Patent Grant
10111664
The present invention relates to apparatus and methods for sealing an iatrogenic puncture in a vessel or other body lumen formed in conjunction with a diagnostic or therapeutic treatment. More particularly, the present invention provides apparatus comprising an introducer sheath including a puncture site closure device comprising an expandable clip with elastic memory. Also, the present invention provides apparatus comprising an introducer sheath including a puncture site closure device comprising a bioabsorbable clip. Further, the present invention includes an apparatus and methods for positioning such a device relative to the body lumen before delivery
Catheterization and interventional procedures, such as angioplasty and stenting, generally are performed by inserting a hollow needle through a patient's skin and muscle tissue into the vascular system. A guide wire then is passed through the needle lumen into the patient's blood vessel. The needle is removed and an introducer sheath is advanced over the guide wire into the vessel. A catheter typically is passed through the lumen of the introducer sheath and advanced over the guide wire into position for a medical procedure. The introducer sheath therefore facilitates insertion of various devices into the vessel while minimizing trauma to the vessel wall and minimizing blood loss during a procedure.
Upon completion of the medical procedure, the catheter and introducer sheath are removed, leaving a puncture site in the vessel. Commonly, external pressure is applied until clotting and wound sealing occurs. However, this procedure is time consuming and expensive, requiring as much as an hour of a physician's or nurser's time, is uncomfortable for the patient, and requires that the patient be immobilized in the operating room, cathlab, or holding area. Furthermore, a risk of hematoma exists from bleeding prior to hemostasis.
Various apparatus have been developed for percutaneously sealing a vascular puncture by occluding or suturing the puncture site. For example, U.S. Pat. Nos. 5,192,302 and 5,222,974 to Kensey et al., describe the use of a biodegradable plug delivered through the introducer sheath into the puncture site. When deployed, the plug seals the vessel and provides hemostasis. Such devices have been slow to gain acceptance in the medical community, however, due to difficulties encountered in positioning the plug within the vessel. Moreover, the agents used to occlude the puncture site are animal-derived, typically collagen-based. Thus, a risk of adverse immunoresponse exists.
Another previously known technique comprises percutaneously suturing the puncture site with specialized apparatus. Such apparatus is described, for example, in U.S. Pat. No. 5,304,184 to Hathaway et al. While percutaneous suturing devices may be effective, a significant degree of skill may be required on the part of the practitioner. Because such devices are mechanically complex, they tend to be relatively expensive to manufacture.
Surgical staples and resilient clips for external skin wound closure are well known in the art, Examples include U.S. Pat. No. 5,026,390 to Brown and U.S. Pat. No. 5,683,405 to Yacoubian et al, which both describe resiliently deformable closure devices suitable for manual external application.
To reduce the cost and complexity of percutaneous puncture closure devices, such devices employing resilient clips or staples have been developed. U.S. Pat. No. 5,478,354 to Tovey et al. describes the use of resilient clips in conjunction with a trocar to close abdominal puncture wounds. U.S. Pat. No. 5,810,846 to Virnich et al. describes a specialized apparatus for closing a vascular puncture site with a plastically deformable clip. The apparatus preferably is advanced over a guide wire through a cannula to the surface of the puncture site, where the staple-like clips are delivered to close the wound.
U.S. Pat. No. 5,782,861 to Cragg et al. describes specialized apparatus for closing a puncture site with a detachable clip. The apparatus comprises a hollow shaft, having a distal end formed with one or more opposed pairs of resilient grasping prongs, that is advanced over a guide wire through a coaxial hollow tube to a position at the distal end of the tube just proximal of the puncture. The grasping prongs are extended beyond the distal end of the tube to grasp the vessel on opposing sides of the puncture. The shaft then is partially retracted, causing the prongs to contract within the tube, thereby sealing the puncture site. Both of the devices described in the foregoing patents have the drawback that a separate device must be deployed through the introducer sheath to close the puncture site, thus prolonging the procedure. Moreover, both devices require relatively complex apparatus and involve time consuming manipulation to achieve hemostasis.
The use of back bleed indication as a positioning technique within a vascular puncture is known. For example, U.S. Pat. No. 4,317,445 to Robinson describes a flashback chamber for providing visual indication of venous entry of a cannula. However, that device does not discuss vascular wound closure. U.S. Pat. No. 5,676,689 to Kensey et al., which claims priority from the U.S. Pat. No. 5,222,974 discussed above, uses a vessel location device to simplify positioning of the biodegradable plug. The vessel locator enables blood from the vessel to flow there through so that the position of the vessel may be determined. However, the Kensey system only proffers one closure device, and that device is complex and raises concerns about biocompatibility. It also requires the closure component to be positioned within the puncture, thereby increasing the likelihood of dangerous over-advancement of the plug into the vessel.
The percutaneous puncture closure devices described in the foregoing patents generally have the drawback that they require relatively complex mechanisms and require time consuming manipulation to achieve hemostasis. It therefore would be desirable to provide apparatus and methods suitable for vascular puncture closure that overcome these disadvantages of previously known devices. It also would be desirable to provide apparatus and methods for vascular puncture closure that quickly and effectively achieve hemostasis. It further would be desirable to provide vascular puncture closure apparatus and methods that do not require the introduction of additional apparatus at the completion of the catheterization procedure to achieve closure. It still further would be desirable to provide apparatus and methods suitable for vascular puncture closure that do not introduce animal-derived material into the bloodstream. It still further would be desirable to provide apparatus and methods wherein all foreign materials left in a patient's body are bioabsorbable.
Generally, embodiments of the present invention can include medical devices and methods of using the same for closing an opening in a body tissue. Such methods can include the following: positioning a closure clip in a first closure clip position adjacent to the opening in the body tissue such that a plurality of spikes of the closure clip are inserted into the tissue at a location outward from a central axis of the opening; and positioning the closure clip in a second closure clip position such that the plurality of spikes are pulled inward toward the central axis of the opening so as to pull the tissue between the opening and each of the spikes together and close the opening. Additionally, the closure clip can be released from a distal end of a closure clip applicator when adjacent to the opening in the tissue. This can be facilitated when the closure clip applicator is positioned adjacent to the opening in the body tissue by using a sheath such that the sheath guides the positioning of the applicator.
Moreover, the sheath can be positioned relative to the opening in the tissue with a guide before the closure clip applicator is positioned adjacent to the opening. During positioning of the sheath, the guide can have a distal portion that extends through the opening of the body tissue and a proximal portion that can be disposed within a lumen of the sheath. This can allow for the guide to center the sheath at the central axis of the opening, which in turn can facilitate the sheath centering the spikes of the closure clip around the opening of the tissue with respect to the central axis when the closure clip is in the second position.
Another embodiment of a method of closing an opening in a body tissue can include the following: positioning a closure clip applicator adjacent to the opening in the body tissue, the closure clip applicator having a closure clip in a radially expanded position at a distal end of the closure clip applicator; positioning the radially expanded closure clip into a first closure clip position adjacent to the opening in the body tissue such that a plurality of spikes of the closure clip are inserted into the tissue at a location outward from a central axis of the opening; and contracting the radially expanded closure clip to a second closure clip position such that the plurality of spikes are pulled inward toward to central axis of the opening so as to pull the tissue between the opening and each of the spikes together and close the opening. Additionally, the closure clip can be released from a distal end of the closure clip applicator when adjacent to the opening in the tissue. This can be facilitated when the closure clip applicator is positioned adjacent to the opening in the body tissue by using a sheath such that the sheath guides the positioning of the applicator.
Moreover, the sheath can be positioned relative to the opening in the tissue with a guide before the closure clip applicator is positioned adjacent to the opening. During positioning of the sheath, the guide can have a distal portion that extends through the opening of the body tissue and a proximal portion that can be disposed within a lumen of the sheath. This can allow for the guide to center the sheath at the central axis of the opening, which in turn facilitates the sheath centering the spikes of the closure clip around the opening of the tissue with respect to the central axis when the closure clip is in the second position.
Yet another embodiment of a method of closing an opening in a body tissue can include the following: inserting a guide through the opening in the body tissue; using the guide to position a closure clip applicator adjacent to the opening in the body tissue with the guide, the closure clip applicator having a closure clip in a radially expanded position at a distal end of the closure clip applicator; positioning the radially expanded closure clip into a first closure clip position adjacent to the opening in the body tissue such that a plurality of spikes of the closure clip are inserted into the tissue at a location outward from a central axis of the guide; and contracting the radially expanded closure clip to a second closure clip position such that the plurality of spikes are pulled inward toward to central axis of the guide so as to pull the tissue between the opening and each of the spikes together and close the opening. Additionally, the closure clip can be released from the distal end of a closure clip applicator when adjacent to the opening in the tissue. This can be facilitated when the closure clip applicator is positioned adjacent to the opening in the body tissue by using a sheath such that the sheath guides the positioning of the applicator.
Moreover, the sheath can be positioned relative to the opening in the tissue with the guide before the closure clip applicator is positioned adjacent to the opening. During positioning of the sheath, the guide can have a distal portion that extends through the opening of the body tissue and a proximal portion that can be disposed within a lumen of the sheath. This can allow for the guide to center the sheath at the central axis of the opening, which in turn can facilitate the sheath centering the spikes of the closure clip around the opening of the tissue with respect to the central axis when the closure clip is in the second position.
These and other embodiments and features of the present invention will become more fully apparent from the following description and appended claims, or may be learned by the practice of the invention as set forth hereinafter.
To further clarify the above and other advantages and features of the present invention, a more particular description of the invention will be rendered by reference to specific embodiments thereof which are illustrated in the appended drawings. It is appreciated that these drawings depict only typical embodiments of the invention and are therefore not to be considered limiting of its scope. The invention will be described and explained with additional specificity and detail through the use of the accompanying drawings.
Generally, the present invention can provide vascular puncture closure apparatus and methods that overcome disadvantages of previously known devices. Also, the invention can provide apparatus and methods suitable for vascular puncture closure that quickly and effectively achieve hemostasis. Additionally, the invention can provide apparatus and methods for vascular puncture closure that do not require the introduction of additional apparatus at the completion of the catheterization procedure to achieve closure. Further, the invention can provide vascular puncture closure apparatus and methods that do not introduce animal-derived material into the bloodstream. Furthermore, the invention can provide apparatus and methods wherein all foreign materials left in a patient's body are bioabsorbable. Moreover, the invention can provide vascular puncture closure apparatus and methods that are safe, lower cost, and easy to use.
I. Closure Systems
Generally, the present invention can include a medical instrument for wound closure. As such, the invention can include a vascular introducer sheath having an integrated wound closure component. The closure component consists of a resilient spring clip disposed on and advanceable over the exterior of the introducer sheath in an expanded delivery configuration until opposite sides of the clip pierce a vessel on opposite sides of a puncture site. The introducer sheath is then withdrawn, enabling the spring clip to contract to its unstressed deployed configuration, thereby drawing opposite sides of the puncture together and closing the wound. Means also are provided for confirming when the spring clip has engaged the vessel wall, thereby indicating to the surgeon that the clip may be deployed and the introducer sheath may be withdrawn. Alternative embodiments of the spring clip also are provided.
