coagulant, an antiinfective, an analgesic, an antiinflammatory moiety, an antiarrhythmic moiety, an antihypertensive moiety, a heart failure agent, a wound healing agent, an antiasthmatic agent, an antidiuretic agent, an antineoplastic agent, an antipyretic agent, and antispasmodic agent, and anticholinergic agent, an immunosuppressive agent, a sympathomimetic agent, a central nervous system stimulant;

a parasympatholytic agent, a hormone, a muscle relaxant, a lipid lowering agent;

an anti-ulcer agent, an anorexic, an antiarthritic, an anticonvulsant;

an antidepressant;

a sedative; and

a tranquilizer.

8. The method of claim 7, wherein the biologically active agent is an anti-coagulant.

9. The method of claim 8, wherein the anti-coagulant is heparin.

10. The method of claim 1, wherein the sol-gel composition further comprises one or both moieties selected from a biocompatible dye and a contrast agent.

11. The method of claim 1, wherein the sol-gel composition is a phase-reversible sol-gel having an elastic modulus (G′

) of at least about 100 to about 500,000 Pascals when in a gel phase.

12. The method of claim 11, wherein the elastic modulus (G′

) is from about 100 to about 20,000 Pascals.

13. The method of claim 1, wherein the sol-gel composition is a thermoreversible sol-gel.

14. The method of claim 13, wherein the thermoreversible sol-gel has a transition temperature of from about 35 °

C. to about 42 °

C.

15. The method of claim 13, wherein the phase transition of the thermoreversible sol-gel occurs due to a change in temperature of about ±

1 °

C. to about ±

10 °

C.

16. The method of claim 13, wherein the thermoreversible sol-gel comprises a polymer and a solvent.

17. The method of claim 16, wherein the solvent is water.

18. The method of claim 17, wherein the polymer is a copolymer of poly(ethylene oxide) and poly(propylene oxide).

19. The method of claim 18, wherein the copolymer has a molecular weight of from about 8,000 to about 16,000.

20. The method of claim 18, wherein the copolymer is present in an amount of about 15% to about 20% by weight.

21. The method of claim 18, wherein the thermoreversible sol-gel further comprises a protein.

22. The method of claim 21, wherein the copolymer is present in an amount of about 15% to about 20% by weight, the protein is present in an amount of about 0.5% to about 2.0% by weight.

23. The method of claim 21, wherein the copolymer is present in an amount of about 17% by weight ±

20% of the 17%, the protein is present in an amount of about 1% by weight ±

20% of the 1% and water in an amount of about 82% by weight ±

20% of the 82%.

24. The method of claim 21, wherein said protein is an albumin.

25. The method of claim 24, wherein the albumin is selected from the group consisting of bovine serum albumin and human serum albumin.

26. The method of claim 1, wherein the first lumen is a vessel of the cardiovascular system of a human.

27. The method of claim 26, wherein the second lumen is selected from the group consisting of a vessel of the cardiovascular system of a human, an arteriovenous graft, an arteriovenous shunt, an allograft, a xenograft, and a synthetic graft.

28. The method of claim 27, wherein the second lumen is a cadaver xenograft.

29. The method of claim 1, wherein at least one of the lumens has a diameter of less than 1 mm.

30. The method of claim 1, wherein the two lumens are selected from the group consisting of human fallopian tubes, vasa deferentia, tubes in the alimentary canal, pancreatic ducts, bile ducts, tear ducts, and mammary ducts.

31. The method of claim 1, wherein joining of the lumens is conducted using a biocompatible adhesive or with sutures.

32. The method of claim 31, wherein the biocompatible adhesive is selected from among a cyanoacrylate-based adhesive, a fibrin-based adhesive, a polyurethane-based adhesive, and a polyisocyanate-based adhesive.

33. The method of claim 31, wherein the adhesive is applied to the cross-sectional surfaces of the lumens.

34. The method of claim 31, wherein the adhesive is applied around the circumference of the joined lumens.

36. The method of claim 1, wherein the lumens are joined end to end.

37. The method of claim 1, wherein the lumens are joined end to side.

38. The method of claim 1, wherein the lumens are joined side to side.

35. The method of 34, wherein the adhesive further forms an external stent.

39. A method for joining at least two non-conjoined lumens having distal ends, comprising the steps of:

a) placing a phase-reversible sol-gel in a liquid phase inside at least a portion of the distal end of the first lumen by injection with a hypodermic needle and/or syringe, and inducing a phase transition wherein the liquid phase changes to a gel phase, and wherein the gel phase of the sol-gel composition provides structural support to said portion of the first lumen;

b) placing a phase-reversible sol-gel in a liquid phase inside at least a portion of the distal end of a second lumen by injection with a hypodermic needle and/or a syringe, and inducing a phase transition wherein the liquid phase changes to a gel phase, and wherein the gel phase of the sol-gel composition provides structural support to said portion of the second lumen;

c) aligning the distal portions of the first and second lumens;

d) joining said lumens so as to provide for a conduit;

e) inducing a phase change in the phase-reversible sol-gel in said conduit wherein said gel phase changes to a liquid phase; and

f) allowing flow through said conduit.

40. A method for joining at least two non-conjoined lumens having distal ends, comprising the steps of:

a) placing a phase-reversible sol-gel in a gel phase inside at least a portion of the distal end of a first lumen by injection with a hypodermic needle and/or a syringe, and in a manner which provides structural support to said portion of the first lumen;

b) placing a phase-reversible sol-gel in a gel phase inside at least a portion of the distal end of a second lumen by injection with a hypodermic needle and/or a syringe, and in a manner which provides structural support to said portion of the second lumen;

c) aligning the distal portions of the first and second lumens;

d) joining said lumens so as to provide for a conduit;

e) inducing a phase change in the phase-reversible sol-gel in said conduit wherein said gel phase changes to a liquid phase; and

f) allowing flow through said conduit.

41. A method for joining at least two non-conjoined lumens having distal ends, comprising the steps of:

a) placing a phase-reversible sol-gel in a liquid phase or a gel phase inside at least a portion of the distal end of a first lumen by injection with a hypodermic needle and/or a syringe, wherein when the sol-gel composition is placed in the lumen in the liquid phase, a phase transition is induced wherein the liquid phase changes to the gel phase, and wherein the gel phase of the sol-gel composition provides structural support to said portion of the first lumen and wherein said sol-gel protrudes from the distal end;

b) mating the distal end of a second lumen with said protrusion from the first lumen thereby aligning the first and second lumens;

c) joining said lumens so as to provide for a conduit;

d) inducing a phase change in the phase-reversible sol-gel in said conduit wherein said gel phase changes to a liquid phase; and

e) allowing flow through said conduit.

42. A method of connecting lumens within a living mammal, comprising the steps of:

providing a phase-reversible gel inside a first lumen by injection with a hypodermic needle and/or syringe, and in a manner which holds the first lumen open;

providing a phase-reversible gel inside a second lumen by injection with a hypodermic needle and and/or a syringe, and in a manner which holds the second lumen open;

applying adhesive between an end of the first lumen and an end of the second lumen and allowing the adhesive to form bonds between the first and second lumens;

inducing a phase change in the phase-reversible gel inside the first lumen and inside the second lumen; and

allowing flow through the first lumen to the second lumen.