U.S. patent number 3,834,394 [Application Number 05/232,323] was granted by the patent office on 1974-09-10 for occlusion device and method and apparatus for inserting the same.
Invention is credited to James A. Hunter, Robert W. Sessions.
United States Patent |
3,834,394 |
Hunter , et al. |
September 10, 1974 |
OCCLUSION DEVICE AND METHOD AND APPARATUS FOR INSERTING THE
SAME
Abstract
A method of effecting the occlusion of a blood vessel by forming
an access opening in the body of the patient communicating with the
desired blood vessel, introducing an occlusion member in the
vessel, moving the member to the desired point of occlusion, and
thereat expanding the member to a size greater than the diameter of
the vessel whereby the member is substantially immovably retained
therein; the member comprising an expandable and contractable body,
capable of disposition in a relatively contracted state in which it
may be positioned at the desired point of occlusion, or in an
expanded state, the body being constructed to contain the means for
effecting such expansion; an example of apparatus for practicing
the method comprising a catheter in the form of an elongated
tubular conduit of a length to extend from said desired point of
occlusion to said access opening and constructed at one end for
operative connection with such an occlusion member and the other
end for operative connection with actuating means cooperable with
means disposed in the tubular conduit for effecing transition of
said member from one of its states to the other of its states.
Inventors: |
Hunter; James A. (Chicago,
IL), Sessions; Robert W. (Lombard, IL) |
Family
ID: |
26925875 |
Appl.
No.: |
05/232,323 |
Filed: |
February 23, 1972 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
Issue Date |
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878813 |
Nov 21, 1969 |
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Current U.S.
Class: |
606/195; 604/907;
604/99.02 |
Current CPC
Class: |
A61B
17/12109 (20130101); A61B 17/12036 (20130101); A61B
17/12031 (20130101); A61M 25/00 (20130101); A61B
17/12136 (20130101); A61B 2090/3933 (20160201); A61M
2025/1054 (20130101); A61M 2025/1052 (20130101) |
Current International
Class: |
A61B
17/12 (20060101); A61M 25/00 (20060101); A61B
19/00 (20060101); A61b 017/12 (); A61m
025/00 () |
Field of
Search: |
;128/325,348,DIG.9,DIG.16 ;138/93 |
References Cited
[Referenced By]
U.S. Patent Documents
Other References
Hughes, Use of an Intra-Aortic Balloon Catheter Tamponade for
Controlling Intra-Abdominal Hemmorrhage in Man, in Surgery, 36
:65-68 1954. .
Luessenhop, Intra-Arterial Instrumentation for Neurosurgery, in The
Bulletin of the Dow-Corning Center. 2 :9. July, 1960..
|
Primary Examiner: Pace; Channing L.
Attorney, Agent or Firm: Hill, Gross, Simpson, Van Santan,
Steadman, Chiara & Simpson
Parent Case Text
This application is a continuation of pending application, Ser. No.
878,813, filed Nov. 21, 1969, now abandoned.
Claims
What is claimed is:
1. A device for effecting the occlusion of a blood vessel
comprising an elongated hollow body element having a wall of
resilient material, being of a cross-section permitting ready
passage through a blood vessel to a desired point of occlusion and
inflatable to have a cross section larger than that of said vessel,
the distal and proximal end portions of said body element being
substantially less deformable than said resilient wall, at least a
portion of the proximal end portion being constituted by a
perforable body of self-sealing material, and insertion means
having a length sufficient to extend from an access opening in the
body of the patient to the desired point of occlusion, said means
being traversed throughout its length by an inflation lumen and
terminating distally in a needle-like element projected through the
proximal end of the body of self-sealing material, and adapted to
be withdrawn therefrom, whereby the hollow body element may be
advanced through the blood vessel to the desired point of
occlusion, inflated by fluid introduced through the inflation lumen
and deposited in the vessel by disengagement of said needle-like
element from said proximal end and withdrawal of said inserting
means from such a vessel, with said hollow body element being in
operatively self-sustaining fixed engagement with the vessel
sidewalls throughout a circumferential band, distributing resulting
outwardly directed pressure forces over a substantial unbroken area
of the vessel sidewalls, thereby protecting the latter from
concentrated puncturing or rupturing forces.
2. A device according to claim 1, wherein said body element is
provided with a longitudinally extending passageway which extends
therethrough and is not in communication with the hollow interior
of said body, forming a bypass between the ends of the latter.
3. A device according to claim 1 which includes a one-way valve in
a position to cooperate with the body of self-sealing material to
prevent deflation of the inflated body element.
4. A device according to claim 1 wherein said valve comprises at
least one flap in a position to rest against the distal end of a
perforation through the self-sealing material.
5. A device according to claim 1 wherein said body comprises an
elongated base structure of relatively fixed length and said wall
is an expandable tubular member disposed in concentric relation
with respect to said base structure, and having its end edges
connected in fluid-tight relation to said base structure, the
latter having a chamber therein communicating with the interior of
said expandable tubular member, the latter in its unexpanded state
having an outer diameter approximately equal to the maximum
diameter of said base structure.
6. A device according to claim 5 wherein said tubular member is
secured at its respective ends to said base structure adjacent
opposite ends of the latter.
7. In a device for insertion in and effecting the occlusion of a
blood vessel, particularly where occlusion is to be for an
indefinitely long period, if not permanently, in which an
expansible member is adapted to be transported through a blood
vessel to a desired point of occlusion by an insertion device
constructed to extend from an access opening in the body of the
patient to the desired point of occlusion and to detachably support
such member at the distal end of such insertion device, whereby the
body element forms the lead member of the structure with expansion
of the member being effected by actuation of means carried by the
insertion device, the improvement in the expansible member
including an elongated hollow, fluid-tight relatively smooth-walled
body element having a tubular, expandable intermediate wall portion
of resilient material and of a non-expanded cross section
permitting ready passage through a blood vessel to a desired point
of occlusion and expandable to form and operatively maintain an
axially extending circumferential band having a cross section
larger than that of such a vessel, the distal and proximal end
portions of said body element being substantially less deformable
than said resilient wall portion, the proximal end portion having
means constructed for detachable engagement with and releasable
support by the distal end of such an inserting device, said body
element upon expansion and disengagement from the distal end of
such insertion device, being adapted to be retained in operative
self-sustaining fixed engagement with the vessel sidewall
throughout such axially extending circumferential band whereby
outwardly directed pressure forces are distributed over a
substantial area of the vessel sidewall, thereby protecting the
latter from concentrated puncturing or rupturing forces.
