The present invention relates to medical devices. More particularly, the invention relates to a removable vena cava clot filter that can be percutaneously placed in and removed from the vena cava of a patient.
Filtering devices that are percutaneously placed in the vena cava have been available for over thirty years. A need for filtering devices arises in trauma patients, orthopedic surgery patients, neurosurgery patients, or in patients having medical conditions requiring bed rest or non-movement. During such medical conditions, the need for filtering devices arises due to the likelihood of thrombosis in the peripheral vasculature of patients wherein thrombi break away from the vessel wall, risking downstream embolism or embolization. For example, depending on the size, such thrombi pose a serious risk of pulmonary embolism wherein blood clots migrate from the peripheral vasculature through the heart and into the lungs.
A filtering device can be deployed in the vena cava of a patient when, for example, anticoagulant therapy is contraindicated or has failed. Typically, filtering devices are permanent implants, each of which remains implanted in the patient for life, even though the condition or medical problem that required the device has passed. In more recent years, filters have been used or considered in preoperative patients and in patients predisposed to thrombosis which places the patient at risk for pulmonary embolism.
The benefits of a vena cava filter have been well established, but improvements may be made. For example, manufacturers of medical devices have been challenged in preventing or lessening implants from perforating vessel walls. As perforation of vessel walls are undesireable, there have been needs for an effective vena cava filter having features that lessen the likelihood of perforation and that can be removed after the underlying medical condition has passed.
Embodiments of the present invention generally provide a removable vena cava filter having features that prevent or lessen perforation of a body vessel when implanted therein.
In one embodiment, the present invention provides a removable filter for capturing thrombi in a body vessel. The filter comprises a plurality of primary struts comprising proximal and distal portions. Each proximal portion has a first end, wherein the first ends are attached together along a longitudinal axis. Each primary strut extends arcuately along the longitudinal axis and linearly radially. The distal portions of the primary struts are configured to expand in the body vessel, engaging the distal hooks with the body vessel. Each distal portion integrally extends from the proximal portion to a plurality of distal hooks. The distal hooks are substantially equal in size relative to each other.
In this embodiment, the filter further comprises a plurality of secondary struts having connected ends attached to each other along the center point. Each secondary strut extends arcuately along a longitudinal center plane and linearly along a diametric center plane from the connected end to a free end to centralize the filter in the expanded state in the body vessel.
In another embodiment, the filter further comprises a hub that axially houses the primary strut first ends and secondary strut first ends and a retrieval hook that extends from the hub opposite the plurality of primary struts for removal of the filter from the body vessel.
Further aspects, features, and advantages of the invention will become apparent from consideration of the following description and the appended claims when taken in connection with the accompanying drawings.
a is a side perspective view of one embodiment of the vena cava filter in an expanded state;
b is a side view of a primary strut of the filter in
c is a side view of the vena cava filter of
a is a cross-sectional view of the vena cava depicting the filter partially deployed leading with the removal hook;
b is a cross-sectional view of the vena cava depicting the filter partially deployed leading with the distal hooks;
a is a cross-sectional view of the vena cava of
b is a cross-sectional view of the vena cava of
a is a cross-sectional view of a body vessel in which a retrieval sheath engages primary struts of the filter in
b is a cross-sectional view of a body vessel in which the retrieval sheath includes the filter in the collapsed state for removal.
In accordance with one embodiment of the present invention,
a illustrates a filter 10 in an expanded state and comprising four primary struts 12 each having first ends that emanate from a hub 11. Hub 11 attaches by crimping first ends 14 of primary struts 12 together at a center point A in a compact bundle along a central or longitudinal axis X of the filter. The hub 11 has a minimal diameter for the size of wire used to form the struts.
Preferably, the primary struts 12 are formed of a superelastic material, stainless steel wire, Nitinol, cobalt-chromium-nickel-molybdenum-iron alloy, or cobalt chrome-alloy or any other suitable superelastic material that will result in a self-opening or self-expanding filter. In this embodiment, the primary struts 12 are preferably formed from wire having a round cross-section with a diameter of at least about 0.015 inches. Of course, it is not necessary that the primary struts have a round or near round cross-section. For example, the primary struts 12 could take on any shape with rounded edges to maintain non-turbulent blood flow therethrough.
As shown in
As shown in
The distal hooks 26, 27 are configured to avoid or lessen perforation of the vessel wall by having more surface area contact with the vessel wall than a single distal hook would otherwise have. As shown in
Preferably, the thicknesses of each of the distal hooks are substantially the same as the thickness of respective primary strut. It is also preferred that the distal hooks of each primary strut are substantially the same in size, e.g., length and thickness. However, it is understood that each set of plurality of distal hooks of a particular primary strut may differ in size from another primary strut. Thus, each primary strut may comprise distal hooks that differ in size from distal hooks of another primary strut.
The primary struts 12 are configured to move between an expanded state for engaging the distal hooks 26, 27 with the body vessel and a collapsed state for filter retrieval or delivery. In the expanded state, each arcuate segment 16 extends arcuately along a longitudinal axis X (as shown in
As discussed in greater detail below, the soft bends of each arcuate segment 16 allow each primary strut 12 to cross another primary strut 12 along the longitudinal axis X in the collapsed state such that each distal hook 26 faces toward the longitudinal axis X for filter retrieval or delivery.
