Patent Application
20130225977
The present invention relates to methods and devices tor providing compositions to body conduits. In particular, the present invention is at least directed to methods and devices for delivery of compositions that allow for diagnosis and/or treatment of conduits and for conduit related conditions.
Delivery of compositions to conduits of human or animal bodies is useful in multiple medical disciplines for various medical conditions. For example, delivery of compositions for the occlusion, of conduits is useful in reproductive control and is the subject of U.S. patent application Ser. No. 11/065,886, and U.S. patent application Ser. No. 12/240,738, each of which is incorporated in its entirety herein. Over the last 50 years, the world has experienced the highest rates of population, growth and the largest annual, population increases recorded in history. Women account for over 50% of the world's population, and play a critical role in family health, nutrition, and welfare. One of the most significant areas in need of attention and innovation in women's healthcare is that of contraception, where the reproductive aged woman is currently faced with sub-optimal, alternatives.
Delivery of compositions to conduits of human or animal bodies is also useful in procedures that, are involved with enhancing the fertility of human or animal bodies. For example, Gamete Intrafallopian Transfer (GIFT) uses eggs that have been, removed from a female's ovaries, combined with, washed sperm, and then both eggs and sperm are placed into the females' fallopian tube(s) through a small incision in her abdomen. The procedure is generally performed, by laparoscopy. GIFT is an assisted reproductive technology that was introduced in 1984 that by-passes one of the normal functions of the fallopian tube, the pick-up of eggs released from the ovaries. Eggs and sperm are placed directly into the ampullary region of the fallopian tube, and fertilization, and early embryo development occurs there, and the embryo is transported to and enters the uterine cavity. GIFT is performed using laparoscopic measures, or other invasive techniques that require surgical intervention or anesthetic procedures, which adds to the risk of the procedures.
Procedures are also performed in conduits of humans and animals to assess the physical condition of such conduits. For example, assessment of conduits such as arteries or veins ate commonly performed so diagnosing and determining needed treatments related to cardiac, neural, kidney and vascular conditions. In assessing the fertility of humans or animals, procedures for determining fallopian patency are commonly performed. Such procedures may involve gas insufflation or radiation exposure, as is the case for hysterosalpingography (HSG), or laparoscopic procedures.
Gas insufflation was used for many years, and is a simple test to carry out and does not require a general anesthetic. An instrument is inserted into the canal of the cervix and carbon dioxide gas is introduced into the cavity of the uterus. The machine controlling the flow of carbon, dioxide also records the pressure of the gas as it builds up in the uterus. If the fallopian tubes are blocked, there is an increase in pressure of the gas within the uterus. If at least one tube is open to the passage of gas, the initial rise in pressure is followed by a sudden, reduction as the gas escapes out of the tubes and into the abdominal cavity. The results of the test are difficult to interpret and do not provide any information about the condition of the fallopian tubes other than that gas is able to pass through at least one fallopian tube. No data is provided about the structure of the tube, the extent of the diameter of the fallopian tube, or whether both tubes are patent. If the test fails, there is no information about the location or nature of the obstruction. The inaccuracy of the test has led it to be largely superseded by other tests.
Hysterosalpingography (MSG) involves a contrast dye inserted into the uterine cavity and viewing the structures revealed by fluoroscopy. The test is normally performed without general anesthetic. The contrast agent, generally a radiopaque dye, shows the structure of the uterus and fallopian tubes as the contrast agent fills the uterine cavity and exits the fallopian tubes, if possible. If the dye fells to eater the tubes this may indicate an obstruction or a temporary spasm of the tubes at this site. Sometimes the dye can be seen to enter the tubes, which then become distended owing to an obstruction at their outer ends. An HSG can identify the site of a tubal obstruction and can also show the presence of an irregularity in the shape of the cavity of the uterus. Discomfort to the patient and exposure to radiation required to view the structures under fluoroscopy are the primary concerns with this procedure.
Laparoscopic methods may also be used to detect patency of the fallopian tubes. A laparoscope is inserted into the abdominal cavity and the uterus, fallopian tubes and ovaries are visually inspected. Tubal patency is tested by injecting a contrast medium, such as, methylene blue dye into the uterus, through the cervix. In anatomically normal fallopian tubes, the dye can be seen passing along them and escaping through the outer openings (fimbria) of the tubes. The procedure is an adjunctive procedure to a laparoscopy and requires general anesthesia for the patient.
Ectopic pregnancies result from a fertilized, egg implanting in an area other than the uterus. About 1% of pregnancies are in an ectopic location with implantation not occurring inside of the womb, and of these 98% occur in the Fallopian tubes. In a typical ectopic pregnancy, the embryo adheres to the lining of the fallopian tube, and does not reach the uterus. The embryo burrows actively into the tubal lining. This burrowing may invade blood vessels and cause bleeding. The intratubal bleeding may expel the implantation out the distal end of the tubal. There is generally no inflammation of the tube in an ectopic pregnancy. The pain, that may he present is caused by prostaglandins released at the implantation site, by distension of the tubal serosal lining or by free blood in the peritoneal cavity, which is a local irritant. The bleeding might be heavy enough to threaten the health or life of the woman, but this is generally seen, when there has been a delay in diagnosis, but sometimes, especially if the implantation is in the proximal tube (just before it enters the uterus), it may invade into a large blood vessel causing heavy bleeding. About 50% of ectopic pregnancies resolve without treatment. The condition may be treated using intramuscular or intravenous methotrexate, but surgical, intervention is often required when the Fallopian tube has ruptured or is in danger of doing so. This intervention may be laparoscopic or by laparotomy. It is common practice to cheek the status of the fallopian tube after an ectopic pregnancy.
An ideal system for delivery of compositions to conduits, such m fallopian tubes, or examination of such conduits to diagnose or assess structural conditions, is one that would provide an immediate diagnosis and allow for concurrent treatment, that is non-surgical, easy to deliver and is an office-based solution, that does not require anesthesia or special equipment not available in an office setting. None of the current options meets these requirements. While the currently available compositions and methods represent a significant advancement in the art, further improvements would be desirable to provide safe, effective and non-surgical devices, compositions, and methods for delivery of compositions to conduits and for treatment and/or diagnosis of conduits. It would be beneficial if these devices, compositions and methods provided an immediate effect or answer, non-surgical, easy to deliver, office-based solution that does not require anesthesia or specialized equipment not available hi an office setting. What is needed are methods, devices and compositions that have these characteristics for the delivery of compositions to conduits and for the treatment and/or diagnosis of conduits, such, as one or more fallopian tubes.
The present invention comprises methods, systems, and devices for the delivery of compositions to conduits, and the treatment of conduits, and/or diagnosis of conditions of conduits. In particular, the present invention comprises methods, systems, and devices for the delivery of compositions to and treatment of conduits, and/or diagnosis of conditions of conduits in humans or other animals. The devices of the present invention are used to deliver compositions including but not limited, to gametes, such, as eggs or sperm, embryos, compositions for determining the patency of the conduit, diagnostic compositions, and therapeutic compositions. The conduit may be a naturally occurring conduit such as a tube or vessel in the body or may be a conduit that has been introduced in the body such as a medical device or through surgical means.
The present invention also comprises delivery systems, methods, and devices for treating a condition of the conduit, such as removal of growths, obstructions, ectopic pregnancy, or direct therapy to an ectopic pregnancy. The systems, methods and devices may comprise removal of implant materials or tissue ingrowth that are blocking the conduit, by creating a channel through an occlusion, or by creating a new channel around the occlusion. The systems, methods and devices may comprise section of a portion of the conduit lining to remove an obstruction, growth or implant, or may comprise a wire or cutting catheter element or a material to dissolve, resolve, or liquefy an obstruction.
One aspect of the present invention comprises delivery systems, methods and devices for providing compositions to fallopian tubes and treatment and/or diagnosis of conditions related to fallopian tubes. One embodiment of this aspect is a method that comprises introduction of a delivery device system for delivery of compositions or treatment elements to one or both fallopian tubes without the need to remove, reinsert, or substantially reposition the delivery device. Such a device may be sized for each recipient by pre-visualization of the anatomy of the recipient, or may be of a design that fits differently sized organs. The compositions may have different functions depending on the desired result. For example, the methods, devices and systems may be used to deliver a contrast media to visualize and document tubal patency or obstruction. The methods, devices and systems may be used for providing gametes or embryos to fallopian tubes in a modified GIFT procedure. Treatment of fallopian tubes may comprise use of a device that is capable of removing an obstruction or growth or delivering a therapeutic agent, drug, or composition to address a tubal abnormality, such as an ectopic pregnancy. In another embodiment, the invention may comprise a device may that is capable of forming a channel through or around an obstruction or ingrown tissue. Methods, systems and devices may comprise placement of elements, such as stents, to maintain the structure of an opened fallopian tube.
The present invention comprises delivery systems, methods and devices for providing compositions to conduits, and methods, systems, and devices for treating and/or diagnosing conditions in conduits. The present invention comprises delivery systems and methods for providing compositions to conduits in the body through the placement of compositions using a delivery device. In an aspect, the present invention comprises providing treatment and/or diagnosis to conduits. Yet another aspect of the present invention comprises methods, delivery systems and compositions to provide compositions to one or both of the fallopian tubes of a female mammal, and methods and systems to provide treatments to one or both of the fallopian tubes. Another aspect comprises methods, delivery systems and compositions to provide compositions to one or both of the fallopian rubes to provide a diagnosis of one or both of the fallopian tubes. A further aspect of the invention comprises methods, delivery systems, and compositions to provide compositions to the vas deferens of a male mammal, and methods, devices and systems to provide treatments and/or diagnosis to such a conduit. Methods, systems and compositions of the present invention may be used in embodiment that permit non-surgical, office-based treatments and provision of compositions.
The present invention comprises methods for providing compositions and diagnosis and/or treatments to conduits, particularly conduits found in human or other animal bodies. Such conduits may exist naturally in the body or be present because of disease, damage, placement of medical devices or surgical means.
As used herein, the term “conduit” shall refer to any tube, duct, or passage, whether natural or synthetic, which carries gas, fluids or solids in a biological system.
As used herein, “occlude” or “obstruct” refers to blocking, partially or fully, the transport of gas, fluids, or solids through a conduit. The term “occlusion” or “obstruction” as used herein, refers to blockage within a conduit wherein such blockage results in partial restriction or complete interruption of the transport of gas, fluids, or solids through the conduit. As used herein, “occlusive material” refers to a composition that is capable of occluding a conduit by effecting au occlusion therein. As used herein, occlusive or occluding material means the initial composition that is placed or inserted into the conduit, as well as the composition, whether the physical, biological, or chemical nature of the composition has changed or not, that is in place in the conduit and provides for the interruption of flow through the conduit. The meaning of the term can he determined from its use in the sentence. Occlusive compositions, occlusion compositions, occlusive materials and occlusion materials are terms used interchangeably herein.
As used herein, occlusive material comprises any natural or synthetic compositions or any combination of natural and synthetic compositions that can be placed at the desired site in the conduit using the delivery systems of the present invention. Occlusive materials of the present invention may comprise materials that are fluid, semi-solid, gels, solids, and combinations thereof. The occlusive materials may further comprise a pre-formed material that is of a shape or size that occludes the conduit or may be a material that will take on a form or shape or size to occlude the conduit. Occlusive materials may further comprise compositions that cure in situ at the desired site in the conduit. The occlusive compositions may further comprise materials that polymerize in situ, wherein the polymerization may be initiated either at the site of interest in the conduit or prior to placement at the site. Occlusive compositions may further comprise combinations of one or more of any of the foregoing materials. Disclosed herein are exemplary compositions and materials suitable for use as occlusive compositions.
As used herein, “cure” means a change in the physical, chemical, or physical and chemical properties of the occlusive material following placement or insertion at the desired site in a conduit.
As used herein, visualization or imaging refers to all forms of imaging that do not require direct visualization such as by hysteroscopy. Examples of imaging include all forms of ultrasound or magnetic resonance imaging, fluoroscopy, or other visualization techniques known to those skilled in the art, which are incorporated within the scope of this definition.
As used herein, the term “delivery system” comprises all components necessary to deliver a composition or provide a treatment and/or diagnosis or all components necessary to open an obstruction, and a delivery device may compose an introducer, one or more catheter(s), combinations thereof, occlusion elements or elements for opening an occlusion, and any other components necessary for the lull functioning of the delivery system.
