Patent Application
20230372668
The technical field generally relates to adjustable sheath devices for insertion into the body to provide intravascular access to various medical devices. This includes but is not limited to all bodily vessels and canals including arteries and vasculature, abdominal and thoracic cavities, cerebrospinal, genito-urinary and gynaecological, upper gastrointestinal and colorectal procedures.
Embodiments generally provide a dynamically expandable sheath capable of expanding within the bodily vessel or canal when a medical device is passed through the sheath and are also capable of retracting back to almost its original size when the medical device is removed from the sheath.
Vascular introducer sheaths are common to intravascular procedures, such as transcatheter aortic valve replacement (TAVR), angioplasty and stenting, to facilitate access to the vascular system for the introduction of removable devices such as wires, balloons, pressure transducers and for the introduction and placement of implantable devices such as mechanical aortic valves and stents.
Vascular introducer sheaths typically consist of a single hollow radial cuff or sleeve through which a device may be passed once the introducer sheath is inserted, manoeuvred and placed within the patient's vasculature. The sleeve terminates at one end with a radial collar which is positioned on or near the patient's skin and within an opening to a blood vessel. The collar typically creates a temporary seal around the opening to the vessel and may include one or more inlets to allow devices and fluids to be passed into the patient's vascular system through the sleeve cavity.
Vascular introducer sheaths are also designed to protect the blood vessel from physical damage that can arise from the insertion of a medical device into the vasculature, particularly where devices are large with respect to the luminal cavity of the vessel. For example, TAVR procedures are typically conducted through the femoral artery, which, in older patients is often smaller in diameter that the device itself. This frequently leads to damage of the artery from the shear forces between the artery wall and the device.
It is common practice during intravascular procedures to insert and remove a series of introducer sheaths of increasing diameter to widen the vascular opening or the vessel until it is large enough to allow for the safe and unobstructed passage of the intravascular device. Depending on the size of the patient's vasculature, procedures commence with the introduction of introducer sheaths of a small diameter and progressively increase in diameter until the aperture and introducer sheath are large enough to allow for the delivery of the removable or implantable device.
For instance, the introduction and delivery of a transcatheter aortic valve typically involves the insertion of a smaller calibre introducer to dilate the arterial access site and vasculature, prior to the insertion of the definite sized sheath and introducer which are often between 14 and 24 French in calibre, depending upon the size required to deliver the transcatheter aortic valve replacement system.
The insertion and removal of each introducer sheath adds to the overall procedure time and increases risk of damage to the vessel wall. While attempts are made to maintain sterility of apparatus and to follow aseptic procedures within theatre rooms, the mere presence of an intravascular opening and introduction of foreign objects into the patient introduces a risk of infection, which increases as the number of objects and duration of the procedure increases. In addition, blood loss and stress to the patient increases with procedure time and with the introduction of objects into the patient. Vascular injury from abrasion of the luminal surface of the vessel or even rupturing of the vessel itself is a significant risk at the opening of the vessel; as the introducer sheath is inserted into the patient and within the patient's vessels, once the introducer sheath is navigated through the patient's vascular system.
Previous attempts to design and develop expanding introducer sheaths that minimise the need to introduce multiple sheaths during intravascular procedures have been largely unsuccessful. Expanding sheaths are designed to be inserted when retracted at a small diameter, enlarged once placed within the vessel and retracted again to reduce their diameter prior to removal. However, many are developed from bonded composite materials with an expanding portion running longitudinally on the sheath. These devices are minimally expanding as only a section of the composite sheath material is capable of expanding and frequently do not expand sufficiently to alleviate the need to introduce a second or third larger introducer sheath into the patient. The engineering of such composite structures frequently results in device failure as the expanding section introduces a weakening in the structure which collapses when forced through the vascular system; resulting in the ‘ridging’ or buckling of the introducer sheath within the vessel. Further, expanding sheaths typically fail to retract to their original diameter frequently causing injury to the vessel or the opening of the vessel during their removal.
When placed within that patient via an opening in the femoral artery, for instance, the introducer sheath plays an essential role in protecting the patient's peripheral vasculature from injury or trauma that may otherwise arise from the passage of an introducer or device through sections of curved or complex vascular channels. However, due to the likelihood of failure of many introducer sheaths, which are too rigid to navigate these curved and complex sections of vasculature and consequently kink and buckle during insertion and placement, sheathless techniques are still frequently practiced during many surgeries. Physicians must make a trade-off between the safety of the sheath when passing through complex areas such as the ilio-femoral system, and the unsheathed device; as the devices themselves are prone to catch or tear at the luminal surface at curvatures in vessels.
Dual layered sheaths known in the art, such as those described in U.S. Pat. No. 8,790,387 and U.S. Ser. No. 10/391,279, are generally constructed of a folded inner layer and an outer layer. However, as an interventional device is passed through the lumen of these systems the inner layer unfolds locally, causing high strain in a small region of the outer layer. As the device tries to collapse once the device has passed through, the folds create a trap risk point for the outer layer, giving unpredictable geometry of the sheath as a whole, and presenting a risk of patient injury.
Other systems such as that described in U.S. Pat. No. 5,201,756, comprise an outer elastic element bonded to an inner relatively inelastic element. However, the bond between the layers reduces the freedom of movement between the layers to an extent that a significant amount of force is required to expand the system, which must be applied to force the device to pass through the sheath.
US20100324490 describes an expandable introducer sheath comprising an inner layer having a radially sliding wall. It is constructed such that a resilient membrane applied to the tube contour by a dip coating method or by gluing to provide adequate adhesion between the two tube layers. This construction, however, results in a compromise to expansion force.
For procedures such as TAVR, which present a viable alternative to more invasive and risky open heart surgeries, the safe passage of guidewires, introducers and the mechanical valve itself through the peripheral vascular system are essential to broadening the accessibility of these vital corrective surgeries to cohorts of patients that would otherwise fail to qualify for them.
For many cohorts of patients, such as the elderly, traditional heart surgeries to correct functional defects in aortic valves are simply too risky. TAVR presents a safer alternative for these patients. However, TAVR procedures performed with current medical technologies and best practices on average in Australia still result in 5.5% of patients suffering major vascular complication, 8.5% with major bleeding, 1.6% with stroke and 1.6% with myocardial infarction. Potential causes of these vascular injuries in TAVR include the patient's vascular calibre, the presence of atherosclerosis, the calibre of the introduced and withdrawn sheath, characteristics of the sheath including its rigidity and the degree to which it is prone to kink or ridge.
Therefore, it is anticipated that addressing any one of these areas of vascular injury during TAVR will improve the safety of TAVR procedures and will open the procedure up to an even greater cohort of patients that are currently unable to access aortic replacement surgery.
In various aspects, the embodiments of the present invention relate to medical devices for insertion into the body to provide access for medical, cosmetic and other procedures. This includes but is not limited to all bodily vessels or canals, such as arterial and venous access, abdominal and thoracic cavities, cerebrospinal, genito-urinary and gynaecological, upper gastrointestinal and colorectal procedures.
It will be understood that the terms “sheath”, “sheaths” and any plural or derivative terms thereof, when used in this specification, specify the components associated with the functioning of a sheath including but not limited to a collar, a valve, a sleeve and any intermediate components. The term “sheath”, “sheaths” and any plural or derivative terms thereof will not be construed to be limited to a sleeve alone.
It will be understood that the term “sleeve” and any plural or derivative terms thereof, when used in this specification, specify a generally longitudinal portion of an introducer sheath for insertion within the patient. The term “sleeve” may include within its definition a sleeve being constructed of more than one piece being joined to form a longitudinal portion for insertion within a patient.
Embodiments relate to a retractable sheath for protecting a luminal surface of a bodily vessel or canal from the introduction of a medical device within the bodily vessel or canal, the retractable sheath comprising; a rigid collar comprising a valve and having an inner surface defining an opening extending through the collar, a continuous elastomeric outer tube having an outer tube proximal opening located at an outer tube proximal end and an outer tube distal opening located at an outer tube distal end defining an outer tube luminal channel therebetween, the outer tube proximal end affixed to the rigid collar, an at least partially discontinuous inner tube formed from a coiled discontinuous sheet having an external sheet surface and internal sheet surface, the at least partially discontinuous inner tube having an inner tube proximal opening located at an inner tube proximal end and an inner tube distal opening located at an inner tube distal end defining an inner tube luminal channel therebetween, the inner tube proximal end affixed to the rigid collar, wherein the at least partially discontinuous inner tube is located within the outer tube luminal channel to form a circumferentially retractable elongated sleeve, a portion of the at least partially discontinuous inner tube is movable independently of the continuous elastomeric outer tube, and the external sheet surface is slidable against an outer tube luminal surface.
