Abstract
The invention is directed to a method of non-invasively treating a varicose vein (2), for example the Great saphenous vein (GSV), wherein the vein or the vein system to be treated is divided into sections (6a, 6b, 6c, 6d) with a length (11) separated by a spacing (s1). The sections can be pre-defined before the treatment, for example to target a junction (4) to a tributary (3), or with respect to the sapheno-femoral junction (8), and can vary in length and location, for example to avoid a sensitive structure (7) such as nerves.
Claims
1.-27. (canceled)
28. A method of treating varicose veins by application of high intensity ultrasound, comprising the steps of identifying at least one first section of the vein to be treated treating the first section by applying HIFU emitted from a treatment head to the first section wherein an area neighboring the section is not treated with HIFU.
29. The method according to claim 28, wherein the at least one first section is part of a segment of the vein that is non-functional, and wherein at least a second section of the segment is not treated with HIFU.
30. The method according to claim 28, wherein the treated section is occluded.
31. The method according to claim 28, wherein the first section is treated without substantially moving the treatment head.
32. The method according to claim 28, wherein the treatment step is repeated at least once for a second section distanced from the first section.
33. The method according to claim 28, wherein the refluxing vein is the Great Saphenous Vein or the Anterior Accessory Saphenous Vein, wherein the first section begins close to the sapheno-femoral junction.
34. The method according to claim 33, wherein the length of the treated section is greater than 5 cm.
35. The method according to claim 33, wherein the length of the first section is chosen such as not to reach the level of the knee.
36. The method according to claim 28, wherein the refluxing vein is a perforator vein, wherein the first section is located close to the fascia.
37. The method according to claim 32, wherein at least one of the length and spacing of the sections is chosen such that sensitive structures such as nerves present along the vein are not subject to HIFU.
38. The method according to claim 32, wherein the refluxing vein to be treated extends in the thigh and in the calf.
39. The method according to claim 32, wherein the number, length and location of the treated sections is defined prior the treatment.
40. The method according to claim 32, wherein the number, length and location of the treated sections is adjusted during the treatment.
41. The method according to claim 40, wherein the length of a treated section is reduced during the treatment in dependence of a reduced visibility of the treated vein wherein the treatment head is moved distally in dependence of the reduced visibility of the vein and a new section is treated at a more distal location.
42. The method according to claim 32, wherein the treatments is controlled on the basis of at least one of the level of total delivered energy, absence of detectable flow in the vein, treatment duration, a total treated length, vein shrinkage, a predefined number of sections treated.
43. The method according to claim 32, wherein the sections are treated from the proximal side of the vein to the distal side of the vein.
44. The method according to claim 32, wherein the treatment starts in the distal side.
45. The method according to claim 32, wherein at least one section is placed to target a junction with a tributary.
46. The method according to claim 28, Wherein the occlusion of the junctions includes one of (i) treating only the vein at said junction, (ii) treating the vein and the tributary at said junction and (iii) treating only the tributary at the junction.
47. A device for treating a patient with HIM, the device comprising a memory unit display a control unit a treatment head with a transducer wherein the control unit is adapted to treat different sections of a vein system with different treatment characteristic, wherein the memory unit is adapted so save the treatment characteristics for each treated section, the display is adapted to display the treatment characteristics for each section, and the control unit is further adapted to compute mean or median values of the treatment characteristics of each treated section.
Description
[0070] In the following, the present invention is described with reference to the figures and preferred embodiments, showing:
[0071] FIG. 1a: schematically the concept of a sectional treatment with several sections.
[0072] FIG. 1b: schematically the concept of a sectional treatment with one section.
[0073] FIG. 2a: schematically the treatment of a vein without particularly adjusting the sections with respect to the tributaries.
[0074] FIG. 2b: schematically a sectional treatment of a vein wherein both the vein and the tributaries are treated.
[0075] FIG. 2c: schematically a sectional treatment of a vein wherein only the tributaries are treated.
[0076] FIG. 2d: schematically a sectional treatment of a vein wherein only the tributaries are treated at the junctions.
[0077] FIG. 2e: schematically a sectional treatment of a vein wherein only the tributaries are treated.
[0078] FIG. 3: schematically a device for carrying out the present invention.
[0079] FIG. 4: schematically by means of a flow chart the steps of a method according to the invention.
[0080] FIGS. 5a-5b: a detailed view of a sectional treatment.
