READY-MADE BIOMEDICAL DEVICES FOR IN VIVO WELDING

Abstract

Disclosed herein is a unique family of medical implants which are engineered outside of a subject's body into a form which may be manipulated in vivo. The implants comprise a region of at least one weldable material which allows welding of the implant to a polymeric material introduced into the body prior to, together with or after the implant has been positioned.

Claims

1-31. (canceled)

32. A kit for in vivo assembly of an implantable article, the kit comprising two or more article segments suitable for assembly into said article, in vivo, at least one of said article segments comprising a material selected from the group consisting of a metal, a ceramic material and a polymer having a softening temperature above 40° C., at least one segment having at least one material region selected of a weldable material, the kit further comprising instructions for assembling said article in vivo.

33. The kit according to claim 32, wherein each of said article segments has at least one material region selected of a weldable material.

34. The kit according to claim 32, wherein each of said article segments comprises a material region of a material selected from the group consisting of a metal, a ceramic material and a polymer having a softening temperature above 40°, and has at least one material region selected of a weldable material.

35. The kit according to claim 32, wherein at least one of the segments is constructed entirely of a weldable polymeric material.

36. The kit according to claim 32, wherein each of said article segments is suited for in vivo welding via each of said at least one material region selected of a weldable material present on each segment.

37. The kit according to claim 32, wherein each article segment comprises at least one region of at least one weldable material.

38. The kit according to claim 32, wherein each article segment is appended or associated with at least one weldable material, said weldable material having been associated with said article segment ex vivo.

39. The kit according to claim 32, wherein one or more of the article segments is manipulated ex vivo to receive thereonto at least one polymeric material, and each of the remaining article segments comprises at least one region of at least one weldable material.

40. The kit according to claim 32, wherein one or more of the article segments is manipulated ex vivo to receive thereonto at least one polymeric material, and each of the remaining article segments is of at least one weldable material.

41. The kit according to claim 32, wherein the weldable material is selected from the group consisting of polymeric materials having a softening temperature between about 37 and 40° C.

42. An implantable article constructed or comprising a material selected from the group consisting of a metal, a ceramic material and a polymer having a softening temperature above 40° C., said article being modified to receive, by welding, onto at least a region thereof an element comprising a polymeric material, wherein welding is achieved in vivo.

43. The article according to claim 42, wherein said at least a region is associated with a polymeric material, said polymeric material having been associated with said region ex vivo, said element being capable of welding to said element in vivo.

44. The article according to claim 43, wherein said polymeric material is associated with a region on said implantable article which is resistant to in vivo welding.

45. An implant when positioned in an animal body, the implant comprising a material region constructed or comprising a material selected from the group consisting of a metal, a ceramic material and a polymer having a softening temperature above 40° C., said material region being associated with a first material, said first material being associated with a second material, wherein association of said region with the first material is achieved ex vivo and wherein association of said first material with said second material is achieved in vivo.

46. The article according to claim 45, being in a form selected from the group consisting of an implant, a device, a system, a prosthesis, an instrument and an accessory.

47. The article according to claim 46, having a metallic backbone.

48. The article according claim 47, associated with at least one weldable polymeric material, said material being fused, welded, incorporated, attached, woven, knitted, braided, or coated, ex vivo, to a surface region of the article.

49. The article according to claim 48, wherein the polymeric material is a polymer formed of an oligomer selected from the group consisting of ethylene glycol dimethacrylate EGDMA, triethylene glycol dimethacrylate TEGDMA, polyethylene glycol PEG 600diacrylate, polypropylene glycol PPG500diacrylate, PEG 600dimethacrylate, PPG500dimethacrylate, double-bond end capped PEG/PPG diblocks and triblocks, low molecular weight polyamides, polyurethanes and polyesters.

50. The article according to claim 42, wherein the weldable material is selected from the group consisting of polymeric materials having a softening temperature between about 37 and 40° C.

51. A method for assembling an implantable article in vivo, the method comprising: delivering into a body region a first segment of said article and positioning said segment at a desired position; delivering, in sequence, one or more segments; and in vivo welding each segment to a previous segment by welding; wherein at least of said article segments is constructed of or comprises a material selected from the group consisting of a metal, a ceramic material and a polymer having a softening temperature above 40° C., and having at least one material region selected of a weldable material, wherein welding is achieved by softening said at least one material region on each of two of the segments to be welded, permitting association of each of the article segments and article assembly; and wherein, optionally, the first segment of said article is constructed of a material selected from the group consisting of a metal, a ceramic material and a polymer having a softening temperature above 40° C., and having at least one material region selected of a weldable material.

Description

BRIEF DESCRIPTION OF THE DRAWINGS

[0174] In order to better understand the subject matter that is disclosed herein and to exemplify how it may be carried out in practice, embodiments will now be described, by way of non-limiting example only, with reference to the accompanying drawings, in which:

[0175] FIG. 1 DSC thermogram of a welding product of an elastomeric polyurethane (CLUR) and a stiff polymethacrylate (PEMA).

[0176] FIGS. 2A-F exemplify a welding method accoridng to the invention using a transparent Tygon model system and a tubular thin device with white holes, shown in FIG. 2A. In FIG. 2B, the device is inserted within the “Tygon vessel”, and in FIG. 2C this first layer of the device is easily expanded and attached to the luminal surface of the “vessel”. In FIG. 2D, the balloon is deflated and removed, while FIGS. 2E and 2F, demonstarte the deployment of a second layer, white and longer, and its subsequent welding together to the first layer already deployed and expanded at the site of performance.

[0177] FIGS. 3A-F provide photos of an exemplary system according to the invention constructed of two different metallic structures, one flat (FIGS. 3A-C) and one tubular (FIGS. 3D-F), demonstrating the in vivo welding concept.

[0178] FIG. 4 shows a model system, mimicking the anatomy of aorta and one renal artery.

[0179] FIG. 5 illustrates another embodiment of the invention.

[0180] FIGS. 6A-B demonstrate a stent according to the invention, wherein in FIG. 6A a coating of a strut of a stent with an in vivo weldable polymer is shown under amplification, and in FIG. 6B the thickness of the coating is shown.

[0181] FIG. 7 shows welding of an in vivo weldable patch.

[0182] FIGS. 8A-D follow a measurement of force required to pull out a patch, welded to a stent (FIGS. 8A-B), using a tensiometer (FIG. 8C). FIG. 8D shows the measured load.

[0183] FIGS. 9A-C show manual extension of a patch welded to the stent.

[0184] FIG. 10 shows the last stage of a mechanical testing of the strength of the welding bond between the stent and the patch.

[0185] FIG. 11 provides a SEM micrograph of a coated stent strut and its welding to an in vivo polymeric patch.

DETAILED DESCRIPTION OF EMBODIMENTS

EXAMPLES

[0186] Reference is now made to the following examples, which together with the above descriptions illustrate some embodiments of the invention in a non limiting fashion.

Materials and Methods

Materials:

[0187] Benzoyl peroxide was obtained from Fluka. [0188] c-Caprolactone was obtained from ACROS Organics. [0189] Ethylene glycol dimethacrylate (EGDMA) was obtained from Aldrich. [0190] Hexamethylene diisocyanate (HDI) was obtained from Aldrich. [0191] 2-Hydroxyethyl methacrylate (HEMA) was obtained from Aldrich. [0192] L-lactide and D-lactide were obtained from Boehringer Ingelheim. [0193] D,L-lactide was obtained from ACROS Organics. [0194] N,N-dimethyl-p-toluidine was obtained from Aldrich. [0195] Polyacrylic acid (PAA) was obtained from Aldrich. [0196] Polycaprolactone (PCL2000, PCL1250 and PCL530) was obtained from Aldrich. [0197] Polyethylene glycol 2000 (PEG2000) was obtained from Aldrich. [0198] Polyethylene glycol 6000 (PEG2000) was obtained from Merck. [0199] Polymethyl methacrylate (PMMA) was obtained from Aldrich. [0200] Poly(styrene-methyl methacrylate) (SMMA) was obtained from Aldrich. [0201] Polytetramethylene glycol (PTMG650 and PTMG1000) was obtained from Aldrich. [0202] Stannous 2-ethyl hexanoate was obtained from Sigma.