As used herein the terms “attach” and “affix”, and any plural or derivative terms thereof, are to be construed as being synonymous. As used in this specification these terms will be understood as specifying any and all forms of joining one item or surface with another. For example, clamping, bonding, weaving, stitching, welding, adhering, laminating, securing, annealing, moulding, heat shrinking and other forms of forming a chemical or physical connection between two or more items or surfaces shall be understood as being captured within the scope of these terms.
As used herein, the term “rigid” and any plural or derivative terms thereof, are to be understood as being relative terms, understood by persons skilled in the relevant art with respect to the context of their use. In particular, the term “rigid” is not to be construed in an absolute sense. For instance, a “rigid collar” shall be understood to include within its scope any suitable material with some pliability but sufficient rigidity that that the collar may be gripped and sufficient force may be applied to the collar, without crumpling or buckling, during insertion of an introducer sheath through an opening into patient.
Embodiments wherein the at least partially discontinuous inner tube is movable independently of the continuous elastomeric outer tube are to be understood as being distinct from a form in which the tubes each move as though they are a single uniform layer.
In order to permit the removal of air trapped between the inner and outer tubes prior to entry to the vascular system certain embodiments may incorporate an opening in the proximal end of the outer tube which is closed with a valve. Prior to a medical procedure fluid such as saline or a sterilising agent may be introduced to the space between the inner and outer tubes through the valve.
The retractable sheath according to embodiments may comprise an external sheet surface of the at least partially discontinuous inner tube in direct contact with the outer tube luminal surface, and the at least partially discontinuous inner tube may be movable independently of the continuous elastomeric outer tube, and the external sheet surface may be slidable against an outer tube luminal surface.
While the at least partially discontinuous inner tube may be movable independently of the continuous elastomeric outer tube, the at least partially discontinuous inner tube and the elastomeric outer tube may be joined, laminated or bonded at a portion thereof. The extent to which they may be joined, laminated or bonded is only sufficient to maintain them in proximity to one another and simultaneously permit the independent movement of one another. For example, the at least partially discontinuous inner tube and the elastomeric outer tube may be joined, laminated or bonded at the proximal end of the retractable sheath, the distal end of the retractable sheath or at selected sections along the length of the retractable sheath.
The retractable sheath according to embodiments may comprise an at least partially discontinuous inner tube being a coiled discontinuous sheet formed from the lamination of at least two layers, the first layer comprising a material selected from a group consisting of low friction polymers, and the second layer comprising a material selected from a group consisting of structural biocompatible materials and sheet woven biocompatible meshes.
Composite material construction of the at least partially discontinuous inner tube may be adopted to impart the properties of more than one material on the inner tube or the adjustable sheath. Composite material construction of the at least partially discontinuous inner tube may be achieved by laminating any number of materials to one another, or by mixing two materials to achieve a composite material. Alternatively, one material may be embedded in another.
Certain embodiments may comprise a continuous elastomeric outer tube formed from a composite material. For example, a material may be embedded within an elastomer during the construction of the continuous elastomeric outer tube to alter its mechanical, biological, aesthetic or optical properties. For example, an isotropic elastomer may be longitudinally reinforced with a material of reduced elasticity to avoid longitudinal extensibility and collapsibility. Or, an elastomer may be circumferentially supported with a material of different hardness to improve local pressure resistance. Additionally, the elastomeric outer tube may be embedded with a radio-opaque stripe to allow visibility under fluoroscopy.
The retractable sheath according to embodiments may comprise an at least partially discontinuous inner tube being a coiled discontinuous sheet formed from the lamination of at least three layers, the first layer comprising a material selected from a group consisting of low friction polymers, the second layer comprising a material selected from a group consisting of structural biocompatible materials and sheet woven biocompatible meshes, and the third layer comprising a low friction polymer.
For example, low friction polymers may be selected from the group consisting of fluoropolymers such as Poly Tetra Fluoro Ethylene (PTFE) or Fluorinated Ethylene Propylene (FEP). Low friction polymers may be selected from other polymers considered to have low friction properties such as High Density Polyethylene or Polyimide, or other polymers incorporating friction modifying additives. Low friction polymers may be Teflon PTFE or 100X FEP from Chemours. The low friction polymer may be PTFE.
Structural materials include those selected based on their mechanical properties such as flexural modulus, tensile strength or strain to failure, and for example may be selected from a group consisting of nylons, polyurethanes, nylon block copolymers, polyethylenes, polypropylenes, polyoxymethylene, or other biologically compatible polymers.
The retractable sheath according to embodiments may comprise an at least partially discontinuous inner tube being a coiled discontinuous sheet formed from a first layer comprising a fluorinated polymer, the first layer also providing the internal sheet surface, bonded to a second layer comprising nylon, a nylon block copolymer, or polyurethane.
The retractable sheath according to embodiments may comprise an at least partially discontinuous inner tube being a coiled discontinuous sheet formed from a first layer comprising a fluorinated polymer, the first layer also providing the internal sheet surface, bonded to a second layer comprising nylon or polyurethane, and a third layer comprising any one of a longitudinal reinforcing element, an axial reinforcing element, or a braided reinforcing element.
For example, the braided layer may comprise a woven stainless steel, nitinol or polymer mesh or other braided mesh well known in the art. The braided layer may be partially or fully integrated into the first and/or second layers.
In preferred embodiments, the at least partially discontinuous inner tube of the retractable sheath may be formed from at least a first coiled discontinuous sheet, the first coiled discontinuous sheet providing the internal sheet surface, the partially discontinuous tube further comprising a second discontinuous sheet, the second discontinuous sheet providing the external sheet surface, and wherein the continuous elastomeric outer tube provides an elastomeric tube inner surface and an elastomeric tube outer surface.
In preferred embodiments, the at least partially discontinuous inner tube may be formed from at least a first coiled discontinuous sheet, the first coiled discontinuous sheet providing the internal sheet surface, the at least partially discontinuous inner tube further comprising a second discontinuous sheet, the second discontinuous sheet providing the external sheet surface, and further comprising at least one intermediary discontinuous sheet positioned between the first coiled discontinuous sheet and the second discontinuous sheet.
In preferred embodiments, the at least partially discontinuous inner tube may be formed from a coiled discontinuous sheet having an oblique edge wherein the coiled discontinuous sheet is wound about the length of the at least partially discontinuous inner tube along the oblique edge.
In preferred embodiments, the at least partially discontinuous inner tube may be formed from a coiled discontinuous sheet having an oblique edge wherein the coiled discontinuous sheet is wound about the length of the at least partially discontinuous inner tube along the oblique edge, at a pitch of approximately between 0.3 lengths of the at least partially discontinuous inner tube and at least 2 lengths of the at least partially discontinuous inner tube.
In preferred embodiments, the at least partially discontinuous inner tube may be formed from a coiled discontinuous sheet having an oblique edge having a sharp edge at the internal sheet surface, wherein the coiled discontinuous sheet is wound about the length of the at least partially discontinuous inner tube along the oblique edge.
In preferred embodiments, the at least partially discontinuous inner tube may have a greater thickness at the inner tube proximal end than at the inner tube distal end.
In preferred embodiments, the at least partially discontinuous inner tube may comprise a tube portion that is between approximately 0.05 mm to 0.5 mm thick.
In preferred embodiments, the at least partially discontinuous inner tube may comprise a tube portion that is between approximately 0.1 mm to 0.4 mm thick.
In preferred embodiments, the at least partially discontinuous inner tube may comprise a tube portion that is between approximately 0.25 mm to 0.35 mm thick.
In preferred embodiments, the at least partially discontinuous inner tube may comprise a radio opaque material selected from the group consisting of metals or radio-opaque polymers, located at the inner tube distal end.
In preferred embodiments, the at least partially discontinuous inner tube may comprise a radio opaque material selected from the group consisting of metals or radio-opaque polymers, located substantially along the length of the inner tube.
In preferred embodiments, the at least partially discontinuous inner tube may comprise a first tapering tube portion at the inner tube proximal end, a second tapering tube portion at the inner tube distal end and a non-tapering portion therebetween.
The at least partially discontinuous inner tube of certain embodiments may comprise a first non-tapering tube portion at the inner tube proximal end, a second non-tapering tube portion at the inner tube distal end and a tapering portion therebetween.
The continuous elastomeric outer tube of certain embodiments may have a greater thickness at the outer tube proximal end than at the outer tube distal end.
The continuous elastomeric outer tube of certain embodiments may comprise a first tube portion having a first thickness and a second tube portion having a second thickness.
The continuous elastomeric outer tube of certain embodiments may comprise a first tube portion having a first thickness and a second tube portion having a second thickness, wherein the first tube portion is located at the outer tube proximal end and is between approximately 30 mm to 100 mm in length.
The continuous elastomeric outer tube of certain embodiments may have a greater hardness at the outer tube proximal end than at the outer tube distal end. Alternatively, embodiments may have a greater hardness at the outer tube distal end than the outer tube proximal end; or indeed both, which may impart other desirable characteristics.