Additionally, the closure component can consist of a bioabsorbable and deformable clip with a bioabsorbable fastener and is disposed on and advanceable over the exterior of the introducer sheath in an expanded delivery configuration until opposite sides of the clip pierce a vessel on opposite sides of a puncture site. The clip is then mechanically deformed with the fastener into a deployed configuration, thereby drawing opposite sides of the puncture together and closing the wound. Means also are provided for confirming when the bioabsorbable clip has engaged the vessel wall to indicate to the surgeon that the clip may be deployed and the introducer sheath may be withdrawn.
In a preferred embodiment, the bioabsorbable clip resembles an inverted “Y” with pointed ends that puncture the vessel to be closed. The fastener comprises a bioabsorbable locking collar that may be advanced down the length of the clip to bring the pointed ends together.
In another embodiment, the bioabsorbable clip comprises a hoop with pointed legs extending therefrom. The hoop has two points of reduced thickness spaced 180 degrees apart on the circumference of the hoop. The fastener comprises a bioabsorbable conical wedge that is pushed down into the hoop to force opposing sides of the hoop towards one another and bring the pointed legs together.
In another embodiment, the present invention includes an integrated vascular device comprising a sheath having a puncture closure component and puncture sealant. The closure component is disposed on and advanceable over the exterior of the sheath, which may, for example, comprise an introducer sheath, a trocar, or a catheter. The closure component may comprise any of a variety of apparatus suited to close a vascular puncture. Once the closure component has been actuated to close the puncture, sealant is introduced to the exterior surface of the closed puncture, preferably through the sheath's interior lumen, where the sealant seals the puncture closed. The sheath with closure component is then removed from the patient.
In a preferred embodiment constructed in accordance with the present invention, the closure component comprises a twist closure device. The device pierces tissue surrounding the vascular puncture and then is rotated to close the wound. In an alternative embodiment, the closure component comprises needles and an elastic segment surrounding the needles. The needles pierce the puncture with the elastic segment expanded. The segment is then allowed to resiliently contract to an unstressed configuration of smaller diameter, thereby drawing the needles together and closing the wound.
In a still further alternative embodiment, the needles, or prongs, are elastically deformed to an expanded diameter, in which they pierce the tissue adjacent to puncture. The needles then are allowed to resiliently contract to an unstressed configuration of smaller diameter, thereby closing the wound.
Sealant then may be introduced, preferably through the interior lumen of the sheath, to seal the puncture closed. The sealant may comprise any of a variety of sealants, per se known, including adhesives, sutures, and clips, all of which are preferably bioabsorbable. Alternatively, the closure component may further comprise the sealant, wherein the closure component is left in place within the vessel until hemostasis naturally occurs, or wherein the closure component comprises a monopolar electrode or opposed bipolar electrodes that cauterize the wound with RF current. In addition to cauterization, RF energy generates heat that beneficially causes shrinkage of the vascular tissue, thereby assisting closure of the wound. Thermal energy from electrical induction, infrared light, ultrasonic vibration, microwave or laser irradiation, and other means may also be used to seal the puncture.
In one embodiment, an apparatus is provided for delivering a closure element into engagement with tissue adjacent an opening into a body lumen. The apparatus includes a sheath including a lumen extending between its proximal and distal ends, and a locator member disposed within the sheath, the locator member having a distal portion extending distally beyond the distal end of the sheath. One or more positioning elements are provided on the distal portion of the locator member, the positioning elements being selectively expandable between a substantially axial collapsed configuration and a substantially transverse expanded configuration. Preferably, the positioning elements are a plurality, e.g. two or more, equally spaced, substantially flexible splines or wings configured for expanding substantially transversely to a longitudinal axis of the sheath. Each spline may have a first fixed end and a second movable end, the second end being axially movable towards the first end to cause an intermediate region of the spline to expand radially outward, thereby defining the radially expanded configuration. Alternatively, the splines may include a plurality of substantially rigid or semi-rigid elements that are hinged such that the splines may be expanded to the expanded configuration.
An actuator may be coupled to the locator member, the actuator configured for controllably expanding the positioning elements from the collapsed configuration to the expanded configuration. The actuator may include a control such that the positioning elements may be selectively expanded to one of a plurality of expanded sizes, e.g., to accommodate insertion into vessels of various sizes.
A housing may be axially slidably disposed on an exterior of the sheath, the housing configured for releasably holding a closure element, the housing being actuable for advancing the closure element distally to deploy the closure element. In a preferred embodiment, the locator actuator may be configured for automatically collapsing the positioning elements to the collapsed configuration upon advancement of the housing to prevent engagement between the closure element and the positioning elements. The housing may be substantially permanently but slidably disposed on the sheath. Alternatively, the housing may be provided separate from the sheath, e.g., with the closure element pre-loaded therein. The housing may be directed over the sheath, e.g., over the proximal end of the sheath, at any time before delivery of the closure element.
In another embodiment, a method is provided for delivering a closure element into a passage communicating with an opening in a wall of a body lumen. An introducer sheath is positioned through a patient's skin towards the body lumen via the passage, the sheath including a lumen extending between its proximal and distal ends. One or more instruments may be introduced through the lumen of the sheath into the body lumen. A diagnostic or therapeutic procedure may be performed using the one or more instruments at a location accessed via the body lumen.
In a preferred embodiment, the body lumen is a blood vessel, such as a peripheral vessel, e.g., the femoral or carotid artery. The procedure may be any of a variety of endovascular procedures, such as angioplasty, atherectomy, stent delivery, delivery of a therapeutic agent, and tissue ablation. Upon completion of the procedure, the devices may be removed from the sheath. A locator may be inserted along or through the sheath until a distal portion of the locator extends beyond the distal end of the sheath and into the body lumen. One or more positioning elements on the distal portion of the locator may be expanded from a collapsed configuration to an expanded configuration. The sheath and locator may then be manipulated with respect to the body lumen until the positioning elements in their expanded configuration contact the wall of the body lumen, thereby providing a tactile indication of a location of the distal end of the sheath. A closure element may then be delivered via the sheath into the passage. The sheath and locator may be withdrawn from the body lumen and opening, leaving the closure element to substantially close the opening.
In one embodiment, an apparatus is provided for delivering a closure element or other annular-shaped device into an opening through tissue, e.g., for engaging tissue adjacent to the opening to close and/or seal the opening. The apparatus includes an elongate member including proximal and distal ends, such as an introducer sheath that includes a lumen for advancing one or more devices into a body lumen during a procedure.
A carrier assembly is slidable on the elongate member, the carrier assembly including an inner carrier member, a middle pusher member, and, optionally, an outer skin, nested together. Each member may have an annular shape, and may include a connector on its proximal end. The pusher member may be disposed about the carrier member to define a space distal to the pusher member along an outer surface of the carrier member. The outer skin has a length, whereby the outer skin may extend over the space and/or contact an outer surface of the elongate member. In a preferred embodiment, the outer skin extends a short distance beyond a distal end of the carrier member, such that the outer skin is slidable along the elongate member. An annular-shaped element, e.g., a clip or other closure device, may be received on the carrier member within the space, the annular-shaped element being deployable from the space upon distal movement of the pusher member relative to the carrier member.
In addition, the apparatus may include an actuator assembly including a housing and inner, intermediate, and outer actuator members that telescope relative to the housing and/or to each other. The housing may be connectable to the proximal end of the elongate member, e.g., to a hub on the proximal end by cooperating connectors on the hub and the housing. Each actuator member may include a connector on its distal end for engaging a respective member of the carrier assembly, thereby coupling movement of the carrier, pusher, and sheath members to the inner, intermediate, and outer actuator members, respectively. If the outer skin is eliminated from the carrier assembly, the outer actuator member may be eliminated from the actuator assembly.
In a preferred embodiment, the actuator assembly includes a control member that is coupled to one or more of the actuator members, preferably, but not necessarily, the intermediate actuator member. The inner, intermediate, and outer actuator members may include cooperating detents for coupling distal movement of the inner, intermediate, and outer actuator members together in a predetermined manner as the control member is directed distally.
For example, a first set of cooperating detents may be provided that initially couples the inner, intermediate, and outer actuator members together, and releases the outer actuator member upon attaining a first distal position. The inner and intermediate actuator members may be directed distally further, consequently permitting the carrier and/or pusher members to be directed distally relative to the outer skin. In an exemplary embodiment, the first set of cooperating detents may include a first detent on the outer tubular member and first pockets in the inner and intermediate tubular members for receiving the first detent therein. Cooperating ramps may be provided on the outer tubular member that are configured for disengaging the first detent from the first pockets upon attaining the first distal position, thereby allowing the inner and intermediate tubular members to be directed distally beyond the first distal position.
In addition, the cooperating detents may include a second set of cooperating detents on the inner and intermediate actuator members for coupling movement of the inner and intermediate actuator members together to a second distal position distal to the first distal position. For example, the intermediate actuator member may include a second detent, and the inner actuator member may include a second pocket for receiving the second detent therein. The housing or the outer actuator member may include a spring element for disengaging the second detent from the second pocket upon attaining the second distal position. For example, the spring element may include a beam extending from the outer tubular member through slots in the inner and intermediate tubular members, the beam being received in the second pocket upon attaining the second distal position, thereby disengaging the second detent and allowing further distal movement of the intermediate member while substantially simultaneously coupling the inner and outer tubular members together.
The intermediate actuator member may be advanced distally beyond the second distal position by directing the control member further distally, thereby directing the pusher member distally with respect to the carrier member to deploy the annular-shaped element from the space.
In addition, the actuator assembly may also include an obturator or locator member that may be part of the actuator assembly or may be connected to the actuator assembly. A distal portion of the locator member may extend distally beyond the actuator members. In addition, the locator member has sufficient length such that the distal portion may extend beyond the distal end of the elongate member when the actuator assembly is connected to the elongate member. One or more positioning elements on the distal portion of the locator member may be movable from a collapsed configuration towards a transversely expanded configuration. A locking mechanism on the locator member and/or actuator assembly may releasably retain the positioning elements in the expanded configuration.
In a preferred embodiment, the locator member is substantially permanently attached to the actuator assembly such that the distal portion extends through and beyond the inner actuator member. Alternatively, the actuator assembly may include a tubular portion or recess communicating via an interior of the inner actuator member with a lumen of the elongate member. In this embodiment, the locator member may be inserted into the tubular portion until the positioning elements are disposed beyond the distal end of the elongate member. One of the inner, intermediate, and outer actuator members may include a third detent for engaging a release mechanism for disengaging the locking mechanism on the locator member. Thus, the positioning elements may be collapsed to the collapsed configuration upon advancing one of the inner, intermediate, and/or outer actuator members, preferably the intermediate actuator member, to its final distal position.
In one embodiment, a closure element is associated with the elongate member for sealing the passage. In a preferred embodiment, the closure element is a plug member disposed on the distal end of the elongate member. The plug member may include a thread pattern on its outer surface, and may include a distal port communicating with a passage therethrough that, in turn, communicates with the lumen in the handle device. A sealing member may be provided in the passage for substantially sealing the passage from fluid flow therethrough. The plug member is preferably releasably attached to the distal end of the elongate member, e.g., by one or more connectors on the distal end of the elongate member and/or on the plug member. Alternatively, the closure element may be a clip that is deployable from the elongate member, e.g., from a housing slidably disposed on the elongate member. A locator member is provided that may be inserted through the lumen, the locator member having a distal portion that extends distally beyond the distal end of the elongate member when the locator member is fully inserted into the lumen. If the closure element is a plug member, the distal portion also extends beyond the plug member, e.g., through the passage therein. The locator member includes an elongate deflectable element including a proximal end and a distal end, and a control element coupled to the distal end of the deflectable element. The control element is movable proximally for causing an intermediate portion of the deflectable element, e.g., the distal portion of the locator member, to buckle substantially transversely with respect to the longitudinal axis. In a preferred embodiment, the deflectable element is a helically wound wire and the control member is a tether extending along at least the intermediate portion of the helically wound wire. The tether may extend within the helically wound wire and/or along an outer surface of at least a portion of the helically wound wire. Preferably, the intermediate portion of the deflectable element has a cross-section in its buckled configuration that is larger than a cross-section of the lumen, thereby preventing the deflectable element from being withdrawn into the plug member and/or elongate member once activated.