8. A member according to claim 7 wherein said body is provided with
expansion means permanently disposed therein.
9. A member according to claim 7 wherein said body is adapted to
receive means therein for effecting such expansion.
10. A member according to claim 7 wherein said body is provided
with a longitudinally extending passageway which extends
therethrough and is not in communication with the hollow interior
of said body, forming a bypass between the ends of the latter.
11. A member according to claim 8, wherein said expansion means
comprises a resilient member disposed in and secured to said hollow
body and arranged to exert forces thereon urging said body into its
expanded position.
12. A member according to claim 9 wherein said expansion means
comprises a coiled spring having its ends secured to said end
portions of greater thickness and is operative to urge such end
portions toward one another.
13. A member according to claim 11 wherein said body is constructed
to receive means for exerting expansion forces thereon in
opposition to said resilient means, to effect contraction of the
body.
14. A member according to claim 12, wherein said body is
constructed to detachably receive elongated relatively rigid means
carried by such insertion means for effecting such contraction of
the body.
15. A member according to claim 7 wherein said body is constructed
for detachable engagement with a fluid conduit whereby the latter
may communicate with the interior of the body element for
discharging fluid therein to effect said expansion.
16. A member according to claim 15 wherein said body is provided
with a port therein constructed to receive the adjacent end of such
a fluid conduit, and a valve member disposed in said body,
operative to permit entry of fluid into said body interior, but
normally prevent fluid flow from said body.
17. A member according to claim 16 wherein said valve member
comprises a flap extending across the inner end of said port.
18. A member according to claim 16 wherein said valve member
comprises a ball disposed in said body and adapted to close said
port, and means carried by said body to retain said ball in
cooperable relation adjacent the inner end of said port.
19. A member according to claim 16 wherein said port of the body is
provided with internal threads for engagement with cooperable
threads on such a fluid conduit.
20. A member according to claim 16 wherein said body has means
thereon for aligning the adjacent end of such a conduit with said
body for operative engagement therewith.
21. A member according to claim 15 wherein at least a portion of
the proximal end of said body is constructed of a self-sealing
material which will permit penetration by such a conduit means, and
effect a resealing thereat upon disengagement of said conduit means
therewith.
22. A member according to claim 7 wherein said body comprises an
elongated base structure of relatively fixed length and said wall
is an expandable tubular member disposed in concentric relation
with respect to said base structure, and having its end edges
connected in fluid-tight relation to said base structure, the
latter having a chamber therein communicating with the interior of
said expandable tubular member, the latter in its unexpanded state
having an outer diameter approximately equal to the maximum
diameter of said base structure.
23. A member according to claim 22 wherein said tubular member is
secured at its respective ends to said base structure adjacent
opposte ends of the latter.
24. In a device for depositing an occlusion member in a blood
vessel, particularly where occlusion is to be for an indefinitely
long period, if not permanently, in which an occlusion member is
adapted to be detachably connected to the distal end of an
inserting device to form a detachable lead structure for guiding
the insertion device as it is advanced through a blood vessel to
the desired point of occlusion and with the occlusion member being
adapted to the expanded at the point of occlusion whereby such
occlusion member, upon disengagement from the inserting device may
be operatively deposited in self-sustaining fixed engagement
throughout a circumferential band of the vessel sidewall, the
improvement in the inserting device comprising an elongated tubular
structure having a length sufficient to extend from an access
opening in the body of the patient to the desired point of
occlusion and terminating distally in a mounting element adapted to
be connected to and detached from the adjacent proximal end portion
of said occlusion member to be employed therewith, and means
disposed within the tubular structure adapted to effect the
expansion of such a body element when mounted thereon, and manually
actuatable means at the proximal end of the insertion device for
effecting actuation of said expansion-effecting means.
25. A member according to claim 24 wherein said expansion effecting
means comprises a wire-like element extending through said tubular
structure engageable at its distal end with such an occlusion
member operative to effect a transition thereof to a relatively
contracted state for insertion in such a blood vessel.
26. A member according to claim 25 wherein said actuating means
comprises a manually engageable member connected to the proximal
end of said elongated tubular structure, and a second manually
engageable member, movable relative to said first member and
operatively connected to the proximal end of said wire-like
element.
27. A member according to claim 25 wherein said elongated tubular
structure is disposed within a second concentrically disposed
conduit, defining a fluid passageway therebetween, said second
conduit having an opening therein adjacent the distal end thereof,
and means adjacent the proximal end of said second conduit for
introducing a contrast medium into said passageway for facilitating
ascertainment of the location of the occlusion member in such a
blood vessel by, for example, X-ray means.
28. A member according to claim 25 wherein said expansion effecting
means comprises a fluid conductible through said elongated tubular
structure, engageable with such an occlusion member for introducing
such fluid into the latter to effect a transition thereof from a
relatively contracted state to relatively expanded state.
29. A member according to claim 28 wherein said actuating means
comprises a fluid-receiving cylinder and a manually actuatable
piston disposed in said cylinder, movement of said piston relative
to said cylinder being operative to effect fluid movement in said
conduit.
30. A member according to claim 29 wherein the end of said
elongated tubular structure constructed for connection to such an
occlusion member, is provided with a connection fitting having
external threads thereon adapted to mate with complementary
internal threads on such an occlusion member.
31. A member according to claim 29 wherein the end of said
elongated tubular structure constructed for connection to such an
occlusion member, is provided with a needle-like fitting adapted to
be inserted through the proximal end of such an occlusion
member.