When the filter 10 is deployed in a body vessel, the distal hooks 26, 27 engage the walls of the body vessel to define a first axial portion to secure the filter in the body vessel. The distal hooks 26, 27 prevent the filter 10 from migrating from the delivery location in the body vessel where it has been deposited. The primary struts 12 are shaped and dimensioned such that, when the filter 10 is freely expanded, the filter 10 has a diameter of between about 25 mm and 45 mm and a length of between about 3 cm and 7 cm. For example, the filter 10 may have a diameter of about 35 mm and a length of about 5 cm. The primary struts 12 have sufficient spring strength that when the filter is deployed the distal hooks 26, 27 will anchor into the vessel wall.
In this embodiment, the filter 10 includes a plurality of secondary struts 30 having connected ends 32 that also emanate from hub 11 as shown in
The secondary struts 30 may be made from the same type of material as the primary struts 12. However, the secondary struts 30 may have a smaller diameter, e.g., at least about 0.012 inches, than the primary struts 12. In this embodiment, each of the secondary struts 30 is formed of a first arc 40 and a second arc 42. The first arc 40 extends from the connected end 32 away from the longitudinal axis X. The second arc 42 extends from the first arc 40 towards the longitudinal axis X. As shown, two secondary struts 30 are located on each side of one primary strut 12 to form a part of a netting configuration of the filter 10. The hub 11 is preferably made of the same material as the primary struts and secondary struts to minimize the possibility of galvanic corrosion or molecular changes in the material due to welding.
When freely expanded, free ends 34 of the secondary struts 30 will expand radially outwardly to a diameter of about 25 mm to 45 mm. For example, the secondary struts 30 may expand radially outwardly to a diameter of between about 35 mm and 45 mm. The second arcs 42 of the free ends 34 engage the wall of a body vessel to define a second axial portion where the vessel wall is engaged. The secondary struts 30 function to stabilize the position of the filter 10 about the center of the body vessel in which it is deployed.
As a result, the filter 10 has two layers or portions of struts longitudinally engaging the vessel wall of the body vessel. The length of the filter 10 is preferably defined by the length of a primary strut 12. Furthermore, the diameter of the hub 11 is defined by the size of a bundle containing the primary struts 12 and secondary struts 30. In this embodiment, the eight secondary struts 30 minimally add to the diameter of the hub 11 or the overall length of the filter 10, due to the reduced diameter of each secondary strut 30. This is accomplished while maintaining the filter 10 in a centered attitude relative to the vessel wall and formed as a part of the netting configuration of the filter 10. As shown, removal hook 46 extends from hub 11 opposite primary and secondary struts 12 and 30.
In this embodiment, each arcuate segment 16 has a thickness of at least about 0.015 inch and a tensile strength of between about 285,000 pounds per square inch (psi) and 330,000 psi. Each distal hook 26 is integral with the arcuate segment 16 and has the thickness and the tensile strength of the arcuate segment. Each secondary strut 30 has a thickness of at least about 0.012 inch and a tensile strength of between about 285,000 psi and 330,000 psi.
c illustrates the filter 10 in a collapsed state disposed in a delivery/retrieval tube 94 for delivery or retrieval. As shown, the filter 10 is shaped for each primary strut 12 to cross another primary strut 12 along the longitudinal axis X. As a result, in the collapsed state, the distal hooks 26, 27 are configured to invert or inwardly face the longitudinal axis X for retrieval and delivery of the filter 10. This inverted or inwardly facing configuration of the distal hooks 26, 27 allows for simplified delivery and retrieval of filter 10. For example, a concern that the distal hooks 26, 27 may scrape, scratch, or tear the inner wall of a delivery/retrieval tube is eliminated, since the filter 10 of the present invention is shaped to have the distal hooks 26, 27 face each other in the collapsed state. Merely one delivery/retrieval tube with a loop snare mechanism may be used to deliver or retrieve the filter 10 of the present invention.
Moreover, in the collapsed state, each primary strut 12 is configured to cross another primary strut 12 along the longitudinal axis X such that the arcuate segments 16, proximal portions 20 or distal portions 23, occupy a first diameter D1. In this embodiment, the first diameter is greater than a second diameter D2 occupied by the distal hooks 26, 27 for filter retrieval or delivery. It has been found that the first diameter of the arcuate segments 16 serves to clear a path of retrieval, reducing radial force from the sheath or body vessel on the distal hooks 26, 27 during removal of the filter 10 from a patient. Reducing the radial force on the distal hooks 26, 27 assists in preventing the distal hooks 26, 27 from scraping, scratching, or tearing the inner wall of a sheath during removal of the filter 10 from a patient.