In another embodiment, a method is provided for sealing a passage communicating with a body lumen using an apparatus, such as that described above. The apparatus generally includes an elongate member including proximal and distal ends, and a closure element deployable from the distal end of the elongate member.
A locator member is coupled to the elongate member such that a distal portion of the locator member extends beyond the distal end of the tubular member. For example, if the elongate member is an introducer sheath or other tubular member including a lumen, the locator member may be inserted into the lumen. The distal end of the elongate member is advanced through a patient's skin towards the body lumen via the passage until the distal portion of the locator member is located within the body lumen. For example, if the closure element is a plug member, the elongate member may rotated to thread the plug member into the passage towards the body lumen.
A deflectable element on the distal portion of the locator member is buckled from an axial collapsed configuration to a transverse expanded configuration. The elongate member is manipulated such that the buckled distal portion engages or otherwise contacts a proximal wall of the body lumen, thereby providing a tactile indication of the location of the distal end of the elongate member relative to the body lumen.
The closure device is then deployed from the distal end of the elongate member within the passage. The elongate member and the locator member are then withdrawn from the passage, leaving the closure element to substantially seal the opening. Preferably, the deflectable element of the locator member includes a helically wound wire, and a tether or other control member coupled to a distal end of the helically wound wire. The tether may be subjected to tension, e.g., directed proximally, to buckle the helically wound wire substantially transversely, thereby defining the transverse configuration.
In a preferred embodiment, the closure element is a plug member releasably coupled to the distal end of the elongate member and including an external thread pattern. If the elongate member is a tubular member, the plug member may include a distal port communicating with the lumen in the tubular member, such that the locator member may be inserted into the tubular member until the distal portion extends through the distal port of the plug member. The distal portion is inserted into the passage until the plug member enters the passage, whereupon the plug member is threaded into the passage until the distal portion of the locator member enters the body lumen. The distal portion may be activated, as described above, and used to provide tactile feedback to position the plug member. For example, the plug member may be at least partially unthreaded before the plug member is deployed within the passage.
In an alternative embodiment, the apparatus may be used in conjunction with an introducer sheath or other tubular member already in place within the passage, e.g., that is used to access the body lumen during a procedure. The locator member may be inserted through the tubular member until the distal portion of the locator member is located within the body lumen. The deflectable element on the distal portion of the locator member may be buckled from an axial collapsed configuration to a transverse expanded configuration. The locator member may be manipulated, e.g., pulled proximally, such that the buckled distal portion engages or otherwise contacts a proximal wall of the body lumen, thereby providing a tactile indication that the distal portion is disposed within the body lumen and/or limiting further proximal movement of the locator member.
A plug member (or other closure device) may then be advanced over the locator member into the passage. For example, the plug member, disposed on the distal end of an elongate member, may be threaded through the tissue along the passage over the locator member. Preferably, the locator member is inserted through the distal port of the plug member and/or through the lumen of the elongate member as the plug member is advanced. Once the plug member attains a desired location within the passage, the plug member may be released from the distal end of the elongate member within the passage. The distal portion of the locator member may be returned to its axial configuration, and the elongate member and the locator member may be withdrawn from the passage, leaving the plug member to substantially seal the opening
To facilitate positioning of the plug member, the locator member may include one or more markers, e.g., disposed on a proximal portion, that may have a predetermined relation with the distal portion of the locator member. For example, the proximal portion of the locator member may include a marker band located a predetermined distance from the distal portion. The elongate member may include a window for observing the marker when the plug member reaches a predetermined location relative the distal portion, e.g., a predetermined distance proximal to the distal portion. Alternatively, the locator member and the elongate member may include cooperate tactile elements, e.g., tabs and pockets, that engage one another when the plug member reaches a predetermined location. The plug member may then be released at the predetermined location, and then the elongate member and locator member may be removed.
Thus, the various embodiments of the present invention that include an integrated vascular introducer sheath with closure component of the present invention overcome disadvantages associated with previously known methods and apparatus for sealing a vascular puncture by providing a quick, simple, safe, lower cost, effective, and easy-to-use solution to wound closure. A closure device and system constructed in accordance with the present invention provide vascular introduction and wound closure in a single device, eliminating the time and manipulation required to insert a separate closure device at the completion of a procedure. Various embodiments of such a closure device and system are described in more detail below.
II. First Closure System Embodiment
Referring to
Clip housing 16 includes an annular-shaped chamber that holds a elastically deformable clip. In accordance with the principles of the present invention, clip housing is slidably disposed on the exterior of introducer sheath 12 and is movable from a stowed position, adjacent hub 14, to a distal clip deployment position, where the spring clip is urged into engagement with tissue surrounding vascular puncture.
Clip actuator 18 comprises plunger 28 and rods 30, which are configured to slidably pass through arc-shaped lumens 22 of hub 14. The distal ends of rods 30 are mounted in clip housing 16, so that movement of plunger 28 causes corresponding proximal or distal movement of clip housing 16. As described in detail hereinafter, when plunger 28 is moved to its proximal-most position, clip housing is disposed adjacent to hub 14 and provides adequate clearance for interventional devices to be inserted device port 25 and central lumen 13 into the patient's vasculature. When moved to its distal-most position, plunger 28 causes rods 30 to urge clip housing 16 distally.
Referring now also to
Spring clip 62 is stored in its expanded delivery configuration in annular chamber 60 so that it slidably passes over clip expander 58 until it abuts proximal ledge 54 of clip bore 52. In a delivery configuration of vascular device 10, the length of annular chamber 60, as measured from the distal end of clip expander 58 to proximal ledge 54, extends within the distal end of clip housing 16 for a sufficient distance to cover the length of clip 62. In this manner, clip housing 16 prevents snagging spring clip 62 from snagging on tissue during advancement of clip housing 16 to its deployed position, as described hereinbelow.
Rods 30 pass through arc-shaped lumens 22 of hub 14 and mounted in bores 40 of clip housing 16. Distal advancement of rods 30 causes clip housing 16, expander 58, and spring clip 62 to advance distally a corresponding distance relative to introducer sheath 12. When plunger 28 is moved to its distal-most position, rods 30 may be rotated within arc-shaped lumens 22 to rotate and advance clip housing 16 relative to clip expander 58. This motion causes clip housing 16 to advance distally along female thread 56 of clip expander 58 until the proximal end of the clip expander contacts proximal ledge 50 of threaded bore 46. Further rotation of rods 30 causes proximal ledge 54 to urge a tissue-engaging portion of spring clip 62 distally off of clip expander 58. With clip housing 16 positioned at a vascular puncture site P, rotation of rods 30 causes the tissue-engaging portion, illustratively spikes, to pierce the vessel wall, as seen in dotted profile in
In alternative embodiments, plunger 28 and rods 30 may be removably coupled to clip housing 16, to permit unobstructed access to device port 26. In this embodiment, rods 30 may include teeth that may be rotated to fixedly engage bores 40 in clip housing 16.
As discussed hereinabove, back bleed indicator ports 42 are coupled to tubes 25 via blood lumens 44 that extend through clip housing 16. Back bleed tubes 25 are slidably disposed through back bleed lumens 24 of hub 14. When the distal end of clip housing 16 is advanced distally against the vessel wall at puncture P, blood enters blood indicator ports 42 and exits tubes 25, providing visual confirmation to the surgeon that the distal end of clip housing 16 is positioned adjacent to the vessel wall. Back bleed tubes 25 thus enable the surgeon to determine when clip housing 16 has been advanced sufficiently to permit clip deployment, while reducing the risk that the clip is either deployed short of the puncture site or extended into the vessel.
Still referring to
Referring now to
Upon removal of the introducer sheath, spring clip 62 resiliently returns to its unstressed deployed configuration, illustrated in
Clip 62 is preferably fabricated from a superelastic material, such as a nickel-titanium alloy, but may comprise any material with sufficient resilience to elastically expand for delivery over sheath 12 and fit within annular chamber 60 of clip housing 16. Clip 62 also may be fabricated from a bioabsorbable material or a combination bioabsorbable and elastically expandable material.
Referring now to
Upon completion of the procedure, vascular device may be advantageously used to close vascular puncture P. At this point, clip actuator 18, housing 16, clip expander 58, and clip 62 are disposed in the proximal-most position adjacent to hub 14, as depicted in
As illustrated in
In
Once the spikes have pierced the vessel wall, clip actuator 18 is rotated counterclockwise within arc-shaped lumens 22 to retract clip housing 16, via threaded bore 46, along clip expander 58. The tissue-engaging members of clip 62 retain the clip within the wall of vessel V while the housing retracts, as shown in
In
Vascular device 10 then is withdrawn from the vessel wall. Once introducer sheath 12 is removed from lumen 80 of clip 62, the clip rotates relative to the vessel wall, as shown in
Although preferred illustrative embodiments of the present invention are described above, it will be evident to one skilled in the art that various changes and modifications may be made without departing from the invention. For example, with minor modifications, vascular device 10 may be configured to carry spring clip 90 of
III. Second Closure System Embodiment
Referring to
Introducer sheath 112 comprises a material typically used for vascular introducer sheaths, such as polyethylene or nylon, and includes central lumen 113 through which other interventional devices may be introduced into the vasculature, for example, to perform a diagnostic or interventional procedure such as angiography, angioplasty, or stenting.
Hub 114 is mounted to the proximal end of introducer sheath 112 and includes side port 122, actuator lumens 124, closure lumens 126, back bleed lumens 128, back bleed tubes 130, and device port 132. Device port 132 communicates with central lumen 113 of introducer sheath 112, and has self-sealing elastomeric membrane 133 disposed across it. Self-sealing membrane 133, which may comprise, e.g., latex or a biocompatible synthetic rubber, permits interventional devices to be introduced through device port 132, while preventing blood loss through central lumen 113. Side port 122 of hub 114 is also in communication with central lumen 113, and is connected to hemostatic port 134 via biocompatible tubing 136.
Clip housing 116 includes two lumens, as described hereinbelow, that each hold a bioabsorbable, deformable clip. In accordance with the principles of the present invention, clip housing 116 is slidably disposed on the exterior of introducer sheath 112 and is movable from a stowed position, adjacent hub 114, to a distal clip deployment position, where the bioabsorbable clip is urged into engagement with tissue surrounding a vascular puncture. Clip housing 116 prevents the clips from snagging on tissue during advancement of clip housing 116.
Clip actuator 118 comprises plunger 138 and rods 140, which are configured to slidably pass through actuator lumens 124 of hub 114. Plunger 138 further includes openings 139. The distal ends of rods 140 are mounted in clip housing 116, so that movement of plunger 138 causes corresponding proximal or distal movement of clip housing 116. As described in detail hereinafter, when plunger 138 is moved to its proximal-most position, clip housing 116 is disposed adjacent to hub 114 and provides adequate clearance for interventional devices to be inserted through device port 132 and central lumen 113 into the patient's vasculature. When moved to its distal-most position, plunger 138 causes rods 140 to urge clip housing 116 distally.