32. A device for effecting the occlusion of a blood vessel,
particulary where occlusion is to be for an indefinitely long
period, if not permanently, comprising an elongated hollow,
fluid-tight, relatively smooth-walled body element and insertion
means therefor, the body element having a tubular-shaped
intermediate wall portion of resilient material and of a cross
section permitting ready passage through a blood vessel to a
desired point of occlusion and expandable to form and operatively
maintain an axially extending circumferential band having
cross-section larger than that of said vessel, the distal and
proximal end portions of said body element being substantially less
deformable than said resilient wall portion, the proximal end
portion being constructed for mounting on and support by said
insertion means, the latter having a length sufficient to extend
from an access opening in the body of the patient to the desired
point of occlusion, said insertion means terminating distally in a
mounting element connectible to and disengageable from cooperable
means carried by the proximal end of the body element and including
means for expanding the latter, with said body element extending
distally of said insertion means and forming the lead structure for
guiding the insertion means as the body element is advanced thereby
through the blood vessel to the desired point of occlusion,
expanded by aid of said means for expanding and deposited by
disengagement of the insertion means therefrom, in operatively
self-sustaining fixed engagement throughout a circumferential band
of the vessel sidewalls to distribute resulting outwardly directed
pressure forces thereon over a substantial area and thereby protect
the vessel sidewall from concentrated puncturing or rupturing
forces.
33. A structure according to claim 32, wherein said hollow body
contains a coiled tension spring having its ends so connected to
the respective end portions that said spring is operative to urge
said body into its expanded state, said insertion means including a
wire-like element having one end extending through the proximal end
portion of said body adjacent the connection of one end of said
spring and bearing on the distal end portion of said body adjacent
the connection of the other end of said spring to maintain said
body in its contracted state, in opposition to the action of said
spring, the opposite end of said wire-like element being
operatively connected to actuating means therefor.
34. A structure according to claim 32, wherein said insertion means
comprises a fluid conduit, the distal end of which is connected to
said body and communicates with the interior of the latter, and
said inserting means includes a syringe structure having a movable
plunger, with the proximal end of said conduit connected to said
syringe structure and communicating with the interior thereof, said
expansion effecting means comprising a liquid disposed in said
syringe, said conduit and said body, whereby movement of said
plunger will force such liquid into said body to expand the same.
Description
BACKGROUND OF THE INVENTION
The present invention pertains generally to the treatment of
vascular conditions and more particularly to those involving
thrombosis. Acute deep thrombophlebitis with secondary pulmonary
embolism continues to a very important clinical problem. In
connection therewith, the management of the patient, at least in
part, embodies principles and measures which are designed to
prevent the spread of lower extremity venous clots to the lungs.
Consequently, in certain patients with thromboembolic disease, it
has become clinically accepted that interruption of the inferior
vena cava becomes strongly indicated. The usual patient falling
into this category is one who has experienced pulmonary embolism of
a sublethal sort in spite of rigid application of clinical measures
exclusive of surgery. For example, patients are encountered in whom
there clearly is need for mechanical interruption of flow through
the inferior vena cava and yet, for whom surgical caval ligation
cannot be done at an acceptable or realistic risk.
As the singular purpose of inferior vena cava ligation is simply to
mechanically obstruct the cava a comparable result could be
obtained if it were possible to create a secure and, if desired,
permanent obstruction within the blood vessel, for example at the
inferior vena cava bifurcation. This would involve introduction of
a suitable mechanical element at the selected point in the vascular
system to enable controlled movement of the element to the desired
point of occlusion and thereat firmly securing the same in place.
This technique would enable suitable introduction of such
mechanical element into the desired blood vessel by relatively
minor surgery with the entire procedure taking place in a matter of
minutes as compared with a normal vena cava ligation which would
require a matter of hours. In addition to the utilization of such a
mechanical element, it will be appreciated that the success of the
operation also is dependent upon proper positioning of such
mechanical element at the desired location in the particular blood
vessel and that to insure this result means should be provided for
accurately visually ascertaining the location of the mechanical
element in the blood vessel.
The present invention proceeds from the concept of utilizing an
expandable and contractable mechanical element as the obstructing
member, which may be inserted, in contracted state, into the blood
vessel, moved to the desired location therein and thereat suitably
expanded, forming what might be termed an intraluminal balloon
which will firmly and securely engage the walls of the vessel
thereat to permanently secure and fix the obstruction at the
desired location. Such a method would enable the element to be
introduced, for example, through the venous system of the neck,
thereby avoiding the use of lower extremity veins. Such obstruction
would thereby effectively block the spread of venous clots in a
lower extremity from spreading to the lungs.
The present invention may be initially considered under three
aspects, the first being the evolvement of a practical method of
achieving the desired results, the second, details surrounding the
construction of the mechanical element which is to perform the
blocking function, and third, the apparatus by means of which the
mechanical element is to be disposed at the precise desired
location in the particular blood vessel.
BRIEF SUMMARY OF INVENTION
The invention therefore has among its objects the development of a
method of effecting the occlusion of a blood vessel which is
relatively simple and readily performed, making use where possible
of steps individually involving known techniques, and which may be
practiced with various types of mechanical blocking elements and
apparatus for effecting the insertion thereof.
A further object is the development of such a method which
preferably will enable withdrawal of the element from the vessel in
a reverse manner to its introduction.
Another object of the invention is the production of a mechanical
element for disposition in a blood vessel to effect an occlusion
thereof, which element is relatively simple in construction,
capable of being selectively contracted and expanded, preferably
being capable of contraction subsequent to its insertion in a blood
vessel to permit withdrawal of the element from such a vessel when
deemed necessary or desirable, and which will firmly and securely
engage the adjacent walls of the blood vessel to insure positive
and secure retention in the blood vessel at the desired
location.
A further object of the invention is the production of apparatus
for practicing the method with such a contractable and expandable
mechanical element, which apparatus is relatively simple in
construction, capable of being readily sterilized, etc. and which
is completely compatible with the method of the invention as well
as the particular mechanical elements employed. Likewise, such
apparatus should be so constructed that a suitably constructed
mechanical element may be inserted thereby into a blood vessel at a
desired location, preferably under supervision by visual means such
as X-ray or other equipment, and which preferably may be employed
both for insertion of the element into the blood vessel and for
withdrawal therefrom.
