Method for applying energy to biological tissue including the use of tumescent tissue compression
DCFirst Claim
1. A method of applying energy to a hollow anatomical structure from within the hollow portion of the structure, the method comprising the steps of:
- introducing a catheter having a working end with an energy application device at the working end into the hollow anatomical structure;
positioning the working end of the catheter proximate a treatment site within the hollow anatomical structure;
injecting a tumescent fluid solution into selected tissue that is in contact with the treatment site to cause the tissue to become tumescent and compress the hollow anatomical structure at the treatment site to a compressed size; and
applying energy to the compressed hollow anatomical structure at the treatment site via the energy application device until the hollow anatomical structure durably assumes a smaller size.
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Abstract
An electrode catheter is introduced into a hollow anatomical structure, such as a vein, and is positioned at a treatment site within the structure. Tumescent fluid is injected into the tissue surrounding the treatment site to produce tumescence of the surrounding tissue which then compresses the vein. The solution may include an anesthetic, and may further include a vasoconstrictive drug that shrinks blood vessels. The tumescent swelling in the surrounding tissue causes the hollow anatomical structure to become compressed, thereby exsanguinating the treatment site. Energy is applied by an electrode catheter in apposition with the vein wall to create a heating effect. The heating effect causes the hollow anatomical structure to become molded and durably assume the compressed dimensions caused by the tumescent technique. The electrode catheter can be moved within the structure so as to apply energy to a large section of the hollow anatomic structure. In a further aspect, the location of the electrodes is determined by impedance monitoring. Also, temperature sensors at the treatment site are averaged to determine the site temperature.
175 Citations
39 Claims
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1. A method of applying energy to a hollow anatomical structure from within the hollow portion of the structure, the method comprising the steps of:
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introducing a catheter having a working end with an energy application device at the working end into the hollow anatomical structure;
positioning the working end of the catheter proximate a treatment site within the hollow anatomical structure;
injecting a tumescent fluid solution into selected tissue that is in contact with the treatment site to cause the tissue to become tumescent and compress the hollow anatomical structure at the treatment site to a compressed size; and
applying energy to the compressed hollow anatomical structure at the treatment site via the energy application device until the hollow anatomical structure durably assumes a smaller size. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17)
saline;
vasoconstrictive agent;
sclerosing agent;
high impedance fluid; and
heparin.
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12. The method of claim 1 further comprising the steps of:
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sensing the temperatures at two separate locations on the energy application device;
averaging the two sensed temperatures at the two separate locations; and
determining a temperature at the energy application device based on the averaged temperatures.
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13. The method of claim 1 wherein the step of applying energy to the compressed hollow anatomical structure at the treatment site comprises applying electrical energy to the inner wall of the treatment site with an electrode, the electrode being in apposition with the inner wall.
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14. The method of claim 1 wherein the step of applying energy to the compressed hollow anatomical stucture at the treatment site comprises applying electrical energy to the inner wall of the treatment site with an electrode, the electrode being in apposition with the inner wall, the method further comprising the steps of:
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applying electrical energy with the electrode to effectively occlude the treatment site at the electrode; and
moving the electrode along the treatment site while maintaining the electrode in apposition with the vein wall while performing the step of applying energy to effectively occlude the treatment site so as to result in a lengthy effective occlusion of the treatment site.
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15. The method of claim 14 wherein the step of applying energy comprises applying sufficient energy to collapse the hollow anatomical structure around the energy application device as it is being moved along the treatment site to result in a lengthy effective occlusion of the treatment site.
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16. The method of claim 1 further comprising the step of determining when apposition of the energy application device with the inner wall of the hollow anatomical structure has occurred by monitoring the impedance experienced by the energy application device.
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17. The method of claim 14 wherein the step of applying electrical energy to effectively occlude the treatment site at the electrode comprises applying said energy with a plurality of electrodes, and further comprises the steps of:
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sensing the temperatures at two separate electrodes; and
averaging the two sensed temperatures; and
determining a temperature at the electrodes based on the averaged temperatures.
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18. A method of applying energy to an inner wall of a vein from within the vein along a treatment portion, the method comprising the steps of:
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introducing a catheter having a working end with an energy application device at the working end into the treatment portion;
injecting a tumescent fluid solution into selected tissue outside the vein but in contact with the vein at the treatment site to cause the tissue to become tumescent and compress the vein at the treatment site to a compressed size;
applying energy to the compressed vein at the treatment site via the energy application device; and
withdrawing the catheter. - View Dependent Claims (19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30)
saline;
vasoconstrictive agent;
sclerosing agent;
high impedance fluid; and
heparin.
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27. The method of claim 18 further comprising the steps of:
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sensing the temperatures at two separate locations on the energy application device; and
averaging the two sensed temperatures at the two separate locations;
determining a temperature at the energy application device based on the averaged temperatures.
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28. The method of claim 18 wherein the step of applying energy to the compressed vein at the treatment site comprises applying electrical energy to the inner wall of the vein with an electrode, the electrode being in apposition with the inner wall.
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29. The method of claim 18 wherein the step of applying energy to the compressed vein at the treatment site comprises applying electrical energy to the inner wall of the treatment site with an electrode, the electrode being in apposition with the inner wall, the method further comprising the steps of:
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applying electrical energy with the electrode to effectively occlude the treatment site at the electrode; and
moving the electrode along the treatment site while maintaining the electrode in apposition with the vein wall while performing the step of applying energy to effectively occlude the treatment site so as to result in a lengthy effective occlusion of the treatment site.
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30. The method of claim 29 wherein the step of applying energy comprises applying sufficient energy to collapse the vein around the electrode as it is being moved along the treatment site to result in a lengthy effective occlusion of the treatment site.
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31. A method of applying energy to a hollow anatomical structure from within the hollow portion of the structure, the hollow anatomical structure having an inner wall, the method comprising the steps of:
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introducing a catheter having a working end with an energy application device at the working end into the hollow anatomical structure;
positioning the working end of the catheter proximate a treatment site within the hollow anatomical structure;
determining when apposition of the energy application device with the inner wall of the hollow anatomical structure has occurred by monitoring the impedance experienced by the energy application device; and
applying energy to the hollow anatomical structure at the treatment site via the energy application device until the hollow anatomical structure durably assumes a smaller size. - View Dependent Claims (32, 33, 34, 35, 36, 37, 38, 39)
sensing the temperatures at two separate locations on the energy application device;
averaging the two sensed temperatures at the two separate locations; and
determining a temperature at the energy application device based on the averaged temperatures.
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39. The method of claim 31 further comprising the steps of:
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expanding a plurality of leads outwardly from the working end of the catheter, wherein the distal ends of the leads move away from each other and into non-penetrating contact with the inner wall of the anatomical structure; and
applying energy to the inner wall of the anatomical structure by the distal ends of the leads until the anatomical structure collapses.
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Specification