Referring now to
Closure component 120 further comprises caps 152 with pin holes (not shown, out of the plane of the cross-section of
As illustrated in
As discussed hereinabove, back bleed indicator ports (not shown) are coupled to back bleed tubes 130 via blood lumens 131 that extend through clip housing 116. Back bleed tubes 130 are slidably disposed through back bleed lumens 128 of hub 114. When the distal end of clip housing 116 is advanced distally against a vessel wall at a vascular puncture, blood enters the back bleed indicator ports and exits through tubes 130, providing visual confirmation to an operator that the distal end of clip housing 116 is positioned adjacent to the vessel wall. Back bleed tubes 130 thus enable the operator to determine when clip housing 116 has been sufficiently advanced to permit clip deployment, while reducing the risk that the clip is either deployed short of the puncture site or extended into the vessel.
In conjunction with clip deployment, a bioglue or tissue sealant may be delivered through hemostatic port 134, biocompatible tubing 136, side port 122 and central lumen 113 of introducer sheath 112 to the vascular puncture to further help seal the vessel after deployment of clips 146. Alternatively, the bioglue or tissue sealant may be delivered through device port 132 or through the back bleed path described above.
With reference now to
Fastener 160 comprises bioabsorbable locking collar 180, which is slidably received on the exterior of clip 146. As seen in
Referring to
With reference to
Upon completion of the procedure, vascular device 110 advantageously may be used to close vascular puncture P. At this point, clip actuator 118, clip housing 116, and closure component 120 with clips 146, are disposed in the proximal-most position adjacent to hub 114.
Clip actuator 118 then is advanced by urging plunger 138 in the distal direction, thus causing rods 140 to slide through actuator lumens 124 of hub 114 and advance clip housing 116. Distal pins 150, mounted in housing 116, abut distal slots 166 and 168 of drivers 158 and holders 156, respectively. Thus, distal advancement of clip housing 116 also distally advances closure component 120. Continued distal advancement of plunger 138 causes the distal end of clip housing 116 to abut against the exterior of the vessel, so that the back bleed indicator ports (not shown) of clip housing 116 directly communicate with the puncture wound. The presence of pressure in the vessel higher than atmospheric pressure causes blood to pass through the indicator ports, through blood lumens 131, and exit through the proximal ends of tubes 130, thus confirming that clip housing 116 is positioned at the puncture site and should not be advanced further.
As seen in
In
As seen in
To achieve this advancement of drivers 158 with respect to clip holders 156, caps 152 are rotated clockwise, as viewed from above, until proximal pins 154 abut against the extreme left of proximal slots 162 and 164, thereby aligning the pins with the longitudinal portions of proximal holder slots 164. Then, force is once again applied to caps 152 to advance drivers 158 and deform clips 146 to their deployed configurations. Specifically, proximal pins 154 abut and apply force to proximal driver slots 162, thereby distally advancing drivers 158. Pins 154 move freely within the longitudinal portions of proximal holder slots 164 until they abut against the distal ends of slots 164. Likewise, distal driver slots 166 move freely until distal pins 150 abut the proximal ends of slots 166. In
In
Clips 146 are detached from clip holders 156 by rotating caps 152 counterclockwise, as viewed from above. Proximal pins 154 of caps 152 move freely within proximal driver slots 162, but abut against the distal end of the longitudinal portions of proximal holder slots 164 and cause clip holders 156 to rotate with respect to collar drivers 158. Distal pins 150 of clip housing 116 move freely within the circumferential portions of distal holder slots 168 during rotation of clip holders 156. Meanwhile, drivers 158 are restrained from rotation by distal pins 150, which abut against distal driver slots 166. Bioabsorbable clips 146 do not rotate because the square cross section of square clip bores 147 of drivers 158 matches the substantially square cross section of clips 146; thus, since drivers 158 are restrained from rotation, so are clips 146. Non-square cross sections for clips 146 and bores 147, capable of performing the restraining function, will be apparent to those of skill in the art and fall within the scope of the present invention.
Since clips 146 are restrained while clip holders 156 rotate, and since proximal ends 172 of clips 146 are attached to clip holders 156, counterclockwise rotation of caps 152 causes clips 146 to snap at their weakest points: narrowed regions 178. Vascular device 110 may then be removed from the patient to complete the procedure.
Although preferred illustrative embodiments of the present invention are described above, it will be evident to one skilled in the art that various changes and modifications may be made without departing from the invention. For example, with minor modifications, vascular device 110 may be configured to carry closure component 190 of
IV. Third Closure System Embodiment
Referring to
Sheath 212, which may, for example, comprise an introducer sheath, a trocar, or a catheter, includes central lumen 213 through which other devices may be introduced into the vasculature, for example, to perform a diagnostic or interventional procedure such as angiography, angioplasty, or stenting, or to seal a puncture site.
Hub 214 is mounted on the proximal end of sheath 212 and includes side port 220, arc lumens 222, and device port 224. Device port 224 communicates with central lumen 213 of sheath 212, and has self-sealing elastomeric membrane 225 disposed across it. Self-sealing membrane 225, which may comprise, for example, latex or a biocompatible synthetic rubber, permits interventional devices to be introduced through device port 224, while preventing blood loss through central lumen 213. Side port 220 of hub 214 is also in communication with central lumen 213, and is connected to hemostatic port 226 via biocompatible tubing 228.
In accordance with the principles of the present invention, closure component 216 comprises lumen 230 that receives sheath 212. Component 216 is slidably disposed on the exterior of sheath 212 and is movable from a stowed position, adjacent hub 214, to a distal deployment position, where tines 217 of component 216 are urged into engagement with tissue surrounding a vascular puncture. Closure component 216 comprises at least two sharpened tips, or tines 217. Tines 217 preferably comprise back bleed ports 232. Closure component 216 is rotatable within arc-lumens 222 about the longitudinal axis of sheath 212, so that, with tines 217 engaging tissue surrounding the vascular puncture, component 216 closes the puncture.
Closure actuator 218 comprises plunger 234 and tubes 236, which are configured to slidably pass through arc lumens 222 of hub 214. The proximal ends of tubes 236 are coupled to back bleed bores 238 of plunger 234. The distal ends of tubes 236 are mounted, either permanently or detachably, in closure component 216, so that movement of plunger 234 causes corresponding proximal or distal movement of closure component 216. Likewise, rotation of plunger 234 causes corresponding rotation of tubes 236 within arc lumens 222, which, in turn, rotates closure component 216 about the longitudinal axis of sheath 212.
Plunger 234 further comprises device bore 240, coaxially aligned with device port 224, and through which interventional devices or puncture sealants may be passed. As described in detail hereinafter, when plunger 234 is moved to its proximal-most position, closure component 216 is disposed adjacent to hub 214 and preferably provides adequate clearance for interventional devices to be inserted through device port 224 and central lumen 213 into the patient's vasculature. When moved to its distal-most position, plunger 234 causes tubes 236 to urge closure component 216 distally. Interventional devices or sealants then may be introduced through device bore 240, device port 224, and central lumen 213 into the vasculature.
Back bleed bores 238 of plunger 232 are in communication with back bleed lumens (not shown) within tubes 236. The back bleed lumens of tubes 236 are in communication with back bleed ports 232 of tines 217, thereby establishing a complete back bleed path through ports 232, the lumens (not shown) of tubes 236, and bores 238. When tines 217 of closure component 216 pierce a vessel wall surrounding a vascular puncture, blood enters back bleed ports 232 and exits through back bleed bores 238, providing visual confirmation to a surgeon that tines 217 are positioned within the vessel wall. The back bleed path thus enables the surgeon to determine when closure component 216 has been sufficiently advanced to permit rotation of component 216 to close the puncture, while reducing the risk that component 216 is either short of the puncture site or is extended into the vessel.
In conjunction with closure of the puncture site caused by rotation of component 216, a puncture sealant may be introduced to the puncture site to seal the site closed. The sealant may, for example, comprise an adhesive, such as a bioglue, tissue sealant, or clotting agent, delivered through hemostatic port 226, biocompatible tubing 228, side port 220 and central lumen 213 of introducer sheath 212 to the vascular puncture to further help seal the vessel after puncture closure with closure component 216. Alternatively, the adhesive may be delivered through device port 224 or through the back bleed path described above. Instead of adhesives, the closure component may further comprise the sealant, wherein the closure component is left in place within the vessel until hemostasis naturally occurs. The sealant may also comprise sutures delivered through central lumen 213. Additionally, the sealant may comprise thermal energy application from, for example, electrical induction, infrared light, ultrasonic vibration, microwave or laser irradiation, and other means.
With reference to
Delivery device 252 further comprises second jaw 266 having female connector 268 coupled to pin 264, so that second jaw 266 pivots about pin 264. Second jaw 266 further comprises moment arm 270. Tension spring 272 is coupled to moment arm 270 and to the interior surface of tube 258 in a manner that biases second jaw 266 against first jaw 260.
First jaw 260 and second jaw 266 preferably form channel 274 when biased against one another. Channel 274 is configured to receive clip 254. The biasing force applied by tension spring 272 holds clip 254 within channel 274, so that the clip may be advanced into tissue surrounding a vascular puncture that has had its edges approximated by closure component 216.
Delivery device 252 still further comprises plunger 276 coupled to pushrod 278 having release arm 280. Pushrod 278 is received within lumen 262 of tube 258, so that release arm 280 engages moment arm 270.
Distal advancement of pushrod 278, via application of force to plunger 276, causes release arm 280 to urge moment arm 270 distally. This motion overcomes the biasing force applied by tension spring 272 and causes second jaw 266 to pivot about pin 264. Second jaw 266 thus no longer contacts first jaw 260, and clip 254 is released from channel 274. Tube 258, first jaw 260, second jaw 266, and clip 254 of sealing device 250 preferably are sized for introduction into a patient's vasculature through device bore 240, device port 224, and lumen 213 of vascular device 210.
Referring to
Upon completion of the procedure, vascular device 210 may be advantageously used to close vascular puncture P. At this point, closure actuator 218 and closure component 216 are disposed in the proximal-most position, with component 216 adjacent to hub 214. Closure actuator 218 is advanced by urging plunger 234 in the distal direction, thus causing tubes 236 to slide through arc lumens 222 of hub 214 and advance closure component 216.
As seen in
In
Upon closure of puncture P, a sealant is introduced to seal the wound closed. The sealant may, for example, comprise an adhesive, such as a bioglue, tissue sealant, or clotting agent, it may comprise a suture, it may comprise thermal energy application, or it may comprise leaving the closure component in place within vessel V until hemostasis naturally occurs. Alternatively, the sealing device may comprise a clip, as described hereinafter.
With reference now to
The sheath 302 may, for example, comprise an introducer sheath, a trocar, or a catheter, and includes central lumen 303 through which other devices may be introduced into the vasculature, for example, to perform a diagnostic or interventional procedure such as angiography, angioplasty, or stenting, or to seal a puncture site. Hub 304 comprises bore 310, which slidably receives actuator 308, and device port 312, which is in communication with central lumen 303 of sheath 302 and permits introduction of interventional devices while preventing blood loss through central lumen 303. Hub 304 further comprises side port 314.