In the practice of the method of the invention, the blood vessel,
for example the inferior vena cava, would be occluded by means of
an expandable mechanical element by the steps of forming an access
opening in the body of the patient, normally at a point remote from
that at which the occlusion is to be located, as for example,
effecting an opening into the venous system of the neck, thereby
avoiding use of lower extremity veins, inserting the occlusion
member in such opening and moving the same by means of the
apparatus to the desired location of occlusion, following which the
occlusion member is expanded to a size greater than the inner
diameter of the blood vessel whereby the member is substantially
immovably retained therein.
A number of constructional examples are disclosed herein which may
be utilized in practicing such method. In general, the devices
illustrated fall into two categories, one of which employs
mechanical means for effecting contraction and expansion of the
occlusion member, and the other of which utilizes a fluid to effect
the expansion, with the occlusion member being constructed in
either case to contain the means for effecting such expansion.
Where fluid is employed as the actuating medium the occlusion
member may be provided with suitable valve means to insure
retention therein of the fluid, following expansion of the member,
such valve means in the examples illustrated taking the form of one
or more flap members, or a ball member, or may rely on part or
entirely in the characteristics of the material forming at least a
portion of the occlusion member to effect a seal upon withdrawal of
the apparatus utilized to insert and actuate the member.
In one form of the invention, the fluid may be supplied to the
occlusion member by means of a permanently connected tubular
conduit which is suitably terminated and closed adjacent the point
of insertion into the patient's body whereby such tube may be left
therein.
Various types of apparatus may be employed in connection with the
practice of the invention and those illustrated are utilizable with
the respective general types of occlusion members disclosed. In
general, such apparatus comprises a catheter in the form of an
elongated tubular conduit of a diameter to be freely received in
the blood vessel involved and of a length greater than the
effective distance from the opening made in the patient's body for
insertion of the occlusion member to the point in the blood vessel
at which it is to be positioned. The tubular conduit is constructed
at one end for operative connection with the occlusion member and
adapted to receive means for effecting the transition of the
occlusion member from one of its states to the other of its states
whereby the occlusion member may be inserted in such a blood vessel
in a contracted state, moved to the desired point and thereafter
expanded. The opposite end of the tubular conduit is adapted to be
operatively connected to actuating means for effecting movement of
the transition-effecting means within the conduit.
Where mechanical means is employed to effect expansion of the
occlusion member the transition-effecting means may comprise a
wire-like element or stylet engageable with the occlusion member to
effect a transition thereof to a relatively contracted state, in
which it is to be inserted in a blood vessel, and in this case, to
effect relative movement between the conduit and the stylet for
effecting disconnection of the latter from the occlusion member,
the actuating means may comprise a pair of manually engageable
members, one of which is operatively connected to the outer or free
end of the conduit, and the other operatively connected to the
corresponding end of the stylet whereby relative movement between
the two members will be reflected in relative movement between the
conduit and the stylet.
Where fluid is employed as the transition-effecting means, the
manually actuated members may be so constructed that the member
connected with the conduit functions as a hollow cylinder
communicating with the conduit interior and the second member
functions as a piston slidably disposed within the cylinder, to
form a syringe by means of which fluid may be forced through the
conduit.
BRIEF DESCRIPTION OF THE DRAWINGS
In the drawings, wherein like reference characters indicate like or
corresponding parts:
FIG. 1 is an elevational view of apparatus for effecting insertion
and expansion of an occlusion member, illustrated at the end of a
tubular conduit forming a part of the apparatus;
FIG. 2 is an enlarged longitudinal sectional view through the
connected occlusion member of FIG. 1, schematically illustrated as
being positioned within a blood vessel, with the occlusion member
being disposed in a relatively contracted state;
FIG. 3 is a sectional view, similar to FIG. 2, illustrating the
occlusion member in a relatively expanded state following
disconnection of the inserting apparatus;
FIG. 4 is a sectional view, similar to FIG. 2, illustrating details
of an occlusion member adapted to be expanded by the reception of
fluid therein, and the adjacent portion of the inserting
apparatus;
FIG. 5 is a sectional view, similar to FIG. 3, illustrating the
occlusion member of FIG. 4 in expanded state following
disconnection of the inserting apparatus therefrom;
FIG. 6 is a sectional view, similar to FIG. 4, illustrating details
of an insertion apparatus constructed to permit subsequent
reengagement thereof with the occlusion member of FIG. 4 for
effecting withdrawal of the latter from the blood vessel;
FIG. 7 is a sectional view, similar to FIG. 4, illustrating a
modified form of connection between the inserting apparatus and the
occlusion member;
FIG. 8 is a sectional view, similar to FIG. 5, illustrating the
occlusion member of FIG. 7 in an expanded state;
FIG. 9 is a sectional view, similar to FIG. 4, illustrating a
modified form of occlusion member provided with a blood
by-pass;
FIG. 10 is a sectional view, similar to FIG. 5, illustrating the
occlusion member of FIG. 9 in expanded position with the by-pass
operatively connecting the vessel interior at opposite sides of the
occlusion member;
FIG. 11 is a sectional view, similar to FIG. 4, of a modified form
of occlusion member utilizing a ball valve arrangement;
FIG. 12 is a sectional view, similar to FIG. 4, illustrating
another form of occlusion member in its contracted state;
FIG. 13 is a sectional view, similar to FIG. 5, illustrating the
occlusion member of FIG. 12 in its expanded state; and
FIG. 14 illustrates a further modification of the invention with
the occlusion member illustrated in inserted position.
DETAILED DESCRIPTION OF INVENTION
In explaining the invention in detail, the construction of the
occlusion members will be initially presented, followed by a
detailed description of the apparatus for inserting such members,
and finally the method of effecting the occlusion by use of such
members and apparatus.