The continuous elastomeric outer tube of certain embodiments may be between 10A to 90A harder at the outer tube proximal end than at the outer tube distal end.
A retractable sheath according to embodiments may comprise a lubricious layer or surface coating applied to any one of an external sheet surface, an internal sheet surface, an elastomeric tube outer surface, or an elastomeric tube inner surface.
A retractable sheath according to embodiments may comprise a lubricious layer or surface coating applied to an internal sheet surface. Surface coatings may comprise substances that act as friction modifiers. Suitable friction modifiers may be selected from a group consisting of hydrophilic polymers (including Polyethylene Glycols and Polyvinylpyrrolidones), fluoropolymers (including polytetrafluoroethylene (PTFE) and perfluoropolyether (PFPE)) and oils (including siloxanes and glycerols).
A retractable sheath according to embodiments may comprise a lubricious layer or surface coating selected from the group consisting of fluoropolymers, polyolefins, polyamides, polymer blends, and radio-opaque additives applied to any one of an external sheet surface, an internal sheet surface, an elastomeric tube outer surface, or an elastomeric tube inner surface.
A retractable sheath according to embodiments may comprise a lubricious layer or surface coating of polytetrafluoroethylene (PTFE) applied to an internal sheet surface.
A retractable sheath according to embodiments may comprise a lubricious layer or surface coating of polytetrafluoroethylene (PTFE), barium sulfate, titanium oxide, bismuth compounds or oils applied to an internal sheet surface or an external sheet surface.
A retractable sheath according to embodiments may comprise a lubricious layer selected from the group consisting of ultra-violet or thermal cure hydrophilic coatings, polytetrafluoroethylene (PTFE) film coatings, and liquid coatings applied to an elastomeric tube outer surface. In various aspects, embodiments of the invention relate to retractable sheaths for protecting a luminal surface of a bodily vessel or canal from the introduction of a medical device within the bodily vessel or canal, the retractable sheath comprising; a rigid collar having an inner surface defining an opening extending through the collar, the rigid collar having attached thereto a circumferentially retractable elongated sleeve having a proximal opening and a distal opening defining a luminal channel therebetween, the elongated sleeve comprising two separate layers including a continuous elastomeric outer layer and an expandable inner layer discontinuous at least in part, the discontinuous part of the expandable inner layer comprising a stiff polymeric sheet characterised as having outward annular resistance when forcibly coiled, the stiff polymeric sheet forming at least part of the expandable inner layer when coiled and positioned longitudinally within a lumen formed by the continuous elastomeric outer layer and positioned substantially in contact with a luminal surface of the continuous elastomeric outer layer, wherein the rigid collar is attached to the circumferentially retractable elongated sleeve or one or more intermediate portions between the circumferentially retractable sleeve and the rigid collar at the proximal end of the sleeve.
In preferred embodiments, the stiff polymeric sheet may comprise an external sheet surface and an internal sheet surface and the external sheet surface is in direct contact with the luminal surface of the continuous elastomeric outer layer, and the expandable inner layer is movable independently of the continuous elastomeric outer layer, and the external sheet surface is slidable against the luminal surface of the continuous elastomeric outer layer.
In preferred embodiments, the expandable inner layer may be a coiled discontinuous sheet formed from the lamination of at least two layers, the first layer comprising a material selected from a group consisting of low friction polymers, and the second layer comprising a material selected from a group consisting of structural biocompatible materials and sheet woven biocompatible meshes.
In preferred embodiments, the expandable inner layer may be a coiled discontinuous sheet formed from the lamination of at least three layers, the first layer comprising a material selected from a group consisting of low friction polymers, the second layer comprising a material selected from a group consisting of structural biocompatible materials and sheet woven biocompatible meshes, and the third layer comprising a low friction polymer.
In preferred embodiments, the expandable inner layer may be a coiled discontinuous sheet formed from a first layer comprising polytetrafluoroethylene, the first layer also providing the internal sheet surface, bonded to a second layer comprising nylon.
In preferred embodiments, the expandable inner layer may be a coiled discontinuous sheet formed from a first layer comprising polytetrafluoroethylene, the first layer also providing the internal sheet surface, bonded to a second layer comprising nylon, and a third layer comprising any one of a longitudinal reinforcing element, an axial reinforcing element, or a braided reinforcing element.
In preferred embodiments, the expandable inner layer may be formed from at least a first coiled discontinuous sheet, the first coiled discontinuous sheet providing the internal sheet surface, the partially discontinuous tube further comprising a second discontinuous sheet, the second discontinuous sheet providing the external sheet surface, and wherein the continuous elastomeric outer layer provides an elastomeric outer layer inner surface and an elastomeric outer layer outer surface.
In preferred embodiments, the expandable inner layer may be formed from at least a first coiled discontinuous sheet, the first coiled discontinuous sheet providing the internal sheet surface, the expandable inner layer further comprising a second discontinuous sheet, the second discontinuous sheet providing the external sheet surface, and further comprising at least one intermediary discontinuous sheet positioned between the first coiled discontinuous sheet and the second discontinuous sheet.
In preferred embodiments, the expandable inner layer may be formed from a coiled discontinuous sheet having an oblique edge wherein the coiled discontinuous sheet is wound about the length of the expandable inner layer along the oblique edge.
Alternatively, the expandable inner layer may be formed from a coiled discontinuous sheet having an oblique edge wherein the coiled discontinuous sheet is wound about the length of the expandable inner layer along the oblique edge, at a pitch of approximately between 0.3 lengths of the expandable inner layer and at least 2 lengths of the expandable inner layer.
Alternatively, the expandable inner layer may be formed from a coiled discontinuous sheet having an oblique edge having a sharp edge at the internal sheet surface, and wherein the coiled discontinuous sheet is wound about the length of the expandable inner layer along the oblique edge.
In certain embodiments, the expandable inner layer may have an inner layer proximal opening located at an inner layer proximal end and an inner layer distal opening located at an inner layer distal end defining an inner layer luminal channel therebetween, the inner layer proximal end affixed to the rigid collar and having a greater thickness at the inner layer proximal end than at the inner layer distal end.
In certain embodiments, the expandable inner layer may comprise an inner layer portion that is between approximately 0.05 mm to 0.5 mm thick.
In certain embodiments, the expandable inner layer may comprise an inner layer portion that is between approximately 0.1 mm to 0.4 mm thick.
In further embodiments, the expandable inner layer may comprise an inner layer portion that is between approximately 0.25 mm to 0.35 mm thick.
The expandable inner layer may, further, comprises a radio opaque material selected from the group consisting of metallic materials or radio-opaque polymers, located at the inner layer distal end.
In certain forms, the expandable inner layer may comprise a first tapering portion at the inner layer proximal end, a second tapering portion at the inner layer distal end and a non-tapering portion therebetween.
In other forms, the expandable inner layer may comprise a first non-tapering portion at the inner layer proximal end, a second non-tapering portion at the inner layer distal end and a tapering portion therebetween.
The continuous elastomeric outer layer may have a greater thickness at the outer layer proximal end than at the outer layer distal end.
In certain forms, the continuous elastomeric outer layer may comprise a first outer layer portion having a first thickness and a second outer layer portion having a second thickness.
A retractable sheath of certain embodiment may have a continuous elastomeric outer layer comprising a first outer layer portion having a first thickness and a second outer layer portion having a second thickness, wherein the first outer layer portion is located at the outer layer proximal end and is between approximately 30 mm to 100 mm in length.
Further, the continuous elastomeric outer layer may have a greater hardness at the outer layer proximal end than at the outer layer distal end.
Preferably, the continuous elastomeric outer layer may be between 10A to 90A harder at the outer layer proximal end than at the outer layer distal end.
In further embodiments, a lubricious layer or surface coating may be applied to any one of an external sheet surface, an internal sheet surface, an elastomeric outer layer outer surface, or an elastomeric outer layer inner surface.
More specifically, a lubricious layer or surface coating may be applied to an internal sheet surface.
The lubricious layer or surface coating of preferred embodiments may be selected from the group consisting of fluoropolymers, polyolefins, polyamides, polymer blends, and radio-opaque additives applied to any one of an external sheet surface, an internal sheet surface, an elastomeric outer layer outer surface, or an elastomeric outer layer inner surface.
In certain embodiments, the retractable sheath may comprise a lubricious layer or surface coating of polytetrafluoroethylene (PTFE) applied to an internal sheet surface.
In particular, the lubricious layer or surface coating may be of polytetrafluoroethylene (PTFE), barium sulfate, titanium oxide, bismuth compounds or oils applied to an internal sheet surface or an external sheet surface.