Methods:

[0203] Polymer molecular weights were characterized by Gel Permation Chromatography (GPC), using a Waters 2690 Separation Module with a Waters 410 Differential Refractometer and Millenium Chromatography Manager.

[0204] Thermal properties and crystallinity were characterized using a Mettler TA 3000 Differential Scanning calorimeter.

[0205] Mechanical properties were determined using an Instron apparatus.

Example 1

Polymer Syntheses

Polycaprolactone Polyurethane (CLUR)

[0206] Polycaprolactone polyurethane co-polymers are generally prepared by co-polymerizing a polycaprolactone-based polymer with hexamethylene diisocyanate, following the exemplary procedures described hereinafter. The polycaprolactone chain is terminated with functional groups that will allow it to react with the diisocyanate, for example, hydroxy, amine, thiol or carboxylic acid groups.

[0207] The polycaprolactone-based polymers PCL2000, PCL1250 and PCL530 were copolymerized with hexamethylene diisocyanate (HDI) to obtain copolymers referred to herein as CLUR (caprolactone urethane) polymers.

[0208] As an example, the synthesis of CLUR2000 from PCL2000 and HDI is described in detail as follows.

[0209] 50.0 grams of OH-terminated PCL2000 was dried at 120° C. under a vacuum for 2 hours with magnetic stirring. Hexamethylene diisocyanate and stannous 2-ethyl hexanoate were added to the reaction mixture at molar ratios of 1:1 (to PCL2000) and 1:100 (to PCL2000), respectively, and reacted at 90° C. for 30 minutes with mechanical stirring under a dry nitrogen atmosphere. The obtained product was dissolved in 150 ml dry dioxane and precipitated in 1200 ml petroleum ether 40-60. The polymer referred to herein as CLUR2000, was then filtered and dried under a vacuum at room temperature for 24 hours.

[0210] Using essentially the same procedures, various CLUR polymers were prepared using PCL diol segments, from PCL530 to PCL 12000.

[0211] The molecular weights, polydispersity indices (PDI), thermal properties and mechanical properties of a few of the CLUR polymers are shown in Table 1.

TABLE-US-00001 TABLE 1 Properties of CLUR polymers Crystal- Mn MW Tm linity Modulus Polymer (g/mol) (g/mol) PDI (° C.) (%) (MPa) CLUR530 126,200 137,300 1.1 40 11 48 ± 8 CLUR1250 98,400 111,500 1.1 38 16 32 ± 6 CLUR2000 107,400 121,400 1.1 48 26 183 ± 6  CLUR530- 120,000 130,500 1.1 36 14 14 ± 3 2000 1:1

[0212] In comparison, PCL2000 exhibited a Tm of 59° C. and a crystallinity of 51%.

[0213] CLUR2000 exhibited water absorption of 3-5%.

Poly(caprolactone-ethylene glycol) polyurethane (e-CLUR):

[0214] Poly(caprolactone-ethylene glycol) polyurethane co-polymers are generally prepared by co-polymerizing a polycaprolactone-based polymer with a polyethylene glycol and hexamethylene diisocyanate, following the exemplary procedures described hereinafter. The preparation follows a similar chemistry as the preparation of CLUR polymers described above.

[0215] Polycaprolactone-based polymers were copolymerized with polyethylene glycol (2 kDa or 6 kDa) and hexamethylene diisocyanate (HDI), to obtain copolymers referred to herein as e-CLUR polymers.

[0216] e-CLUR2000 was prepared using various PEG:PCL molar ratios. The synthesis of e-CLUR2000 with a 1:10 PEG:PCL molar ratio is described in detail as follows.

[0217] 25.0 grams of OH-terminated PCL2000 and 2.5 grams of PEG2000 were dried at 120° C. under a vacuum for 2 hours with magnetic stirring. Hexamethylene diisocyanate (HDI) and stannous 2-ethyl hexanoate were then added to the reaction mixture at molar ratios of 1:1 and 1:100 (to total PCL2000 +PEG2000), respectively, and reacted at 90° C. for 30 minutes with mechanical stirring under a dry nitrogen atmosphere. The obtained product was dissolved in 150 ml dry dioxane and precipitated in 1200 ml petroleum ether 40-60. The e-CLUR2000 polymer was then filtered and dried under a vacuum at room temperature for 24 hours.

[0218] Using essentially the same procedures, e-CLUR2000 (e-CLUR2K-2K) was prepared using 2:10 or 3:10 PEG:PCL molar ratios. In addition, e-CLUR2K-6K was prepared using PCL2000 and PEG6000.

[0219] The molecular weights, polydispersity indices (PDI), thermal properties and mechanical properties of the e-CLUR polymers are shown in Table 2.

TABLE-US-00002 TABLE 2 Properties of e-CLUR polymers Polymer (molar % of PEG relative Mn MW Tm Crystallinity to PCL) (g/mol) (g/mol) PDI (° C.) (%) Modulus (MPa) e-CLUR2K-2K (10%) 86,000 103,900 1.2 46 27 194 ± 17 e-CLUR2K-2K (20%) 98,900 112,600 1.1 48 26 187 ± 14 e-CLUR2K-2K (30%) 90,400 106.600 1.2 47 21 147 ± 6  e-CLUR2K-6K (10%) 124,600 180,400 1.4 55 29 191 ± 15

[0220] e-CLUR polymers were considerable more hydrophilic than CLUR polymers, with e-CLUR2000 exhibiting water absorption of 120-150%, in contrast to the 3-5% absorption by CLUR2000.

Polytetramethylene Glycol (PTMG) Polyurethane:

[0221] Polytetramehylene glycol polyurethane co-polymers are generally prepared by co-polymerizing polytetramethylene glycol with a bifunctional molecule, such as a diisocyanate (e.g., hexamethylene diisocyanate), following the exemplary procedures described hereinafter.

[0222] 20.0 grams of PTMG650 were dried at 120° C. under a vacuum for 2 hours with magnetic stirring. Hexamethylene diisocyanate (HDI) and stannous 2-ethyl hexanoate were then added to the reaction mixture at molar ratios of 1:1 and 1:100 (to PTMG650), respectively, and reacted at 70° C. for 1 minute, with mechanical stirring under a dry nitrogen atmosphere. The obtained product was dissolved in 150 ml dry dioxane and precipitated in 1200 ml petroleum ether 40-60. The PTMG polyether-urethane polymer was then filtered and dried under a vacuum at room temperature for 24 hours.

[0223] The modulus of the PTMG650 polyurethane was 90±8 MPa.

Poly(caprolactone-lactic acid) polyurethane:

[0224] Poly(caprolactone-lactic acid) polyurethane co-polymers are generally prepared by co-polymerizing a polycaprolactone-based polymer with lactides (e.g., L-lactide, D-lactide or D,L-lactides) and hexamethylene diisocyanate, following the exemplary procedures described hereinafter.

[0225] Triblock copolymerss of polylactic acid-polycaprolactone-polylactic acid (PLA-PCL-PLA) were prepared by the ring opening polymerization of the lactide (L-lactide, D-lactide or D,L-lactides) initiated by the hydroxyl end groups of the PCL polymers. Chain extension of the triblock was then carried out using hexamethylene diisocynate (HDI), producing a polyester-urethane.

Poly(caprolactone-tetramethylene glycol) (PCL-PTMG) polyurethane:

[0226] Poly(caprolactone-tetramethylene glycol) polyurethane co-polymers are generally prepared by co-polymerizing a polycaprolactone-based polymer with polytetramethylene glycol and hexamethylene diisocyanate, following the exemplary procedures described hereinafter.