OCCLUSION MEMBERS
Referring initially to FIGS. 2 and 3, the reference numeral 1
indicates generally an occlusion member, schematically illustrated
as being disposed in a blood vessel 2 having side walls 3, the
member 1 being illustrated in a relatively contracted form in which
it has a configuration generally approaching an ellipsoid, i.e.,
having a longitudinal cross-sectional configuration, as viewed in
FIG. 2, closely approaching an ellipse, and a transverse
cross-sectional configuration which is substantially circular. As
used herein the terms "contracted" or "expanded" have reference
only to the transverse cross-sectional state of the occlusion
members, i.e., the dimensions involved in effecting the
occlusion.
The occlusion member may be constructed of any suitable material
which is capable of the desired contraction and expansion and which
is inert to body fluids and materials. Silicone compositions which
possess such characteristics are particularly efficient for this
purpose and are currently used for materials and elements to be
inserted in the human body. As illustrated in FIG. 2, the opposite
end portions 4 of the member are of considerably greater thickness
than the intermediate connecting portion 5 whereby such end
portions are substantially form-retaining in either the contracted
state illustrated in FIG. 2 or the expanded state illustrated in
FIG. 3, thus substantially concentrating any expansion at the
intermediate portion 5 of generally tubular configuration.
Extending between and having its free ends anchored in the enlarged
end portions 4 is a helical tension spring 6 which is in a
relatively expanded or tensioned condition when the occlusion
member is in the retracted position illustrated in FIG. 2 or is in
a contracted position to draw the ends 4 toward one another when
the occlusion member is in its expanded position, as illustrated in
FIG. 3. Thus, in this construction the occlusion member, under the
action of the spring 6, tends to assume its operatively expanded
position as illustrated in FIG. 3 and the inserting apparatus must
be suitably constructed to move the respective end portions 4
without stretching said vessel to the operatively retracted
position illustrated in FIG. 2, in which position the occlusion
member may be inserted in the blood vessel involved.
It will be particularly noted that in this construction the
relatively heavy end portions 4 tend to concentrate the lateral
expansion to the thin wall intermediate portion 5, and at the same
time, provide a firm and secure anchorage for the ends of the
spring 6.
As discussed in greater detail in connection with the apparatus for
inserting this occlusion member, the occlusion member is brought
into the operatively contracted configuration illustrated in FIG. 2
by exerting oppositely directed axial forces on the end portions 4,
in opposition to the action of the spring 6, to separate the end
portions 4 sufficiently to bring the intermediate portion 5 into
the configuration illustrated in FIG. 2. Upon release of the
respective end portions 4 the spring 6 will draw such end portions
into the positions illustrated in FIG. 3 resulting in expansion of
the intermediate portion 5 to effect engagement with and sufficient
outward expansion of the walls 3 of the blood vessel 2 to ensure a
firm retention of the member at its location of initial expansion
in the blood vessel.
FIGS. 4 to 14 illustrate forms of occlusion members which employ a
liquid to produce the desired expansion of the occlusion member
within the blood vessel involved, such fluid being suitably
discharged into the occlusion member, with the means for effecting
the supply of fluid to the occlusion member being disconnectable in
all cases but that illustrated in FIG. 14, and in some instances
are constructed for reconnection to the occlusion member in the
event it is desired to effect a withdrawal thereof from the blood
vessel. In all of these forms, the occlusion member, while
generally constructed similar to that illustrated in FIGS. 1 and 2,
is formed with an initial configuration corresponding substantially
to the retracted position of the member illustrated in FIG. 2, and
which thus represents the retracted state of the member in which it
is introduced into the desired blood vessel, following which fluid
is supplied to the interior of the member operative to effect an
expansion of the intermediate portion 5 thereof to a position
similar to that illustrated in FIG. 5 and corresponding to the
expanded state of the member illustrated in FIG. 3.
In this construction the spring 6 is omitted and the end portion
4', of increased thickness, is provided with a fluid inlet defined
by an internally threaded sleeve 7 embedded in the end portion 4'
and extending therethrough. The sleeve 7 may be suitably assembled
with the body of the member 1, as for example, at the time of
fabrication of the latter, whereby the sleeve is firmly secured in
leak-proof relation to the portion 4'. In this particular
embodiment the inner end of the inlet formed by the sleeve 7 is
adapted to be closed, under action of fluid within the member, by a
valve member in the form of a flap or leaf, which may be suitably
fabricated from the same material as the member 1, as for example,
a suitable silicone composition, and is suitably secured to the
member, as indicated at 9, to permit the flap to move to an open
position as illustrated in FIG. 4 or to a closed position as
illustrated in FIG. 5. In the construction of FIGS. 4 and 5 the
transition of the occlusion member from such contracted state to
such expanded state is adapted to be effected by fluid supplied to
the member through a tubular conduit 11 which is of suitable
flexible material such as one of the synthetic materials now
employed in various types of catheters, and is provided at the end
thereof with a tubular fitting 12 having an externally threaded
portion 13 extending axially outward beyond the end of the conduit
11 and threadedly engageable with the internal threads of the
sleeve 7, whereby the end of the conduit 11 may be suitably
connected with the member 1 by screwing the threaded end 13 into
the sleeve 7. As fluid is discharged from the conduit 11, such flow
will move the flap into open position and upon receipt of
sufficient fluid within the member 1 the fluid pressure in the
conduit 11 may be relieved whereby the internal fluid pressure
within the member 1 will move the flap 8 to its closed position as
illustrated in FIG. 5. The threaded end 13 of the conduit 11 may
then be unscrewed from the sleeve 7, permitting withdrawal of the
conduit, the occlusion member remaining stationary during this
operation as a result of its engagement with the vessel walls.
FIG. 6 illustrates a modified conduit structure for use with the
occlusion member of FIG. 4 whereby the member can be returned to
its original contracted state and thus enable withdrawal thereof
from the blood vessel. In this embodiment, the member 13' has an
effective length which is greater than the corresponding thickness
of the end portion 4' whereby the member 13' may be threaded a
sufficient distance into the sleeve 7 to protrude therebeyond,
lifting the flap 8, as illustrated in FIG. 6, to open the valve
formed thereby and permit fluid to be withdrawn from the expanded
member through the conduit 11 permitting the latter to return to
its original contracted state in which it may be withdrawn from the
blood vessel. To facilitate engagement of the threaded portion 13'
with the threads of the sleeve 7, the end of the latter preferably
is flared as indicated at 14 (FIG. 5) and in like manner the
extreme end of the portion 13 is preferably tapered as indicated at
14'.