[0081] FIG. 1a shows schematically a method according to the invention, wherein several sections 6a, 6b, 6c, and 6d are treated along a vein system 1,2. Here, the refluxing vein 2 is the Great Saphenous Vein (GSV) or the Anterior Accessory Saphenous Vein (AASV) one treated section 6d begins as close as possible to the sapheno-femoral junction 8, preferably at a distance d1 smaller than 2 cm. The length L1 of the treated section 6d neighbouring the sapheno femoral junction 8 is bigger than the other treated sections. Alternatively, this section could also have the same size but the delivered energy could be higher, or the linear endovenous energy density could be higher than for the other sections 6a, 6b, and 6c. In the shown embodiment, the treated sections have equal spacings s1, but could also be of unequal spacing and/or lengths. In between the sections 6c and 6b, a nerve 7 is close to the refluxing vein 2. The position, length, and/or spacing of the treated sections is thus adjusted to avoid exposing and/or harming the nerve 7, which is a sensitive structure.
[0082] However, in the shown embodiment, the sections are not specifically arranged with respect to the junctions 4 between the tributaries 3 and the refluxing vein 2. Thus, one section 6b lies at a junction 4, while the other sections 6a, 6c, and 6d do not. The sections 6a, 6b, 6c, and 6d are spread equally along the treated vein 2. Here, the treatment is started with proximal section 6d, while an area neighboring the section 9 is not treated. Alternatively, the treatment can be started with a distal section 6a.
[0083] FIG. 1b shows a vein system with a vein 1, and an insufficient vein 2 fed by smaller veins 3. According to the embodiment of the invention shown in FIG. 1b, only one section 6e of the vein 2 is treated.
[0084] Here, the refluxing vein 2 is the Great Saphenous Vein (GSV) (or alternatively the Anterior Accessory Saphenous Vein (AASV)). The treated section begins as close as possible to the sapheno-femoral junction 8, preferably at a distance d2 smaller than 2 cm. The length L2 of the treated section is larger than 5 cm, most preferably larger than 10 cm, but does not reach the level of the knee (not shown in FIG. 1b).
[0085] FIGS. 2a-2e show several other embodiments of the method according to the invention where the vein 2 to be treated has several tributaries 3.
[0086] In FIG. 2a, a treatment of a refluxing vein 2 with several tributaries 3 is schematically shown. The sectional treatment approach is applied independently from the location of the tributaries 3, but the treatment is begun at the sapheno-femoral junction 8. The sections 6f, 6g, 6h, and 6j are spread uniformly along the treated vein 2 and are adapted in the lengths L3 and spacing s3 irrespective of the position of the tributaries 3. Thus, in this particular embodiment, section 6g is located at a junction 4 between the refluxing vein 2 and a tributary 3, while the other sections 6f, 6h, and 6j are not. In this embodiment, only the vein 2 is treated even if a section 6g lies at a junction 4, meaning that the tributary 3 is not treated.
[0087] FIG. 2b shows schematically an embodiment of the method according to the invention, where sections 6k and 6l are placed to target the junctions 4 with the tributaries 3. This allows for avoiding a recanalization due to the blood inflow or a bypass of the treated sections which would transmit the increased pressure to the bottom of the leg. Both the vein 2 and the tributaries 3 are treated in the junction areas 4. Furthermore, in the shown embodiment, the sections have a length, spacing, and placement irrespective of the distance d3 to the sapheno-femoral junction 8 and the vein 1. However, the sections 6k, 61 are located such that they coincide with the junctions 4 and are thus not necessarily spread uniformly along the treated vein 2.
[0088] FIG. 2c shows schematically another embodiment of the method according to the invention where only the tributaries 3 close to the junctions 4 are treated. The sections 6m and 6n lie on the tributaries 3, while the refluxing vein 2 itself is not treated.
[0089] FIG. 2d shows schematically an embodiment of the method according to the invention, where at each junction area 4a, 4b, 4c, and 4d, only the tributary portion of the junction is treated. As such, only the part of the refluxing vein 2 that is directly adjacent to the vein 1 is treated and section 6p is placed accordingly. Similarly, the sections 6q, 6r, and 6s are placed such that the tributaries 3a, 3b, and 3c are treated at the junction area 4b, 4c, and 4d where they are connected to the refluxing vein 2. In contrast to FIG. 2c, the refluxing vein 2 is also treated with a section 6p at the junction 4a between the vein 1 and the refluxing vein.
[0090] FIG. 2d corresponds to a preferred method of treatment of a GSV or an AASV. This embodiment includes treatment of at least one section at the sapheno-femoral junction 8 and occlusion of some of, preferably all, the tributaries 3 upstream to or at the junctions with the GSV or AASV.
[0091] Preferably, the length 15 of the treated section 6p at the sapheno-femoral junction 8 is larger and/or the delivered energy is higher, and/or the linear endovenous energy density is higher for the other sections 6q, 6r, and 6s.