In general, the methods of the present invention comprise administration of delivery systems that deliver compositions or provide treatments and/or diagnosis to conduits. The delivery systems comprise devices that are capable of delivering compositions to the desired site. Disclosed herein are exemplary methods, delivery systems, and compositions for delivery of compositions to or treatments of conduits or diagnosis of conditions of conduits of the reproductive tracts of mammals. Such methods and compositions can be used in other physiological systems and biological sites of humans or other animals, and delivery systems for such biological sites are contemplated by the present invention.
The present invention comprises methods for treating and/or diagnosing conditions associated with conduits. The methods comprise elements for removal of obstructions in conduits, including removal using compositions or devices having elements for making openings or channels through or around one or more obstructed regions. Elements for removal include, but are not limited to, physical removal of the obstruction or growth, destruction of the obstruction or growth using physical, chemical or biological methods, canalization of one or more obstructed regions, and placement of new conduits, such as stents or bypass materials to restore functionality to the formerly occluded region. Disclosed herein are exemplary methods, delivery systems and compositions for removal of the occlusion of conduits of the reproductive tracts of mammals to restore fertility functionality, or the removal of growths or implanted tissue in the fallopian tubes. Such restorative methods and compositions can be used in other physiological systems and biological sites of humans or other animals, and delivery systems for such biological sites are contemplated by the present invention.
One aspect of the present invention comprises methods of providing compositions for mammalian females that use visualization of the composition provided by a delivery system that delivers a sonolucent or radiopaque composition, for example, to a target site, tot example, from the cornual aspect of the uterus into each fallopian tube, wherein the composition is capable of creating an image of the structure of each fallopian tube or an image of composition introduction to and exit from the fallopian tube. As a step in providing such a contrast media composition to the fallopian tubes, the delivery device may be used to provide a contrast material composition for viewing of the uterine cavity.
Visualizable compositions for visualization of structures, such as sonlucent or radiopaque compositions include those compositions currently used, to view structures of humans or animals, and include, but are not limited to, iodine based contrast media such as urografin, omnipaque, diatrizoate, metrizoate, ioxaglate iopamidol, iohexol, ioxilan, iopromide and iodixanol, non-iodine based, contrast media such as barium sulfate, and other types of contrast media such as gadolinium, ionic or non-ionic contrast material, and gas/liquid phase contrast media such as air bubbles in saline, or frothed compositions. The contrast medium may comprise metals, paramagnetic materials, high atomic number non-metal materials, radioisotopes, gases or gas precursors, chromatophores, fluorophores, electrical impedence materials, and any combinations thereof. The methods of viewing such visualizable compositions include those currently used with the compositions and include, but are not limited to, fluoroscopy, radiography, nuclear medicine systems, ultrasound, magnetic resonance systems and any combinations thereof.
A further aspect comprises using the delivery system to provide compositions for viewing of the fallopian tubes, compositions comprising gametes or embryos, compositions for removal of obstructions or implanted tissues, and other compositions or elements for treatment of the fallopian tubes. One aspect comprises methods that use ultrasound, MRI or fluoroscopy for visualization and positioning of the device and monitoring and confirming the placement of the composition when a visualizable composition is used. A method comprises introduction of the device, including inserting the shaft of the introducer through the cervix until the atraumatic tip contacts the uterine fundus as determined by visualization such as ultrasound or through the sensation of the operator or combination of both visualization, and tactile feel. When the tip is appropriately placed, optionally, the operator may engage a member that aids in stabilizing the delivery device, referred to herein as a delivery device stabilizer. For example, this member may be a depth stop or uterine length marker, a member which indicates that the tip is in position and the introducer shaft should not be introduced any further, and includes, but is not limited to, other delivery device stabilizers such as those shown in
A further aspect of the present invention comprises methods wherein at least one catheter undergoes the following steps. At a proximal end of the catheter, one end of the catheter which is near the housing and distant from the delivery end of the catheter, a cartridge containing balloon distension medium is connected to the balloon fitting, the stopcock is opened, and the distension medium is delivered to effect inflation of the balloon positioned at the delivery end of the catheter. The stopcock is then closed and the cartridge is disconnected from the fitting or is automatically held inflated by mechanism in the introducer housing. At a proximal cud of the catheter, a cartridge containing the composition to be delivered is then connected to the delivery catheter fitting or engaged into the introducer housing, the material is delivered through the catheter and out of the delivery end of the catheter that is at or adjacent to the delivery site. The material may be delivered directly to the target site or may move from the delivery site to the target site location. Once the material has achieved its purpose, such as filling the fallopian, tube sufficiently for visualization by ultrasound or flouroscopy, the balloon is deflated. A catheter is then retracted until it is housed within the introducer shaft or fully removed from the introducer. Depending on the delivery device or method, a new catheter may be provided through the introducer, and the procedure is repeated for another conduit.
Following activity by one or mom catheters, if necessary, the delivery device stabilizer is disengaged. The delivery system is then withdrawn from the patient. The compositions or treatments may be delivered sequentially or simultaneously to the two fallopian tubes. The device is designed tor delivery of compositions to at least one of two separate sites with minimal to no repositioning and without removal of the device, including the introducer, until the procedure is complete. One or both of the delivery catheters may be retracted into the introducer without repositioning or removal of the entire device.
Yet another aspect of the present invention comprises a delivery system for providing compositions or treatments to or into the fallopian tubes comprising a delivery device comprising an introducer with one or two lumens, or more lumens, optionally one or more delivery device stabilizers, a housing element which may function as a handle if needed, elements for attachment or incorporation of one or more containers of balloon distension medium and the composition to be delivered, and at least one catheter for delivery of the composition. The at least one catheter may comprise an end structure, which is a balloon or other similarly functioning member that may function to hold the catheter in position, prevent or minimize leakage of the composition from the target site or perform both functions or other functions. The composition may he mixed prior to delivery and then delivered, from the container through at least one catheter to one or more target sites.
One aspect of the present invention comprises a delivery system comprising an introducer, one or more catheters wherein each may have a distinct function or design, and one or more cartridge components wherein each cartridge may have a distinct design and contain a distinct composition.
Now referring to
Now referring to
In
Once the delivery end (7) of the catheter is positioned within the uterine cornua (24), the catheter position, may be maintained by a locking mechanism which may be attached to the housing (5) at or near the catheter insertion hole (6), at another location within the housing (5), or by a mechanism that is separate from the housing (5) and which serves to grab, clamp, hold or otherwise stabilize the catheter such that it does not move and such that the delivery end remains in the target location. In another aspect of the invention, inflation of the balloon as described below is sufficient to maintain position of the catheter, and no additional locking mechanism may be required.
A cartridge (14) containing balloon distension medium (22), which has been previously prepared or mixed if such mixing is necessary, is then fitted to a fitting with a stopcock (12), the stopcock is opened, and the distension medium (22) delivered to effect inflation of the end structure (8) which is a balloon in the figure. Distension medium may comprise any flowable or liquid material suitable for inflation of the end structure (8) which is a balloon in the figure, such material being chemically compatible with the material of the end structure (8) which is a balloon in the figure and may be biologically compatible in the event distension medium is introduced into the uterine cavity or fallopian tubes. Exemplary distension media include, but are not limited to, air and sterile isotonic saline solution. Following inflation of the end structure (8) which is a balloon in the figure, the stopcock is then closed, the cartridge disconnected from the fitting (12), and the procedure repeated to inflate the balloon on the contralateral side. The balloons may be distended simultaneously using two cartridges. A cartridge (14) containing a composition (23) is then connected to the delivery catheter fitting (11), and the plunger (18) is pressed into the barrel (17) of the cartridge to deliver the composition (23) into and through the catheter, and exiting through the delivery end of the catheter (7) toward the target location.
While the exemplary method shown in
The delivery system may comprise ease of use features as depleted in
Depicted in
The tips of the arms (41) of the cervical clamp (39) may further comprise one or more grasping teeth, or may include other shapes or mechanisms tor former or more comfortable attachment to the cervix (20). The tips (41) and arms (43) may be made from the same material or of distinct materials as required; for example, the digs may incorporate a material that is compressible and conformable to the cervix and may be designed to alter shape when in contact with the cervix to provide increased comfort or improved gripping. One aspect of the invention envisions that the tips (41) interact with the cervix (20) in such a manner that the grip strength of the clamp is sufficiently low that the patient feels little or no pain with minimal or no anesthesia while having sufficient grip strength to hold, fix, and/or stabilize the position of the introducer. The cervical clamp (39) has a cylindrical lumen (36), which allows for mounting onto or sliding over the introducer shaft (3).
As depicted in
Now referring to
In
Once the delivery end (7) of the catheter is positioned within the uterine cornua (24), the catheter position may be maintained by a locking mechanism which may be attached to the housing at or near the catheter insertion hole (6), at another location within the housing, or by a mechanism that is separate front the housing, which serves to grab, clamp, hold or otherwise stabilize the catheter such that it does not move and such that the delivery end remains in the target location. In another aspect of the invention, an end structure of the catheter may be used, tor example by inflation of the balloon as described below is sufficient to maintain position of the catheter, and no additional locking mechanism may be required, or a balloon or end structure may be used with one of the catheter stabilizing components. For example, if a balloon catheter is used, a cartridge containing balloon distension medium (22), which has been previously prepared or mixed if such mixing is necessary, is then fitted to a fitting with a stopcock (12), the stopcock is opened, and the distension medium (22) delivered to effect inflation of the balloon or cartridge incorporated in the introducer housing is activated. Distension medium, may comprise any flowable or liquid material suitable for inflation of the balloon, such material being chemically compatible with the material of the balloon and may be biologically compatible in the event distension medium is introduced into the uterine cavity or fallopian tubes. Exemplary distension media include, but are not limited to, air and sterile isotonic saline solution.
Following inflation of the balloon, the stopcock is then closed, the cartridge disconnected from the fitting (12) or is automatically held inflated by mechanism in the introducer housing element. A cartridge containing a flowable composition (23) is then connected to a catheter fitting, and the plunger is pressed into the barrel of the cartridge, either located outside or inside the introducer housing element, to deliver the composition (23) into and through the catheter, and exiting through the delivery end of the catheter (7) toward the target location. As depicted in
As shown in
A single exit port device and methods, such as that shown in
a shows two delivery catheters adjoined together for the simultaneous advancement through a signal lumen introducer to deliver occlusive material to each fallopian tube. The adjoined catheters comprise the delivery ends (7a/b) of each catheter through which is shown as a balloon, which may function to hold the catheters in position and may prevent or minimize leakage of the occlusive material away from the target; the shafts of the catheters (36a/b) which for a certain length are fused together and are separated distally (37a/b) to allow independent movement to each cornua. In this figure, each catheter is shown with a pre-formed curve, in the area that is not fused, which functions in movement of the delivery end of the catheter from the introducer shaft into the cornual aspect of the uterus. Each catheter may include two lumens, one for inflation of a balloon and one for delivery of the occlusive material. The catheter lumen may be bifurcated so as to provide attachments to two fittings (38a/b) that each mates with a cartridge that contains flowable material to be delivered, such as the occlusive material; and two fittings with a stopcock (35a/b) that mates with a cartridge that contains material to be delivered, such as distension media for inflation and deflation of the balloon. One aspect of the present invention comprises a delivery catheter that is a double lumen delivery catheter. It should be understood that the delivery catheter may comprise a number of features and designs known in the art for catheters and that would be useful for the function of the delivery system. The catheters of the present invention may be single lumen or dual lumen catheters, or other catheters that would function in the present invention. One aspect of the invention comprises a stopcock is used to prevent leakage of the balloon distension medium after placement. It should be understood that other devices, such as a valve or diaphragm, including a self-sealing diaphragm, may also serve the same function and be useful in obtaining and maintaining inflation of the balloon of the present invention. The catheters may have end structures other than balloons and these embodiments would not require the elements needed for balloon inflation/deflation. End structures may comprise single or double walled balloons, cups, discs or other structures known to those skilled in the art.
FIG. 9B1-6 shows embodiments of cross section views of the introducer shaft lumen, which may be a single one lumen (1), dual lumen with a septum horizontally across the shaft (2), dual lumen with the septum vertically across the shaft (3), dual lumen with individual round diameter channels (4), dual lumen with individual oval or similar shaped diameters (5) and dual lumen with a free forming septum (6). The shape of the lumens is intended to enhance advancement of one or more catheters through the shaft. The septum construction dividing the lumen can be solid, rigid, semi-rigid or flexible, made from a material of any of a variety of durometers, or made of the introducer shaft material or different material bonded, fused or joined to the introducer shaft material. The septum traverses the length of the lumen of the introducer shaft, from the housing to an area below or proximal of the exit port(s) or substantially near the exit port(s).