FIGS. 7 and 8 illustrate a further embodiment of the invention in
which the end portion 4' is provided with an inwardly directed
extension 15 in the form of a block of gum rubber, the inner end of
which carries the flap valve 8. This embodiment has a normal
configuration corresponding to that illustrated in FIG. 7 in which
the member is in its relatively contracted state and adapted to be
expanded to a position such as illustrated in FIG. 8. The supply
conduit 11 in this construction is provided with a hollow
needle-like discharge fitting 12", the free end 13" of which is of
a length to be inserted through the end portion 4' and block 15,
pivoting the flap valve 8 into the position illustrated in FIG. 7,
in which condition the occlusion member may be inserted into the
blood vessel involved and fluid subsequently supplied to the
interior of the member to expand the same to the position
illustrated in FIG. 8. Following expansion, the needle-like
extension 13" may be withdrawn from the member with the flap 8
initially sealing the opening in the block 15 as soon as the free
end of the needle 13" passes into the block, and as the needle is
withdrawn from the latter, the gum rubber will resume its original
form to provide a self-sealing action supplementing that effected
by the flap valve 8.
FIGS. 9 and 10 illustrate a further modification employing an
occlusion member of a construction similar to that illustrated in
FIGS. 4 - 6 but omitting the threaded sleeve 7 and utilizing a pair
of flap valves 8 and 8' to seal the inlet opening formed by the
insertion of the needle like end 13" of the fitting 12' illustrated
in FIG. 7. In this construction two flaps are utilized to ensure an
efficient seal. This embodiment also illustrates an additional
feature of the provision of a passageway 16 extending completely
through the occlusion member. The passageway 16 is illustrated as
being formed by a tubular member 17 having sufficient wall rigidity
to permit passage of blood from one end of the expanded occlusion
member to the opposite end thereof, thereby by-passing the same and
at the same time possesses sufficient resiliency to permit proper
expansion or contraction of the member 17 as transition is effected
from one state to another. This construction thus permits the flow
of a limited amount of blood in the vessel, which may be desirable
in some applications.
FIG. 11 illustrates a further embodiment of occlusion member of a
construction similar to that heretofore described, in which the
principal difference is in the valve structure, the flap valve 8 of
the previous forms being replaced by a ball valve member 8" which
is retained in operative position adjacent the fluid inlet 7' by a
suitably formed retaining cage 9' or the like. This embodiment is
adapted to receive fluid from the conduit 11 through a fitting 12'
similar to that illustrated in FIGS. 7 and 9, but in which the
length of the outwardly extending portion 13" is less than the
thickness of the adjacent end portion 4' whereby the member 13"
when fully inserted into the end portion will not engage the ball
8".
FIGS. 12 and 13 illustrate a further embodiment of an occlusion
member according to the invention. This construction employs an
elongated generally cylindrical body member 18 having enlarged end
portions 19 and 21, connected by a hollow intermediate portion 22
which is provided with transversely extending openings 23 in the
side walls thereof. Secured to the portions 19 and 21 and disposed
in substantially concentric relation with respect to the
intermediate portion 22 is a relatively thin walled tubular or
sleeve-like member 24 having its end edges secured to the
respective members 19 and 21 whereby the portion of the member 24
extending between the members 19 and 20 forms the expandable side
wall of the member. In this construction at least the portion 21 of
the body member 18 is of gum rubber and has a relatively long axial
length so that the self-sealing action thereof provides all the
seal necessary to retain the expanding fluid within the member.
This construction may utilize the same conduit 11, fitting 12' and
needle-like extension 13" for supplying fluid to the occlusion
member, the extension 13" being inserted through the end portion 21
whereby the open end of the member 13" is disposed within the
chamber defined by the intermediate portion 22 of the body 18 so
that the entering fluid may flow into such chamber, through the
openings 23 and exert an expanding force on the tubular member 24.
Upon withdrawal of the needle 13" from the portion 21, following
expansion thereof in the blood vessel involved, the self-sealing
action of such portion will effectively seal the interior of the
member.
APPARATUS FOR EFFECTING INSERTION AND EXPANSION OF OCCLUSION
MEMBERS
The apparatus for effecting the insertion and expansion of the
respective occlusion members can be substantially identical for all
of the various types of occlusion members illustrated with the
exception of the particular means for effecting the transition from
one state to the other of the occlusion members. Thus where the
occlusion member utilizes mechanical means for expansion, for
example, that illustrated in FIGS. 2 and 3, the means for effecting
the transition likewise will normally be mechanical, whereas for
the remaining forms illustrated utilizing fluid means this
apparatus may employ a liquid as the transition effecting means.
Consequently, the apparatus illustrated in FIG. 1, while including
mechanical means for effecting such transition, may be readily
utilized with the other forms of occlusion member by merely
omitting the mechanical transition effecting means and substituting
a fluid therefor, with the end of the conduit 11 being modified as
heretofore described to accommodate the particular type of
occlusion member with which it is to be employed.
The manually actuatable members in either form of the apparatus may
be of substantially identical construction corresponding, for
example, to the construction of a hypodermic syringe, and in the
embodiment illustrated in FIG. 1 such manually actuatable members
may comprise a hypodermic body or cylinder and plunger. Thus, the
tubular conduit 11 is illustrated as being connected at one end to
the occlusion member 1 and at the opposite end suitably connected
to the body or cylinder 31 of a syringe which is provided with a
cooperable plunger 32, the body 31 having a manually engageable
flange or lip 33 and the plunger a like flange or lip 34. Thus by
suitable manual actuation thereof relative insertion and withdrawal
of the plunger 32 may be effected with respect to the body 31.