The lubricious layer may be selected from the group consisting of ultra-violet or thermal cure hydrophilic coatings, polytetrafluoroethylene (PTFE) film coatings, and liquid coatings applied to an elastomeric outer layer outer surface.
In various aspects, the embodiments of the present invention relate to a retractable sheath for protecting the luminal surface of a blood vessel from the introduction of a medical device within the bodily vessel or canal, the retractable sheath comprising; a rigid collar having an inner surface defining an opening extending through the collar, the rigid collar having attached thereto a circumferentially retractable elongated sleeve having a proximal opening and a distal opening defining a luminal channel therebetween, the elongated sleeve comprising two separate layers including a continuous elastomeric outer layer and an expandable inner layer discontinuous at least in part, the discontinuous part of the expandable inner layer comprising a stiff polymeric sheet characterised as having outward annular resistance when forcibly coiled, the stiff polymeric sheet forming at least part of the expandable inner layer when coiled and positioned longitudinally within a lumen formed by the continuous elastomeric outer layer and positioned substantially in contact with a luminal surface of the continuous elastomeric outer layer, wherein the rigid collar is attached to the circumferentially retractable elongated sleeve or one or more intermediate portions between the circumferentially retractable sleeve and the rigid collar at the proximal opening end of the sleeve.
Embodiments designed as such provide a dynamically expandable sheath capable of expanding within the bodily vessel or canal when a medical device is passed through the sheath and are also capable of retracting back to almost their original size when the medical device is removed from the sheath.
This functionality is achieved from a unique design concept, whereby the elastomeric outer layer provides resistive pressure to expansion of the elongated sleeve to force the retraction of the sleeve, and the expandable inner layer provides a small amount of resistive pressure to the retraction of the sleeve to form a channel within it, however the resistive pressure of the elastomeric outer sleeve is greater than the resistive pressure of the expandable inner layer. This configuration results in the passive retraction of the sleeve as a medical device is passed through the sleeve. This design contrasts significantly with traditional introducer sheaths which have a retracting outer or a single expanding and retracting layer, which generally fails to retract evenly in a radial fashion, thereby causing ridging of the sheath, or failure to retract closely enough to its original size to enable the safe removal of the sheath.
It is well understood that introducer sheaths must offer a balance of characteristics; firstly, they must include sufficient bendability to navigate a network of vascular channels and sufficient rigidity to prevent kinking and buckling, but they must also include sufficient resilience to retract when circumferentially expanded, or when inadvertently bent or kinked. Frequently, prior art devices will seek to improve either the former or the latter, but few address the combination of requirements of the requirements outlined above for introducer sheaths.
The present design concept enables a complementarity of physical characteristics to be provided. Each layer of the elongated sleeve imparts different physical characteristics to provide a complementarity of physical properties that cannot be provided by any single material. In particular, the expandable inner layer of embodiments provides rigidity while the elastomeric outer layer provides resilience and both provide a sufficient degree of bendability to navigate a patient's vasculature.
For example, optimal longitudinal bendability, rigidity, stiffness and/or resilience prevents unacceptable kinking and buckling. These characteristics are not governed by the radial resilience of the sheath. The introduction of a longitudinal reinforcing element within the sheath provides for such composite physical characteristics to be achieved. For example, embodiments may be configured to withstand kinking and buckling by including a longitudinal reinforcing element in the inner tube or the outer tube. Preferred embodiments may include a stiff yet pliable material, such as forming a thickened portion along the length of the outer tube latex material or a metal rod incorporated along the length of the outer tube or the inner tube, to minimise longitudinal expansion and compression to overcome buckling whilst enabling sufficient bendability to navigate the patient's body.
Furthermore, the orientation of the seam along length of the expandable inner layer and/or the degree of lapping of the expandable inner layer can also be altered to adjust and optimise the resilience and flexibility of the sheath.
Additionally, the multi-layer design concept according to embodiments may provide a better opportunity for persons skilled in the art to optimise physical properties of the retractable sheath by allowing for a broader selection of materials for forming the elastomeric outer layer and the expandable inner layer, or it may offer the opportunity for persons skilled in the art to localise desired physical properties of the retractable sheath.
Selection of suitable materials must also be suited to the desired shape of the expandable sheath or the elongated sleeve. Particular shapes may impart functional characteristics that may be desired in certain embodiments.
For instance, to ease insertion, embodiments may comprise an elongated sleeve that is longitudinally tapered at least partially between the proximal opening and the distal opening. The degree of tapering may be critical for certain uses, for instance, for TAVR procedures where the valve may well be larger than the patient's femoral artery, the degree of tapering preferably facilitates ease of entry of the retractable sheath into an opening in the vessel where the opening of the vessel and the vessel itself may be gently stretched and enlarged by insertion of the tapered sleeve and access of the device may be eased by insertion into the larger opening of the sleeve. Further, tapering may permit expansion of the sheath with less introducing force than a non-tapered expanding sheath.
The sleeve may incorporate a first substantially parallel section extending from the collar to account for the variation in depth of the patient artery from the skin, then taper to a second substantially parallel section extending towards the distal opening.
Certain embodiments may be constructed from multiple tapered and non-tapered sections to achieve the desired levels of expansion along the length of the sleeve.
Therefore, the sleeve edge defining the distal opening preferably has a circumference about at least about 20% smaller than the sleeve edge defining the circumference of the proximal opening. Or, more specifically, the sleeve edge defining the distal opening preferably has a circumference at least about 25% smaller than the sleeve edge defining the circumference of the proximal opening. For many indications such as TAVR, a distal opening having a circumference of at least about 35% of the circumference of the proximal opening is preferred. In practice, a preferred circumference of the distal opening is in a range of between about 35% and 40% of the circumference of the proximal opening.
Shapes such as tapering, may be achieved by shaping just one of the elastomeric outer layer or the expandable inner layer. For instance, the expandable inner layer may be shaped to be cylindrical with no taper, and the taper of the elongated sleeve imparted by a tapered elastomeric outer layer. Further, the tapered shape of the expandable inner layer may be achieved by a coiling the stiff polymeric sheath into a tapered shape.
The expandable inner layer and elastomeric outer layer may both be shaped longitudinally to be partially or completely tapered to achieve the final desired taper characteristics of the device. As such, the expandable inner layer and the elastomeric outer layer may be variable tapered longitudinally, and/or with respect to one another.
The design of retractable sheaths of certain embodiments may comprise an elongated sleeve comprising a substantially cylindrical portion terminating at the proximal opening. In particular, the expandable inner layer may comprise a substantially cylindrical continuous portion terminating at the proximal opening and a discontinuous stiff polymeric sheet portion terminating at the distal opening coiled and positioned longitudinally within the lumen formed by the continuous elastomeric outer layer and positioned substantially in contact with the luminal surface of the continuous elastomeric outer layer.
In preferred embodiments, the substantially cylindrical portion terminating at the proximal opening is sized to promote a robust seal to the vascular opening. This non-tapered portion of the expandable inner layer may comprise an axial seam or joint line and may be integrally formed with the discontinuous tapered portion.
Preferably, the overlap of the discontinuous portion of the coiled stiff polymeric sheet increases from the proximal end to the distal end, creating a helical edge along the length of the elongated sleeve. An angled edge may aid the smooth expansion and retraction of the expandable inner layer.
Further, the number of turns of the helically wound stiff polymeric sheet alters its properties through resistance to radial expansion and contraction, as well as bendability of the sheath as the longitudinal stiffness of the stiff polymeric sheet is broken or relaxed along the length of the sheath.
The expandable inner layer may comprise cut outs, slits and other sections to improve or alter the physical properties of the elongated sleeve, in particular, the bendability, resistance to kinking or resilience of the elongated sleeve.
The expandable inner layer may be integrally formed from a substantially uniform stiff polymeric material comprising a notch or cut-out between the substantially cylindrical continuous portion and the discontinuous stiff polymeric sheet portion. The discontinuous stiff polymeric sheet portion may be configured to coil in an overlapping arrangement in its relaxed state and to coil helically about the longitudinal axis of the elongated sleeve.
Helical winding is preferred as it typically facilitates the expanding and retracting of the discontinuous stiff polymeric sheet portion. It also has the best combination of properties of reduced kinkability and most typically flexibility during introduction.
In particular, an edge of the discontinuous stiff polymeric sheet portion may wind helically about the longitudinal axis of the elongated sleeve. The discontinuous sheet portion preferably winds about the longitudinal axis of the sheath a number of times approximately equal to the number of times the distal portion is wound plus about 0.5 to about 1.5. More particularly, the number is approximately equal to the number of times the distal portion is wound plus about 1.
Alternately, an edge of the discontinuous stiff polymeric sheet portion may wind helically about the longitudinal axis of the sleeve with a helical pitch of between 0.3 L and 3 L, where L is the longitudinal length of the sleeve.
The helical pitch may rotate in a clockwise or counter clockwise direction relative to the view towards the distal end, with a leading or trailing outer edge.