The delivery systems of the present invention comprise elements for introducing delivery devices into the body, elements for providing compositions or occlusive material such as reservoirs and pumps, devices for in situ delivery of compositions and compositions comprising occlusive materials, elements for polymerizing or coagulating the occlusive materials, including using mechanical, biological or chemical methods; elements tor visualization of procedures, pre- and post-procedural compositions and methods of treatment, elements and compositions for supporting or inducing tissue ingrowth or wound healing or similar type response or degradation of the occlusive material, and elements for opening conduits or re-opening of an occluded conduit.
The present invention comprises methods for occluding fallopian tubes that are useful for providing female sterilization. It is well known in the art that a primary cause of naturally occurring infertility in females is blockage of the oviducts from the ovary to the uterus. Females having this natural condition normally do not even realize it exists and do not suffer any adverse side effects besides being infertile. Moreover, the condition can sometimes be successfully reversed, thus restoring the ability to bear children. For example, methods, systems and devices of the present invention can be used to assess the structure and patency of fallopian tubes, or structure of the uterine cavity, to provide a diagnosis of a condition related to a fallopian tube or the uterus, or to repair anomalies in fallopian tubes, or remove ectopic implants or naturally occurring oviductal tubal occlusions.
The present invention comprises systems, methods and devices for providing compositions for diagnosis of conditions related to the conduit, such as diagnosis of conditions of fertility or infertility or confirmation of occlusion post sterilization procedure, for example, provision of the compositions that allow for determination of fallopian tubal patency in humans and mammals. In one aspect of the invention, a delivery device as described herein is inserted and positioned in the uterus by the operator, by either tactilely determining the placement, or using visualization techniques, such as ultrasound, or x-ray, or combination of both tactile feel and visualization, but generally not hysteroscopy, to determine the location of the delivery device to ensure correct placement. Once in place, the operator provides a composition that can be visualized from the interior or exterior of the body by known techniques. For example, a composition may compose a radiopaque substance, such as lipoidol, or a water-soluble medium, such as urografin. Imaging of the tubes is obtained by flouroscopy and X ray. The course and patency of the tube and some peritubal adhesions may be assessed, for example, the latter may be assessed by intraperitoneal pooling of contrast medium. Sonography during instillation of a composition is also contemplated by the present invention. The composition is provided through a lumen in at least one delivery catheter, and exits the delivery end of the catheter. If a catheter with an end structure is used, the end structure, such as a balloon, prevents or minimizes back-flow of the composition leaving the catheter and encourages forward flow of the composition away from the catheter end. The composition flows as far as possible in the fallopian tube, either to an obstruction or flows out the Umbrae end of the tube into the peritoneal cavity or to a desired location controlled by volume of composition delivered. The one or more delivery catheters are then withdrawn into the introducer portion of the device. In certain embodiments, the introducer may be rotated so that an exit port is aligned with the opposite uterine cornua, without withdrawal, and an untreated or unevaluated fallopian tube is treated or diagnosed by advancing a catheter and providing a composition.
In methods of providing a contrast agent composition, the uterine structure may be evaluated for diagnostic purposes. An aspect comprises use of an end structure of a delivery catheter to block the cervix so that the contrast agent Composition is contained within the uterus and may enter the fallopian tubes. For example, if one or more balloon catheters are used, and the uterine examination occurs after provision of contrast agent to the fallopian tubes as described above, the balloon of the catheter(s) is deflated and the introducer is retracted for example, to the level of the internal cervical os, while leaving the delivery end of one catheter within the uterine cavity. The balloon may be re-inflated to block the cervical entrance, and a contrast agent composition is provided through the catheter and into the uterine cavity. Once observations are completed, the balloon can be deflated to remove the catheter and allow egress of the composition. Alternatively, a delivery device stabilizer may provide a sufficiently sealing function so that when the introducer shaft is retracted to some extent and a contrast medium composition is released in the uterine cavity through the one or more catheters, a sufficient amount of the composition is retained in the uterus for observation of the structure.
The present invention comprises systems, methods and devices for providing compositions comprising therapeutic agents for treatment of the conduits. For example, the present invention comprises systems, methods and devices for providing compositions comprising therapeutic agents for treatment of one or more fallopian tubes in a mammal. In one aspect of the invention, a delivery device as described herein is inserted and positioned in the uterus by the operator, by either tactilely determining the placement, or using visualization techniques, such as ultrasound or x-ray or combination of both tactile feel and visualization, but generally not hysteroscopy, to determine the location of the delivery device to ensure correct placement. Once in place, the operator provides a composition that provides a therapeutic treatment to a body part by providing the composition to the interior of the uterine cornua, to one or more areas of the interior lumen of a fallopian tube, to the fimbrae, to an ovary surface, or to the peritoneum. For example, a composition may include, but is not limited to, hormones, fertility enhancing compounds, fertility interfering compounds, motility enhancing compounds, motility interfering compounds, compounds affecting the cilia/deciliation cycle, cilia growth enhancing or interfering compounds, ovarian follicle treatment compounds, antibacterial, antimicrobial, antifungal, antiviral, antimycoplasmal, or antiparisital compounds, compounds that reduce inflammation or scar tissue formation, and others that may treat or prevent conditions related to the fallopian tube, uterus, ovaries, or other organs or coverings reached by a composition flowing from the cornua or ostia of a fallopian tube. For example, infections related to pelvic inflammatory disease (PID) may be treated by a composition comprising one or more antibiotics, antimycoplasma agents, or antiviral compounds; fallopian tubal fluid may be altered by provision of compositions comprising mucoproteins, electrolytes or enzymes to enhance or inhibit fertility, compositions comprising hormones or other compounds may be used to affect motility or cilia such as progesterone, estrogen, adrenergic active compounds, noradrenergic active compounds, or prostaglandins. A composition may be provided through a lumen in at least one delivery catheter, and exits the delivery end of the catheter. If a catheter with an end structure is used, such as a balloon, the end structure prevents or minimizes back-flow of the composition leaving the catheter and encourages forward flow of the composition away from the catheter end. The composition flows as far as desired in the fallopian tube or flows out the fimbrae end of the tube. The catheter or a smaller catheter provided within a first delivery catheter, may be advanced to a particular site in the fallopian tube or uterus. After the composition has been provided, the one or mom delivery catheters are then withdrawn into the introducer portion of the device. In certain embodiments, the introducer may be rotated so that an exit port is aligned with the opposite uterine cornua, without withdrawal, and an untreated fallopian tube is treated by advancing a catheter and providing a composition. In methods of providing a therapeutic composition, the uterine structure may also be treated, either internally or externally.
The present invention comprises systems, methods and devices for providing therapeutic agents for treatment of the conduits, wherein the therapeutic agents include, hut are not limited to, device elements such as wines, catheters with cautery elements, scraping or rotoring elements, suction devices, stents, or other device elements that can be provided by a catheter delivery end, or provided through a first catheter and that can affect tissue or fluid. For example, the present invention comprises systems, methods and devices for providing therapeutic agents comprising device elements for treatment of one or more fallopian tubes in a mammal. In one aspect of the invention, a delivery device as described herein is inserted and positioned in the uterus by the operator, by either tactilely determining the placement, or using visualization techniques, such as ultrasound or x-ray, or a combination of tactile feel and visualization, but generally not hysteroscopy, to determine the location of the delivery device to ensure correct placement. Once in place, the operator provides a therapeutic agent including device elements that provides a therapeutic treatment to a body part by providing the device element to the interior of the uterine cornua, to one or more areas of the interior lumen of a fallopian tube, to the fimbrae, to an ovary surface, or to the peritoneum. For example, a therapeutic agent including device elements such as a wire, cautery, rotoring section, or scraping section, alone or in combination with one or more stents, may be used to treat occlusions of the fallopian tube, such as those due to PID, to treat constrictions, to treat conditions such as salpingitis isthmica nodosa (SIN); to treat neoplasms of the fallopian tubes, to provide tuboplasty procedures, removal of mucous plugs, or to repair anatomical abnormalities such as diverticulum. A therapeutic agent comprising device elements is provided to the site by at least one delivery catheter, and may be found on or near the delivery end of the catheter, and may be an end structure. The catheter is then advanced to the target site where the device elements affect the target site. The therapeutic agent comprising device elements may be provided through the delivery catheter and advanced out of the end of the delivery catheter to the target site. After the target site has been affected by the therapeutic agent comprising device elements, the one or mom delivery catheters are then withdrawn into the introducer portion of the device. In certain embodiments, the introducer may be rotated so that an exit port is aligned with the opposite uterine corona, without withdrawal, and an untreated fallopian tube is treated by advancing a catheter and providing the therapeutic agent comprising device elements. In methods of providing a therapeutic agent, the uterine structure may also be treated, either internally or externally.
A therapeutic agent including device elements may be used to treat conditions related to ectopic pregnancy, the implantation of a fertilized egg in the fallopian tube. Incidence of ectopic pregnancy is increasing and is the number two cause of maternal mortality in the U.S. The device element may be used to remove the ectopic gestation by suction, retraction, surgical removal, or treat the ectopic tissue through the delivery of pharmacologic agents. A therapeutic agent including device elements may be used to treat conditions related to fertility such as closing of the fallopian tubes to prevent passage of gametes. Such closure may be accomplished by methods and compositions taught herein, and may he accomplished by known methods of tubal sterilization such as section of the tube in various ways.
The present invention comprises systems, methods and devices for providing compositions comprising ceils and compounds for fertility to one or more fallopian tubes in a mammal. In one aspect of the invention, a delivery device as described herein is inserted and positioned in the uterus by the operator, by either tactilely determining the placement, or using visualization techniques, such as ultrasound or x-ray, or combination, of both tactile feel and visualization, but generally not hysteroscopy, to determine the location of the delivery device to ensure correct placement. Once in place, the operator provides a composition for fertility by providing the composition to the interior of the uterine cornua, to one or more areas of the interior lumen of a fallopian tube, or to the fimbrae. For example, a composition may include, but is not limited to, hormones, fertility enhancing compounds, gametes, sperm, ova, combinations of sperm and ova, one or more zygotes, or one or more embryos. For example, in a modified GIFT (gamete-intra-fallopian transfer) procedure, sperm and a number of ova, such as from 2 to 8, from 2 to 6, from 2 to 4, are provided in a composition and delivered into one or both fallopian tubes at or near the ostia of the fallopian tube. For example, in a modified ZIFT (zygote intra-fallopian transfer), one or more zygotes are in a composition that is delivered as described herein to one or both fallopian tubes at or near the ostia of the fallopian tube. For example, sperm alone or several ova alone may be provided in a composition to one or both fallopian tubes using methods and devices described herein. A composition may be provided through a lumen in at least one delivery catheter, and exits the delivery end of the catheter. If a catheter with an end structure is used, such as a balloon, the end structure prevents or minimizes back-flow of the composition leaving the catheter and encourages forward flow of the composition away from the catheter end. The composition may flow as far as desired in the fallopian tube. The catheter or a smaller catheter provided within a first delivery catheter, may be advanced to a particular site in the fallopian tube or uterus. After the composition has been provided, the one or more delivery catheters ate then withdrawn into the introducer portion of the device. In certain embodiments, the introducer may be rotated so that an exit port is aligned with the opposite uterine corona, without withdrawal, and an untreated fallopian tube is treated by advancing a catheter and providing a composition. In methods of providing a composition, the composition may be provided to the uterus using methods, systems and devices described herein.
Aspects of the present invention comprise a delivery system, compositions comprising one or more occlusive materials, and a method for tubal occlusion and more particularly occlusion of the fallopian tubes of a female mammal for the purpose of permanent or reversible sterilization. In one aspect of the invention, a delivery device is inserted and positioned so as to reach the area in which the occlusion is desired while the operator either tactilely determines the placement and/or visualizes utilizing imaging the delivery device to ensure correct placement. Once in place, the operator instills the occlusive agent through a lumen in the delivery catheter, creating the occlusion. The delivery device is then withdrawn, leaving the occlusion in place. Confirmation of occlusive material placement may be made utilizing visualization, such as ultrasound. Fibrous tissue grows into the material or a wound healing response is elicited as the occluding material resorbs or degrades, leaving an occlusion, fashioned of the patient's own tissue or an obliterated lumen. The delivery system may be used to deliver an agent, such as a device or composition, to reverse the occlusion, and methods for reopening the occlusion are described.