Connection of the conduit 11 to the body 31 may be achieved by any
suitable means as for example a suitable fitting indicated
generally by the numeral 35 which is of known construction and
currently utilized in connecting catheters and the like to
cooperable syringes.
Encircling the conduit 11 is a tubular sheath 36 of suitable
construction, which likewise may be of a type commonly employed in
the medical field, the end thereof adjacent the occlusion member 1
having an opening 37 therein while the opposite end is suitably
secured to a standard type of fitting 38 which in turn is connected
to a Y-fitting 39 having a fluid inlet stem 41. The latter is
constructed to receive and retain a suitable tube or conduit from
which a contrast medium may be injected into the passageway formed
between the outer face of the conduit 11 and the inner face of the
conduit 36 and ejected through the opening 37 into the blood vessel
adjacent the occlusion member 1, to enable visual ascertainment of
the location of the occlusion member 1 in the blood vessel by
suitable means such as X-ray equipment or the like.
In the embodiment of the apparatus illustrated in FIG. 1,
constructed for use with occlusion members of the type illustrated
in FIGS. 2 and 3, the actuating means is mechanical and in the form
of a wire-like element 42 corresponding generally to stylets of the
type employed in catheters and the like to maintain their shape and
prevent clogging, etc. In the present instance, however, the
adjacent end of the element 42 is firmly secured to the inner end
of the plunger 32, for example by means of a suitable connecting
member 43, in which the end of the stylet is rigidly clamped, with
the member 43 being suitably secured to the plunger end.
The element 42, as clearly illustrated in FIG. 2, is of such a
length that the free end thereof may be inserted through the one
end portion 4 of the occlusion member and engage the inner face of
the opposite end portion 4, whereby separating forces may be
applied to the two end portions, in opposition to the action of the
spring 6, and thereby effect transition from the expanded state to
the contracted state of the occlusion member, as illustrated in
FIG. 2. It might be pointed out that in this construction the
tension exerted by the spring 6 tending to draw the two end
portions 4 into the position illustrated in FIG. 3 is so adjusted
as to merely ensure that the spring will exert sufficient force to
effect the desired expansion of the occlusion member. Under such
conditions the free end of the stylet 42 may be seated on the
adjacent end portion 4 of the occlusion member with the latter
having sufficient rigidity to provide an adequate seat therefor,
even when the spring is in its expanded position as illustrated in
FIG. 2, without puncturing such end portion. Likewise, the piercing
of the end portion 4 adjacent the conduit 11 by this stylet and
engagement of the latter therewith will result in sufficient
frictional forces between the stylet and such end portion that the
occlusion member will be effectively retained in its contracted
position until withdrawal of the stylet therefrom. Withdrawal of
the stylet may be effected by outward movement of the plunger 32
with respect to the cylinder 31, thereby withdrawing the free end
of the stylet into the conduit 11 with the adjacent free end of the
conduit 36, possibly supplemented by the free end of the conduit
11, being engaged with the adjacent end portion 4 whereby movement
of the latter is prevented while the stylet is being withdrawn from
the occlusion member. Such withdrawal thereby permits the spring 6
to effect transition to the expanded state of the occlusion member,
as illustrated in FIG. 3.
Where an occlusion member is employed which utilizes a fluid as the
actuating means for transition of the occlusion member from one
state to the other, the same general apparatus illustrated in FIG.
1 may be employed, merely eliminating the stylet 42 and connecting
member 43 and providing the free end of the conduit 11 with a
suitable fitting 12, as previously described, to enable operative
connection of the conduit 11, now employed as a fluid supply line,
to the associated occlusion member, for example the fitting 12
previously described with respect to the occlusion member
illustrated in FIGS. 4-6.
In some cases it may be desirable to form the fluid conduit 11
integrally with the occlusion member. Such a construction is
illustrated in FIG. 14, in which the occlusion member 1 is of a
construction similar to FIG. 11 but omits the valve structure 8",
9' and the fitting 12', with the adjacent end of the conduit 11
being integrally connected to the adjacent end portion 4' of the
occlusion member. In this construction, as illustrated in FIG. 14,
the conduit 11 would not be removed from the patient but merely
terminated and closed just inside the opening through which it was
inserted into the patient's body and such opening suitably sutured
as indicated at 44.
METHOD OF INSERTING AND EXPANDING OCCLUSION MEMBERS
The practice of the present method will be generally the same
irrespective of the particular occlusion member employed or the
particular apparatus utilized therewith.
Assuming that the occlusion member involved is constructed in
accordance with the disclosure of FIGS. 2 and 3, and the apparatus
constructed as illustrated in FIG. 1, the plunger 32 is moved
inwardly in the cylinder 31 a sufficient distance to expose the
free end of the stylet 42. Such free end is then inserted in the
adjacent end portion 4 of the occlusion member 1, feeding the
stylet through such portion into the interior of the occlusion
member. Continued insertion of the stylet will result in engagement
of the free end thereof with the inner face of the opposite end
portion 4 and effect separating movement of the latter with respect
to the other end portion, resulting ultimately in the occlusion
member being disposed in its relatively contracted state as viewed
in FIG. 2. As previously mentioned, the pierced end portion 4 of
the occlusion member will frictionally engage the adjacent inserted
portion of the stylet and provide adequate frictional engagement to
insure retention of the occlusion member in the desired contracted
state. An access incision is then made into the body of the
patient, extending into the venous system at a point from which the
occlusion member may be moved to the desired location of occlusion.
For example, where such occlusion member is to be positioned within
the inferior vena cava it may be introduced into the venous system
of the neck, thereby avoiding use of a lower extremity vein. The
occlusion member may then be moved through the blood vessel in
which it has been inserted, in a manner similar to that employed
with other catheters, utilizing the conduit 11, and/or the conduit
36 as the motivating member until the desired location has been
reached. Obviously the length of the respective conduits and the
stylet must be such that they have a length somewhat greater than
the effective distance from the point of insertion into the body of
the patient to the location at which it is desired to effect the
occlusion. When it is desired to ascertain the progress of the
occlusion member a desired amount of a suitable contrast medium may
be introduced through the Y-member 39 and discharged from the
opening 37 to a point initially adjacent to the occlusion member.