[0227] Triblock copolymers of polycaprolactone-polytetramethylene glycol-polycaprolactone (PCL-PTMG-PCL) are prepared by the ring opening polymerization of c-caprolactone initiated by the hydroxyl end groups of polytetramethylene glycol (e.g., PTMG1000). Chain extension of the triblock is then carried out using hexamethylene diisocyanate (HDI), producing a polyether-ester-urethane.

Example 2

Preparation of In Vivo Weldable Polymeric Components

[0228] The following describes exemplary methodologies used for preparing a device according some embodiments of the invention.

Dip Coating:

[0229] Devices were prepared by dip coating on a suitable mold, typically a cylindrical (4-10 mm diameter) polytetrafluoroethylene-coated mandrel, by slowly dipping the mold into a container containing a solution of 15-20% (w/w) polymer in chloroform, and then slowly withdrawing the mold.

[0230] Dipping and withdrawing the mold was performed at a constant velocity in order to obtain a uniform coating. An electronic motor was used to control the vertical movement and speed during the dipping and withdrawing of the mold. The polytetrafluoroethylene-coated mandrel was dipped 7 cm into the polymer solution, typically using a cross head speed (CHS) of 10 mm per minute.

[0231] For the formation of devices with a wall thickness of 100-700 μm, 3 to 10 dipping cycles were preformed, and the polytetrafluoroethylene-coated mandrel was then dried at room temperature overnight. After the evaporation was complete and the polymer was dry, the polymer tube was extracted from the mandrel.

[0232] CLUR2000 and e-CLUR2000 tubes prepared according to this method are shown below.

Electrospinning:

[0233] Electrospinning is a technique capable of producing nanometric fibers in a relatively well controlled and reproducible manner, producing highly porous 2-dimensional meshes as well as 3-dimensional constructs. Electrospinning is performed by applying a high voltage, using an electrode, to a capillary filled with the polymer fluid to be spun. The resulting fibers are collected on a grounded plate.

[0234] In an exemplary procedure, 8-15% (w/w) polymer solutions in chloroform were used, and the grounded plate was metal mandrel with a 5.5 mm diameter. The distance between the electrospinning needle and the collector mandrel was between 10-60 cm, depending on the thickness of the fibers to be obtained. Voltages in a range of from 5 kV to 30 kV were utilized for the formation of device walls with thicknesses in a range of from 100 μm and 700 μm, respectively.

Air Spray:

[0235] This technique is capable of forming nanometric and micrometric fibers in a relatively well controlled and reproducible manner, producing porous structures. The air spray technique is conducted by passing high pressure dry air through a capillary filled with a solution containing the polymer to form an aerosol, which is sprayed on a collector, such as a rotating polytetrafluorethylene-coated mandrel. In an exemplary procedure, 8-15% (w/w) polymer solutions in chloroform were used. The distance between the polymer spray gun and the collector mandrel varied between 10 cm and 60 cm, for the formation of the devices with wall thicknesses ranging from 100 μm to 700 μm. A 2 bar air pressure was applied.

[0236] The air spray technique produces a polymer in the form of a network of fibers.

[0237] The diameter of the fibers in the network depends on the type of polymer, its molecular weight, the concentration of the polymer in the aerosol solution, the solvent and the distance between the spray gun and the mandrel.

Example 3

Expanded In Vivo Weldable Polymeric Components

[0238] In vivo weldable polymeric components prepared from CLUR2000 using the air spray technique described above were expanded by inserting a balloon into the in vivo weldable polymeric component and inflating the balloon with warm (50° C.) water.

[0239] Due to the shape of the balloon, the tubular structures were expanded primarily in their mid-section. The less expanded edges of the tubular structures were cut off in order to better observe the expanded middle sections. The diameter of the tubular CLUR2000 structures could be increased considerably by expansion.

[0240] Additional air-sprayed CLUR2000 tubular structures were expanded as described above using a balloon which expanded the full length of the tubular structures. The dimensional changes of tubular structures as a result of expansion were then measured and are given in Table 3 below.

TABLE-US-00003 TABLE 3 Dimensional changes of tubular structures as a result of expansion Dimension Before expansion After expansion Change Length (cm) 7.5 7.5 +0% Inner diameter (mm) 5.3 14.1 +266% Outer diameter (mm) 8.2 15.3 +186% Thickness (mm) 1.4 0.6 −60%

[0241] The effect of expansion on the stiffness of the tubular structures was measured by determining the transverse moduli of the structures before and after expansion.

[0242] The mechanical properties of the tubular structure were also determined before and after expansion. The expansion described above increased the modulus from 26±2 MPa to 82±9 MPa, the strain at peak was reduced by expansion from 285±42% to 28±4%, and the stress at peak was increased by expansion from 4.9±0.2 MPa to 9.0±0.6 MPa.

[0243] Furthermore, the transition temperature was essentially unchanged by expansion, whereas the crystallinity of the polymer in the tubular structure increased from 26.12% before expansion to 31.59% after expansion.

[0244] Expanded tubular structures were re-warmed by reinserting the balloon into the lumen of the structure and filling the ballon with warm (50° C.) water. The balloon was then deflated by removal of the water at a rate of 0.25 ml/second. The tubular structure contracted as the balloon deflated, and the inner wall of the tubular structure remained attached to the balloon.

[0245] The expansion and contraction of the tubular structures were reversible over the course of at least 3 or 4 cycles of expansion and contraction.

Example 4

[0246] Polymer In Vivo Weldable Polymeric Components with an Adhesive Coating

[0247] A biocompatible adhesive substance in solid (e.g., powder), semisolid (e.g., gel) or liquid (e.g., solution) form is added to the outer surface of a polymer device, to produce an adhesive coating. The adhesive substance may be added as a layer on top of the outer surface of the polymer device or as a layer incorporated into the polymer of the polymer device.

[0248] In an exemplary procedure, biocompatible polyacrylic acid adhesive coatings were added to polymer devices prepared as described hereinabove, according to the following exemplary procedures.

[0249] A 2.5% solution of polyacrylic acid (typically having a molecular weight of 1,250,000) in ethanol is sprayed on the top of the outer layer of the device using the air spray technique described above. The device is then dried in a vacuum at room temperature in order to remove all traces of the solvent.

[0250] In an alternative method, powdered polyacrylic acid is homogeneously dispersed on the outer layer of the device. An additional thin layer of fibers is then sprayed over the polyacrylic acid particles in order to retain them on the outer surface of the device.

[0251] When the device is exposed to the biological aqueous environment, the polyacrylic acid coating becomes adhesive, which improves the ability of the device to adhere to tissue and remain in place.

Example 5

[0252] In Vivo Weldable Polymeric Components with Polyurethane Foam

[0253] Compressible cuffs are prepared from a foam comprising an elastomer (e.g., a polyurethane and/or a silicone elastomer) and attached (e.g., by crimping) to an outer surface of a polymeric component. The cuffs may cover the outer surface of the whole component or cover the ends of the device or following any other pattern.

[0254] In an exemplary procedure, highly compressible (95% compression) polyurethane foam cuffs were attached to the ends of an in vivo weldable polymeric component prepared as described hereinabove. The foam cuffs were attached by placing the cuffs around the edges of the in vivo weldable polymeric component and then crimping the edges of the in vivo weldable polymeric component, as shown below. The foam cuffs are for improving the ability of the device to grip to a surface, in specific embodiments.

Example 6

In Vivo Weldable Polymeric Components in a Branched In Vitro Aorta-Renal Ranch Model

[0255] This example aims at showing the ability of the polymeric components of this invention to easily, rapidly and strongly in vivo weld, under moderate heating and pressure, so they can be used for both shaping and welding a device in situ.

[0256] An in vivo weldable branched polymeric component was tested using an in vitro model of the aorta-renal branch, which was constructed from perpendicular polymeric tubes. The branched polymeric component was constructed in vivo from two in vivo weldable tubular structures prepared from CLUR2000 using the air-spray technique described above.