Closure component 306 comprises outer housing 316 having lumen 318 configured to slidably receive sheath 302, bore 320 for slidably receiving inner housing 322, lumen 324 adapted to receive closure actuator 308, and needles or prongs 326 with sharpened tips 328. Inner housing 322 has lumen 323 adapted to receive sheath 302 and channels 330 adapted to receive prongs 326. Component 306 comprises at least two prongs 326, and preferably comprises four.
Closure actuator 308 comprises actuation tube 332 having lumen 333, actuation rod 334 disposed within actuation tube 332, first plunger 336 coupled to the proximal end of tube 332, and second plunger 338 coupled to the proximal end of rod 334. The distal end of tube 332 is affixed, either permanently or detachably, in lumen 324 to outer housing 316 of closure component 306, while the distal end of rod 334 is coupled to inner housing 322.
To perform an interventional procedure through central lumen 303 of sheath 302, the sheath is advanced through skin, fat, and muscle tissue into vessel V, through vascular puncture P, in accordance with well-known techniques. With closure component 306 in the proximal-most, fully retracted position adjacent hub 304, the interventional procedure then is performed by introducing one or more interventional devices, e.g. angioplasty balloons, stent delivery systems, atherectomy devices, etc., through device port 312 and lumen 303 of sheath 302, again in accordance with well-known techniques. Side port 314 may be used to infuse fluids, e.g., contrast agents or medications, into the vessel through sheath 302 during the interventional procedure.
Upon completion of the procedure, apparatus 300 advantageously may be used to close the vessel. Closure component 306 is advanced distally by urging plungers 336 and 338 distally. Inner housing 322 is only partially received within bore 320 of outer housing 316 so that prongs 326 are elastically deformed and received within channels 330. As shown in
In
In
Referring to
Sheath 352 may, for example, comprise an introducer sheath, a trocar, or a catheter, and includes central lumen 353 through which other devices may be introduced into the vasculature, for example, to perform a diagnostic or interventional procedure such as angiography, angioplasty, or stenting, or to seal a puncture site. Closure component 354 comprises spacer 356, needles 358, and needle cover 360. Spacer 356 is coaxially and slidably disposed about the exterior of sheath 352, and preferably has an annular diameter of about 1 mm to ensure that needles 358 engage the tissue surrounding puncture P rather than enter the puncture, so that the needles are able to draw the wound closed, as described hereinbelow. Needles 358 are disposed between spacer 356 and cover 360 during advancement to puncture P. Needles 358 comprise ledges 362, which act as positive stops to prevent excessive advancement of the needles with respect to cover 360, which comprises corresponding annular ledge 364. Cover 360 further comprises elastic segment 366, configured to elastically deform needles 358. Closure component 354 comprises at least two needles 358, and preferably comprises four. Needles 358 may further comprise retaining means (not shown), such as barbs or hooks, to assist in gripping tissue.
As shown in
In
A sealant, such as a bioglue, tissue sealant, or clotting agent, then may be introduced to the puncture site to seal the wound closed. Alternatively, closure component 354 may be maintained in position until hemostasis occurs naturally, or sutures may be introduced through central lumen 353. In addition, or in the alternative, RF energy may be applied across needles 358 or a clip, such as clip 254 of sealing device 250 of
Illustratively,
V. Fourth Closure System Embodiment
Turning now to
The sheath 412 includes a substantially flexible or semi-rigid tubular body 415 including a lumen 416 extending between its proximal and distal ends 418, 420. The distal end 420 has a size and shape to facilitate insertion into a blood vessel, e.g., having a tapered tip 422 for facilitating substantially atraumatic introduction through the passage and at least partially into the vessel. The lumen 416 has a size for accommodating insertion of one or more devices therethrough, such as a catheter, guidewire, and the like (not shown). The sheath 412 also preferably includes a seal (not shown), such as a hemostatic valve, within the lumen 416 at or near the proximal end 418 that provides a fluid-tight seal, yet accommodates insertion of one or more devices, such as the locator 414, into the lumen 416 without fluid passing proximally from the sheath 412.
Optionally, the sheath 412 may include a side port 419 that communicates with the lumen 416, for example, to allow the infusion of fluids into the lumen 416, through the sheath 412. Alternatively, or in addition, the side port 419 may be used to provide a “bleed back” indicator, such as that disclosed in U.S. Pat. No. 6,626,918, entitled “Apparatus and Methods for Positioning a Vascular Sheath,” which is assigned to the assignee of the present invention. The disclosure of this patent and any references cited therein are expressly incorporated herein.
A housing 424 is slidably disposed on an exterior of the sheath 412, the housing 424 configured for releasably holding the closure element 426. The housing 424 may include an ejector or other mechanism (not shown) for deploying the closure element 426 from the housing 424. In a preferred embodiment, the closure element 426 is an annular-shaped clip, including one or more barbs 428 for engaging the tissue around the puncture adjacent to the wall of the vessel. Preferably, the clip 426 is configured for drawing the tissue around the puncture at the wall of the vessel substantially closed and/or for enhancing hemostasis within the puncture. Exemplary embodiments of a housing and closure element for use with an apparatus in accordance with the present invention are disclosed U.S. Pat. Nos. 6,197,042, 6,461,364, and 6,391,048, which are expressly incorporated herein by reference.
The housing 424 is actuable from the proximal end 418 of the sheath 412 (
Alternatively, the housing 424 may be provided separate from the sheath 412 (not shown), e.g., with the closure element 426 preloaded therein. In this embodiment, the housing actuator assembly 430 may also be provided separate from the sheath 412, as shown, either coupled to or separate from the housing 424. Any time before delivering the closure element 426, the housing 424 may be directed over the sheath 412, e.g., by inserting the proximal end 418 of the sheath 412. The housing actuator assembly 430 may be attached to the proximal end 418 of the sheath 412, e.g., by cooperating connectors (not shown). The housing 424 may be coupled to the housing actuator assembly 430, if not already attached, thereby preparing the housing 424 for use.
In a preferred embodiment shown in
A loose end 450 of the control wire 444 may be coupled to the second actuator member 448. For example, the housing actuator assembly 430 may be advanced over the control wire 444 such that the loose end 450 passes through aperture 452 in the first member 446 and is received in a mating pocket 454 in the second member 448, as best seen in
The second actuator member 448 may be movable with respect to the first actuator member 446 by one or more rods or rails (not shown) extending therebetween. Thus, the second actuator member 448 may be movable from a first or proximal position (not shown), located a first distance from the first actuator member 446, distally to a second or distal position (shown in
In a preferred embodiment, the second actuator member 448 is biased to its distal position, for example, by spring 456 or other biasing element. The second actuator member 448 may be locked in its proximal position, for example, by a locking mechanism (not shown), thereby retaining the housing 424 in its proximal position. When it is desired to advance the housing 424, a button, switch, or other activation member (not shown) may be deployed to release the locking mechanism, thereby automatically directing the second actuator member 448 towards the first actuator member 446, and thereby advancing the housing 424 to its distal position, as described further below. The closure element 426 may be automatically ejected from the housing 424 once it reaches the distal position or the closure element 426 may be subsequently ejected by a separate action. It will be appreciated by those skilled in the art that other housing actuator configurations may be provided for advancing the housing 424 with respect to the sheath 412, e.g., to deliver the closure element 426.
The housing actuator assembly 430 may also include an adjustment mechanism, such as threaded bolt or knob 458. For example, the knob 458 may be provided on the first actuator member 446 such that, as the knob 458 is rotated, the first actuator member 446 may be moved axially with respect to the sheath 412. Because the first actuator member 446 may be adjusted distally or proximally with respect to the sheath 412, the distal position of the second actuator member 448 consequently may be adjusted. This, in turn, may facilitate adjusting the distal position of the housing 424, e.g., to compensate for the thickness of a particular wall of a blood vessel when a closure element 426 is delivered to close a puncture in the wall.
Turning to
As best seen in
One or more, and preferably a plurality of, positioning elements 464 are provided on the distal portion 460 that may be selectively expandable between a substantially axial collapsed configuration (shown in
Optionally, the splines 464 may include radiopaque markers (not shown) or may be at least partially formed from radiopaque material to facilitate observation of the splines 464 using fluoroscopy or other imaging systems. In addition, the housing 424 may include a radiopaque marker, e.g., at its distal end (not shown) and/or the closure element 426 may include a radiopaque marker or may be made from radiopaque material. This may facilitate monitoring the relative location of the closure element 426 to the splines 464, as described further below.
Returning to
A locator actuator 470 may be coupled to the locator member 414, the locator actuator 470 configured for selectively expanding the splines 464 from their collapsed configuration to their expanded configuration. For example, the locator actuator 470 may include a switch 472 that may be depressed or rotated to retract or move the rod 438 proximally, thereby expanding or deploying the splines 464. The locator actuator 470 preferably includes a lock (not shown) for securing the rod 438 in a proximal position and thereby locking the splines 464 in their expanded configuration. The lock may be released, for example, by depressing the switch 472. The locator actuator 470 may include a spring 474 or other biasing mechanism for biasing the rod 438 distally, e.g., to return the splines 464 to their collapsed configuration when the lock is released. For example, as described further below, the lock may be released upon activation of the housing actuator assembly 430, e.g., when the second actuator member 448 moves towards its distal position.
Turning to
As shown in
The passage 492, and consequently the sheath 412, may be oriented at a substantially acute angle alpha (“α”) with respect to the vessel 490, thereby facilitating introduction of devices through the lumen 416 of the sheath 412 into the vessel 490 with minimal risk of damage to the vessel 490. One or more devices, such as a guide wire, a catheter, and the like (not shown), may be inserted through the sheath 412 and advanced to a desired location within the patient's body. For example, the devices may be used to perform a therapeutic or diagnostic procedure, such as angioplasty, atherectomy, stent implantation, and the like, within the patient's vasculature.
After the procedure is complete, the device(s) may be removed from the sheath 412, and the locator member 414 may be inserted through the hemostatic valve (not shown) into the lumen 416. If the housing 424 is not already provided on the sheath 412, the housing 424 and/or the housing actuator assembly (not shown) may be advanced over or otherwise attached to the proximal end of the sheath 412, preferably before the locator member 414 is inserted into the sheath 412.
As shown in
Alternatively, the sheath 412 may include a side port (not shown) at or near its distal end 420 and a bleed back lumen (also not shown) that extends from the side port to the proximal end of the sheath 412. Before or after insertion of the locator member 414, the sheath 412 may be manipulated until “bleed back” (i.e., blood entering the side port and passing proximally through the lumen due to exposure of the side port to blood pressure within the vessel) indicates a desired position for the distal end 420 of the sheath 412. For example, the sheath 412 may be partially withdrawn from the vessel 490 before the locator member 414 is inserted into the sheath 412 to minimize contact between the vessel wall 498 and the distal portion 460 of the locator member 414 during insertion of the locator member 414 into the sheath 412.
As shown in
Turning to
Alternatively, or in addition, the splines 464 include radiopaque markers, such that fluoroscopy and the like may be used to monitor and position the distal portion 460 of the locator member 414. The housing 424 and/or closure element 426 may also include radiopaque markers such that a relative position of the closure element 426 with respect to the splines 464, and consequently to the wall 498 of the vessel 490, may be ascertained before the closure element 426 is deployed from the housing 424.