An aspect of the present invention comprises a delivery system and device comprising a transcervical introducer sheath comprising a housing and a shaft, pails of which may be made of a standard medical-grade metal or plastic such as stainless steel, nylon, PTFE, or polyurethane, FEP, pebax, HDPE, which may be naturally sonolucdent or may require enhancement of ultrasound visibility by coating with a sonolucent material or otherwise modifying the material. The sheath may comprise an atraumatic tip to allow for comfortable placement and, combined with selection of a suitably flexible material, to prevent damage to the uterine wall. The introducer shaft has sufficient diameter to allow for introduction of other components of the delivery system. The introducer may contain one, two or more lumens that guide catheters into position, for example delivery catheters for delivery of compositions or occlusive materials. The introducer may include a mechanism to modify the angle of the introducer relative to the surrounding tissues, such as the cervix or uterus, to allow for a better fit to the anatomy of the individual patient, including such individual variations as ante- or retroverted/ante- or retroflexed uterus. Modified versions of the introducer may allow for uses other than for the occlusion of the fallopian tube(s), such as the localized delivery of contrast media for confirmation of tubal patency or the delivery to or removal from the fallopian tube(s) of other material or devices for diagnosis, treatment, or examination, of the tube, including the delivery of systems for re-opening an occlusion. One aspect of the introducer sheath is that it can be visualized using imaging techniques such as ultrasound. Visualization may be used to guide accurate placement and to ensure that the tip of the device does not penetrate the uterine wall. Operator feel may be used to guide accurate placement and to ensure that the tip of the device does not penetrate the uterine wall. A delivery device stabilizer may be included to ensure that accurate placement is maintained throughout the procedure. The delivery device stabilizer may comprise or include an element to fix or hold the introducer in place, such as a mechanism or device to attach or hold the introducer within the cervix or to otherwise maintain the device in the desired position, minimizing risk to the patient and allowing the operator greater flexibility to carry out other aspects of the procedure. Fixation may be accomplished through physical elements such as clamping, suction, wedging, inflation, or by other elements that maintain the device in the desired position.
A delivery system of the present invention comprises a device that can be configured in a collapsed, retracted, or folded form for insertion through the cervix, which may comprise an introducer sheath. After introduction, the device is positioned so that an atraumatic tip containing a single or multiple holes or exit ports at the tip of the device to be positioned near the desired location so that a catheter may reach the desired location, such as within the cornual aspect of the uterus at or near the ostium of a fallopian tube. The one or more exit ports allow for a catheter exiting the port to be in an orientation in three dimensional space that is convenient and beneficial for providing a material or for performing an activity at a desired location. One aspect of the catheter is that it can be visualized using imaging techniques such as ultrasound. Visualization may be used to guide accurate placement of the catheter and to ensure that the tip of the catheter does not penetrate the uterine wall. Operator feel may be used to guide accurate placement and to ensure that the tip of the device does not penetrate the uterine wall. The present invention, comprises methods for providing a delivery device that has at least one end of a delivery catheter with an opening that is placed within the corneal aspect of the uterus at or near the ostium of a fallopian tube. In one embodiment, the delivery device comprises two delivery catheters, with each catheter having its delivery opening positioned simultaneously or sequentially at the ostia of both fallopian tubes. In an embodiment of the present invention, a method comprises providing a delivery device which comprises one delivery catheter, with a catheter having its delivery opening positioned at the ostia of a fallopian tube. In other embodiments, such a device may be shaped like a Y, a T, or an arrow wherein one or more exit ports are positioned near or within the uterine cornua or at or near the ostia. The delivery system may utilize existing catheter-based technology, for example, one or more balloon catheters, and may incorporate standard materials such as Pebax, nylon, PTFE, polyurethane, vinyl, polyethylene, ionomer, polyamide, polyethylene terephthalate, and other materials. These materials may be naturally sonolucent or may be modified to enhance their ultrasound visibility, such as by coating or the inclusion of air bubbles within the material. Embodiments of the present invention may include an element for controlled flexion or rotation of the delivery system, which may aid in positioning one or more ends at the desired anatomic location. The catheters may be designed with one or mom curves that ensure that the tip is guided to the uterine cornua. Such curves may be either pre-formed to suit a majority of female reproductive anatomies or may be selected based on the individual anatomy of a single female patient.
The present invention comprises methods for occlusion of fallopian tubes comprising delivery of devices, such that the methods incorporate operator tactile feel and/or intra-procedure visualization without hysteroscopy, and positioning of the delivery end of a delivery catheter at or within the uterine cornea at or near the ostia of both fallopian tubes without the need for removal and reintroduction of instrumentation. Embodiments of the present invention comprise delivery devices that are sized appropriately for a general population of patients and also comprise delivery devices that are custom-fitted and individually tailored to meet individual patient anatomical needs. Delivery devices taught in the prior art, such as U.S. Pat. Nos. 5,746,769, 6,145,505, 6,176,240, 6,476,070, 6,538,026, 6,634,361, 6,679,266, and 6,684,384, 5,954,715, 6,068,626, 6,309,384, 6,346,102, and 6,526,979 do not consider individual patient anatomy, may require the use of a hysteroscope for direct visualization, and necessitate cannulation of each tube sequentially, with the need to reposition, withdraw and reinsert the device, enhancing the technical difficulty of the procedure and consequently the inherent risk of failure.
One aspect of this invention contemplates the use of pre-procedure imaging, such as by ultrasound, to allow for selection or adjustment of lengths and angles of the deployed delivery device and selection of appropriate delivery device stabilizer to accommodate individual patient anatomy. This pre-procedure imaging is used to rule out anomalies that may preclude use of the system and may be used to determine the uterine width between the fallopian tubes to select the correct size delivery system or to adjust the angle or shape of a delivery end so it may be properly located within or at the uterine cornua or at or near the ostium of a fallopian tube for deployment. Imaging may also elucidate the size and shape of the cervical os and canal, guiding selection of size and shape of delivery device stabilizer or spacer. Alternatively, one of a set of predetermined sizes of the delivery system could be selected based on the pre-procedure imaging information. The ability to adjust placement of the delivery catheter delivery ends or tips, including the angle and length for each individual end or in combination, during the procedure based on tactile feedback, imaging, or both tactile and imaging information is also contemplated. Other pre-procedure methods include the use of hormonal medications to control estrogen/progesterone cycle changes or prevent placement of the device during pregnancy and the use of pre-operative medications such as anti-infective or immune response therapies, and the use of nonsteroidal anti-inflammatory drugs to minimize discomfort and tubal spasm.
The present invention further comprises post-procedure methods and Compositions. Post-procedure methods may comprise steps to determine treatment was effective, for example, ultrasound or X-ray visualization, to allow for visualization of patency of a fallopian tube, or confirmation that the composition or occlusive material was delivered correctly or continues to provide an occlusion over time. Post-procedure methods and compositions may further comprise the use of hormonal agents to prohibit menstrual shedding of the endometrium and is also contemplated to minimize the risk of expulsion for a period of time, for example to allow for a period of time for resorption or degradation of the occlusive material and tissue ingrowth or scarring, wound healing or similar type response, or hormonal treatments to aid in implantation of provided zygotes or embryos. For example, use of a long-acting hormonal medication such as an injectable medroxyprogesterone acetate depot may serve the function of both, the pre- and post-operative hormonal therapy without the need for reliance on patient compliance. Post-operative methods and compositions may further comprise antibiotic or steroidal compositions.
Methods of the present invention comprise visualization of one or more steps of the methods. Visualization of the insertion of the introducer sheath, placement of the entire device, and release of the composition are included. In methods taught herein. Visualization of the occluded region, removal of the occlusive material, reopening of the conduit and testing for return of functionality of the conduit are included in methods tor reversing the occlusion of the commit Such visualization methods are known to those skilled in the art. U.S. Pat. Nos. 4,731,052 and 4,824,434 teach that ultrasound may be used for visualization of internal structures. The compositions and devices of the present invention comprise materials that allow for visualization, such as by ultrasound or fluoroscopy, during the procedure to ensure appropriate patient selection and device placement and localization, and for post-application monitoring to confirm appropriate material placement and the presence or absence of an occlusion.
Once the delivery device is appropriately placed, the composition is introduced through the delivery device for the methods of the present invention. In one aspect of the invention, the delivery device has individual lumens in the shaft of the introducer, with one or more exit ports to provide a delivery catheter end or tip directed toward the opening of a fallopian tube. An aspect of the invention allows for the simultaneous or sequential delivery of compositions to the fallopian tubes without the need to withdraw and reinsert or substantially reposition the device. The composition is delivered by actions of the operator manually or automatically once the device is in position. One aspect of the invention contemplates that the composition may be visualized by imaging such as ultrasound. Compositions may be naturally sonolucent or may be modified to have enhanced sonolucency by the introduction of materials or bubbles such as microbubbles of air or other gases. These microbubbles may be present within the composition prior to attachment to the delivery system or may be introduced into the composition during the delivery process, such as through the use of a cavitation mechanism.
It is contemplated that the methods taught herein are effective with one application of a composition or a device element to at feast one conduit, though the methods comprise at least one application to at least one conduit. Embodiments also comprise one or more applications to at least one conduit during one delivery cycle. For example, once the delivery device is in place in the uterus, with at least one end of the delivery catheter at the site or sites to be affected, a composition or device element may be applied once, and then, without removal, one or more repeating applications may be performed. Alternatively, compositions or device element treatments may be placed at the site or sites over multiple treatments. For each treatment, the delivery device would be inserted and removed. Such multiple applications may occur on consecutive days of insertion and removal or the days of insertion and removal may be interspersed with days of no applications. Such treatment regimens may be designed with individual patient needs taken into account by those skilled in the art, such as the treating physicians. Such treatment regimens may utilize the same or different compositions or treatments at each application.
Occlusive compositions include natural or synthetic materials. Natural materials include those round in animals or plants and not necessarily in the species hi which they are used. Synthetic materials include any materials that can be made by humans or machines in laboratory or industrial settings. The compositions may comprise materials that are initially mostly fluid that polymerize in situ to become solid or semi-solid materials, may comprise solid materials that may or may not change properties such as flexibility, once placed at the site or sites for occlusion, may comprise a mixture of fluids with gas, solid articles or both, dispersed therein. The occlusive material compositions may be a pre-formed shaped material that is released by the device once one or more delivery ends are in position, and the compositions may comprise occlusive material that starts as a liquid or semi-solid that cures in situ. The compositions of the present invention may include solid structures such a stents, rods, pellets, heads, and other tissue bulking agents that provide a solid structure to the occlusion formed at the site or sites. Compositions of the present invention may also combine pre-formed structures, such as spheres or particles, with material that starts as a liquid or semi-solid and cures in situ entrapping the preformed structures.
One aspect of the present invention comprises an occluding composition comprising a liquid that is mixed prior to delivery or does not require pre-mixing such as the single liquid composition, is ultrasound visible, and cures upon delivery into and through the tubal ostia within 3 cm of the ostium, within 5 cm of the ostium, or within 8 cm of the ostium to provide mechanical blockage and is at least 73% resorbed at a range of between about 30 to about 365 days. In one embodiment, the occluding composition is not hydrophilic and does not swell in the presence of fluids in the environment. In another aspect, the occlusive composition forming the occlusion may aid in the initiation or stimulation of tissue growth into the occluded site, wherein the occlusion is replaced by tissue that maintains the occlusion after resorption of the occlusion material. In another aspect, the occlusive composition forming the occlusion may aid in the initiation or stimulation of a wound healing or similar type response at the occluded site, wherein the occlusion removes an internal layer of the fallopian tube lumen allowing for complete healing of the lumen wails, resulting in obliteration of the lumen. In another embodiment, the occluding composition is ultrasound visible once it has cured in situ. In another aspect, an embodiment of the invention contemplates use of an occlusive material that has a functional lifespan wherein for a period of time it forms the physical occlusion or blockage of the lumen, and after period of time, the occlusive material is gone, having been, resorbed or degraded, hut is not replaced by tissue ingrowth or wound healing, so that the lumen is again open and functional.