[0092] Similarly, if a tributary 3a is larger than the other tributaries 3b and 3c, the length L6 of the treated section 6q at the junction 4b is preferably larger and/or the delivered energy is preferably higher, and/or the linear endovenous energy density is preferably higher than for the sections 6r and 6s at the sections 4c and 4d.
[0093] FIG. 2e schematically shows another preferred embodiment of the method according to the invention, wherein only the tributaries 3 are treated. The sections 6t, 6u, and 6v are located at a distance d4, d5, and d6, from the junction areas 4, respectively.
[0094] FIG. 3 shows schematically a device 42 which can be used to perform the method according to the invention, wherein a patient 31 is treated by HIFU. The device comprises a treatment head 34 which is placed on the patient's leg 32 below his knee 41. Here, some of the treated sections lie in the calf and thus, some areas below the knee are treated. It is possible, however, to only treat sections in the thigh. In this particular embodiment of the device, the treatment head 34 comprises a balloon 36 that is in contact with the patient's leg 32 and enables acoustic coupling. The treatment head 34 comprises a transducer 35 for emitting ultrasound waves. A control unit 40 controls the emission of HIFU pulses. A memory unit (not shown) saves the number of sections and at least some of the treatment characteristics for each section. In this exemplary embodiment, the memory unit saves the number of sections that were treated along with their location and pulse power, pulse length, and the number of pulses. In this particular case, other treatment characteristics are not of interest, but it is clear to a person skilled in the art that the memory may also save other treatment characteristics as required. The treatment head 34 is connected to the control unit 40 through a robotic arm 33. The arm 33 comprises mechanical joints 39 in order to perform a controlled movement 38 of the arm. In this embodiment, the device comprises a user interface in the form of a display 37. The display displays to a user the treatment characteristics that were saved in the memory. Here, this happens in the form of a schematic diagram which shows the location of the sections on a dedicated part of the screen. In addition, the control unit also computes the average pulse power and the standard deviation, which is classified into ranges associated to a color. The different sections on the displays are thus colored, wherein each color represents a pulse power range. The other treatments characteristics are displays as alphanumerical digits on the display. They may, however, also be displayed symbolically by, for example, a number of dots in the sections, the thickness of a line, or others.
[0095] Treatment parameters for the sections Include, but are not limited to, frequency, number of pulses, energy, pulse spacing, duration, LEED (W/cm), and fluence (W/cm.sup.2).
[0096] FIG. 4 shows schematically, by way of a flow chart, the steps of a method according to the invention. In a first step 51, a section to be treated is identified and the treatment parameters are determined. Here, the treatment parameters include the frequency, number of pulses, and total delivered energy for all sections to be treated. Other parameters can be included in addition or as an alternative to the parameters used here. A treatment step 52, comprising the emission of a HIFU pulses with the pre-determined frequency is performed subsequently without moving the treatment head. Alternatively, multiple HIFU pulses can be emitted in one treatment step. A further step consists in comparing the treatment with a pre-determined stopping condition 58. Here, the treatment a section shall be terminated upon delivery of a total amount of energy. Alternatively, stopping parameters could total number of HIFU pulses, total length of the treated section, duration of the treatment, and others. If the condition for stopping 53 is not met, the visibility of the treated vein is checked 54. If is well visible 56, the treatment is continued by performing another treatment step 52. If the vein is not visible 57, the treatment head is moved, preferably distally, in a movement step 55, for example to treat another section. Subsequently, the treatment is continued with another treatment step 52. If and when the stopping condition 53 is met 58, the treatment of section is stopped 59. If another section is planned to be treated 60, the procedure is repeated 62 with another treatment step 52 for the new section. In this embodiment, the treatment parameters are pre-defined for the next section and another planning and identifying step 51 can be omitted. However, it would also be possible to identify a section and/or determine the treatment parameters after a section has already been treated. If no new section is to be treated, the procedure is finished 61.
[0097] FIG. 5a shows schematically a varicose vein 100 before a treatment. In healthy parts of the vein 101′,101″, the vein 100 comprises valves 102 that are functional and prevent the flow of blood in a direction opposite the natural direction of flow 105 of blood. The vein 100 has a varicose segment 103 where a diameter of the vein is extended and the vein 100 dilated. The valves 105 do not close in the varicose segment 103. Therefore, blood may flow against the normal direction 105.
[0098] FIG. 5b schematically shows the vein 100 after a treatment according the invention. A section 104′ at a distal end, i.e. at a downstream end of the segment 103, has been treated with HIFU and is completely occluded as a result. A second section 104″ adjacent to the first section 104′ is untreated. The occlusion of first section 104′ is sufficient to restore the functionality of the vein system. Additionally, it would be possible to treat at least a part of the second section 104″ with a sclerosant.