The number of turns of the discontinuous stiff polymeric sheet portion about the longitudinal axis of the elongated sleeve and the degree of overlap of the discontinuous stiff polymeric sheet portion upon itself as it winds helically about the longitudinal axis of the elongated sleeve may both, individually or together, alter the performance properties of the sheath. Axial stiffness along the length of the sheath increases as the degree of overlapping of the discontinuous stiff polymeric sheet portion increases, however, stiffness may be decreased with an increase in the number of turns of the discontinuous stiff polymeric sheet portion upon itself about the longitudinal axis of the elongated sleeve.
Winding of the discontinuous stiff polymeric sheet portion about the longitudinal axis of the sheath may be increased up to a number of times approximately equal to the number of times the distal portion is wound plus about 2. This may adjust the annular resistance of the sheet for the passage of a medical device through it, which in turn may assist in protecting the luminal wall of the patient's vasculature. Conversely, winding may be decreased down to a number of times approximately equal to the number of times the distal portion is wound plus about 0.5 to adjust the flexibility of the sheath by reducing the degree of overlapping of the stiff polymeric sheet and breaking the degree of longitudinal stiffness of the stiff polymeric sheet.
The shape of the notch or cut out can be selected from a variety of shapes, for example circular, triangular, ovoid, or T-shaped and may be selected on the basis of the desired physical properties of the elongated sleeve.
The expandable inner layer may comprise a series of small cut outs along its length which may improve the bendability of the elongated sleeve. For instance, this may include a series of notches or a series of slits.
In an alternative embodiment the expandable inner layer may be configured from a continuous thin strip. The strip may further comprise a series of longitudinal coils projecting from an edge, wherein the coils wind back over the continuous thin strip. The wound coils are typically of length between 1 mm and 10 mm, with a spacing between them of 0.1 mm to 10 mm. In certain embodiments, the diameter of each coil may be consistent along the length of the continuous strip, or be of varying diameter along the length whereby at least the coil at the distal end is a smaller diameter to the coil at the proximal end.
The stiff polymeric sheet of embodiments may be formed from a material comprising at least one member selected from the group consisting of polyethylene, polypropylene, nylon, polyester, PTFE, FEP, eFEP, PFA, polyolefins, polyurethanes, polyamides, polyether blends, co-polymers thereof or other biologically compatible polymers. Preferably the stiff polymeric sheet is formed from polypropylene or a fluoropolymer.
The stiff polymeric sheet may be constructed as a laminate of different polymers, for example a 2-layer laminate of a higher-stiffness low-lubricity polymer with a lower-stiffness high-lubricity polymer, or a 3-layer laminate of a higher-stiffness low-lubricity polymer between separate layers of lower-stiffness high-lubricity polymer. Additional layers maybe included to improve bonding between dissimilar materials. The lamination may be radial or circumferential. The material used for the Stiff polymeric sheet may include performance modifying additives such as friction modifiers, colourants, radio-opaque particles or mechanical reinforcement.
The stiff polymeric sheet thickness is selected according to the desired flexibility and strength of the overall system. Preferably the thickness is between 0.05 mm and 0.5 mm. In certain embodiments the thickness is between 0.1 mm and 0.4 mm. In certain embodiments the thickness is between 0.25 mm and 0.35 mm. The thickness of the stiff polymeric sheet may vary along the length of the sleeve. In certain embodiments the thickness of the sheet may be greater at the proximal end than the distal end. The thickness may taper over a length of the sleeve, or may step between thicknesses at a defined point.
Where certain materials are adopted, the discontinuous portion of the expandable inner layer may be prone to becoming locked in an expanded position as the edges of the overlapping portions may abut against one another and become locked in that position. To avoid this problem such edges may be rounded, blunt, or cut at a non-orthogonal angle.
The design of the stiff polymeric sheet may comprise at least three edges, wherein at least one edge terminates in an oblique cut. Further, at least two substantially opposite edges may intersect at a point or edge defining the distal opening and the at least one of the two edges are formed by an oblique cut.
A non-orthogonal cut of the stiff polymeric sheet may be selected to promote a desired orientation and/or degree of coiling of the sheet or it may promote an increased edge overlap for a given diameter.
In an alternative embodiment, the expandable inner layer may be formed from a helically wound continuous strip or wire. It may be characterised by a strip or wire thickness of dimension ‘W’, wherein it is wound with a helical pitch of between ‘W’ and ‘2W’.
Preferably, the pitch of the helical strips is between about 0.5 lengths to 2 lengths where each length is the axial length of the split. More specifically, a preferred helical pitch is 0.9 lengths to 1.1 lengths.
The helical wire may be constructed of titanium, titanium alloy or stainless steel, or of a polymeric material such as polyester, polyethylene, polypropylene or other biocompatible material. It may be tapered along the length of the elongated sleeve.
The prior art describes multi-layer sheaths in which two or more layers are bonded to one another. An inherent feature of the design concept of embodiments is that the combination of the physical characteristics of each layer is lost when layers are bonded together.
Thus, in preferred embodiments, the continuous elastomeric outer layer and the expandable inner layer are movable with respect to one another. Preferably, the luminal surface of the continuous elastomeric outer layer and an outer surface of the expandable inner layer are movable with respect to one another, and preferably have a low coefficient of friction. Acceptable coefficients of friction are well known to persons skilled in the art, thus the selection of materials that have an inherent coefficient of friction that is adequately low is well known to such persons.
Regardless however, the inner and outer layers may be fixed relative to each other at the proximal end, which may be through direct relative attachment through welding, bonding or clamping, or which may be achieved through attachment of both tubes to a haemostatic valve or similar device. This ensures that the layers, while they are enabled to move relative to one another, remain fixed in a desired position.
In particular, the proximal end of the inner layer may be attached to the rigid collar by bonding an area of the exterior surface of the expandable inner layer to the inner surface of the rigid collar. The elastomeric outer layer may be maintained in place once positioned upon the exterior surface of the rigid collar by virtue of a relaxed proximal circumference equal to or less than the outer circumference of the rigid collar.
In particular, the proximal end of the inner or outer layer may be attached to the rigid collar by clamping between two elements. In particular, the inner and outer layer may be attached to the rigid collar in a common clamp joint.
In certain embodiments, the elongated sleeve may comprise a lubricious layer or surface treatment between the luminal surface of the continuous elastomeric outer layer and the outer surface of the expandable inner layer. Preferably, these comprise at least one member selected from the group consisting of silicon, glycerine oil, fluoropolymer oil, grease, PTFE, or a hydrophilic polymer to reduce the coefficient of friction. The lubricious layer may further comprise hydrogel-based coatings that can include medicinal agents to treat or avoid infections or allergies. These substances or other hydrophilic coatings may be applied to the inner surface of the expandable inner layer to reduce the coefficient of friction between the medical device and the retractable sheath.
Preferably the lubricious layer is an oil of viscosity 20-1500cSt.
Turning now to the design of the elongated sleeve of several embodiments, the continuous elastomeric outer layer may be comprised of an elastomeric material, such that the continuous elastomeric outer layer is capable of being expanded upon stretching of the elastomeric material and retracted upon relaxation of the elastomeric material. Preferably, the selection of suitable materials enables the elastomeric material to be capable of returning to a circumference of about 135% or less of its initial circumference once retracted. Typically, the resting circumference of the proximal edge will be about 135% greater than the resting circumference of the distal edge, thus, the elastomeric material must be capable of returning to a circumference of at least the size of the proximal opening.
More preferably, the elastomeric material to be capable of returning to a circumference in the range of about 110% and about 120% of its initial circumference once retracted. Most preferably the elastomeric material is capable of returning to a circumference in the range of 100-110% of its initial circumference once retracted.
Further, the selection of suitable materials may enable the continuous elastomeric outer layer must be capable of being expanded upon stretching of the elastomeric material to about 1.35 times or greater of its unstretched circumference. The desirable capacity of the elastomeric to expand would ideally not limit the types of medical devices that may be passed through it, therefore the continuous elastomeric outer layer is preferably capable of being expanded upon stretching of the elastomeric material to between about 300% to 400% of its unstretched circumference.
Preferably, the continuous elastomeric outer layer is formed from a member of the group consisting of latex rubber or non-latex substitutes including nitrile rubber, polyvinylchloride, neoprene, polypropylene and polyisoprene, polyurethane and polyurethane blends, thermoplastic olefins, styrenic elastomers, and other thermoplastic elastomers. Preferably the continuous elastomeric outer layer is formed from a silicone material or a silicone composite material.