Such contrast mediums contain materials which are relatively opaque
to the particular radiation to be employed therewith, whereby such
material will be relatively opaque under the action of such
radiation, readily enabling visual observation of the location of
the occlusion member. Such materials are currently in common
medical use, materials of this type being known, for example, under
the tradenames RENOVIST and HYPAQUE which may be termed radiopaque
dyes and may, for example, contain a percentage of iodine as the
dye medium. Such materials usually are designated by percentages,
for example, HYPAQUE 90 percent and HYPAQUE 50 percent, the
percentage indicating how much iodine is contained therein and thus
how much radiation will be required to provide a suitable visual
effect.
When arrival at the desired location has been ascertained, manual
forces are applied to the plunger 32 to move the same outwardly
with respect to the cylinder 31 thereby applying withdrawing forces
to the stylet 42 which will initially result in expansion of the
occlusion member under the action of the spring 6 until it has
assumed the position illustrated in FIG. 3, following which
continued withdrawal movement of the stylet will result in
withdrawal thereof from the pierced end portion 4 of the occlusion
member and disconnection of the occlusion member from the inserting
apparatus, which may then be withdrawn from the patient. As
previously mentioned, the self-sealing characteristics of the
material of the end portion 4, such as a silicone, will result in a
resealing of the puncture therein made by the stylet, insuring an
effective sealing of the interior of the occlusion member.
Where the occlusion member is adapted to be expanded by the
introduction of a suitable fluid therein, the occlusion member is
initially connected to the end 13 of the cooperable fitting 12.
Depending upon the relative rigidity of the occlusion member in its
rest or contracted state of this type of occlusion member, as
illustrated in FIG. 4, the device may be initially filled with the
expanding fluid, inserting sufficient fluid to merely fill the
member when the latter is in its rest state, following which
introduction into the body of the patient is made in the same
manner as previously described. When the occlusion member has
reached its desired location additional fluid may be discharged
from the supply conduit 11 into the occlusion member to effect
expansion thereof to the state illustrated in FIG. 5. Withdrawal of
the fitting 12 from the occlusion member may then be effected, the
flap valve 8 or other valve means effectively sealing the interior
of the occlusion member and preventing leakage of fluid therefrom.
Following disconnection of the conduit 11 from the occlusion member
the inserting apparatus may be removed from the body of the patient
and the original incision suitably sutured.
In this type of operation various different fluids may be employed
as the expanding means. In many cases it may be desirable to
utilize a liquid contrast medium, such as that previously
described, as the expanding means and at least partially filling
the retracted member therewith in which case it may be unnecessary
to employ a separately inserted contrast medium as previously
described in connection with the use of mechanical expansion means.
However, in some instances it may be desirable to utilize other
materials as for example a suitable silicone, which may be inserted
into the occlusion member in liquid form and which will
subsequently harden therein, thereby eliminating any possibility of
subsequent deflation of the occlusion member. In the event the
material employed as the expansion means does not possess
sufficient inherent opacity to function as a contrast medium, a
suitable contrast medium may be employed, injecting the same
through the Y-fitting 39 in the same manner as previously described
in connection with the mechanical expanding means.
Where an occlusion member, such as illustrated in FIG. 14, is
employed, in which the fluid supply conduit for effecting expansion
of the occlusion member is integrally connected with the latter,
the same general sequence of steps may be performed. However, in
this case the occlusion member and its associated conduit 11 is
inserted in the cooperable conduit 36 and its free end connected in
suitable manner to the fitting 35 or its equivalent, following
which introduction into the body of the patient and disposition to
the desired location is effected in the same manner as previously
described, utilizing a contrast medium as the expanding fluid or
utilizing a separate contrast medium as previously described.
Assuming that such occlusion member does not contain an internal
valve, the conduit 11 may be suitably tied off or sealed adjacent
its outer end, and following disconnection from the syringe, the
outer conduit 36 may be withdrawn from the patient. The conduit 11
is then closed off, forming the sole closure, and the excess
conduit cut off to provide a termination of the closed conduit
within the patient's body, following which the original incision
may be suitably sutured. With this arrangement the occlusion member
may be subsequently removed by merely effecting a reopening at the
point of insertion, bringing the end of the conduit 11 to the
exterior, opening the free end of the latter and permitting the
expanding fluid to be discharged therefrom. Upon return of the
occlusion member to its original contracted state it may be readily
withdrawn from the patient's body, utilizing the conduit 11 as the
means for effecting such withdrawal.
In the event this type of occlusion member contains suitable valve
means such as a valve flap 8, following expansion of the occlusion,
the conduit 11 is disconnected from the actuating syringe and the
outer conduit 36 withdrawn, the conduit 11 severed at the desired
point and the open end thereof suitably sealed, after which it is
disposed as illustrated in FIG. 14 and the insertion incision
sutured. Retraction of this type of member could be effected with
suitably unobstructed conduit by insertion of a valve opening
stylet in the conduit.
Where a fluid is employed as the expanding medium and such fluid is
of such character that it will supply an adequate opacity for
visual examination, it may be desirable in some cases to so
construct the conduit 11 that it will provide adequate stiffness or
rigidity to facilitate insertion and movement of the occlusion
member within the blood vessel involved, whereby the outer conduit
36 may be omitted, this arrangement being capable of usage under
suitable conditions with any of the occlusion members
illustrated.
It will be noted from the above description that we have produced a
novel method of effecting occlusion of a blood vessel together with
novel means for forming such an occlusion, as well as a novel
apparatus for practicing the method, the method being exceedingly
simple and yet capable of ready practice with occlusion members of
relatively simple construction and apparatus which is simple in
design and readily operated, utilizing techniques with which the
surgeon is normally completely familiar.
Having thus described our invention it will be obvious that various
materials may be used and modifications may be made in the same
without departing from the spirit of our invention, hence we do not
wish to be understood as limiting ourselves to the exact method,
construction, form and arrangement of parts herein shown and
described or usage mentioned.
* * * * *