In a preferred method, the splines 464 automatically return to their collapsed configuration when the closure element 426 is deployed from the housing 424 or when the housing 424 reaches its distal position, as shown in
Once the clip 426 is successfully deployed within the passage 492, i.e., into the wall 498 of the vessel 490, the apparatus 410 may be withdrawn from the passage 492. If the splines 464 of the locator member 414 are not automatically collapsed during advancement of the housing 424, the splines 464 may first be affirmatively collapsed, e.g., by depressing the locator actuator (not shown). The entire apparatus 410 may then be removed in one step, or alternatively, the locator member 414 may first be withdrawn from the sheath 412 before withdrawing the sheath 412, thereby leaving the clip 426 in place to close and/or seal the passage 492.
Turning to
The locator member 514 includes a distal portion 560 that terminates in a substantially rounded, soft, and/or flexible distal tip 562, possibly including a pigtail (not shown) that may facilitate atraumatic advancement of the distal portion 560 into a blood vessel or other body lumen. The locator member 514 preferably has a length relative to the sheath such that the distal portion 560 extends beyond a distal end of the sheath when the locator member 514 is fully received in the sheath, similar to the embodiment described above.
A plurality of splines 564 are provided on the distal portion 560 that may be selectively expandable between a substantially collapsed configuration (shown in
Each spline 564 preferably has a first fixed end 564a and a second movable end 564b. The second end 564b may be axially movable towards the first end 564a to cause an intermediate region 564c of the spline 564 to expand transversely outward, thereby defining the substantially transverse expanded configuration. In a preferred embodiment, the actuator rod 538 extends through the distal portion 560 and is coupled to the second end 564b of the splines 564 and/or to distal tip 562 of the locator member 514. The rod 538 may be moved axially with respect to the body 532 to selectively expand the splines 564 between the collapsed and expanded configurations.
Turning to
In addition, the locator actuator 570 may allow the splines 564 to be expanded to one of a plurality of expanded configurations. For example, the locator actuator 570 may include an internal member (not shown), coupled to the control rod 538, that is slidable within an actuator body 576. A button 572 extending from the internal member is slidable in an axial slot 574 in the actuator body 576 for controlling movement of the control rod 538. The button 572 may be moved, thereby moving the control rod 538 and consequently moving the splines 564. For example, as shown in
In an alternative embodiment, shown in
In a further alternative, shown in
For example, a spline 664b on the posterior side of the locator member 614 (away from the surface of the patient's skin) may be expanded towards the proximal end of the locator member 614 at an acute angle alpha, i.e., corresponding substantially to the angle of the passage through the patient's skin to the vessel 690, e.g., about thirty or forty five degrees. In contrast, the spline 664a on the anterior side of the locator member 614 (i.e. towards the surface of the patient's skin) may be expanded away from the proximal end of the locator member 614 at an oblique angle of one hundred eighty degrees less “alpha.” Thus, the splines 664a, 664b may be expanded to predetermined angles that facilitate better contact with the wall of the vessel, e.g., to better “present” the vessel wall during deployment of a closure element.
In yet another alternative embodiment, shown in
When the locator member 714 is fully inserted into an introducer sheath 712, such as those described above, the distal portion 717 of the sleeve 715 extends beyond a distal end 720 of the sheath 712. The splines 764 may then be selectively deployed from within the sleeve 715, expanded to a substantially transverse expanded configuration, collapsed, and retracted back into the sleeve 715.
For example, the sheath 712 may be positioned through a puncture 792 into a vessel 790, e.g., to perform a procedure within a patient's vasculature, as described above. The locator member 714 may then be inserted into the sheath 712 until the distal portion 717 extends beyond the distal end 720 of the sheath 712. The splines 764 may then be expanded, and the sheath 712 and locator member 714 manipulated to a desired position, e.g., such that the splines 764 contact the wall 798 of the vessel 790, thereby providing a tactile indication of the position of the sheath 712.
A closure element, such as clip 726 may then be deployed, e.g., from a housing (not shown) slidably mounted on the sheath 712. Barbs or tines 728 on the clip 726 penetrate into the wall 798 of the vessel 790, e.g., to close the opening in the wall 798 of the vessel 790, as described above. If the barbs 728 penetrate completely through the wall 798 of the vessel 790, the sleeve 715 protects the splines 764 and/or the body 733 of the locator member 714. The barbs 728 may engage but not penetrate or otherwise catch on the distal portion 717 of the sleeve 715, because of its substantially rigid and/or smooth construction. Thus, the barbs 728 may not penetrate or otherwise catch on the splines 764 when the clip 726 is deployed. The splines 764 may be collapsed and retracted into the sleeve 715, either manually or automatically, similar to the embodiments described above. When the sheath 712 is withdrawn from the puncture 792, the barbs 728 may slide along the distal portion 717 of the sleeve 715 until the distal portion 717 is withdrawn from within the clip 726, whereupon the barbs 728 may move inwards to close and/or seal the opening in the wall 798 of the vessel 790.
In alternative embodiments, the apparatus and methods of the present invention may be used to locate an introducer sheath within a blood vessel and/or to deliver closure elements other than a clip. For example, the apparatus may be used to deliver a collagen plug and the like into the passage, or a sealing material (either alone, or in conjunction with a clip).
VI. Fifth Closure System Embodiment
Turning to
As best seen in
Returning to
For example, the hub assembly 830 may include a rear main body 1022, a spacer 1023, a nose ring 1024, and a strain relief forward nose 1026 that may be substantially permanently attached to one another. The keel member 1020 may include a tubular portion 1046, and a shoulder portion 1048 connected by a radial spoke 1050 that may extend transversely with respect to the longitudinal axis 828. The proximal end 822 of the sheath 812 may be connected to the tubular portion 1046 such that a passage 1052 through the tubular portion 1046 communicates with the lumen 820. The main body 1022 and nose ring 1024 may be connected to the shoulder portion 1048 such that an annular passage 838 may be defined between the tubular portion 1046 and the main body 1022 and nose ring 1024. The passage 838 may have a “C” shape along the portion of the hub assembly 830 through which the spoke 1048 of the keel member 1020 extends.
With particular reference to
In addition, the hub assembly 830 may include one or more connectors on its proximal end 832, such as tabs 834 (see
Returning to
As best seen in
A tongue 850 may extend proximally from the proximal end 846 substantially parallel to the longitudinal axis 828. The tongue 850 may include a tab 852 or other connector, having a ramped proximal edge 852a and a substantially blunt distal edge 852b, for coupling movement of the carrier member 840 to the actuator assembly 816, as described further below. The distal end 848 of the carrier member 840 may be tapered or otherwise configured for facilitating substantially atraumatic advancement of the carrier member 840 through tissue, also as described further below.
The pusher member 842 is also an annular body 854, including proximal and distal ends 856, 858 and a tongue 860 extending from the proximal end 856 having a tab 862 thereon. The pusher member 842 is configured to slidably fit around the carrier member 840, but has a substantially shorter length than the carrier member 840. Thus, the carrier and pusher members 840, 842 may at least partially define a space 815 distal to the distal end 858 of the pusher member 842 and along an outer surface of the carrier member 840.
The anchor member or ring 844 may also be an annular body 864, including proximal and distal ends 866, 868 and a tongue 870 extending from the proximal end 866 having a tab 872 thereon, similar to the carrier and pusher members 840, 842. The anchor member 844 preferably includes an outer skin or sleeve 845 (shown in phantom in
The outer sleeve 845 may be formed from a substantially flexible material, which may be inelastic or elastic, and/or may include a substantially slippery outer surface. Exemplary materials include polytetrafluoroethylene (PTFE), polyethylene terephthalate (PET) or other polyester, latex, silicone, polyamides, polyurethanes, and/or blends or copolymers thereof. The outer sleeve 845 may have a length that is substantially longer than the carrier member 840 such that the outer sleeve 845 extends beyond the distal end 848 of the carrier member 840. For example, the outer sleeve 845 may extend up to fifteen millimeters (15 mm) or more beyond the carrier member 840 and/or may slidably surround the sheath 812. The outer sleeve 845 may protect the clip 805 or tissue through which the carrier assembly 814 is advanced, and/or may facilitate advancing the carrier assembly 814 through multiple layers of tissue, as explained further below.
Optionally, the outer sleeve 845 may include weakened regions, e.g., longitudinal slots or perforations 845a or thin walled regions (not shown), that may be torn, expanded, and/or enlarged during advancement of the carrier and pusher members 840, 842 relative to the outer sleeve 834, as explained further below. For example, the outer sleeve 845 may include a plurality of longitudinal slots 845a with circumferentially adjacent slots being staggered longitudinally from one another, as shown in
In a further alternative, a substantially flexible sleeve or skin (not shown) may be provided that extends over the space 815, similar to the outer sleeve 845, but that may be bonded or otherwise secured to the outer surface of the introducer sheath 812. Embodiments of such a skin may be found in U.S. Pat. No. 6,749,621, which is incorporated herein by reference. In yet another alternative, it may be possible to eliminate the anchor member 844 and/or the outer sleeve 845 completely, such that the clip 805 remains exposed on the carrier member 840.
In a preferred embodiment, the carrier, pusher, and anchor members 840, 842, 844 are coaxially disposed with respect to one another such that they telescope at least partially within one another. When the carrier, pusher, and anchor members 840, 842, 844 are coaxially disposed, the tongues 850, 860, 870 preferably overlap and/or are coextensive with one another, as shown in
The carrier assembly 814 may be used to deploy a clip 805 or other closure element from the space 815 defined by the carrier assembly 814. In a preferred embodiment, the clip 805 is a generally annular-shaped clip, including one or more barbs and/or tines 807 for engaging the tissue around an opening, e.g., in or adjacent to a wall of a blood vessel (not shown). Preferably, the clip 805 is configured for drawing the tissue around a puncture in the wall of the vessel substantially closed and/or for enhancing hemostasis within the puncture. Exemplary embodiments of a closure element are disclosed in U.S. Pat. Nos. 6,197,042, 6,461,364, 6,391,048, 6,623,510, which are incorporated herein by reference.
Returning to
Turning to
In the preferred embodiment shown in
The distal ends 892, 894, 896 include detents for engaging respective detents on the carrier assembly 814. For example, the detents may be pockets 904, 906, 908 including a tapered proximal edge and a substantially blunt distal edge (only edges 908a, 908b are shown and labeled in
Returning to
The inner, intermediate, and outer actuator members 876-880 include one or more sets of cooperating detents for coupling distal movement of the inner, intermediate, and outer actuator members 876-880 in a predetermined manner, as the knob 910 is directed distally. The term “detents” refers to any combination of mating elements, such as tabs, pockets, slots, ramps, cantilevered members, and the like, that may be selectively or automatically engaged and/or disengaged to couple or decouple the actuator members 876-880 relative to one another. The cooperating detents described below are merely exemplary and not exhaustive.
Preferably, the cooperating detents include a first set of cooperating detents for releasably coupling the outer tubular member 880 to the inner and intermediate tubular members 876, 878. When the carrier assembly 814 reaches a first distal position, e.g., near the distal end 824 of the sheath 812, the outer tubular member 880 may be decoupled and preferably anchored from further substantial axial movement. As the knob 910 is directed further distally, the inner and intermediate tubular members 876, 878, and consequently the carrier and pusher members 840, 842, may continue to be directed distally, while the outer tubular member 880 and the sheath member 844 remain anchored in place.