Preferably the material hardness is in the range of 30 Shore A to 90 Shore A. More preferably, the material hardness is in the range of 50 Shore A to 60 Shore A
Preferred materials for forming the elastomeric outer layer are selected from those that may be formed to a thinness, without rupturing, having a sufficient resistant pressure to retract the expandable inner layer. In doing so, the user need not apply significant force to the medical device during insertion to forcibly expand the elastomeric outer layer, which may otherwise risk damage to the vessel. Thus, the continuous elastomeric outer layer preferably comprises a thickness of about 0.35 mm or less. Or more specifically, the continuous elastomeric outer layer preferably comprises a thickness of about 0.2 mm.
The thickness of the elastomeric outer layer may be uniform or vary along the longitudinal length of the sleeve. Variation in thickness along the length of the sleeve allows may be tailored to a desired longitudinal collapsing resistance and internal pressure resistance along the length of the sleeve relative to the extent of tapering along the length of the sleeve.
In certain embodiments the thickness of the elastomeric outer layer will be greater at the proximal end than the distal end. In certain embodiments the elastomeric outer layer has increased thickness extending up to 100 mm from the collar.
The thickness variation of the elastomeric outer layer may be generated through lamination of multiple layers of polymeric material, overmoulding, dip coating, stretching, or other manufacturing process. Multiple layers may be bonded with adhesive, thermally welded, or held in place with friction. The thickness change may be gradual or stepped.
Additionally, the hardness of the material of the elastomeric outer layer may vary through the longitudinal length to further tailor the longitudinal collapsing resistance and internal pressure resistance along the length of the sleeve. In certain embodiments the material hardness varies from 60 Shore A at the proximal end to 30 Shore A at the distal end.
To further improve longitudinal collapsing resistance of the outer elastomeric layer, the layer may comprise a circumferentially continuous elastomeric outer tube having two or more layers comprising an elastomeric layer extending longitudinally and spanning the entire length of the sleeve and a circumferentially discontinuous semi-rigid support layer bonded to the elastomeric layer and being formed from one or more semi-rigid support elements, the support layer bonded about the distal opening and extending longitudinally therefrom towards the proximal opening, wherein the circumferentially discontinuous semi-rigid support layer is configured to resist longitudinal compression of the circumferentially continuous elastomeric outer tube.
In preferred embodiments, the rigid collar is provided by a haemostatic valve connector. The haemostatic valve connector may comprise a haemostatic valve to prevent the patient losing blood from the opening in the vessel.
The haemostatic valve connector may further comprise an opening for introducing a medical device into the lumen of the elongated sheath. It may also comprise one or more inlets for introducing fluids into the patient's vascular system.
To promote visibility of a medical device or the retractable sheath to x-ray imaging equipment during medical procedures, the elongated sleeve may comprise a radio opaque marker. The radio opaque marker is preferably located at the distal end of the elongated sleeve and may equally be bound to the elastomeric outer layer or the expandable inner layer. The marker may be a metallic wire such as nitinol, bonded or stitched to the sleeve, or it may be polymer-based such as a tungsten-filled nylon, polyethylene or polyurethane, bonded to the sleeve. Alternatively, the radio opaque marker may be bonded to the elastomeric outer layer and the expandable inner layer, thus binding the layers together at the distal end of the elongated sleeve. Alternately, the radio opaque marker may be distributed through a polymer used for either or both of the stiff polymeric sheet or elastomeric outer layer.
During the insertion of the retractable sheath into the patient a rigid introducer may be inserted within the expandable inner layer. In certain embodiments, the retractable sheath may be provided with a rigid introducer within the lumen of the elongated sleeve and protruding past the distal end of the elongated sleeve.
Upon insertion, the rigid introducer may protrude past the distal end of the expandable inner layer. The rigid introducer typically has a tapered tip. It may include a small hole to allow passage of a wire that may have been previously inserted into the vessel.
The rigid introducer may be tapered to align with the diameter of the distal opening in the elongated sleeve or to align with the outer profile of the elongated sleeve.
Alternatively, the external surface of the rigid introducer may be stepped to match both the distal inner diameter of the expandable inner layer and proximal inner diameter of the expandable inner layer.
The external surface of the rigid introducer may be stepped or tapered to match both the distal inner diameter of the expandable inner layer and distal outer diameter of the elastomeric outer.
Following insertion of the retractable sheath, the rigid introducer may be removed to allow other devices to be routed through the lumen of the elongated sleeve.
The use of a retractable sheath according to embodiments may therefore comprise the steps of; obtaining a retractable sheath according to embodiments, passing a rigid introducer through the lumen of the retractable sheath, and introducing the retractable sheath into a bodily vessel or canal.
A method according to embodiments may comprise the additional steps of removing the rigid introducer, and passing a medical device through the lumen of the retractable sheath.
A retractable sheath according to embodiments is preferably manufactured by obtaining a rigid collar, an elastomeric outer layer and an expandable inner layer as described in accordance with embodiments, attaching the expandable inner layer at the proximal opening with the rigid collar, and placing the expandable inner layer within the elastomeric outer layer.
Alternatively, the elastomeric outer layer may be co-moulded within the rigid collar.
Broad embodiments of the invention now will be described with reference to the accompanying drawings together with the Examples and the preferred embodiments disclosed in the detailed description. The invention may be embodied in many different forms and should not be construed as limited to the embodiments described herein. These embodiments are provided by way of illustration only such that this disclosure will be thorough, complete and will convey the full scope and breadth of the invention.
Several embodiments of the invention are described in the following examples.
The Computed Tomography scan illustrated at
The shape of the channel of passage shown in
Sleeve 220 tapers away from collar 210 for ease of insertion within an incision made to access the patient's vascular system. Sleeve 220 is a smooth, flexible structure tapering from proximal end 230 and narrowing towards distal end 240 to ease the insertion and navigation of the sheath within a vessel. Sleeve 220 is expandable and retractable to enable a wider introducer, valve or other medical device to be introduced into the patient through the lumen of the sleeve, which is capable of expanding around the device, and gently press against the luminal wall of the vessel as it travels through the vessel; and then to also retract to a size similar to its original size once the device is removed, so that it can be gently removed from the patient.
Collar 210 is formed from a rigid polymer such as polyethylene, polyester or polypropylene, however, it may equally be formed from any rigid, biocompatible material determined by those skilled in the art as being suitable for the intended purpose.
Outer elastomeric tube 410 is formed from an elastomeric material that can be stretched when pressure is exerted from within the lumen of the sleeve but also substantially returns the sleeve to its original diameter once internal pressure is relaxed. The outer elastomeric tube, in a relaxed state, has wall thickness of less than 0.5 mm, and preferably less than 0.2 mm. Elastomeric tube 410 is formed from silicone to maximise the elasticity and minimise wall thickness and thereby minimise the risk of damage to the vascular system. However, other materials may be selected by those skilled in the art for this use once determined as having suitable properties. These may include materials such as latex rubber or non-latex substitutes including nitrile rubber, polyvinylchloride, neoprene, polypropylene and polyisoprene and the like.
The inner tube may be made of a polymer material such as polyethylene, polypropylene, nylon, polyester, PTFE or other film-like material.
Expanding inner layer 420 is formed as a sheet of polymeric material such as polyethylene, polypropylene, nylon, polyester, PTFE or other film-like material sheet trimmed to the approximate length of outer elastomeric tube 410 to a width required to be wound three times within distal end 240 of sleeve 220. A suitable material is selected by persons skilled in the art on the basis of its stiffness when wound helically at a pitch equal to the helical pitch at the distal end plus about 1. It would be well known to those skilled in the art, several materials may be suitable for forming expanding inner layer 420.
While the expanding inner layer may be constructed from a sheet that is wound or coiled, more successful construction commences with an extruded tube which is subsequently sliced along its longitudinal axis and the sheet portion then wound or coiled. Suitable materials have a balance of resilience and flexibility to allow expansion and contraction without permanent deformation, and they resist buckling and collapse. Likely material choices are polypropylene or polyethylene or polyurethane or fluoropolymer.
For most uses, the nominal inner diameter of the extruded tube will be larger than the nominal size of the device intended to be delivered through the sheath. In the present embodiment, the nominal inner diameter of the extruded tube is selected to be in the range of 5-20% larger than the nominal size of the payload intended to be delivered through the sheath. This reduces the risk that the two longitudinal edges of the sheet will come into contact during use of the sheath.
Expanding inner layer 420 and outer elastomeric tube 410 are fixed relative to one another at proximal end 230. They may be attached through welding, bonding or clamping, or by attachment of each to collar 210. Along the length of sleeve 220, expanding inner layer 420 and outer elastomeric tube 420 are free to move relative to one another. A lubricant such as oil, grease, hydrogel or other low friction surface treatment may be applied between expanding inner layer 420 and outer elastomeric tube 420 to facilitate movement between them. At distal end 240 of sleeve 220, expanding inner layer 420 and outer elastomeric tube 410 may be attached to one another at a section of the circumference of outer elastomeric tube 410. They may be attached through welding, bonding or stitching.