[0257] In the first step, an in vivo weldable polymeric component was deployed in the smaller tube of the in vitro model, which corresponds to the renal artery, and said in vivo weldable polymeric component had, in a specific embodiment, a tubular structure with an expanded annular area at the proximal end, namely that that faces the aorta. The branch component was placed in the tube of the in vitro model which corresponds to the renal artery, with the expanded annular area slightly protruding into the tube corresponding to the aorta. The purpose of this expanded annular area of the in vivo weldable component deployed in the renal artery is to generate a larger are of welding with the in vivo weldable component to be deployed in the aortic vessel, as described below.

[0258] The component was then expanded “in situ” by inserting a balloon into its lumen and inflating the balloon with warm (typically around 50° C.) water, until the branch component attached firmly to the walls of the “renal artery”. The balloon was also placed in the “aorta” adjacent to “renal artery”, and inflated with warm water until the expanded annular area of the branch component tightly attached to the wall of the “aorta”.

[0259] In the second step, a main in vivo weldable component was deployed in the tube of the in vitro model which corresponds to the aorta, perpendicularly to the previously deployed branch component, as described above.

[0260] The main in vivo weldable component is then expanded and welded together “in situ” to the in vivo weldable branch component previously deployed within the “renal artery”, by inserting a balloon into the main component and inflating the balloon with warm (typically around 50° C.) water until the pressure required, typically of at least 2 atmospheres, is achieved.

[0261] Then, a hole was then formed outwardly in the wall of the main in vivo weldable component so as to form a single branched structure comprising the two welded components, such that a fluid may flow freely from one component to the other. The balloon was further inflated with warm water in the area of the hole so as to cause protrusions and flaps created by formation of the hole to weld to the internal wall of the branch component. In some embodiments, said hole is preformed, and not generated in vivo.

[0262] The model was then dissected and the branched component was removed and analyzed. The two tubular components had been welded together, and the inner surfaces of the tubular structures were smooth, showing that protrusions and flaps formed by creation of the hole were fully welded to the walls of the branch component. The two components, namely the main and the branch in vivo weldable components were strongly welded by both the expanded annular section of the branch, that was welded to the external wall of the main component, and the protrusions and flaps generated by the hole, that welded into the internal wall of the branch component.

[0263] These results indicate that moderate heating can be used for both shaping and welding a device in situ.

Example 7

In Vivo Weldable Polymeric Components in Cadaveric Pig Aorta Sections

[0264] This example aims at showing the ability of the polymeric components of this invention to easily, rapidly and strongly expand under moderate heating and pressure, so they can be used for both shaping and welding a device in vivo. Even though this example does not relate to the in vivo welding of the component, the expandability is a key feature of some of these devices, so they can be brought in contact with another in vivo weldable component and welded together. Among many others, for example the struts of a metallic stent, coated with an in vivo weldable polymer.

[0265] An in vivo weldable polymeric component prepared from CLUR2000 by air spray, as described hereinabove, was tested in cadaveric pig aorta section. The in vivo weldable polymeric component was expanded in situ with a balloon filled with warm (50° C.) saline, until the in vivo weldable polymeric component tightly and securely adhered to the walls of the aorta. The attachment of the component to the walls of the aorta lumen was then assessed.

[0266] After 8 hours, the pig was sacrificed, and the aorta was examined The diameter of the polymeric component increased by a factor of more than 3, and it became tightly attached to the luminal surface of the vessel. The placement was secure, as it was extremely difficult to remove the polymeric component from the aorta section, following explantation. The force required to remove the polymeric component from the aorta section, was approximately 10 times the force typically applied by blood flow at this site.

Example 8

An In Vivo Weldable Polymeric Component Deployed in an Ex Vivo Model

[0267] This example aims at showing the ability of the polymeric components of this invention to easily, rapidly and strongly expand under moderate heating and pressure in an in vivo model. Even though this example does not relate to the in vivo welding of the component, the expandability is a key feature of some of the embodiments of the invention disclosed hereby, so they can be brought in contact with another in vivo weldable component and welded together. Among many others, for example, the struts of a metallic stent, coated with an in vivo weldable polymer.

[0268] An in vivo weldable polymeric component prepared from CLUR2000 by air spray, as described hereinabove, was mounted on a balloon and deployed ex vivo by inflating the balloon in situ with warm water. The polymeric component had excellent mechanical properties so as to maintain its shape after deployment in the vessel and also “pulsate” in unison with the vessel, when an external force was applied. The placement was secure, and it was extremely difficult to remove the expanded in vivo weldable polymeric component from the aorta. In a pull out test, the force required to remove the expanded polymeric component was around 45 N.

Example 9

Sealing of an Aneurysm in an In Vitro Model

[0269] An in vitro model of an aneurysm was used to determine the ability of an in vivo weldable polymeric component according to embodiments of the invention to seal an aneurysm and improve blood flow. The aneurysm model was prepared from latex, by dip coating a metal mold in a latex solution, and then drying the latex layer and removing the mold.

[0270] An in vivo weldable polymeric component with foam cuffs was prepared as described above and placed in the aneurysm model.

[0271] The in vivo weldable polymeric component walls proved to be impermeable to liquid, such that liquid passed through it without leaking into the aneurismal sac.

[0272] Moreover, vacuum could be applied to the aneurysm, indicating that the endograft sealed the aneurysm against gases, in addition to liquids.

Example 10

[0273] In Vivo Weldable Polymeric Component with a “smart” Monomer Component

[0274] A polymer is mixed with a monomer which can be polymerized by a suitable stimulation, such that the mixture is an expandable polymeric component. The monomer per se softens the polymer (e.g., by acting as a plasticizer), whereas the polymerized monomer is a solid material which provides mechanical support, and consequently strength and stiffness, to the polymer which was originally in the system. The monomer is thus a “smart component” for softening and then hardening the polymeric component, as required and when desired.

[0275] In an exemplary procedure, films containing various mixtures of a polymer and a monomer were prepared.

[0276] PMMA, HEMA and benzoyl peroxide (BP) were dissolved in chloroform at various PMMA:HEMA ratios, and with 100:1 HEMA:BP ratio (w/w). The solution was cast in a Petri dish and the chloroform was allowed to evaporate during the course of 24 hours. Dog-bone samples were cut out of the obtained film, and their modulus was measured using an Instron apparatus. HEMA was then polymerized within the PMMA matrix by adding N,N-dimethyl-p-toluidine to the surface of the PMMA/HEMA films and then incubating the film for 1 hour at 37° C. The modulus of the reacted samples was measured using an Instron apparatus.

[0277] As shown below, HEMA considerably reduced the moduli of HEMA:PMMA mixtures in a concentration-dependent manner. As further shown therein, polymerization of the HEMA considerably increased the moduli of the mixtures.

[0278] Films containing poly(styrene-methyl methacrylate) (SMMA) and HEMA were prepared as described above for PMMA/HEMA films.

[0279] As shown below, HEMA considerably reduced the moduli of HEMA:SMMA mixtures in a concentration-dependent manner, as for HEMA:PMMA mixtures.

[0280] The glass transition temperatures (T.sub.g) of the HEMA:SMMA mixtures were determined by Differential Scanning calorimetry.

[0281] As shown below, the glass transition temperatures of SMMA decreased considerably in the presence of HEMA. The decrease was concentration-dependent, with 10-30% HEMA resulting in a transition temperature in a range of about 40-55° C., in contrast to the 100° C. transition temperature in the absence of HEMA.

[0282] In addition, films containing CLUR2000 as an expandable component (EC) and HEMA as a smart component (SC) were prepared as described above for PMMA/HEMA films.

[0283] As shown below, HEMA considerably reduced the moduli of CLUR2000 mixtures in a concentration-dependent manner. As further shown therein, polymerization of the HEMA considerably increased the moduli of the mixtures.