In a further aspect of the present invention, the occlusive material comprises a two component liquid comprising a resorbable polymer solution or solid polymer component and a liquid cyanoacrylate tissue adhesive component. The resorbable polymer may be a polyester polymer selected from polylactide, polyglycolide or polycaprolactone, or a polyester copolymer selected from poly(lactide/glycolide) acid (PLGA) or poly(lactid-co-ε-caprolactone) (PLCL), or polyacrylic (to include methacrylates and cyanocrylates), or polyvinylics including polyvinyl alcohols, polyvinyl pyrrolidones, polyvinyl ethers, polycyanoacrylates, polyanhydrides, such as maleic anhydride groups. These polymers may be copolymers or blends of these. The resorbable polymer solution or polymer solid may be any other known polymer or copolymer such as those based on a polyether backbone. The polymer solution may be any composition that undergoes degradation upon contact with body fluids as would typically be encountered in such structures as the fallopian tubes or other comparable animal ducts. The polymer solution may be of copolymer or multi-polymer compositions. It may be of varying molecular weight depending upon the need of a particular viscosity. The polymer solution may also be composed of diluents or other additives to control the level of fluidity for ease of blending into the cyanoacrylate monomer. The chosen polymer solution or solid polymer may be of any material that has been found to be compatible with human or animal tissue or of such activity that will enhance the desired occluding of the treated passageway. The cyanoacrylate tissue adhesive component comprises any of a number of alkyl- or alkoxyalkyl-2-cyanoacrylates such as methyl, ethyl, propyl, butyl, n-butyl-2-cyanoacrylate, methoxypropyl, methoxybutyl, 2-methoxybutyl-2-cyanoacrylate, or any other such cyanoacrylates either as a single monomer or combinations thereof. The technical literature is abound with the numerous and typical such materials of which any and all may be utilized as a component, either as a single monomer composition or as formulations curing into various polymer, co-, and multi-polymer occluding agents. Components may be mixed prior to entry in the catheters for delivery. In curing, the cyanoacrylate components polymerize and results in the desired occlusion in which the non-cyanoacrylate components are homogeneously or heterogeneously incorporated. The cyanoacrylate adheres to the lumen wall to anchor the occlusion in place. Non-cyanoacrylate components may be included and these components may encourage more rapid degradation of the occlusive composition.
A single liquid composition is also contemplated. The single liquid composition comprises a tissue adhesive, such as a cyanoacrylate or therapeutic or diagnostic agent with a nano- or micro-particulate material, which may be organic or inorganic in composition. In one aspect of the invention, the particles are capable of visualization by ultrasound. The particles and tissue adhesive or therapeutic or diagnostic agent are combined prior to delivery to the target site. In another aspect of this embodiment is the use of particles which can be formulated and remain suspended or can be reconstituted into suspension so as to eliminate the on-site preparation. The composition, including the tissue adhesive cures by the polymerization of the tissue adhesive, entrapping the particles, and anchors the occlusion. In the lumen by adhesion to the lumen wall.
In a farther aspect of the invention, a cyanoacrylate composition with polar moieties, such as ether segments is contemplated as an occlusive material so that rapid loss of the occlusive material is achieved, from 1 to 12 months, under 12 months time, post delivery, in the presence of proteinaceous substances, principally animal or human tissue. The rapid degrading or resorbing cyanoacrylate tissue adhesive component(s) comprises any of a number of cyanoacrylates, such as methoxyethyl, ethoxyethyl and methoxypropyl cyanoacrylates, including, known carbalkoxyalkyl 2-cyanoacrylates. The cyanoacrylate component can be used alone or in combination with other cyanoacrylate components and/or in combination with resorption-enhancing organic or inorganic materials that further accelerate expulsion from the patient. Such additives provide the freedom to fine tune the desired time to degrade, resorb or eliminate the occlusive composition from the patient. Such compositions are noted in examples 9 and 10.
Another aspect of the present invention comprises a group of occluding substances that use a two part system similar to the foregoing liquid polymer compositions. These substances are two part isocyanates/polyols, two part acrylic cures similar to the reactive and anaerobic adhesives of the Loctite/Henkel Corporation and similar sources, or two part epoxy systems. The isocyanates undergo evolution of carbon dioxide and promote porosity and rapid resorption or degradation. These compositions serve to exemplify the numerous possible candidates for creating these occlusions. It must further be understood that these two part or, on she prepared systems, can also be combined with other occluding compositions. For example the carbon dioxide releasing, porosity inducing, nature of the isocyanate can be combined with the other tissue adhesives, such as the cyanoacrylates to provide the occlusive and resorbing or degrading compositions.
In a method of the present invention, the resorbable or degradable occluding compositions and the location of the occlusion to a portion of the fallopian tube, for example, extending over at least 0.5 cm of the Fallopian tube, provides for a persistent block and creates a permanent contraceptive method. The resorbable or degradable nature of the occluding composition and the proximity of the occlusion to the ostia, extending over a limited length of the fallopian tube, may allow for ease in the reversibility of the contraceptive method. As the occlusive implanted-composition is resorbed or degraded, them is ingrowth of tissue or a similar type response that maintains the occlusion. The tissue occlusion so formed can be recanalized to provide an open conduit for fertilization without the need for surgical removal and reapportion of the tube across the area of the occlusion.
A wide variety of materials are known in the art that can be used to form the conduit occlusions of the present invention, such as oviduct occlusions. U.S. Pat. No. Re 29,345 teaches the use of silastic that is partially pre-formed and partially in situ cured. U.S. Pat. No. 4,185,618 teaches the use of a gel-forming carrier substance that holds in place a tissue fibrosis-promoting material. U.S. Pat. No. 4,365,621 and 4,509,504 describe the use of a swelling material that is inert and permanent. U.S. Pat. No. 6,096,052 describes the use of a mesh-based material that supports fibrous tissue ingrowth. U.S. Pat. No. 4,700,701 describes the use of a resorbable plug in combination with physical and/or chemical elements of inducing a scarring reaction. U.S. Pat. No. 5,989,580 incorporates the use of a biocompatible, non-degradable implanted polymer of several types that can be removed by dissolution. U.S. Pat. No. 6,605,294 teaches the use of absorbable polymers, pre-shaped with at least one rod-shaped portion, to occlude fallopian tubes. U.S. Pat. No. 5,894,022 teaches using a composition that may form a degradable mesh. U.S. Pat. Nos. 6,371,975, 6,458,147, and 6,743,248 teach the use of a polyethylene glycol and protein composition for the occlusion of vascular access puncture sites. The present invention comprises these and other occlusive compositions for blocking a conduit that may be introduced using the delivery devices of the current invention.
One aspect of the occlusive compositions of the current invention comprises a resorbable or degradable material capable of providing an initial mechanical blockage and initiating or supporting the tissue ingrowth or wound healing or similar type response necessary to create the occlusion and/or an adhesive composition that maintains the position of the material during curing and the initial phase of tissue ingrowth or wound healing. U.S. Pat. Nos. 4,359,454, 6,476,070, and 6,743,248 teach the use of cyanoacrylate, and in particular a composition containing either n-methyl or n-hexyl cyanoacrylate, as a resorbable, yet scar-promoting, material. Other patents teach compositions of polymerizable monomers, such as cyanoacrylates, alone or in combination with other materials, such compositions that may be useful as occlusive agents or adhesives in the present invention and/or as resorbable materials-capable of initiating or supporting tissue ingrowth to form a permanent adhesion. These include U.S. Pat. Nos. 5,328,687, 5,350,798, 6,010,714, 6,143,352, 6,174,919, 6,299,631, 6,306,243, 6,433,196, 6,455,064, 6,476,070, 6,538,0.26, 6,579,469, 6,605,667, 6,607,631, 6,620,846, and 6,723,144.
A further aspect of the current invention includes materials that are delivered in a solid or non-solid form which may be used to deliver or adhere materials that may be useful in promoting or forming occlusions or which may be useful in forming occlusions in and of themselves whereas such material may be resorbable or degradable or permanent. Such materials include dry compositions that hydrate and form crosslinked hydrogels, as taught by U.S. Pat. No. 6,703,047, U.S. Pat. Nos. 5,612,052, 5,714,159, and 6,413,539 teach self-solvating polyester copolymers that form hydrogels upon contact with body fluids. U.S. Pat. No. 4,804,691 teaches compositions of hydroxyl-terminated polyesters crosslinked with diisocyanate. U.S. Pat. No. 6,723,781 teaches crosslinked, dehydrated hydrogels. Hyaluronic acid based hydrogels are taught in U.S. Pat. Nos. 5,866,554 and 6,037,331. Two part hydrogels are taught in U.S. Pat. No. 6,514,534. Crosslinked bioadhesive polymers are taught in U.S. Pat. Nos. 6,297,337 and 6,514,535. Thermosensitive biodegradable polymers are taught in U.S. Pat. No. 5,702,717.
The present invention comprises compositions that form an occlusion in a conduit, wherein the occluding material is resorbed or biodegraded by the body in a range from at least about 20% to about 100%, or in a range from at least about 20% to about 80%, from a range of at least about 20% and about 60%, from a range of at least about 30% to about 50%, from a range of at least about 30% to about 80%, from a range of about 70% to about 100%, and from a range of about 40% to about 100%. Occluding materials may be resorbed or degraded 80% to 100% over a time period of 1 to 90 days, 1 to 60 days, 1 to 45 days, 1 to 30 days, 5 to 25 days, 10 to 20 days, 5 to 10 days, 1 to 10 days, 1 to 15 days, from 30 to 90 days, from 15 to 30 days, from 20 to 30 days, from 10 to 30 days, from 10 to 60 days, from 10 to 90 days, so that the occlusion remaining is formed by tissues of the patient or a wound healing response or similar type response. Such resorption or degradation may occur substantially over a period of time from about 30 days to 365 days, from about 30 days to 180 days, from about 30 days to 90 days, from about 60 days to 365 days, from 60 days to 180 days, or from about 90 days to 365 days. A composition comprises a material that is resorbed or biodegraded by the body in a range of at least about 20% to substantially 100% in a period of time of about 30 days to 365 days, where the initial occlusion formed by the material is maintained thereafter by the tissue that grows into the site or wound healing response or similar type response.
The present invention comprises compositions that form an occlusion in a conduit, wherein the occluding material is not resorbed or biodegraded by the body but instead, the composition is expended, such as in fragments, over time from the conduit. Fragments of the occluding material may be expelled over a time period of 1 to 90 days, 1 to 60 days, 1 to 45 days, 1 to 30 days, 5 to 25 days, 10 to 20 days, 5 to 10 days, 1 to 10 days, 1 to 15 days 30 to 90 days, 15 to 30 days, 20 to 30 days, 10 to 30 days, 10 to 60 days, 10 to 90 days, so that the occlusion remaining is formed by tissues of the patient or a wound healing response or similar type response. Such expulsion of occluding material may occur substantially over a period of time from about 30 days to 365 days, from about 30 days to 180 days, from about 30 days to 90 days, from about 60 days to 365 days, from 60 days to 180 days, or from about 90 days to 365 days. A composition comprises a material that is expelled by the body in a range of at least about 20% to substantially 100% in a period, of time of about 30 days to 365 days, where the initial occlusion formed by the material is maintained thereafter by the tissue that grows into the site or wound healing response or similar type response.
The present invention contemplates use of an in situ curable material, which lowers the risk of expulsion by allowing the material to conform and adhere to the walls of the conduit, or specifically the uterus and/or fallopian tube. Compositions capable of in situ curing preferably comprise a material that is flowable at a temperature outside or within physiologic limits but curable at physiologic temperatures such as those taught by U.S. Pat. Nos. 5,469,867 and 5,826,584. High viscosity liquids capable of delivering and maintaining materials in place that are useful for the present invention are taught in U.S. Pat. Nos. 5,747,058, 5,968,542, and 6,413,536. Alternatively, the material may cure on contact with the tissue environment as described in U.S. Pat. Nos. 4,359,454, 6,476,070, and 6,538,026; on contact with a curing agent (as typified in two part systems) as described by U.S. Pat. Nos. 5,278,202 and 5,340,849; or on dissipation of the solvent as described by U.S. Pat. Nos. 4,938,763, 5,278,201, 5,324,519, 5,487,897, 5,599,552, 5,599,552, 5,632,727, 5,702,716, 5,728,201, 5,733,950, 5,736,152, 5,739,176, 5,744,153, 5,759,563, 5,780,044, 5,792,469, 5,888,533, 5,990,194, 6,120,789,6,130,200, 6,395,293, 6,461,631, 6,528,080, and Re 37,950 as well as world-wide patent numbers WO 97/42987, WO 99/47073, and WO 00/24374.