Expanding inner layer 420 and outer elastomeric tube 410 may also be stitched or stapled together with an x-ray opaque material such as stainless steel, titanium, nickel-titanium alloy or other metal or metal alloy, for sensing.
Additionally, to promote ease of feeding devices through expanding inner layer 420, the inner surface of its luminal wall may be coated in a lubricious coating such as silicone or glycerine oil, fluoropolymer based oils, grease, PTFE, hydrophilic polymer or other low friction surface.
Such lubricious coatings may also be applied within the wrapped area of the expanding inner layer.
In a similar fashion, outer elastomeric tube 410 can be coated externally in a low friction layer to promote ease of insertion into the vascular system. Surface treatments can include those potentially applied to the expanding inner layer, as well as hydrogel-based coatings that can include medicinal agents to treat or avoid infections or allergies.
Introducer device 510 is formed with a tapering at its tip to match the inner profile of expanding inner layer 420. However, it may be formed of a uniform diameter to match the inner diameter of expanding inner layer 420, or of a stepped diameter to match both the inner diameter of expanding inner layer 420 at its proximal and distal ends. After insertion of the adjustable sheath into the vessel, introducer device 510 is removed to allow other devices to be routed through the inner lumen of adjustable sheath 200.
Introducer device 510 may include a small hole at its tip to permit the passage of a wire previously inserted into the vessel.
Introducer device 510 may be constructed in multiple pieces, with its outer temporarily clamped between two or more pieces such that the user may adjust the position of the introducer pieces to release outer elastomeric tube 410. In an alternative embodiment, the outer elastomeric tube 410 may fold over within the expanding inner layer 420 at the distal end 240 and be retained by the introducer device 510 during vascular insertion and become released during removal of the introducer device 510, as described above.
Expanding inner layer 420 may be cut and shaped into many different shapes. As an alternative, it may be cut so that, in its relaxed state, it is coiled to form a cylinder with no taper wherein the taper induced by a tapered outer tube.
In an alternative embodiment, the expanding inner layer 420 is created through a helically wound continuous strip or wire, characterised by a strip or wire thickness of dimension ‘W’, wound with a helical pitch of between ‘W’ and ‘2W’. The helical winding can be constructed of wire such as titanium, titanium alloy or stainless steel, or of a polymeric material such as polyester, polyethylene, polypropylene or other biocompatible material.
The helical winding is tapered from distal end to a proximal end.
In a further alternative embodiment, the expanding inner layer 420 is formed by a continuous thin strip with a series of orthogonal wound coils propagating from one edge such that the coils wind back over the continuous strip. The wound coils are typically of length between 1 mm and 10 mm, with a spacing between them of 0.1 mm to 10 mm. In certain embodiments the diameter of each coil may be consistent along the length of the continuous strip, or varying diameter along the length whereby at least the coil at the distal end is a smaller diameter to the coil at the proximal end.
To promote visibility of the adjustable sheath to x-ray imaging equipment during medical procedures, a radio opaque marker may be incorporated into the sleeve, in particular at the distal end 240. The marker may be a metallic wire such as nitinol bonded or stitched to the tube, or polymer-based such as a tungsten-filled nylon, polyethylene or polyurethane bonded to the tube, or similar components known to those skilled in the art.
The radio opaque marker can be incorporated at one of any number of places in the expanding inner layer 420 or the outer elastomeric tube 410.
The embodiments described herein may be adapted for application in the treatment of a range of different patient types and pathologies. Where the optimisation of the expanding inner layer's physical characteristics is required, for example to impart greater rigidity, resilience or bendability to the sheath to meet the patient's needs, the inner layer may be formed of a composite material to achieve the desire physical characteristics.
While
Applications requiring the use of a thin sheath are accommodated by moulding an elastomeric outer tube formed of a composite material construction having a braided nylon mesh moulded within an elastomeric skin. This form of the elastomeric outer tube provides greater structural rigidity without the bulk or thickness of the three layer adjustable sheath described above.
To permit the removal of air trapped between outer elastomeric tube 410 and expanding inner layer 420 prior to insertion of the adjustable sheath within the vascular system, certain embodiments may incorporate an opening in proximal end 230 of the outer elastomeric tube 410, which is closed with a valve (not shown).
Attachment of adjustable sheath 200 to sheath collar 210 is achieved in the
In use, prior to a medical procedure, fluid such as saline or a sterilising agent may be introduced to the space between the inner and outer tubes through a valve.
In certain embodiments, for instance to adapt the expanding inner layer to lap onto itself when constructed of a composite material or to avoid otherwise lapping in an undesirable way, the angle of the expanding inner layer cut may be modified.
In addition to the angle of the cut, the helical cut of the expanding inner layer can also vary in the direction of the rotation of the helix, as well as the mode of lapping onto itself.
For simplicity, the above embodiments have described the tapering of the adjustable sheath and being uniformly tapered from the proximal end of the sheath to the distal end of the sheath. However, it may be advantageous to certain uses to vary the position and distance of tapering of the adjustable sheath.
Stepped wall thickness of outer elastomeric tube 410 aids the entry and passage of the sheath within a cavity by providing mixed properties along the length of the sheath. The stepped thickness of sheath wall 450 shown at
Design: Measure the sheath diameter before insertion of the introducer within the sheath, and after retraction of the introducer. Report the percentage retraction of the sheath to its original diameter. Report the force required to retract the introducer.
Acceptance Criteria: Target maximum retraction percentage.
Sample Size Tested: One sample of a benchmark sheath, prototype sheath with straight cut taper, prototype sheath with spiral cut taper, prototype sheath with v-cut taper.
Methods: The proximal outer diameter and the distal end outer diameter of the test sheaths were measured before insertion of the introducer. The introducer was then inserted through the sheath, until it protruded through the distal end. Then the introducer was pulled back through the sheath and fully removed. The force to retract the introducer was recorded to assess any difficulty in retraction. The sheath distal end outer diameter was then remeasured to assess the amount of retraction or spring-back. The retractability percentage was then calculated as a percentage of the initial distal size reduction.
Results:
All samples experienced the smooth insertion of the introducer, with none requiring excessive force to insert the introducer. All adjustable sheaths demonstrated the characteristic of retracting to the limit of the sheath's capacity once the introducer had protruded past the end of the sheath.
After retraction of the introducer the V-cut prototype did not fully retract due to the cut edges colliding and failing to lap correctly. The outer layer of the V-cut prototype pulled back from the end of the inner layer by approximately 4 mm, possibly due to increased friction against the introducer.
Conclusion: All prototype sheaths demonstrated the ability to retract after insertion and removal of the introducer. The V-cut prototype gave the smallest distal end measurements but did not retract as intended. The straight cut and spiral cut prototypes showed nearly equivalent performance, however other performance characteristics should be considered when selecting a preferred design. The force required to retract the valve delivery system is not excessive for any of the designs, and would not pose a problem for a user, or a risk of damage.
Design: Measure the force required to deflect the sheath without the introducer at angles of up to 30°.
Acceptance Criteria: Force the sheath to bend at an angle up to 30°. This should not exceed the benchmarked force.
Sample Size Tested: One sample of benchmark sheath, prototype sheath with straight cut taper, prototype sheath with spiral cut taper, prototype sheath with v-cut taper.
Method: A jig was constructed to hold the sheath, with a cantilever length of 200 mm. A hand-held force gauge was used to deflect the sheath and display the applied force in grams. The applied force was converted to N for consistency.
Results: The table below shows the force in N to deflect each sample.
Conclusion: All prototype sheaths demonstrated improved bendability compared to the benchmark sample. The three different prototype sheaths displayed different bending and stiffness characteristics as demonstrate in
Design: Measure the force required to kink the sheath, and the angle at which kinking occurs.
Acceptance Criteria: Angle required to kink the sheath should exceed the benchmark.
Sample Size Tested: One sample of the benchmark sheath, a prototype sheath with a straight cut taper, a prototype sheath with a spiral cut taper, a prototype sheath with a v-cut taper.
Method: A jig was constructed to hold the sheath, at a cantilever length of 200 mm. A hand-held force gauge was used to deflect the sheath and display the force applied in grams. Applied force was been converted to N for consistency. The angle to kink was read with reference to the template, which represents the angle between the sheath axis and a line from the point of bending to the sheath distal end.
Results:
The spiral cut and v cut samples were able to bend beyond an angle of 90 degrees without kinking. The test for these samples was stopped at this point as the samples exceeded the testing capacity.
Conclusion: All prototype devices demonstrated improved resistance to kinking compared with the benchmark. The V-cut sample and spiral cut samples both deflected further than the straight cut sample without kinking.
Design: Measure the force required to push a defined payload of 6.7 mm diameter through the sheath.