[0284] As is further shown, the moduli of CLUR2000 and CLUR2000/HEMA mixtures were significantly lower than the moduli of PMMA, SMMA and the corresponding PMMA/HEMA and SMMA/HEMA mixtures.

[0285] In addition, films containing 80 kDa polycaprolactone (PCL80K) as an expandable component and ethylene glycol dimethacrylate (EGDMA) as a smart component were prepared as described above for PMMA/HEMA films.

[0286] As shown, EGDMA considerably reduced the moduli of PCL8OK mixtures in a concentration-dependent manner

[0287] The above results indicate that various monomers can be used as smart components for both softening polymeric materials to varying degrees and hardening the material when desired by polymerization of the smart component.

Example 11

[0288] In Vivo Weldable Polymeric Component with a Cross-Linking “Smart” Component

[0289] An in vivo weldable polymeric component is prepared by using an expandable polymeric material comprising a functional group (e.g., thiohydroxy, amine, azide, alkyne, an unsaturated bond, a nucleophilic leaving group) and a cross-linking molecule, such as an at least bi-functional molecule (e.g., a diacrylate, a dimethacrylate, a dithiol, a diamine), which comprises functional groups (e.g, a nucleophilic leaving groups, unsaturated bonds, alkyne groups, azide groups, thiohydroxy groups, amine groups) capable of reacting with the functional group of the polymeric material. For example, alkyne groups may be reacted with azide groups by click chemistry.

[0290] Under physiological conditions and/or a suitable trigger, the reactions between the cross-linking molecule and the polymeric component are initiated, resulting gradually in cross-linking of the polymeric material. The modulus of elasticity of the polymeric component gradually increases over a period of time as the amount of cross-links increases, and the device becomes stronger and stiffer, such that the expanded state of the device is maintained.

[0291] In an exemplary procedure, a polymer (e.g., poly(2-hydroxyethyl methacrylate)) comprising alkyne groups (e.g., by linking propargyl alcohol to the polymer via hexamethylene diisocyanate, as show below), is reacted in vivo with a cross-linking molecule comprising azide groups (e.g., polyoxyethylene bis(azide)) via copper(I) catalysis, as shown below. The copper-catalyzed “click” reaction between the azide and alkyne groups results in a cross-linked polymer, which causes the structure to become stiffer.

Example 12

[0292] “Smart” In Vivo Weldable Polymeric Component with Cross-Linking Functional Groups

[0293] An in vivo polymeric component is prepared comprising an expandable polymeric system comprising two complementary functional groups (e.g., an azide and an alkyne, unsaturated carbon-carbon bond and a thiohydroxy, an unsaturated carbon-carbon bond and an amine, a carboxylic acid and an amine, a hydroxy and an isocyanate, an amine and an isocyanate, and a thiohydroxy and an isocyanate) attached to a polymer (e.g., as substituents attached to the polymer backbone). The polymeric component may comprise a polymer having two complementary functional groups, or two polymers, each having a functional group complementary to the functional group of the other polymer.

[0294] Under physiological conditions or due to the application of a trigger, reactions between the complementary functional groups are initiated, resulting gradually in cross-linking of the polymer molecules in the polymeric system. The modulus of elasticity of the polymeric system gradually increases over a period of time as the amount of cross-links increases, and the device becomes stronger and stiffer, such that the expanded state of the device is maintained.

[0295] In an exemplary procedure, a polymer comprising an azide group is prepared using a monomer (e.g., 2-hydroxyethyl methacrylate) with an azide-containing monomer, 2-(2-azidoisobutyloxy)ethyl methacrylate and an alkyne-containing monomer.

[0296] The azide-containing monomer is prepared by first preparing 2-(2-bromoisobutyloxy)ethyl methacrylate [Xu et al., J Poly Sci A: Poly Chem. 46, 5263-5277 (2008)] by reacting 2-hydroxyethyl methacrylate with 2-bromoisobutyl bromide, and then reacting the 2-(2-bromoisobutyloxy)ethyl methacrylate with sodium azide.

[0297] The alkyne-containing monomer is prepared by linking propargyl alcohol to a monomer (e.g., 2-hydroxyethyl methacrylate) via hexamethylene diisocyanate, similarly to the method described below.

[0298] The azide-containing monomer is then copolymerized with the alkyne-containing monomer (e.g., by free radical polymerization), with or without an additional monomer such as 2-hydroxyethyl methacrylate, to obtain a polymer having both azide and alkyne groups.

[0299] A device comprising the obtained polymer is placed in a vessel in a body, and the polymer is reacted in situ by copper(I) catalysis. The copper-catalyzed “click” reaction between the azide and alkyne groups results in a cross-linked polymer, which causes the device to become stiffer.

[0300] In an additional exemplary procedure, a polymer comprising an azide group is prepared by polymerizing (e.g., by free radical polymerization) the azide-containing monomer described hereinabove, with or without copolymerization with additional monomer such as 2-hydroxyethyl methacrylate. In addition, a polymer comprising an alkyne group is prepared by polymerizing (e.g., by free radical polymerization) the alkyne-containing monomer described hereinabove, with or without copolymerization with additional monomer such as 2-hydroxyethyl methacrylate.

[0301] A device comprising the polymer comprising an azide group and the polymer comprising an alkyne group is placed in a vessel in a body, and the two polymers are reacted in situ by copper(I) catalysis. The copper-catalyzed “click” reaction between the azide and alkyne groups results in cross-linking of the two polymers, which causes the device to become stiffer.

[0302] Click chemistry encompases several reactions that are fast, selective, high yielding, and can be conducted in aqueous media and aerobic systems. The most common of these efficient reactions is the copper-catalyzed azide-alkyne cycloaddition, but the toxicity of copper led to the development of bio-orthogonal reactions whose components are inert to the surrounding biological environment and lack metal catalysts, called Cu-free click reactions. One important type of Cu-free click chemistry is the reaction between azide groups and strained cyclo-octyne moieties. One embodiment of the invention harnesses this chemistry to in situ react two polymers, whereby a substantial stiffening of said polymeric system takes place once the tubular member has been deployed and expanded at the site of an aneurismal sac. One example of this embodiment is the reaction of a derivatized poly(acrylic acid), comprising pendant azide groups, and a derivative of poly(hydroxyl ethylmethacrylate) having pendant cyclo-octyne groups, as follows:

Synthesis of Cyclo-Octyne-Containing Polymer:

[0303] 8,8-Dibromobicyclo[5.1.0]octane was synthesized according to procedure for the synthesis of 9,9-dibromo[6.1.0]nonane. Then, it was reacted with polyhydroxyethylmethacrylate, AgClO.sub.4 and MeNO.sub.2 to obtain poly((Z)-2-bromocyclooct-2-enyloxyethylmethacrylate). The product was converted into poly(Cyclooct-2-ynyloxyethylmethacrylate) through a two step reaction with (1) 1,8-diazabicyclo[5.4.0]undec-7-ene and (2)NaOMe and water.

Synthesis of Azide-Containing Polymer:

[0304] Polyacrylic acid was reacted with thionyl chloride and O-(2-Aminoethyl)-O′-(2-azidoethyl)nonaethylene glycol was added to produce an amide derivative of polyacrylic acid with pendant azide groups. Alternatively O-(2-Aminoethyl)-O′-(2-azidoethyl)monaethylene was reacted with mehtylene chloride and then polymerized with CuBr/2,2-bipyridine to obtain the same product.

[0305] The two polymers are subjected to conditions that affect a Cu-free click reaction.

Example 13

[0306] In Vivo Weldable Polymeric Component with a Plasticizer “Smart” Component

[0307] An in vivo weldable polymeric component is prepared comprising an expandable polymeric system comprising a polymer and a small hydrophilic molecule, such as low-molecular weight (e.g., 250-850 grams/mol) polyethylene glycol which plasticizes the polymeric material, thereby rendering the component more expandable and less stiff.