In this embodiment,
In
During deployment, the secondary struts 30 expand first to centralize or balance the filter within the vessel. When the free ends of the secondary struts emerge from the distal end of either of the delivery tubes 48 or 50, the secondary struts 30 expand to an expanded position as shown in both
When the filter 10 is fully expanded in the vena cava, the distal hooks 26, 27 of the primary struts 12 and the second arcs 42 of the secondary struts 30 are in engagement with the vessel wall. The distal hooks 26, 27 of the primary struts 12 have anchored the filter 10 at the location of deployment in the vessel, preventing the filter 10 from moving with the blood flow through the vessel. As a result, the filter 10 is supported by two sets of struts that are spaced axially along the length of the filter.
a and 5 illustrate the filter 10 fully expanded after being deployed in inferior vena cava 52. As shown, the inferior vena cava 52 has been broken away so that the filter 10 can be seen. The direction of the blood flow BF is indicated in
The spring biased configuration of the primary struts 12 further causes the distal hooks 26, 27 to engage the vessel wall and anchor the filter at the location of deployment. After initial deployment, the pressure of the blood flow on the filter 10 contributes in maintaining the hooks 26, 27 anchored in the inner lining of the inferior vena cava 52. As seen in
As seen in
a depicts a netting configuration or pattern formed by the primary struts 12, secondary struts 30, and the hub 11 relative to radial axis R. The netting pattern shown in
a depicts the netting pattern including primary struts and secondary struts at substantially equal angular space relative to each other. The netting pattern provides an even distribution between the primary and secondary struts to the blood flow, increasing the likelihood of capturing thrombi. However, as shown in
a illustrates part of a retrieval device 65 being used in a procedure for removing the filter 10 from the inferior vena cava 52. In this example, the retrieval device 65 is percutaneously introduced into the superior vena cava via the jugular vein. In this procedure, a removal catheter or sheath 68 of the retrieval device 65 is inserted into the superior vena cava. A wire 70 having a loop snare 72 at its distal end is threaded through the removal sheath 68 and is exited through the distal end of the sheath 68. The wire 70 is then manipulated by any suitable means from the proximal end of the retrieval device such that the loop snare 72 captures the removal hook 46 of the filter 10. Using counter traction by pulling the wire 70 while pushing the sheath 68, the sheath 68 is passed over the filter 10.
As the sheath 68 passes over the filter 10, the primary struts 12 and then the secondary struts 30 engage the edge of the sheath 68 and are caused to pivot or undergo bend deflection at the hub 11 toward the longitudinal axis of the filter. The pivoting toward the longitudinal axis causes the ends of the struts 12 and 30 to be retracted from the vessel wall. In this way, only surface lesions 74 and small point lesions 76 on the vessel wall are created in the removal procedure. As shown, the surface lesions 74 are created by the ends of the secondary struts 30 and the small point legions 76 are created by the distal hooks 26, 27 of the primary struts 12. However, it is to be noted that any other suitable procedure may be implemented to remove the filter from the patient.
Although the embodiments of this device have been disclosed as being constructed from wire having a round cross section, it could also be cut from a tube of suitable material by laser cutting, electrical discharge machining or any other suitable process.
The primary and secondary struts can be formed from any suitable material that will result in a self-opening or self-expanding filter, such as shape memory alloys. Shape memory alloys have the desirable property of becoming rigid, that is, returning to a remembered state, when heated above a transition temperature. A shape memory alloy suitable for the present invention is Ni—Ti available under the more commonly known name Nitinol. When this material is heated above the transition temperature, the material undergoes a phase transformation from martensite to austenic, such that material returns to its remembered state. The transition temperature is dependent on the relative proportions of the alloying elements Ni and Ti and the optional inclusion of alloying additives.
In other embodiments, both the primary struts and the secondary struts are made from Nitinol with a transition temperature that is slightly below normal body temperature of humans, which is about 98.6° F. Thus, when the filter is deployed in the vena cave and exposed to normal body temperature, the alloy of the struts will transform to austenite, that is, the remembered state, which for the present invention is an expanded configuration when the filter is deployed in the body vessel. To remove the filter, the filter is cooled to transform the material to martensite which is more ductile than austenite, making the struts more malleable. As such, the filter can be more easily collapsed and pulled into the sheath for removal.
In other embodiments, both the primary struts and the secondary struts 40 are made from Nitinol with a transition temperature that is above normal body temperature of humans, which is about 98.6° F. Thus, when the filter is deployed in the vena cave and exposed to normal body temperature, the struts are in the martensitic state so that the struts are sufficiently ductile to bend or form into a desired shape, which for the present invention is an expanded configuration. To remove the filter, the filter is heated to transform the alloy to austenite so that the filter becomes rigid and returns to a remembered state, which for the filter is a collapsed configuration.
While the present invention has been described in terms of preferred embodiments, it will be understood, of course, that the invention is not limited thereto since modifications may be made to those skilled in the art, particularly in light of the foregoing teachings.
Number | Date | Country | Kind |
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61/092765 | Aug 2008 | US | national |
This application claims the priority benefit of U.S. Provisional Application Ser. No. 61/092,765, filed on Aug. 29, 2008 entitled “VENA CAVA FILTER HAVING PLURALITY OF HOOKS,” the entire contents of which are incorporated herein by reference.
Filing Document | Filing Date | Country | Kind | 371c Date |
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PCT/US09/55381 | 8/28/2009 | WO | 00 | 5/2/2011 |