First and second ramps 920, 922 are provided on the outer tubular member 880 and the housing 874 of the actuator assembly 816 (only a portion of which is shown) of the sheath 812 (not shown). The first and second ramps 920, 922 slidably engage one another as the actuator members 876, 878, 880 and/or the carrier assembly 814 (not shown) reach the first distal position. Alternatively, the second ramp 922 may be provided on a portion of the hub assembly 830 (not shown). Preferably, the first ramp 920 on the outer tubular member 880 defines a free end of a first cantilevered beam 924 from which the first tab 914 extends inwardly. The beam 924 includes a hole 926 therethrough and the second ramp 922, which is relatively stationary, includes a recess or other feature 928 therein.
The actuator members 876, 878, 880 may be advanced distally (in direction of arrow) until the cooperating first and second ramps 920, 922 slidably engage one another. As the actuator members 876, 878, 880 are advanced further distally, the first ramp 920 slides up onto the second ramp 922, thereby deflecting the first beam 924 outwardly until the first tab 914 is disengaged from the first pockets 916, 918, as shown in
In addition to the first set of cooperating detents described above, the actuator assembly 816 may include a second set of cooperating detents for releasably coupling the inner tubular member 876 and the intermediate tubular member 878 and/or recoupling the inner and outer tubular members 876, 880. Thus, the inner and intermediate tubular members 876, 878 may be directable to a second distal position distal to the first distal position (while the outer tubular member 880 remains substantially stationary). When the carrier and pusher members 840, 842 approach the second distal position, the cooperating detents may decouple the intermediate tubular member 878 from the inner tubular member 876 and/or anchor the inner tubular member 876 in place, e.g., relative to the outer tubular member 880. The intermediate tubular member 878, and consequently the pusher member 842 (not shown), may then be advanced further distally beyond the second distal position, as described further below.
Turning to
The outer tubular member 880 includes a spring element 938 that is configured for disengaging the second tab 930 from the second pocket 932 upon attaining the second distal position. For example, the spring element 938 may include a transverse beam 940 that extends from a third cantilevered beam 941 on the outer tubular member 880. The transverse beam 940 extends through slots 942, 944 in the inner and intermediate tubular members 876, 878, e.g., transversely to the longitudinal axis 828, and preferably substantially perpendicular to the longitudinal axis 828.
Preferably, the transverse beam 940 has an inverted “T” shape, as best seen in
Consequently, before the inner and intermediate tubular members 876, 878 reach the second distal position, the shoulders 946 may slide along the outer surface of the intermediate tubular member 878 while the stem 948 slides inside the narrow region 942a, 944a of the slots 942, 944. Alternatively, the shoulders 946 may slide along an outer surface (not shown) of the inner member 876 if the slot 944 is wide its entire length. The tip 950 of the transverse beam 940 may move along the inner tubular member 876, e.g., at a predetermined clearance from the inner surface thereof such that the tip 950 does not touch the inner surface of the inner tubular member 876. Alternatively, the tip 950 may slide along the inner surface of the inner tubular member 876.
When the inner and intermediate tubular members 876, 878 approach or attain the second distal position, the shoulders 946 may enter the wide regions 942b, 944b, e.g., due to the bias of the beam 941. This action may produce two substantially simultaneous results. First, when the shoulders 946 enter the wide regions 942b, 944b, i.e., such that the beam 940 moves transversely, the tip 950 of the beam 940 may push the second tab 930 radially outward, thereby disengaging the second tab 930 from the second pocket 932. Thus, further distal movement of the intermediate tubular member 878 may be allowed independent of the inner tubular member 876. In addition, the shoulders 946 of the beam 940 may enter the wide region 942b of the slot 942. Because the wide region 942b has a size corresponding substantially to a cross-section of the transverse beam 940, the inner tubular member 876 is consequently coupled to the outer tubular member 880 as it is disengaged from the intermediate tubular member 878.
Thus, the inner tubular member 876 may be substantially locked in place, e.g., to the outer tubular member 880 since the outer tubular member 880 has been previously secured in place. Preferably, these two actions, i.e., releasing the intermediate tubular member 880 and securing the inner tubular member 876 in place occur substantially simultaneously.
Returning to
In addition, the obturator assembly 818 includes an obturator housing 980 on the proximal end 974 of the rail 972. The obturator housing 980 may include one or more tabs 992 for engaging complementary slots 994 in the side plates 991. Thus, the obturator assembly 818 may be secured within the housing 874 of the actuator assembly 816 when the tabs 992 are received in the slots 994. The side plates 991 may be connected to the frame subassembly 990, and the handle covers 874a, 874b are secured over the side plates 991. When the obturator assembly 818 is mounted within the housing 874, the rail 972 may extend through the actuator members 876, 878, 880, e.g., until the distal portion 982 extends beyond the distal ends 892, 894, 896 of the actuator members 876, 878, 880.
Turning to
One or more, and preferably a plurality of, positioning elements 986 are provided on the distal portion 982 that may be selectively expandable between a substantially axial collapsed configuration (shown in
In one embodiment, the obturator assembly 818 includes four splines 986 that are substantially equally spaced about the distal portion 982. Alternatively, the obturator assembly 818 may include a pair of splines (not shown) that are disposed generally opposite one another about the distal portion. The obturator assembly 818 may include more or fewer splines without deviating from the scope of the present invention. Additional embodiments of positioning elements are disclosed in co-pending application U.S. Pat. No. 6,780,197, the disclosure of which is expressly incorporated herein by reference.
Optionally, the splines 986 may include radiopaque markers (not shown) or may be wholly or partially formed from radiopaque material to facilitate observation of the splines 986 using fluoroscopy or other imaging systems. Alternatively, or in addition, the carrier assembly 814 may include one or more radiopaque markers, e.g., at its distal end (not shown) and/or the clip 805 may include radiopaque marker(s) or may be made from radiopaque material. This may facilitate monitoring the location of the clip 805 relative to the splines 986, as described further below.
Returning to
Turning to
For example, the rail 972 and rod 978 may initially be moved together, e.g., to deploy the distal portion 982, as shown in
The obturator housing 980 (see
Alternatively, as shown in
At any time before advancing the carrier assembly 1114 to deploy the clip 805 thereon, the obturator assembly 1118 may be inserted into the lateral port 1152, thereby introducing a distal portion 1182 of the obturator assembly 1118 into the sheath 1112. An obturator housing 1181 of the obturator assembly 1118 may include one or more detents (not shown) for engaging complementary-shaped detents (also not shown) on the lateral port 1152. Thus, the obturator assembly 1118 may be substantially secured axially with respect to the lateral port 1152, and consequently relative to the actuator assembly 1116 and sheath 1112. Otherwise, the actuator and obturator assemblies 1116, 1118 may operate similar to the previous embodiment.
Turning to
As shown in
The passage 892, and consequently the sheath 812, may be oriented with respect to the vessel 890, thereby facilitating introduction of devices through the lumen 820 of the sheath 812 into the vessel 890 with minimal risk of damage to the vessel 890. One or more devices, such as a guide wire, a catheter, and the like (not shown), may be inserted through the sheath 812 and advanced to a desired location within the patient's body. For example, the devices may be used to perform a therapeutic or diagnostic procedure, such as angioplasty, atherectomy, stent implantation, and the like, within the patient's vasculature. After the procedure is complete, the device(s) may be removed from the sheath 812, and the actuator assembly 16 may be attached to the hub assembly 830 of the sheath 812.
Turning to
The carrier assembly 814 is also disposed at least partially within the passage 838 (not shown in
Thus, as the actuator members 876, 878, 880 are advanced into the passage 838, the tongues 850, 860, 870 may be received in the longitudinal slots 886, 888, 890, preferably until the tabs 852, 862, 872 are received in the pockets 904, 906, 908, as best seen in
Alternatively, for the apparatus 1110 shown in
Turning to
Turning to
Turning to
Turning to
When the carrier assembly 814 reaches a first distal position (
Turning to
When the carrier and pusher members 840, 842 reach a second distal position, the second set of cooperating detents (not shown, but described above with reference to
As shown in
In a preferred method, shown in
For example, as the intermediate tubular member 878 is advanced to a third position beyond the second distal position, it may release the lock in the obturator housing 980, thereby causing the splines 986 to collapse and/or the distal portion 982 to retract into the sheath 812. Alternatively, the splines 986 may be collapsed before the clip 805 is ejected completely from off of the carrier member 840, or even before the pusher member 842 begins to deploy the clip 805. This may avoid any risk of contact between the clip 805 and the splines 986.
The relative lengths of the actuator members 876, 878, 880 and the sheath 812 and/or the length of the longitudinal slots 886, 888, 890 may be set such that the second distal position is at a region proximal to the wall 898 of the vessel 890. For example, as shown in
Once the clip 805 is successfully delivered, the apparatus 810 may be withdrawn from the passage 892. If the splines 864 of the locator member 814 are not automatically collapsed during advancement of the housing 824, the splines 864 may be affirmatively collapsed, e.g., by depressing the switch 988. The entire apparatus 810 may then be removed in one step. Alternatively, as in the embodiment of
Thus, the clip 805 remains in place within the wall 898 of the vessel 890 or in the surrounding tissue 896 adjacent the vessel 890 to close and/or seal the passage 892. The clip 805 may remain substantially permanently in the patient's body. Alternatively, the clip 805 may be formed from bioabsorbable material, and may remain until the passage 892 is at least partially healed and the clip 805 is absorbed by the surrounding tissue 896.
VII. Sixth Closure System Embodiment
Turning to
With particular reference to
In a further alternative, the helically wound wire 1244 may extend only partially from the distal end 1248 towards the proximal end 1246 (not shown). In this alternative, the locator member 1216 may include a substantially straight wire, tubular body, or other proximal portion (not shown) that may extend from the helically wound wire to the proximal end 1246 of the locator member 1216. The proximal portion may be relatively more rigid, e.g., resistant to buckling than the helically wound wire and/or may be supported by the wall of the lumen 1240 of the handle device 1214.
The locator member 1216 also includes a tether or other control element 1250 that is coupled to the helically wound wire 1244. Preferably, the tether 1250 is an elongate wire, ribbon, cable, and the like that has a distal end 1252 that is coupled to the distal end 1248 of the helically wound wire 1244. The tether 1250 may include a handle 1256 on its proximal end 1258 for selectively pulling the tether 1250 in a proximal direction to cause the helically wound wire 1244 wire to buckle, as explained further below.
The tether 1250 may extend along an outer surface of the helically wound wire 1244 at least partially from the distal end 1248 towards the proximal end 1246, thereby defining a deflectable distal portion 1254. For example, the tether 1250 may extend along the outer surface of the helically wound wire 1244 along its entire length. Alternatively, the tether 1250 may extend along the outer surface of the distal portion 1254, and then may pass between turns of the helically wound wire 1244, and extend within the helically wound wire 1244 to the proximal end 1246 of the locator member 1216. In a further alternative, the tether 1250 may extend its entire length within the helically wound wire 1244. For example, if the helically wound wire 1244 has gaps between adjacent turns, the helically wound wire 1244 may be compressed when the tether 1250 is pulled to cause the helically wound wire 1244 to buckle.
An actuator (not shown) may be provided on the proximal end 1246 of the locator member 1216. The actuator may be coupled to the proximal end 1258 of the tether 1250 and to the helically wound wire 1244 for providing controlled relative movement of the tether 1250 and the helically wound wire 1244, as will be appreciated by those skilled in the art.