[0308] Continuous contact with an aqueous environment in vivo results in gradual leaching of the hydrophilic plasticizer from the device. The modulus of elasticity of the polymeric system gradually increases over a period of time as the concentration of plasticizer decreases, and the device becomes stiffer, such that the expanded state of the device is maintained.

Example 14

In Vivo Weldable Polymeric Components Comprising “Smart” Amorphous Polymers

[0309] An in vivo weldable polymeric component is prepared comprising an amorphous polymer capable of undergoing considerably morphological changes by crystallization, resulting in a pronounced increase in the strength and stiffness of the material. The polymeric component is deployed and expanded in its non-crystalline state, characterized by enhanced flexibility, while, in situ, microstructural ordering phenomena take place following stimulation, which result in a marked increase in stiffness over time. The polymer has a suitable segmental mobility at physiological conditions which allows for morphological rearrangement.

[0310] The amorphous polymer is formed by exposure to a temperature sufficiently high to melt all crystallites (e.g., 70-80° C.), followed by a very rapid quenching, for example, by immersing the material in liquid nitrogen, to solidify the material while preventing it from crystallizing

[0311] The glass transition temperature of the polymer is below 37° C. When the device is inserted into a body, it is flexible and enables smooth navigation to the site and expansion. After prolonged exposure to physiological temperatures, the polymer reverts to its crystalline state, resulting in the concomitant increase in stiffness.

[0312] In an exemplary procedure, a device is prepared comprising an amorphous polymer having the general formula:

J.sub.1-K.sub.1-L.sub.1-Y-L.sub.2-K.sub.2-J.sub.2

[0313] wherein:

[0314] J.sub.1 and J.sub.2 are each a relatively low-weight (e.g., 350 Da) polyalkylene glycol (e.g., methyl polyethylene glycol);

[0315] K.sub.1 and K.sub.2 are each a hydrophobic (e.g., water insoluble) segment;

[0316] L.sub.1 and L.sub.2 are each independently a bifunctional linking moiety or absent; and

[0317] Y is selected from the group consisting of a polyester (e.g., polycaprolactone), a polyurethane, a polyamide, a silicone polymer, a polyacrylate, a polymethacrylate, and a polyolefin, of suitable molecular weight, as described in detail hereinabove.

[0318] The polymeric component is placed in a vessel in a body, such that the device is under physiological conditions at a temperature of 37° C. When the device is in place, a balloon is inserted into the device and inflated, thereby expanding the polymeric component. Over a period of time (e.g., 20 minutes), the polymer becomes more crystalline and the device becomes stiffer, such that the expanded state of the device is maintained.

Example 15

In Vivo Weldable “Smart” Amorphous Cross-Linked Polymeric Components

[0319] An in vivo weldable polymeric component is prepared from an amorphous polymeric system comprising polymeric chains cross-linked by cross-linking moieties (e.g., aliphatic oligoesters) which are degradable (e.g., via enzymatic action) under physiological conditions. The polymeric chains are of a material which would be crystalline or semi-crystalline in the absence of the cross-linking moieties.

[0320] The cross-linking moieties degrade in vivo and the crystallinity in the polymeric system gradually increases over a period of time as the degree of cross-linking decreases, and the device becomes stiffer, such that the expanded state of the device is maintained.

Example 16

[0321] In Vivo Weldable Polymeric Components with Segregating “Smart” Components

[0322] An in vivo weldable polymeric component is prepared comprising a polymeric system having at least two components. The polymeric device is placed in a vessel in a body, such that the device is. When the device is in place, a balloon is inserted into the device and inflated, thereby expanding the device.

[0323] Under physiological conditions the components then segregate over a period of time due to chemical incompatibility of the components and/or reaction products of components (e.g., products of polymerization and/or cleavage of cross-linking of the original components). For example, polymerization of a component facilitates segregation by reducing the entropy of a non-segregated mixture, and cleavage of cross-linking facilitates segregation of incompatible components by increasing molecular mobility (e.g., of a polymer chain).

[0324] As the phase blending, which inhibits crystallization, decreases, some or all of the segregated components begin to crystallize. Due to the crystallization, segregation results in a gradual increase in the stiffness of the device, such that the expanded state of the device is maintained.

Example 17

Additional Examples of the Preparation of Devices

Example A

[0325] One method to prepare a balloon expandable bare metal stent for in situ welding was to dip-coat said stent in a 3% (w/w) CLUR solution in chloroform. The bare metal stents, for example, were commercially available and composed of stainless steel, were lowered into a solution manually or with a constant speed. In the case of computer-controlled dip coating, a stent was lowered into the solution with an exemplary crosshead speed of 10 mm/min In the occasion where solution remained webbed between the struts after extracting it from the solution, the solution was removed using a 21G hollow needle. Another method to remove the excess polymer was by gently blotting the relevant areas with light contact with absorbent paper. The solvent was left to vaporize under a fume hood leaving a continuous polymeric coating on the metal struts. The thickness of the coating was varied by adding additional dipping cycles, typically in the 5-15 micrometer range.

Example B

[0326] Another method to render bare metal stents in vivo weldable, was to gently eject with a 21G hollow needle a polymer solution of 5% (w/w) CLUR in chloroform directly on the bare metal struts of the stent. As the solvent evaporated the struts were encapsulated with the polymer and there was no webbing formed between the struts spanning the open cells. Similarly, the stents were left to dry until the solvent evaporated.

Example C

[0327] Another method to coat the struts of the bare metal stent with an in vivo weldable polymer was to exploit the Venturi effect and generate an aerosol, optionally of 2% (w/w) chloroform CLUR solution. The aerosol can be modulated to form particles on the nano or micro scale. These particles once deposited on the stent surface may coalesce to generate a homogenous layer by a moderate application of heat. This method is particularly illustrative of how one can render a non-in vivo weldable surface into an in vivo weldable surface. Surfaces that are weldable are repeatedly weldable. This includes other polymeric materials, such as PET stent-grafts, which have transition temperatures significantly higher than physiological temperatures which would make them unsuitable for in vivo welding but nevertheless were rendered in vivo weldable with the application of a thin coating.

Example 18

Method of Implementation

[0328] One method to implement the in vivo weldable stent grafts is to initially deliver the coated stent to the anatomically correct position with the aid of radiopaque markers located on the ends of the components of the device. After expansion of the stent, a second balloon catheter delivers an in vivo weldable polymeric component onto the stent. A suitably warm solution, typically saline, is used to warm the balloon as required and, in conjunction with the pressure from the balloon, the polymeric component is permanently bound to the stent forming a stent graft. Further stents and polymeric components may be further attached upstream or downstream of the initial stent by overlapping the sleeves. Additional configurations are also engineered using the technology disclosed hereby, as dictated by anatomical and clinical considerations.

Additional Examples

[0329] Further illustration of the invention is presented below.

[0330] The in vivo welding concept aims at rapidly welding together two or more medical devices inside the human body, at a physiologically acceptable temperature, that will result in a strong and reliable connection.

[0331] Not only the same or similar polymers were welded together, but also polymers differing substantially in ther composition and mechanical properties were successfully bonded together under physiologically acceptable conditions. The DSC thermogram shown in FIG. 1 demonstrated that the welding together of an elastomeric polyurethane (CLUR) and a stiff polymethacrylate (PEMA) succeeds to blend together the polymers at the molecular level, as shown by the disappearance and shift of the peaks in the three traces shown.

[0332] Several polymers proved to be in vivo weldable and perfomed successfully as both the in vivo weldable component/s and also the in vivo weldable polymer/s that render/s the in vivo non weldable component/s, in vivo weldable. Biostable as well as biodegradable polymers were identified. Among the former, several polyether urethanes can be mentioned. The polyethers used in this class of materials were typically polytetramethylene glycol, polypropylene glycol and polyethylene glycol of various molecular weights, among others. One example of this family, among other families, is the polyether urethane consisting of a polytetramethylene glycol (MW=650) soft segment and hexamethylene diisocyanate (HDI) as the chain extender. This polymer displays a T.sub.r at around 45-46° C., and attains an Ultimate Strength value of 42 MPa and a Young modulus of around 90 MPa.