The present invention comprises use of compositions made from one material or a combination of more than one material to form the occlusion, particularly compositions that comprise materials that cure or polymerize by differing mechanisms or differing rates by the same mechanism. For example, the compositions may comprise a combination of two materials, one of which cures or polymerizes because an activating agent is present and the other cures, polymerizes or solidities, all of which are interchangeable terms, because of the pH of the environment in which it is placed. Components of the mixture may serve different or overlapping roles; for example, a tissue adhesive component may primarily serve to minimize expulsion of the implant while tissue in-growth or wound healing or similar type response is occurring, while another component may primarily initiate or support the tissue growth or wound healing or similar type response. In another example, a tissue adhesive component(s) may initially serve to solidify and hold the implant at the desired location and begin the degradation process as the tissue ingrowth, wound healing, or similar type response is on-going. The tissue adhesive component may be selected from the group of materials containing cyanoacrylates, polyacrylic acids, polyethylene glycols, modified polyethylene glycols, thrombin, collagen, collagen-based adhesives, fibrin, fibrin glue compositions, gelatin-resorcinol-formaldehyde-glutaraldehye (GRFG) glue, autologous blood in combination with collagen and/or thrombin, cross linked albumin adhesives, modified glycosaminoglycans, poly(N-isopropylacrylamide)-based adhesives, alginates, chitosan, and gelatin, crosslinked with carbodiimide or genepin, among others, in a proportion of the overall composition from about 5% to 50%, from about 75 to 95%, from about 60%-80%, from about 5% to 25%, from about 10% to 30%, or from about 10% to 23%. The material added primarily for the initiation or support of tissue ingrowth or wound healing or similar type response may be chosen from the group consisting of solid or solvated resorbable or degradable polymers, including the resorbable or degradable polyesters or their copolymers. The occlusive promoting component, including or excluding the presence of solvent, may comprise from about 1 to 15%, 20% to 80%, from about 50% to 80%, from about 40 to 70%, or from about 50% to 90% of the overall composition.
Additional components may be included to stabilize the overall mixture or to control the viscosity, curing time, resorption timeframe, plasticity, or to enhance visualization of the material. Such agents may include: polymerization inhibitors and stabilizers including, for example sulfonic acid, lactic acid, acetic acid, sulfur dioxide, lactone, boron trifluoride, hydroquinone, hydroquinone monomethyl ether, catechol, pyrogallol, benzoquinone, 2-hyroxybenzoquinone, p-methoxy phenol, t-butyl catechol, organic acid, butylated hydroxyl anisole, butylated hydroxyl toluene, t-butyl hydroquinone, alkyl sulfate, alkyl sulfite, 3-sulfolene, alkylsulfone, alkyl sulfoxide, mercaptan, and alkyl sulfide; emulsifying agents such as polyvinyl alcohol; echogenic agents such as microbubbles of air or gas, microparticles or spheres of crosslinked albumin with en topped air or gas (Albunex), sonicated albumin, gelatin-encapsulated air or gas bubbles, nanoparticles, microparticles, spheres, or microcapsules of resorbable materials with entrapped air or gas, particles of other materials with entrapped air or gas; contrast agents such as metal particles, metal nanoparticles, metal oxide nanoparticles; viscosity-modifying materials such as crosslinked cyanoacrylate, polylactic acid, polyglycolic acid, lactic-glycolic acid copolymers, polycaprolactone, lactic acid-caprolactone copolymers, poly-3-hydrosybutyric acid, polyorthoesters, polyalkyl acrylates, copolymers of alkylacrylate and vinyl acetate, polyalkyl methacrylates, and copolymers of alkyl methacrylates and mono-enes or di-enes; and plasticizers such as dioctyl phthalate, dimethyl sebacate, trethyl phosphate, tri(2-eyhylhexy)pbosphate, tri(p-cresyl)phosphate, glyceryl triacetate, glyceryl tributyrate, diethyl, sebacate, dioctyl adipate, isopropyl myristate, butyl stearate, lauric acid, dibutyl phthalate, trioctyl trimellitate, and dioctyl glutarate. The composition may further contain colorants such as dyes and pigments. The total amount of these agents may comprise from about 0.1% to 10%, from 1% to 10%, or from 5% to 20% of the overall composition.
The combination of two or more materials that cure by different mechanisms, including contact with tissue or the appropriate curing environment for example, conditions such as aqueous, ionic, temperature, or pH, chemical crosslinking, or solvent dissipation, among others, is contemplated by the current invention. The combination of one or more materials that cure by one or more mechanisms combined with one or materials that am pre-cured or pre-formed into particles, spheres, or other structures, is also contemplated by the current invention.
The present invention contemplates the use of pre-formed solid materials such as particles, spheres, capsules, or the like, in combination with a liquid or semi-solid material. The pre-formed solids may comprise degradable or resorbable materials and may have enhanced ultrasound visibility or may serve to enhance ultrasound visibility of the composite occlusive material. The particles as contemplated may be nanoparticles of an average size ranging from about 100 to 2000 nanometers, about 100 to 1000 nanometers, about 250 to 2000 nanometers, or about 500 to 2000 nanometers in diameter. Particles may also be microparticles with an average size ranging from about 0.1 to 1000 micrometers, about 0.1 to 250 micrometers, about 1 to 500 micrometers, about 50-500 micrometers, about 100-750 micrometers, or about 250 to 1000 micrometers. The liquid or semisolid material acts as a transport medium for the pre-formed solids and then, cures in situ, entrapping the solids. The particles may be coated with or contained within a material that enhances their miscibility and/or dispersability with the liquid or semi-solid material or minimizes the tendency of the particles to promote the premature coring of the liquid or semi-solid material prior to delivery. Coating materials may include extremely low moisture content formulations of the particulate constituent materials or other polymers or copolymers containing, for example, caprolactone, poly-β-hydroxybutyrate, delta-valerolactone, as well as polyvinylpyrrolidone, polyamides, gelatin, albumin, proteins, collagen, poly(orthoesters), poly(anhydrides), poly(α-cyanoacrylates), poly(dihydropyrans), poly(acetals), poly(phosphazenes), poly(urethanes), poly(dioxinones), cellulose, and starches. The following patents and U.S. patent applications teach manufacturing methods for creating echogenic particles for use in ultrasound contrast agents: U.S. Pat. Nos. 5,352,436; 5,562,099; 5,487,390; 5,955,143; 2004/0161384; 2004/0258761; and 2004/0258769, Particles made by these methods are contemplated by the present invention.
The present invention also comprises methods tor sequential applications of the same or different materials. For example, a composition of the occluding material that functions as the in situ curable material may be placed in the site or sites, and an adhesive composition may be applied separately either before or after the curable material so as to fix the implanted material in place, thus lowering the risk of expulsion. The in situ curable materials may cure or solidity in the native environment of the fallopian tube, or the curing may require the presence of an energy source, such as light, heat, other electromagnetic waves, sound waves, or microwaves or the presence of an initiator and/or accelerator for curing. The additional energy sources may be provided by the delivery device or another introductory vehicle or by sources outside the body.
The end structure of a delivery catheter may have alternative shapes that aid in maintaining the delivery end of a catheter at the site, aid in delivery of compositions, aid in removal of the catheter from the site, aid in localizing an occlusion, perform actions on a site such as cautery or scraping, and other shapes and designs for functions by a catheter end. For example, a delivery device used for occluding the fallopian tubes in a mammal, providing a catheter having an end that is placed within the uterine corona at or near the tubal ostia, may have end structures that comprise a shape that aids in delivery of a composition, for example by maintaining the catheter in position and preventing or minimizing the composition from flowing in multiple directions. This end structure may function to guide placement of the end of the catheter or anchor the catheter end to and/or cover the ostium of the tube and may take the form of a nozzle, cup, or balloon, A nozzle, cup or balloon is useful for preventing or minimizing leakage of compositions away from the implantation site. Preferably, the end structures do not adhere to the compositions although the use of an absorbable, detachable end structure that may adhere to the composition and be left in place after removal of the remainder of the delivery system is also contemplated. Using a catheter having a structure that conforms to the shape of the uterine corona, maintaining localized delivery to at least one ostia eliminates the need to cannulate into the fallopian tube. End structures comprise device elements for affecting tissues such as cautery elements, suction elements, cutting elements, scraping elements, wire elements, energy delivering elements, freezing elements, or grasping elements.
The present invention comprises methods for female sterilization wherein the delivery catheter is not inserted into the fallopian tube and in which the occlusive material is introduced within the uterine cornua at or near the tubal ostia affecting portions of the endometrium and/or tubal epithelium. The extent of the occlusion such as the portion of the uterine cornua and fallopian tube blocked by the occlusive material, may be controlled by modification of the curing time, viscosity, and amount of material delivered. The current invention comprises methods for effective blockage of a conduit, such as a fallopian tube, by occluding a minimal portion of the fallopian tube. Such occlusion may block a conduit for less than 1.0 mm of the length of the conduit, for less than 1 cm of the length of the conduit, for less than 3 cm of the length of the conduit, for less than 5 cm of the length of the conduit, or for less than 8 cm of the length of the conduit, or to the fimbrae area. For example, in occluding a fallopian tube, an embodiment of the present invention comprises methods of application of an occluding material such that no more than 5 cm of the fallopian tube is occluded. In affecting this length of tube, the anatomical areas of the fallopian tube targeted for occlusion include the areas within the fallopian tube wall, (the interstitial segment) and early portions of the isthmic section. The present invention may not be dependent on the length, width or depth of the solidified occluding material, and the extent of the solidified occluding material may be dependent on whether subsequent reversal of the occlusion is desired. If reversal of the occlusion is contemplated at the time of occluding, a minimal amount of occlusion may be achieved, thus allowing for more ease in reversing the occlusion and opening the conduit.
In one method of delivery of the occlusive material, pressure generated in the lumen of the delivery system forces the occlusive material through the delivery device, including at least one opening in at least one delivery end, out of the device and into the area to be blocked. Once the occlusive material has been delivered, the delivery device is removed in whole or in part from the patient (the end structure may be detachable and fashioned from a resorbable or degradable material designed to be left in place). For example, once the occlusive material is delivered to the site or the occlusive material cures in situ, the delivery device can be collapsed, re-folded, re-sheathed, or directly removed in one or more pieces from the patient.
The compositions of the present invention comprise occlusive materials and may further comprise one or more agents that are capable of providing other functions, including but not limited to, a curable carrier for the occlusive material, allowing for controlled release of a substance, enhancing the ability of the occlusive material to cause fibrosis, wound healing or similar type response or inhibit contraception. Quinacrine is well established to create scarring of the tubal epithelium and cause tubal blockage. In combination with the occlusive material, low dosages of quinacrine or other sclerotic agents, such as tetracycline, may assist in creation of the fibrous tissue blockage or wound healing or similar type response. The compositions of the present invention comprise fibrous tissue growth promoting agents such as growth factors or pro-inflammatory reagents that are known to those skilled in the art. U.S. Pat. No. 3,803,308 teaches that the instillation of copper or zinc salts alone into the uterus inhibits contraception. Current copper intrauterine devices have incorporated this concept. The present invention comprises compositions comprising copper salts or other metallic elements in addition to the occlusive material. Inclusion of hormonal contraceptives within the occlusive material to limit further the risk of pregnancy during the timeframe of tissue ingrowth or wound healing or similar type response is contemplated.
The present invention comprises methods for using energy-delivering devices to initiate or completely form an occlusion. Such methods comprise activities at the site of the placement of the occlusive materials to aid in the formation of tissue growth or wound healing or similar type response and/or biodegradation or resorption of the occlusive material. Such activities include, but are not limbed to, use of cautery methods, bipolar coagulating current, a high frequency generator to produce a tissue damaging current, and use of laser, light, microwave, and radiofrequency energy. Devices for providing such activities and uses thereof are taught in U.S. Pat. Nos.4,700,701; 5,095,917; 5,474,089; 5,954,715; and 6,485,486.