When the proximal end of the tether 1250 is in its distal-most position, the helically wound wire 1244 may extend generally parallel to the longitudinal axis 1238, thereby defining an axial or inactivated configuration, such as that shown in
Turning to
The plug member 1212 generally includes a helical thread pattern 1218, including one or more helical threads, that extends at least partially between its proximal and distal ends 1220, 1222. The helical thread pattern 1218 is preferably substantially rigid and may have a substantially square cross-section to facilitate sealing of a passage into which the plug member 1212 is threaded.
A sealing member (not shown) may be provided within the lumen 1224 for substantially sealing the lumen 1224 from fluid flow therethrough. The sealing member is preferably formed from a material that expands when exposed to fluids, e.g., a gel foam, and may be bioabsorbable, e.g., if the plug member 1214 is. Before exposure to fluid, the sealing member may be substantially recessed from the lumen 1224, thereby accommodating inserting devices therethrough. Upon exposure to fluid, e.g., blood, the sealing member may expand, e.g., due to hydration and the like, across the lumen 1224 and/or otherwise substantially seal the lumen 1224.
Alternatively, the sealing member may be a valve (not shown) or a coil of material that is biased to substantially seal the lumen 1224 from fluid flow. For example, the sealing member may be biased to substantially seal the lumen 1224, yet may be deflected to accommodate insertion of one or more devices therethrough. In a further alternative, the lumen 1224 may have a relatively small cross-section, and the sealing member may be omitted.
Additional information regarding plug members appropriate for use with the present invention may be found in U.S. Pat. No. 5,292,332 to Lee and U.S. Pat. No. 5,290,310 to Makower et al., the disclosures of which are expressly incorporated herein by reference.
Returning to
The plug member 1212 and the distal end 1236 of the handle device 1214 generally include one or more connectors (not shown) for releasably securing the plug member 1212 to the handle device 1214, as described in application U.S. Pat. No. 6,780,197, which is incorporated herein by reference. Preferably, cooperating connectors (not shown) substantially couple the plug member 1212 to the handle device 1214 such that the plug member 1212 cannot move independently of the handle device 1214, e.g., such that the plug member 1212 may be rotated only by rotating the handle device 1214. Preferably, the handle 1242 includes an actuator (not shown) that may be activated to release the connectors securing the plug member 1212 to the handle device 1214.
When the locator member 1216 is fully inserted into the handle device 1214, the distal portion 1254 of the locator member 1216, is preferably disposed beyond the distal end 1236 of the handle device 1214, and, more preferably, beyond the distal end 1222 of the plug member 1212, as shown in
Turning to
The puncture 892 may be used to provide percutaneous access to the vessel 890. For example, the puncture 892 may facilitate performing an endovascular procedure within a patient's vasculature, such as angioplasty, stenting, atherectomy, and the like, or may otherwise provide access via the vessel 890 to a region within the patient's body. Upon completion of the procedure, any instruments, such as an introducer sheath (not shown), may be removed from the vessel 890 and puncture 892.
The apparatus 1210 may then be introduced into the puncture 892, for example, by initially inserting the distal portion 1254 of the locator member 1216 into the puncture 892. The distal portion 1254 may have a substantially atraumatic distal tip, e.g., tapered and/or relatively flexible, to facilitate advancement of the apparatus 1210 into the puncture 892. As the distal portion 1254 of the locator member 1216 is advanced into the puncture 892, the plug member 1212 may be inserted into the puncture 892, as shown in
Because of the thread pattern 1218, the handle device 1214 may be rotated in a first direction to thread the plug member 1212 into the puncture 892. Consequently, the outer surface 1230 and/or the thread pattern 1218 may engage tissue 896 surrounding the puncture 892, thereby substantially sealing the puncture 892 from fluid flow, such as blood flow, within the vessel 890. The apparatus 1210 may be rotated in the first direction about its longitudinal axis 1238 to thread the plug member 1212 substantially atraumatically deeper into the puncture 892.
Turning to
Once it is confirmed that the distal portion 1254 is located within the lumen 890, the locator member 1216 may be activated, e.g., by pulling the handle 1256 proximally or activating an actuator (not shown) at the proximal end of the locator member 1216. This causes the distal portion 1254 to buckle to its transverse configuration, as shown in
Rotation of the apparatus 1210 may then be reversed, i.e., in a second direction opposite the first direction, to withdraw the plug member 1212 a predetermined distance relative to the vessel 890. As the plug member 1212 is withdrawn, the distal portion 1254 of the locator member 1216 may engage a wall 898 of the vessel 890, thereby creating resistance to further rotation. This may provide tactile feedback that the plug member 1212 is disposed at a desired location, e.g., within the puncture 892 in close proximity to the vessel 890, but not extended into the vessel 890.
The plug member 1212 may then be released from the handle device 1214. The locator member 1216 may be deactivated, i.e., returned to its axial configuration, and then withdrawn from the plug member 1212, either simultaneously with withdrawal of the handle device 1214 or before withdrawal of the handle device 1214. The sealing member (not shown) preferably substantially seals the lumen 1224 (not shown, see
Preferably, as explained above, the sealing member is a material that expands when exposed to fluid. For example, as the locator member 1216 is withdrawn (either before or along with the handle device 1214), fluid, e.g., blood, may flow proximally through the lumen 1224 in the plug member 1212, e.g., until it encounters the sealing member. Although a relatively small amount of fluid may pass beyond the sealing member, the sealing member may expand substantially due to the fluid contact until it substantially seals the lumen. Alternatively, the sealing member may be a valve that may open to accommodate the locator member 1216, but may automatically close upon withdrawal of the locator member 1216.
If the plug member 1212 is bioabsorbable, it may remain within the puncture 892 as the tissue heals, thereby allowing the wall 898 of the vessel 890 and tissue 896 surrounding the passage 892 to at least partially heal before the plug member 1212 is absorbed. Alternatively, the plug member 1212 may be retrieved once the tissue between the plug member 1212 and the vessel 890 has substantially healed.
In an alternative embodiment, a guidewire (not shown) may be used during the procedure. The apparatus 1210 may be provided initially without the locator member 416, and the guidewire may be backloaded through the plug member 1212 and handle device 1214. The guidewire may be used to guide the plug member 1212 as it is threaded through the puncture 892 until it at least partially enters the vessel 890. Once the vessel 890 has been attained, the guidewire may be withdrawn, and the locator member 1216 may be inserted through the handle device 1214 until the distal portion 1254 extends beyond the plug member 1212 into the vessel 890. The distal portion 1254 may be activated, and then the procedure may proceed substantially as just described to deliver the plug member 1212.
In a further alternative, the locator member 1214 shown in
Turning to
As shown in
The plug member 1212 may then be advanced over the locator 1216 member into the passage 892. For example, the plug member 1212, disposed on the distal end 1236 of an elongate member 1214, may be threaded through the tissue 896 along the passage 892 such that threads 1218 on the plug member 1212 substantially engage the surrounding tissue 896. The locator member 1216 may pass through a passage 1224 in the plug member 1212 and/or through the lumen 1240 of the elongate member 1214. Once the plug member 1212 reaches a desired location within the passage 892, the plug member 1212 may be released from the distal end 1236 of the elongate member 1214.
To facilitate positioning of the plug member 1212 relative to the vessel 890, the locator member 1216 and/or the elongate member 1214 may include one or more depth markers. For example, the locator member 1216 may include a marker band 1260 at a predetermined location relative to the distal portion 1254. The elongate member 1214 may include a window 1262 or other opening at a predetermined location on its proximal end 1234. When the marker band 1260 on the locator member 1216 appears in the window 1262, it may provide a visual indication that the plug 1212 is disposed at a predetermined position relative to the wall 898 of the vessel 890. Alternatively, the locator member 1216 and the elongate member 1214 may include other cooperating elements, e.g., cooperating tactile elements as described above, for identifying when the plug 1212 is disposed at a predetermined location.
After the plug 1212 is released from the elongate member 1214, the distal portion 1254 of the locator member 1216 may be returned to its axial configuration, and the elongate member 1214 and the locator member 1216 may be withdrawn from the passage 892, leaving the plug member 1212 to substantially seal the passage 892, similar to the embodiments described above.
The present invention may be embodied in other specific forms without departing from its spirit or essential characteristics. The described embodiments are to be considered in all respects only as illustrative and not restrictive. The scope of the invention is, therefore, indicated by the appended claims rather than by the foregoing description. All changes which come within the meaning and range of equivalency of the claims are to be embraced within their scope.
This U.S. patent application is a continuation of U.S. application Ser. No. 12/941,809, filed Nov. 8, 2010, which is a continuation-in-part of U.S. application Ser. No. 10/264,306, filed Oct. 3, 2002, now U.S. Pat. No. 7,901,428 which is a continuation of U.S. application Ser. No. 09/546,998, filed Apr. 11, 2000, now U.S. Pat. No. 6,461,364, which is a continuation-in-part of U.S. application Ser. No. 09/478,179, filed Jan. 5, 2000, now U.S. Pat. No. 6,197,042. Additionally, U.S. patent application Ser. No. 12/941,809 is a continuation-in-part of U.S. application Ser. No. 11/198,811, filed Aug. 4, 2005, now U.S. Pat. No. 7,828,817, which is a continuation of U.S. application Ser. No. 10/081,723, filed Feb. 21, 2002, now U.S. Pat. No. 6,942,674. Additionally, U.S. patent application Ser. No. 12/941,809 is a continuation-in-part of U.S. application Ser. No. 10/006,400, filed Nov. 30, 2001, now U.S. Pat. No. 7,842,068, which is a continuation-in-part of U.S. application Ser. No. 09/732,835, filed Dec. 7, 2000, now U.S. Pat. No. 6,780,197. Also, U.S. application Ser. No. 12/941,809 is a continuation-in-part of U.S. application Ser. No. 10/147,774, filed May 17, 2002, now U.S. Pat. No. 7,931,669 which is a continuation of U.S. application Ser. No. 09/610,238, filed Jul. 5, 2000, now U.S. Pat. No. 6,391,048, which is a continuation-in-part of U.S. application Ser. No. 09/478,179, filed Jan. 5, 2000, now U.S. Pat. No. 6,197,042. All foregoing patents and applications are incorporated herein by reference in their entireties.
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| Number | Date | Country | |
|---|---|---|---|
| 20140309686 A1 | Oct 2014 | US |
| Number | Date | Country | |
|---|---|---|---|
| Parent | 12941809 | Nov 2010 | US |
| Child | 14312339 | US | |
| Parent | 09546998 | Apr 2000 | US |
| Child | 10264306 | US | |
| Parent | 10081723 | Feb 2002 | US |
| Child | 11198811 | US | |
| Parent | 09610238 | Jul 2000 | US |
| Child | 10147774 | US |
| Number | Date | Country | |
|---|---|---|---|
| Parent | 10264306 | Oct 2002 | US |
| Child | 12941809 | US | |
| Parent | 09478179 | Jan 2000 | US |
| Child | 09546998 | US | |
| Parent | 11198811 | Aug 2005 | US |
| Child | 12941809 | US | |
| Parent | 10006400 | Nov 2001 | US |
| Child | 12941809 | US | |
| Parent | 09732835 | Dec 2000 | US |
| Child | 10006400 | US | |
| Parent | 10147774 | May 2002 | US |
| Child | 12941809 | US | |
| Parent | 09478179 | Jan 2000 | US |
| Child | 09610238 | US |