[0333] The photos of FIGS. 2A-F illustrate the in vivo welding of various in vivo weldable polymeric components of the invention, layer by layer, following the step-by-step procedure of deploying and building a thicker in vivo weldable polymeric component, from extremely thin components.

[0334] In this case, a transparent Tygon model system and a tubular thin device with white holes, is shown in FIG. 2A. In FIG. 2B, the device is inserted within the “Tygon vessel”, and in FIG. 2C this first layer of the device is easily expanded and attached to the luminal surface of the “vessel”. In FIG. 2D, the balloon is deflated and removed, while FIGS. 2E and 2F, demonstarte the deployment of a second layer, white and longer, and its subsequent welding together to the first layer already deployed and expanded at the site of performance

[0335] This procedure is conducted among various polymeric components and/or with any additional device, tissue, instrument or accesory. In some embodiments, two or more in vivo weldable polymeric components may be welded together so that they partially or totally encapsulate or “sandwich” any device, tissue, instrument or accesory.

[0336] The photos shown in FIGS. 3A-C present a system constructed of two different metallic structures, one flat (FIGS. 3A-C) and one tubular (FIGS. 3D-F), conclusively proving the in vivo welding concept.

[0337] In the case of the flat metallic grid (FIGS. 3A-C), the in vivo weldable polymeric component (the square patch on the mesh) was welded to a metallic mesh, which was previously rendered in vivo weldable by coating with an in vivo weldable polymer. The coating of the mesh was achieved ex vivo, while the polymeric component was welded to the modified mesh under in vivo conditions. As apparent from the photos, the welded connection between the two was found very strong, that efforts to remove the patch, resulted in the destruction of the metallic grid.

[0338] The metallic tubular structures (FIGS. 3D-F) were chosen to mimic stents implanted throughout the vasculature and weldable connectors, in this case terminal, were added to them. Then, the “stents” were connected in series and in parallel, by rapidly and strongly welding them together via the in vivo weldable polymeric connectors. The strength of the connections was conclusively demonstrated both mechanically (see below), as well as by determining their stability under strong high volume water flow.

[0339] Since the key feature of the devices being developed is their in vivo weldability, the temperature at the device/tissue interface, is a key safety factor and was, therefore, measured.

[0340] In the experiment showed above, the temperature measured by a thermocouple at the outer surface of the device, was significantly lower than the temperature inside the balloon. In this case, while inside the balloon the water temperature was 44° C., the temperature measured at the outer surface of the device, the surface that will be in contact with the tissue, was 39° C. only. These data demonstrate that while the temperature can be sufficiently high to efficiently weld the in vivo weldable polymeric component, the tissue will be exposed to a significantly lower and physiologically acceptable temperature. It should also be stressed that the welding process, from the moment warm saline is introduced into the balloon, until the balloon is deflated and removed, takes only one-two minutes.

[0341] Work was also conducted using tubular polymeric model systems, with Tygon transparent tubing mimicking the vessels. FIG. 4 shows such a model system, in this case mimicking the anatomy of aorta and one renal artery.

[0342] FIG. 5, middle picture, illustrates a hybrid EVAR device comprising a metallic stent and the in vivo weldable component, deployed sequentially and welded together in vivo. The left picture illustrates the hybrid EVAR in a “pantalones” configuration, where the device is deployed in the abdominal aorta and in the iliac arteries as well. In this case, the primary role of the in vivo weldability feature is to stabilize the multicomponent structure, by also strongly welding the different devices, as well as to prevent blood leakage, due to the hermetic sealing of the joint between two stents. The right picture illustrates a scenario where infra-renal landing zones are absent.

[0343] In this very challenging case, the metallic stent is deployed first, protruding supra-renally, and then the in vivo weldable device is deployed, so that it strongly welds to the metallic stent, without blocking the blood flow from the aorta into the renal arteries. Furthermore, the in vivo weldable component can be tailored at the OR, as dictated by the specifics of the anatomy of the patient. These are three of the most challenging scenarios, where the advantageous features of the devices disclosed hereby, play a cardinal role. The in vivo weldable devices of this invention, not only improve the outcome of the procedure but also significantly expand the scope of application of the EVAR technology, making patients that would have had to undergo open surgery or did not have any other modality of treatment available to them, eligible to undergo the minimally invasive EVAR procedure. In other embodiments, more than one device may be deployed sequentially, in any order, as the peculiarities of each case demand In some aspects of other embodiments where two or more devices have to be deployed in a head-to-tail configuration, each of the devices may be deployed sequentially, optionally the in vivo weldable metallic stent having its struts coated with an in vivo weldable polymer being deployed first and firmly positioned at its site of performance, followed by the deployment of the in vivo weldable polymeric sleeve, and the in vivo welding of both components is conducted. In some embodiments, the in vivo weldable polymeric sleeve may be somewhat longer than the stent, so it protrudes longitudinally, allowing to weld the two or more devices positioned in series, to be welded together. In yet another embodiment, the in vivo weldable metallic stent having its struts coated with an in vivo weldable polymer is deployed initially and securely placed at its site of performance, followed by the deployment of the in vivo weldable polymeric sleeve, and then both components are in vivo welded, with the distal end of one stent touching or very close to the proximal end of the other stent. In this embodiment an in vivo weldable polymeric connector is deployed bridging over the gap between the two stents, and strongly connecting them together. Said gap between the two stents can be inexistent, in which case the stents touch each other, up to being of macroscopic dimensions, depending on the site and the particular requirements dictated by each clinical case. In yet other embodiments, two or more of the devices may be deployed when in a side-by-side configuration, as in the common “kissing stents” case. In some aspects of these embodiments, an external, longitudinal connector will be deployed between the two “kissing stents”, securely in vivo welding the two.

[0344] In yet other aspects of these embodiments, two or more of the devices may be deployed when in a branched configuration, and in vivo welded together via in vivo weldable protrusions of the in vivo weldable polymeric component in vivo welded to each of the two or more stents, said protrusions allowing the strong and firm connection between the different devices. In yet other embodiments, in vivo weldable polymeric connectors are deployed at the junction between two stents, and strongly connecting them together at the in vivo weldable junction between them. In some embodiments, other procedures based on in vivo welding

[0345] In FIG. 6A, a coating of a strut of a stent with an in vivo weldable polymer is shown under amplification, and in FIG. 6B the thickness of the coating (in this case, around 15 micrometers) is shown.

[0346] FIG. 7 shows the welding of an in vivo weldable patch (with stripes, for visualization purposes) and a metallic stent, with its struts coated with the same polymer (see table in FIG. 7). The patch illustrates not only the deployment of a patch, but also that of any other in vivo weldable polymeric component.

[0347] FIGS. 8A-D follow the measurement of the force required to pull out the patch, welded to the stent (FIGS. 8A-B), using a tensiometer (FIG. 8C). As apparent from FIG. 8D, the patch finally failed at a load of around 16 N, ruptured at the hole done to introduce the hook of the tensiometer. To any versed in the art it is evident that a huge stress concentration takes place at the hole done to introduce the hook of the tensiometer. It is also worth noticing that the welding bond did not fail.

[0348] FIGS. 9A-C show the manual extension of the patch welded to the stent, up to around 300% elongation, with the welding connection staying in place, under those harsh conditions.

[0349] FIG. 10 shows the last stage of a mechanical testing of the strength of the welding bond between the stent and the patch. As is apparent from the photo, it was the metallic stent itself that failed, with the welding bond between the patch and the stent sustaining the large stresses applied.