Acceptance Criteria: Force to push a payload through the sheath should be less than 40N
Samples Tested: Sheaths having a lapping inner layer and fully longitudinal elastomeric outer layer were tested against a first commercial product (Benchmark 1) having a continuous folded inner layer and partially longitudinal elastomeric outer layer and a second commercial product (Benchmark 2) having a continuous folded inner layer and a fully longitudinal elastomeric outer layer.
Method: Retain the sheath by clamping the sheath collar to a rigid fixture. Attach the defined payload to a force measuring instrument capable of recording force and distance travelled. Traverse the payload through the sheath at a constant velocity, recording force vs distance travelled.
Results:
Conclusion: The sheath consisting of the lapping inner layer met the acceptance criteria for pushing a defined payload through the sheath. The sheath consisting of the lapping inner layer had approximately 40% lower push force than the best folded layer construction. The sheath consisting of the lapping inner layer also showed more consistent push force along the length of the sheath.
The adjustable sheath is constructed by manufacturing the expanding inner layer and the outer elastomeric tube, assembling and bonding both components to a commercially available collar having a haemostatic valve.
The expanding inner layer is manufactured from medical grade polyamide according to standard extrusion or injection moulding techniques. For a straight cut inner layer, the raw material is extruded into a long tapered cylindrical shape and a slit cut along the length of the shape.
For a helical inner layer, once the inner layer is moulded to a desired size and shape, the layer is heat shrunk around a mould of the desired diameter to form a cylindrical portion to bond to the collar. The remaining sheet portion of the layer is cut at an oblique angle to a shape required to coil within the outer elastomeric tube.
The outer elastomeric tube is formed from silicone to a desired tapered shape using resin moulding techniques know to skilled persons to be suited for moulding and curing thin silicone sheets and tubular structures. The proximal section of the outer elastomeric tube is formed to the same or a slighter larger diameter of the cylindrical portion of the expanding inner layer.
The sheet portion of the expanding inner layer is manually coiled to a smaller diameter than the outer elastomeric tube and placed within the tube once aligned at the proximal end. A small amount of adhesive is applied at the proximal (or wider) edge of the tapered sleeve such that the adhesive is in contact with the outer elastomeric tube and the expanding inner layer. The proximal edge is then placed around the opening of a commercially available haemostatic valve to bind both the expanding inner layer and the outer elastomeric tube to the collar of the haemostatic valve. Once the adhesive has been allowed to set the sheath is ready for use.
Throughout this specification the word “comprise”, or variations such as “comprises” or “comprising”, will be understood to imply the inclusion of a stated element, integer or step, or group of elements, integers or steps, but not the exclusion of any other element, integer or step, or group of elements, integers or steps.
It will be understood that the terms ‘fastener’ or ‘fastening’, ‘coupling’ or ‘sealing’ when used alone or together with other terms such as ‘means’ or others, may be used interchangeably where interpretation of the term would be deemed by persons skilled in the art to be functionally interchangeable with another. Further, the use of one of the aforementioned terms does not preclude an interpretation when another term is included.
The various apparatuses and components of the apparatuses, as described herein, may be provided in various sizes and/or dimensions, as desired. Suitable sizes and/or dimensions will vary depending on the specifications of connecting components or the field of use, which may be selected by persons skilled in the art.
It will be appreciated that features, elements and/or characteristics described with respect to one embodiment of the disclosure may be used with other embodiments of the invention, as desired.
Although the preferred embodiments of the present disclosure have been disclosed for illustrative purposes, those skilled in the art will appreciate that various modifications, additions and substitutions are possible, without departing from the scope and spirit of the disclosure and accompanying claims.
It will be understood that when an element or layer is referred to as being “on” or “within” another element or layer, the element or layer can be directly on or within another element or layer or intervening elements or layers. In contrast, when an element is referred to as being “directly on” or “directly within” another element or layer, there are no intervening elements or layers present.
As used herein, the term “and/or” includes any and all combinations of one or more of the associated listed items.
It will be understood that, although the terms first, second, third, etcetera, may be used herein to describe various elements, components, regions, layers and/or sections, these elements, components, regions, layers and/or sections should not be limited by these terms. These terms are only used to distinguish one element, component, region, layer or section from another region, layer or section. Thus, a first element, component, region, layer or section could be termed a second element, component, region, layer or section without departing from the teachings of the present disclosure.
Spatially relative terms, such as “lower”, “upper”, “top”, “bottom”, “left”, “right” and the like, may be used herein for ease of description to describe the relationship of one element or feature to another element(s) or feature(s) as illustrated in the figures. It will be understood that spatially relative terms are intended to encompass different orientations of structures in use or operation, in addition to the orientation depicted in the drawing figures. For example, if a device in the drawing figures is turned over, elements described as “lower” relative to other elements or features would then be oriented “upper” relative the other
elements or features. Thus, the exemplary term “lower” can encompass both an orientation of above and below. The device may be otherwise oriented (rotated 90 degrees or at other orientations) and the spatially relative descriptors used herein should be interpreted accordingly.
The terminology used herein is for the purpose of describing particular embodiments only and is not intended to be limiting of the disclosure. As used herein, the singular forms “a”, “an” and “the” are intended to include the plural forms as well, unless the context clearly indicates otherwise. It will be further understood that the terms “including”, “comprises” and/or “comprising,” when used in this specification, specify the presence of stated features, integers, steps, operations, elements, and/or components, but do not preclude the presence or addition of one or more other features, integers, steps, operations, elements, components, and/or groups thereof.
Embodiments of the description are described herein with reference to diagrams and/or cross-section illustrations, for example, that are schematic illustrations of preferred embodiments (and intermediate structures) of the description. As such, variations from the shapes of the illustrations as a result, for example, of manufacturing techniques and/or tolerances, are to be expected. Thus, embodiments of the description should not be construed as limited to the particular shapes of components illustrated herein but are to include deviations in shapes that result, for example, from manufacturing.
Unless otherwise defined, all terms (including technical and scientific terms) used herein have the same meaning as commonly understood by one of ordinary skill in the art to which this description belongs. It will be further understood that terms, such as those defined in commonly used dictionaries, should be interpreted as having a meaning that is consistent with their meaning in the context of the relevant art and will not be interpreted in an idealised or overly formal sense unless expressly so defined herein.
Any reference in this specification to “one embodiment,” “an embodiment,” “example embodiment,” etc., means that a particular feature, structure, or characteristic described in connection with the embodiment is included in at least one embodiment of the description. The appearances of such phrases in various places in the specification are not necessarily all referring to the same embodiment. Further, when a particular feature, structure, or characteristic is described in connection with any embodiment, it is within the purview of one skilled in the art to effect and/or use such feature, structure, or characteristic in connection with other ones of the embodiments.
Embodiments are also intended to include or otherwise cover methods of using and methods of manufacturing any or all of the elements disclosed above.
While the invention has been described above in terms of specific embodiments, it is to be understood that the invention is not limited to these disclosed embodiments. Upon reading the teachings of this disclosure many modifications and other embodiments of the invention will come to the mind of those skilled in the art to which this invention pertains, and which are intended to be and are covered by both this disclosure and the appended claims.
All publications mentioned in this specification are herein incorporated by reference. Any discussion of documents, acts, materials, devices, articles or the like which has been included in the present specification is solely for the purpose of providing a context for the present invention. It is not to be taken as an admission that any or all of these matters form part of the prior art base or were common general knowledge in the field relevant to the present invention as it existed in Australia or elsewhere before the priority date of each claim of this application.
It is indeed intended that the scope of the invention should be determined by proper interpretation and construction of the appended claims and their legal equivalents, as understood by those skilled in the art relying upon the disclosure in this specification and the attached drawings.
| Number | Date | Country | Kind |
|---|---|---|---|
| 2018903540 | Sep 2018 | AU | national |
| 2023201186 | Feb 2023 | AU | national |
This application is a continuation-in-part of and claims priority to and the benefit of U.S. patent application Ser. No. 17/567,663, filed Jan. 3, 2022, which is a continuation of U.S. patent application Ser. No. 17/278,065, filed Mar. 19, 2021 and issued May 31, 2022 as U.S. Pat. No. 11,344,698, which is a U.S. national stage entry of International Patent Application No. PCT/AU2019/051010, filed Sep. 20, 2019, which claims priority to and the benefit of Australian Provisional Patent Application No. 2018903540, filed Sep. 20, 2018, the entire disclosures of all of which are hereby incorporated herein by reference. In addition, this application claims priority to and the benefit of, and incorporates herein by reference in its entirety, Australian Patent Application No. 2023201186, filed Feb. 28, 2023.
| Number | Date | Country | |
|---|---|---|---|
| Parent | 17278065 | Mar 2021 | US |
| Child | 17567663 | US |
| Number | Date | Country | |
|---|---|---|---|
| Parent | 17567663 | Jan 2022 | US |
| Child | 18327310 | US |
