The present invention relates to closure of openings in tissue walls percutaneously, and more specifically to methods and devices therefor with one or more balloons.
Percutaneous access provides minimally invasive access to subcutaneous tissues walls, such as for example vascular access without excessive cut downs or other invasive techniques. Access is acquired by a needle puncture through the skin into the desired vessel. A guide wire is then inserted into the vessel through the access site. The initial puncture is expanded through progressive dilation over the guide wire; the access site is dilated such that the desired endovascular device can be inserted into the vessel. Once the procedure is complete, the delivery system of the endovascular device is removed through the access site. However, once the delivery system is withdrawn from the vessel a lesion remains. The device described herein provides temporary hemostatis around the access site (specifically the lesion in the vessel wall), and promotes healing of the native vessel with small intestine submucosa (SIS).
Current percutaneous closure devices are typically limited to use in peripheral access cases (access site size typically less than or equal to 10 Fr), and some require permanent implantation; direct pressure on the access site is also used to provide hemostasis. Thus, there is a need for improvement in this field.
The present invention is defined by the claims. As merely a summary, this may include a device for closure of an opening in a medical patient's subcutaneous tissue wall. The device may include a catheter having one or more inflatable, bio-degradable balloons. It may also include one or more sheets of extracellular matrix (ECM) material loaded on and around said catheter, wherein upon inflation of the one or more balloons the sheet(s) of ECM material are held against the tissue wall by the balloon(s).
The present invention may also include surgical insertion methods of the various devices shown and described.
Further forms, objects, features, aspects, benefits, advantages, and embodiments of the present invention will become apparent from a detailed description and drawings provided herewith.
For the purpose of promoting an understanding of the principles of the invention, reference will now be made to the embodiments illustrated in the drawings and specific language will be used to describe the same. It will nevertheless be understood that no limitation of the scope of the invention is thereby intended. Any alterations and further modifications in the described embodiments, and any further applications of the principles of the invention as described herein are contemplated as would normally occur to one skilled in the art to which the invention relates. One embodiment of the invention is shown in great detail, although it will be apparent to those skilled in the relevant art that some features that are not relevant to the present invention may not be shown for the sake of clarity.
Percutaneous access provides minimally invasive vascular access without excessive cut downs or other invasive techniques. Access is acquired by a needle puncture through the skin into the desired vessel. A guide wire is then inserted into the vessel through the access site. The initial puncture is expanded through progressive dilation over the guide wire; the access site is dilated such that the desired endovascular device can be inserted into the vessel. Once the procedure is complete, the delivery system of the endovascular device is removed through the access site. However, once the delivery system is withdrawn from the vessel a lesion remains. The device described herein provides temporary hemostatis around the access site (specifically the lesion in the vessel wall), and promotes healing of the native vessel with SIS.
Current percutaneous closure devices are limited to use in peripheral access cases (access site size typically less than or equal to 10 Fr), and some require permanent implantation; direct pressure on the access site is also used to provide hemostasis. The proposed device allows for closure from large French size delivery systems typically used in endovascular aneurysmal and abdominal arterial repairs. This device also performs the closure with no long term implantation. The device design will target closure of 6-24 Fr percutaneous access.
The proposed design consists of a balloon catheter, knot pusher, and a decoupler. These components are housed typically in a 12 Fr sheath, although other sizes may be used. There are two balloons on the catheter. The distal balloon is situated near the tip of the catheter. This balloon is disk like in shape (
A pre-tied sliding and self-locking knot will be looped over the catheter proximal to the proximal balloon. The post of the knot will be threaded through the lumen of a stiff cannula pusher. The pusher will be used to tighten the knot onto the catheter. The knot will be tied with an absorbable suture. The knot pusher will extend past the sheath, and it will be manipulated by the physician to achieve proper knot positioning. When a decoupler is employed, it will cut the catheter proximal to the knot. A possible decoupler consists of coiled wires which, when current is applied, fuse and sever the catheter stem.
The proposed device allows for closure from large French size delivery systems typically used in endovascular aneurysmal and abdominal arterial repairs. This device also performs the closure with no long term implantation. The device design will target closure of typically 6-24 Fr, and preferably 12-24 Fr, percutaneous access.
The term “bio-degradable” means able to be broken down and absorbed in, resorbed and/or passed from the human body.
The term “central hole” means an opening (round, slit(s), rectangular or any other shape) in a sheet or other member that is at least partially within about the central two-thirds of the shape.
The term “closing a lumen” means reducing its cross section at one or more points sufficient to substantially restrict fluid flow through the lumen. This may be done with one or more knot, noose, check valve, plug, flap and/or other structure.
The term “cutting off” means fully or substantially severing one part so it may be separated from another.
The term “depth” means the average distance of an element taken in a direction proximal to distal.
The term “distal” means, relative to a reference, toward the doctor or other operator of the device; normally the opposite of “proximal”.
The term “ECM material” means material harvested from a (previously) living animal which is an extracellular matrix, typically including collagen. This includes without limitation material harvested from the walls of animal intestine, bladder, liver, and stomach.
The term “loaded” means placed into position prior to insertion into a patient.
The term “proximal” means, relative to a reference, away from the doctor or other operator of the device; normally the opposite of “distal”.
The term “radius” means the average distance of an element taken in a direction from the center to the perimeter.
The term “sheet” means a generally flat member which is thinner in depth than in the other dimensions and is at least somewhat flexible. It may be single layer, multi-layer, formed, cut, pressed, molded, porous, non-porous, and/or otherwise. A sheet may be round (such as a round disk), rectangular, square, elliptical, hexagonal, octagonal, oblong, irregular or any other shape.
The term “small intestine submucosa” means material (sheet, solid shape, powder, liquid or otherwise) which is entirely or partially made up of portions of the submucosal layer of an animal's small intestines.
The term “subcutaneous tissue wall” means any tissue wall of a patient beneath the skin, including without limitation blood vessel walls.
The proposed device 10 may comprise a balloon catheter 20, an optional knot pusher 72 (see
An optional type of alternative of a sheet of
A decoupler may be used to cut the catheter proximal to the knot. A possible decoupler consists of coiled wire(s) 81, 82, 83 (see
The following is a summary of one example that can be used for the delivery procedure for the devices disclosed herein:
1. Remove delivery system of the last endovascular device used in the repair, while maintaining vessel access with the guide wire.
2. Prep the proposed closure device's balloons, and flush the catheter with saline.
3. Advance the device until into the desired vessel.
4. Expand the distal balloon while inside the vessel. Then pull back on the sheath to verify that the inflated balloon can provide adequate closure of the lesion.
5. While maintaining tension against the inner side of the vessel wall, inflate the proximal balloon. There should now be successful closure of the lesion or opening. Retract the guide wire.
6. Advance the pusher to tighten the knot.
7. Once the knot is tight, engage the decoupler to cut the catheter and extra suture.
8. Remove the remains of the severed delivery system from the access site.
While the invention has been illustrated and described in detail in the drawings and foregoing description, the same is to be considered as illustrative and not restrictive in character, it being understood that only the preferred embodiment has been shown and described and that all changes, equivalents, and modifications that come within the spirit of the inventions defined by following claims are desired to be protected. All publications, patents, and patent applications cited in this specification are herein incorporated by reference as if each individual publication, patent, or patent application were specifically and individually indicated to be incorporated by reference and set forth in its entirety herein.
This application claims the benefit of U.S. Provisional Application No. 61/727,958, filed Nov. 19, 2012, which is hereby incorporated by reference in its entirety.
Number | Date | Country | |
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61727958 | Nov 2012 | US |