[0350] The SEM micrograph shown in FIG. 11, presents the coated strut and its welding to an in vivo polymeric patch and said patch is welded to a second one. The efficiency of the welding process is apparently shown.

[0351] Another system according to the invention is constructed of a Tygon “vessel” and three in vivo weldable components, that were welded endoluminally, within the Tygon “vessel”. In a kit of the invention, certain components were deployed endoluminally, being separated by a distance of around 3 mm Then, an in vivo weldable component was deployed and welded together via an in vivo weldable connector deployed across a 3 mm gap.

[0352] Enabling a surgeon to follow closely and accurately the two components of the device, e.g., a stent and a sleeve, throughout the whole deployment procedure, is of the utmost importance. In light of the above, it was imperative rendering the sleeve radiopaque, and doing so in a manner that does not hamper any of its performance requirements. In various embodiments of this invention, therefore, radiopaque sleeves were produced by adding a radiopaque agent such as, without limitation, BaSO.sub.4 or ZrO.sub.4, among several others. Among them, when the sleeve is prepared following the dip coating technique or a similar one, to add particles of the radiopaque agent to the dip coating solution. The same applies if the sleeve is prepared by extrusion and similar processing techniques. In all these cases the radiopaque particles, may be added prior to or during the production or immediately after, when the sleeve is still soft and somewhat tacky, due to the presence of some solvent, in techniques involving solvents, or heat, in those methods where heat is used during the manufacture of the sleeve. Another method implemented and disclosed hereby for the generation of radiopaque sleeves focuses on “stamping” the radiopaque agent, such as BaSO.sub.4, among others, to produce radiopaque sites, such as dots and bands, at different positions along the sleeve such as, without limitation, its proximal and distal ends. This can be achieved by slightly heating the sleeve and applying pressure to the radiopaque powder and the somewhat softened polymer. Optionally, the softening can also be achieved by using a proper liquid, able to suitably soften the polymeric sleeve, enabling the efficient “stamping” of the radiopaque agent. Additional approaches taught by the present invention included using radiopaque markers and attaching them to the sleeve by, for example, without limitation, welding them to the polymeric sleeve by means of a small weldable patch. This forms a “sandwich” configuration, with the marker, typically tantalum, being in the middle, between the sleeve and the patch, as shown below.

[0353] Another method disclosed hereby was to incorporate a radiopaque fiber or wire at selected locations in the sleeve, by any technique such as, without limitation, passing through the radiopaque string/lace/ribbon/yarn/ through the sleeve.

[0354] Since in many instances the sleeve will directly interface with blood, and, therefore, typically, being satisfactorily non-thrombogenic is a crucial requirement and, therefore, any method able to achieving this goal, is applicable to the sleeves disclosed hereby. These methods include entrapping by chemical or physical or biological means molecules able to improve the blood compatibility of the sleeves, said molecules being released from the sleeve over time. Heparin is one example of the plethora of molecules able to perform this task. These bioactive molecules may be directly dispersed within the sleeve, or in any other configuration such as, without limitation, as aggregates, or encapsulated in nano or microparticles of any geometry, or any other format that will allow the optimal release of said molecules, and combinations thereof. Additionally, said molecules can be physically and/or chemically and/or biochemically attached to the surface of the sleeve. In the alter embodiments, said species can bepermanetly attached to the surface and/or they can be released over time. Given their well-recognized ability to minimize protein adsorption and cell attachment on surfaces, polyethylene glycol (PEG) chains is one of the molecules covalently grafted to the sleeve surface. One of the surface grafting schemes performed, consisted of exposing the sleeve surface to plasma of ammonia, whereby amine moieties were generated. These amine groups performed as reactive anchoring sites and were reacted with difunctional molecules, such as, without limitation diisocyanates, such as hexamethylene diisocyanate (HDI), which, in turn, reacted with the PEG chains, via their terminal OH groups. In some instanced themolecules is more than bifunctional.

[0355] The occurrence of the plasma treatment was determined by contact angle measurements. The initial contact angle of CLUR polymers, around 80°, substantially decreased to around 40°, due to the presence of the hydrophilic amine groups on CLUR′ surface, after its exposure to plasma of ammonia.

[0356] Additionally, PEG molecules of different molecular weights were end-capped with one terminal C═C double bonds by reacting them, with isocyanatoethyl methacrylate (IEMA), for example, whereby the corresponding methacrylate was formed, as shown below. This surface modification scheme was performed using PEG chains of various molecular weights and generating different surface densities.

[0357] The success of the addition of double bonds to PEG1000, 2000 and 3400 was evaluated by H-NMR analysis, which demonstrated that in all cases, there was one double bond per PEG chain.

[0358] Once the PEG methacrylates were synthesized, the double bond was reacted with the NH.sub.2 moieties generated by the plasma of ammonia on the surface of the sleeve, through the Michael addition reaction.

[0359] After carrying out the Michael addition, the samples were thoroughly washed and then studied by performing contact angle measurements and XPS analysis.

Percutaneous Implantation of Covered Stent Devices into Abdominal Aorta and Iliac Arteries in Pigs

[0360] A medium size (typically between ˜40-60 Kg) pig model was chosen for investigating the performance of the devices disclosed hereby, based on the performance of a series of CT angiographic studies in animals weighing

[0361] Typically the surgical procedure was as follows. Using Ultrasound guided bilateral femoral artery access with commercially available vascular access devices, catheter angiography of the abdominal aorta and pelvic arteries was performed. In one animal, three commercially available “Advanta V12” (Atrium Medical Corporation) covered stents were inserted, one in the distal abdominal aorta, and one in each of the common iliac arteries. All three devices were inserted in a simple linear configuration. In a second specimen, four Advanta 12 covered stents were inserted, two overlapping in the distal abdominal aorta, and one in each of the common iliac arteries with proximal overlap with the lower stent in the aorta together with “kissing” of the two iliac stents.

[0362] Both animals were then maintained in the animal facility according to ethically acceptable practice for a period of approximately six weeks. At that point in time, the terminal experiment was performed, again “back to back”, on one day. After the induction of general anesthesia, the animal was transported to the CT scanner, where CT angiography was performed to evaluate stent positioning, evidence of vascular “injury” or presence of “neo-intimal hyperplasia”. The configuration observed demonstrated overlapping stents in the aorta and smaller caliber stents overlapping and “kissing” within the larger aortic device.

[0363] The axial images of the CT angiography were evaluated for reasons described above. Multi-planar and volumetric reconstruction of the CT angiography images was subsequently performed for the purpose of data evaluation and presentation.

[0364] The sleeping animal was then returned to the animal lab where the abdominal aorta and proximal pelvic arteries were surgically explanted in a terminal procedure. The specimens were photographed and examined for macroscopic evidence of major vascular injury (inflammation, dilatation, perforation, adhesion, etc.). The specimens were labeled and placed in 10% formalin for subsequent pathological evaluation.

Biocompatibilty and Thrombogenicity Study of the Sleeve

[0365] The biocompatibility study will be conducted at HARLAN Laboratories Inc., in Rechovot and the thrombogenicity analysis was performed in collaboration with the Department of Hematology, Coagulation Lab at the Hadassah Medical Center. The polymer component study material was evaluated using standard mechanisms that assess thrombogenicity in absolute and relative terms (i.e. in vitro comparison to other materials with known degrees of thrombogenicity).

[0366] The animal experiments were conducted on ˜50 kilogram female pigs, under general anesthesia, using bilateral femoral artery access. 8 Fr. vascular sheaths were used and the devices were implanted along the aorta and iliac arteries of the animal The animal received aspirin 100mg/day post-operatively.

[0367] A one week post insertion angiogram showed stable position of both stent and sleeve, suggesting durable and stable welding. Also, no significant stenosis was observed and thromogenicity profile was good. Furthermore, normal flow was observed and all branches were open. Follow up angiography performed after 38 days demonstrated normal flow and no stenosis of note. The animal was healthy with no signs of ischemia.