The present invention also comprises delivery systems, methods and devices for removing at least one occlusion at the occluded site. As used herein, the term reversing the occluded site, means making the conduit capable of transporting again. Making the conduit capable of transporting can include, but is not limited to, removal of the original occluding material, creating a new lumen through the occluded site, such as forming a channel through the occluding material or the in-grown tissue at the occluded site, or by-passing the occluded site. The methods of the present invention comprise delivery of devices that place permanent plugs within one or more conduits, simultaneously or sequentially, wherein such plugs are structured such that a device of the present invention can be used to remove the plugs at a later time. Structures tor such plugs are taught U.S. Pat. No. Re 29,345. Such plugs are not resorbable or biodegradable by bodily actions and thus may incorporate elements for anchoring the plugs within the conduit. The occlusion may be removed from the conduit by destruction of the occluding material. For example, Shockwaves can be used to shatter the material, similar to that used in lithotripsy methods, and the material is expelled from the conduit. Chemical or biological elements, such as instillation of solvents or enzymes, can be used to disintegrate the occlusion. Removal devices of the present invention can be used to affect one or both fallopian tubes that have occluding material therein, by physical removal of plugs, provision of materials that recanalize the occluding site, or that mechanically form a new channel through or around the occluded site. The device may also deliver a stent or other device to ensure that the new channel remains open. U.S. Pat. Nos. 4,983,177; 5,989,580; 4,664,112 and ethers teach methods for reversibility of occluded sites. In methods for reversing the blockage of fallopian tubes, the present invention contemplates systems, methods and devices that are capable of reversing the occlusion in each fallopian tube under tactile determinations by the operator and/or imaging/visualization and without removal and reinsertion or the need to reposition substantially the delivery device until one or both tubes are unblocked. The present invention contemplates methods and devices to open the fallopian tubes one at a time, or unblock both tubes under operator feel and/or imaging visualization and without the withdrawal and reproduction of instrumentation, which represents an advantage over the prior art.
In one aspect of the present invention in which a partially or fully resorbable or degradable material is used to cause occlusion of a conduit, minimal or no permanent foreign body remains in position. In fallopian tube occlusion, the occlusion is located at or near the ostium of the tube, making non-surgical access simple. A catheter with a working head for the removal of an occlusion in a vessel or other body passageway can be used with the delivery device. A method for reversal of such blocked tubes incorporates the use of a catheter-based delivery system similar to that used for the introduction of the occlusive material. In this aspect of the invention, the lumen or lumens of the delivery device are used for the introduction of a stiff or cutting catheter or a catheter for instillation of a dissolution, medium (e.g., enzyme or solvent) that recanalizes the blocked section(s) of the tube. A stent or other device to maintain the opening may be placed through the delivery device as well.
In general, the present invention comprises methods tor occluding at least one conduit in a human or animal body, comprising, providing a delivery system capable of delivering an effective amount of a composition comprising an occlusive material, wherein the delivery system comprises a delivery device comprising at least an introducer shaft for providing one or more catheters; one or more catheters, a catheter comprising an end structure on a delivery end and attachment elements on a proximal end, a composition comprising an occlusive material, and elements for providing the composition comprising an occlusive material into and through a catheter and delivering an effective amount of the composition comprising an occlusive material at or near the target site such that the material occludes the lumen of the conduit; and occluding the conduit with the composition comprising an occlusive material at or within the lumen of the conduit. Elements for providing the delivery composition include, but are not limited to, syringes and pressure systems, pumps, containers with plungers to force material into the catheters, or other methods and devices for moving flowable material through a catheter or tube. The methods further comprise opening conduits, whether the conduit is occluded by methods of the present invention or by other methods or processes, including natural and synthetic or medical processes. The methods may comprise opening two conduits without removal and re-introduction or substantial repositioning of the introducer shaft. Such a method may be used to treat fallopian tubes of a mammal.
The compositions used in the methods of the present invention comprising the occlusive material may be mixed prior to delivery to the lumen. The compositions may comprise a tissue adhesive and a solvated polymer, or a polymer that is so bible in the adhesive wherein the composition cures in situ. The composition comprising the occlusive material may be ultrasound visible. The ultrasound visible material may comprise microbubbles of air or other gases or microparticles of a material that entrap air or gas. Compositions of the present invention comprise compositions wherein the tissue adhesive is cyanoacrylate, polyacrylic acids, polyethylene glycols, modified polyethylene glycols, thrombin, collagen, collagen-based adhesives, fibrin, fibrin glue compositions, gelatin-resorcinol-formaldehyde-glutaraldehye (GRFG) glue, autologous blood in combination with collagen or thrombin, crosslinked albumin adhesives, modified glycosaminiglycans, poly(N-isopropylacrylamide)-based adhesives, alginates, or chitosan or gelatin, crosslinked with carbodiimide or genepin; and the solvated polymer is a resorbable polyester, including polylactide, polyglycolide, or polycaprolactone or copolymers of these materials. Including poly(lactide-/glycolide) acid (PLGA) or poly(lactide-co-ε-caprolactone) (PLCL). The compositions may be visible by ultrasound. The compositions may further comprise tissue scarring agents, fibrosis agents, fertilization inhibitors, contraceptive agents, tissue growth or wound healing promoters, hormones, polymerization, inhibitors, polymerization stabilizers, emulsifying agents, echogenic agents, contrast agents, viscosity-modifying materials, plasticizers, colorants or combinations thereof.
The cured compositions of the present invention swell less than 20%, and may be about 20% to about 100% substantially resorbed or degraded in a range of about 30 to about 365 days. Once resorbed or degraded the occlusion may be maintained by tissue ingrowth or a wound healing or similar type response.
Compositions of the present invention may also comprise a tissue adhesive and particles. The particles may be nano- or micro-particles comprising spheres of resorbable polymers. The particles may be from about 0.1 micrometer to about 1000 micrometers in diameter. The compositions may be viewable by ultrasound or other imaging techniques. The compositions may further comprise a curable carrier for the occlusive materials, a control release agent, tissue scarring agents, wound healing promoting agents, fibrosis agents, fertilization inhibitors, contraceptive agents, tissue growth promoters, hormones, polymerization inhibitors, polymerization stabilizers, emulsifying agents, echogenic agents, contrast agents, viscosity-modifying materials, plasticizers, colorants or combinations thereof.
The present invention comprises methods for contraception comprising providing a delivery system capable of delivering an effective amount of a composition comprising an occlusive material, wherein the delivery system comprises a delivery device comprising at least an introducer shaft for providing one or more catheters; one or more catheters, such as a dual lumen balloon catheter; a composition comprising an occlusive material and elements for providing the composition comprising an occlusive material into and through the catheters; delivering an effective amount of the composition comprising an occlusive material at or near the target location such that the material occludes the lumen of at least one fallopian tube; and occluding the fallopian tube with the composition comprising an occlusive material at or within the lumen of the conduit.
The present invention comprises devices, and methods of using such devices, comprising an introducer shah having at least one exit port, or only one exit port, for providing at least one catheter; at least one catheter, a catheter may have an end structure at the delivery end or may comprise attachment elements at the proximal end, or both; the device may further comprise a composition for diagnosis or treatment of a conduit, and elements for providing the composition into and through the catheters. The end structure of a catheter may be a cup, nozzle, or a balloon. The devices may further comprise a delivery device stabilizer for holding the contraceptive device in place once positioned. The delivery device stabilizer may fit over or attach to the cervix or fit into or expand within the cervix to hold the device in position.
Methods of the present invention comprise methods for diagnosis of conditions of conduits. A method of diagnosis may comprise visualization of the condition of a conduit. For example, a method of diagnosis may comprise providing a visualizable composition directly to at least one fallopian tube of a human or animal; subjecting at least one fallopian tube to a visualization procedure; and determining whether the visualizable fluid flows through at least one fallopian tube. The condition of the fallopian tube, such as patency or physical structure of the tube, such as abnormalities, may be determined by visualization of the flow, or lack of flow, of the visualizable composition in the lumen of the fallopian tube. The visualizable composition is provided directly to the fallopian lube, which is meant that the visualizable composition is delivered only to the fallopian tube, or only to the fallopian tube first, and not by a filling of the uterus with a fluid and having that fluid overflow into the fallopian tubes.
The uterus may also be visualized using a visualizable composition of the present invention. By providing the visualizable composition directly to the uterus, if is meant that the composition is provided to the uterus first. Other structures, which may be visualized by a visualizable composition flowing from the fallopian tube, either out through the fimbrae of the fallopian tube, or flowing from the ostia of the fallopian tube, may be viewed by providing a visualizable composition directly to a fallopian tube.
A visualizable composition may be contrast medium. Contrast medium comprises sonolucent substances, radiopaque substances, iodine based contrast media, urografin, omnipaque, diatizoate, metrizoate, ioxaglate iopamidol, iohexol, ioxilan, iopromide and iodixanol, non-iodine based contrast media, barium sulfate, gadolinium, ionic or non-ionic contrast material and gas/liquid phase contrast media, air in saline, or frothed compositions or combinations thereof. Techniques for viewing visualizable compositions, visualization, procedures, comprise sonography or ultrasound, fluoroscopy, radiography, nuclear medicine techniques, magnetic resonance techniques and any combinations thereof.
The visualizable composition may be provided directly to a fallopian tube by a delivery system capable of delivering an effective amount of a visualizable composition, wherein the delivery system comprises a delivery device comprising at least an introducer shaft with at least one exit port for providing at least one catheter; at least one catheter, and elements for providing the visualizable composition comprising into and through at least one catheter. Use of this delivery device allows for the visualizable composition to be provided without removal and re-introduction or substantial repositioning of the introducer shaft. The catheters may have other elements, such as end structures on the delivery end of the catheter or attachment elements on the proximal end of the catheter, or both. The catheter may further comprise an end structure which is a cup, nozzle, or a balloon. The delivery system may further comprise a delivery device stabilizer for holding the delivery device in place once the device is positioned.
The present invention comprises methods of treatment, comprising, providing an effective amount of a treatment composition directly to one or more fallopian tubes of a human or animal; and allowing the composition to remain in the one or more fallopian tubes for a predetermined time. The treatment composition is provided directly to the fallopian tube, such as delivery to the fallopian tube ostia without providing the treatment composition first to the uterus by filling the uterus with the treatment composition and having the composition flow into the fallopian tubes. The present invention comprises methods tor direct delivery of treatment compositions to the uterus.
Treatment compositions are provided to treat conditions related to fallopian tubes or structures that can be reached by compositions flowing from the fallopian tube, either through the Umbrae end or from the ostia. Such structures that may be reached this way include, hut are not limited to, the uterus, the ovaries, the fallopian tube, the fimbrae, the cul de sac, the exterior of organs of the peritoneal cavity, or the lining of the peritoneal cavity.
Treatment compositions comprise effective amounts of compounds, pharmaceutical agents, or active agents that will affect the condition of the cells or tissues that are contacted by the treatment composition. Treatment composition comprise effective amounts of living cells, such as gametes, sperm, ova, zygotes, embryos, blastocysts or other cells which may result in an entire human or animal. Such treatment compositions are useful infertilization methods and may be used for creating a pregnant state in a human or animal. Treatment compositions comprise therapeutic agents comprising methotrexate, hormones, fertility enhancing compounds, fertility interfering compounds, motility enhancing compounds, motility interfering compounds, compounds affecting the cilia/deciliation cycle, cilia growth enhancing or interfering compounds ovarian follicle treatment compounds, antibacterial, antimicrobial, antifungal, antiviral, antimycoplasmal, or antiparisital compounds, compounds that reduce inflammation or scar tissue formation, composition comprising one or more antibiotics, antimycoplasma agents, or antiviral compounds; compositions comprising mucoproteins, electrolytes or enzymes to enhance or inhibit fertility, progesterone, estrogen, adrenergic active compounds, noradrenergic active compounds, nonsteroidal anti-inflammatory drug, prostaglandins, other compounds that may treat or prevent conditions related to the fallopian tube, uterus, ovaries, or other organs or coverings reached by a composition flowing from the cornua or ostia of a fallopian tube or any combination thereof, or combinations thereof. Treatment compositions comprise hormones for fertility, fertility enhancing compounds, gametes, sperm, ova, combinations of sperm and ova, one or more zygotes, or one or more embryos, or combinations thereof.
Treatment compositions may be provided directly to at least one fallopian tube by a delivery system capable of delivering an effective amount of a treatment composition, wherein the delivery system comprises a delivery device comprising at least an introducer shaft with at least one exit port for providing at least one catheter; at least one catheter, and elements for providing the treatment composition comprising into and through at least one catheter. Use of this delivery device allows for the treatment composition to be provided without removal and re-introduction or substantial repositioning of the introducer shaft. The catheters may have other elements, such as end structures on the delivery end of the catheter or attachment elements on the proximal end of the catheter, or both. The catheter may further comprise an end structure which is a cup, nozzle, or a balloon. The delivery system may further comprise a delivery device stabilizer for holding the delivery device in place once the device is positioned.
The present invention comprises methods and devices that allow for the one-time penetration of the cervix, comprising an introducer shaft having at least one exit port, or only one exit port, which functions to orient delivery catheters in three dimensional space. The atraumatic tip of the introducer shaft is provided through the cervix and into the uterine cavity. Once the tip is located at the uterine fundus, and optionally stabilized by stabilization elements, a catheter may be advanced through the introducer shaft and the delivery end of the catheter exits the single exit port. The catheter may be used to provide occluding compositions or the delivery of materials or devices for re-opening an occluded conduit, such as a fallopian tube. After the appropriate action, such as providing a composition to the fallopian tube, the catheter is retracted so that the delivery end of the catheter is within the introducer shaft or may be removed from the introducer entirely. The introducer shaft is then rotated so that the single exit port is now open toward the untreated uterine cornea. The delivery device is not removed from the patient, such as by withdrawal through the cervix after treatment at one fallopian tube, and may not have been repositioned other than by rotation. A catheter, such as the original catheter or a new catheter, is advanced through the single exit port and the occluding composition or materials or devices for re-opening an occluded fallopian tube are provided at or near the uterine cornua or at or near the opening of the fallopian tube. Once the delivery is completed, the catheter is retracted into the shaft, if used, a stabilizing device is disengaged, and the introducer shaft is retracted from the uterine cavity, through, the cervix and to the exterior of the patient.
The introducer shaft allows for separation of the uterine walls, for positioning at the fundus of the uterus (the top portion of the uterus), and orientation of one or more catheters to the fallopian tubes. The catheter, such as a balloon catheter, may be of a length that allows for variation in uterine sizes. The introducer shaft may be of a length that allows for advancement into varying lengths of uterine cavities. Alignment of the catheters with the tubal ostia is provided by the orientation of one or more exit ports, wherein such orientation directs the catheters in a generally perpendicular fashion to the ostia. Prior art devices do not provide for a flexible system that can orient a catheter to a particular location in the uterus without visualization means such as a hysteroscope.
It must be noted that, as used in this specification and the appended claims, the singular forms “a”, “an”, and “the” include plural referents unless the context clearly dictates otherwise.
All patents, patent applications and references included herein are specifically incorporated by reference in their entireties.
It should bed understood, of course, that the foregoing relates only to exemplary embodiments of the present invention and that numerous modifications or alterations may be made therein without departing from the spirit and the scope of the invention as set forth in this disclosure.
Although the exemplary embodiments of the present invention described in detail methods, delivery systems, and compositions to diagnosis, treat, occlude the fallopian tubes of human, the present invention is not limited to these embodiments. There are numerous modifications or alterations that may suggest themselves to those skilled in the art for use of the methods, delivery systems, and compositions herein for the diagnosis, treatment, occlusion of a variety of conduits in both human and non-human mammals.
The present invention is further illustrated by way of the examples contained herein, which are provided for clarity of understanding. The exemplary embodiments should not to be construed in any way as imposing limitations upon the scope thereof. On the contrary, it is to be clearly understood that resort may be had to various other embodiment, modification, and equivalents thereof which, after reading the description herein, may suggest themselves to those skilled in the art without departing from the spirit of the present invention and/or the scope of the appended claims.
A solution, of 25/75 poly lactide-co-ε-caprolactone (PLCL) was prepared 50% by weight in n-methyl-pyrrolidone (NMP) and sterilized. A mixture of 2-methoxypropyl cyanoacrylate (MPCA) with a biocompatible acid, in this case glacial acetic acid (AA), was prepared containing approximately 1 part MPCA and 1 part AA and sterilized. Implantable material A was prepared immediately prior to use by mixing 0.8 cc PLCL solution with 0.2 cc MPCA mixture until homogeneity of the mixture was achieved. The resultant mixture initially warms indicative of curing but remains adhesive to tissue and flowable through a 20G IV catheter for at least 15 min at room temperature in the absence of an aqueous environment. In contact with either water or animal tissue, the implantable material completes its curing quickly, forming a semi-solid material that is compressible and flakes relatively easily.
A solution of 50/50 poly lactide-co-glycolide (PLGA) was prepared 25% by weight in ethyl alcohol (EtOH) and sterilized. A mixture of butyl cyanoacrylate (BCA) with AA was prepared containing approximately 2 parts BCA and 1 part AA and sterilized. Implantable material B was prepared immediately prior to use by mixing 0.4 cc PLGA solution with 0.4 cc BCA mixture until homogeneity of the mixture was achieved. The resultant mixture initially warms indicative of curing but remains strongly adhesive to tissue and flowable through a 20G IV catheter for at least 15 min at room temperature in the absence of an aqueous environment. In contact with either water or animal tissue, the implantable material completes its curing quickly, forming a relatively incompressible semi-solid material that fractures on attempted bending.
Particles of 50/50 PLGA were prepared by dissolving PLGA in methylene chloride to create a 25% weight/volume solution, emulsifying in a 0.3% polyvinyl alcohol (PVA) solution, and further addition of PVA solution with 2% isopropyl alcohol to remove solvent. Particles were collected, lyophilized, and sterilized. Particles (0.25 g) were added to 0.75 g of a sterilized mixture containing 2 parts BCA and one part AA. The resulting particulate suspension was flowable at room temperature but cured on contact with water or animal tissue, forming a stiff, adherent material.
Particles of 50/50 PLGA were prepared as described in Example 3 with the addition of hydroquinone (0.5%) to the PVA emulsification, resulting in the entrapment of hydroquinone on the surface of the particles. The particles were collected, lyophilized, and sterilized. Particles (0.25 g) were added to 0.75 g of sterilized BCA. The particulate suspension remained flowable at room temperature with no indication of cyanoacrylate polymerization. The composition hardened on exposure to water or tissue, forming a stiff, adherent material.
Fourteen candidate materials prepared similarly to the previous examples have been studied for their ability to create a mechanical occlusion and generate a tissue ingrowth response when placed into the fallopian tubes of rabbits. One of the materials, methyl cyanoacrylate (MCA), has a history of use in effecting female sterilization, in animals and humans but was shown to have an unacceptable biocompatibility profile and was used as a control in one of the studies. Each of the test and control materials was placed into the fallopian tubes of seventy-four New Zealand white rabbits through an open procedure in which a 20G IV catheter or a modified delivery system catheter was used as the delivery system. Materials were infused through the catheter into the cornual aspect of the right and left uterine body; finger pressure or atraumatic clamps were used to prohibit backward flow of the material into the remainder of the uterine horn. Forward flow of the material was stopped once materials were seen within the cul-de-sac (i.e., peritoneal spill had occurred) or the full volume of material had been delivered or the material was stopped by another atraumatic clamp. It was noted that, in comparison to the control material which cured very rapidly, sticking to the catheter, and with a high beat of curing, the test materials had a longer curing timeframe (within the time prior to closure but sufficiently long to remove the catheters without adhesion) and did not generate as much heat. Once both right and left tubes had been treated, the reproductive organs were repositioned within the pelvis, and the incision was closed. At various time points from 1 day to 2 months, the animals were sacrificed. At times, dye infusion testing was used to demonstrate that the fallopian tubes of all animals were blocked. Test materials that generated an excessive amount of inflammation and adhesions or to benign of a reaction were ruled out. The remaining test materials and the control generated an appropriate tissue response, completely blocking the lumen of the fallopian tube with inflammatory cells and debris. Test materials may have contained a plasticizer, such as ATC and stabilizers, such as BHA as indicated in the table below. Approximate percentage of each component is indicated.
Use of the delivery system in explained human uteri
A prototype delivery system comparable to that shown in
A delivery system comparable to that shown in
Occluding Compositions with Degradation Evaluated
Solutions containing various percentages of cyanoacrylates, such as methyl cyanoacrylate (MCA), methoxy isopropyl cyanoacrylate (MIPCA), methoxy propyl cyanoacrylate (MPCA), ethoxy ethyl cyanoacrylate (EECA), methoxy ethyl cyanacrylate (MECA), n-butyl cyanacrylate (nBCA), octyl cyanoacrylate (OCA) with plasticizers (additives) with or without Poly Lactic Glycolic Acid (PLGA) were used. Approximately 0.6 grams of each formulation, simulating the amount being provided to the fallopian tube, were applied to a natural wool disc of approximately ¼ inch by 1 inch disc, simulating a protenacious environment to polymerize. The treated disc was immersed in a test tube or centrifuge tube containing 40 ml of a buffered saline solution, pH 7.4 simulating the human or animal environment. The containers were sealed and immersed in constant temperature environments at 37° C., or normal body temperature. The investigated samples were weighed to determine the exact amount of formula deposited on each treated disc. The containers were subjected to slow agitation, simulating peristaltic motion in the fallopian tubes. The samples were held at the specified temperature for a period of time as noted in the tables below. Upon the desired time expiration, the buffer was discarded and the container was transferred to a vacuum chamber fitted with a vacuum pump capable of drawing down to 100-500 millitorr. The containers were subjected to evacuation for a time period sufficient to achieve constant weight at room temperature. The effectiveness of each composition was determined by the degree of material loss after the specified times of immersion and compared to control conditions. Data points are averaged.
Occluding Compositions Comprising Multiple Cyanoacrylates with Degradation Evaluated
Solutions comprising various percentages of mom than one cyanoacrylate with or without an additive(s) were used. The same method as described in Example 9 was utilized in this evaluation of degradation.
An occluding composition was introduced by ice syringe to a channel sized to mimic the human fallopian tubes in an ultrasound phantom model. An ultrasound machine (manufactured by GE Medical Systems, model: Voluson: 730Pro) was used to visualize the occluding composition. The ultrasound probe was positioned near the cured occluding composition that occupied the channel within the ultrasound phantom model. A clear image of the resulting solid or semi-solid occluding composition was visible on the monitor, confirming the ability to view the occluding composition once cured in situ in a patient post delivery.
A delivery system comparable to that shown in
U.S. patent Documents
1. Abma J C, Chandra A. Mosher W D, et al. Fertility, family planning, and women's health; new data from the 1995 National Survey of Family Growth. Vital Health Stat. 1997; 23(19).
2. ACOG Practice Bulletin 46: Clinical management guidelines for obstetrician-gynecologists. Obstetrics and Gynecology. 2003; 102:647-658.
3. American Foundation for Urologic Disease. Facts about vasectomy safety.
4. Canavan T. Appropriate use of the intrauterine device. American Academy of Family Physicians. December 1998.
5. Clenney T, et al. Vasectomy Techniques. American Academy of Family Physicians. July 1999.
6. Fertility, Contraception and population policies. United Nations, Population Division, Department of Economic and Social Affairs. 25 Apr. 2003. ESA/P/WP.182.
7. Hendrix N, et al. Sterilization and its consequences. Obstetrical and Gynecological Survey. Vol 54(12), December 1999, p 766.
8. Holt V L, et al. Oral contraceptives, tubal sterilization, and functional ovarian cyst risk. Obstet Gynecol. 2003; 102:252-258
9, Jamieson D J, et al. A comparison of women's regret after vasectomy versus tubal sterilization. Obstetrics Gynecology. 2002;99 1073-1079.
10. Snider S, The pill: 30 years of safety concerns. U.S. Food and Drug Administration. April 2001.
11. Viddya Medical News Service. Side effects of tubal ligation sterilizations, Vol 1, Issue 249.
This application, is a continuation-in-part of U.S. patent application Ser. No. 11/065,886, filed Feb. 24, 2005, which claims the priority of U.S. Provisional Patent Application 60/547,491, filed Feb. 25, 2004, and U.S. Provisional Patent Application 60/587,604, filed Jul. 13, 2004, each of which is herein, incorporated by reference in its entirety.
| Number | Date | Country | |
|---|---|---|---|
| 60547491 | Feb 2004 | US | |
| 60587604 | Jul 2004 | US |
| Number | Date | Country | |
|---|---|---|---|
| Parent | 12240791 | Sep 2008 | US |
| Child | 13286127 | US |
| Number | Date | Country | |
|---|---|---|---|
| Parent | 13286127 | Oct 2011 | US |
| Child | 13684549 | US |
| Number | Date | Country | |
|---|---|---|---|
| Parent | 11065886 | Feb 2005 | US |
| Child | 12240791 | US |
