In many medical procedures, such as, for example, balloon angioplasty and the like, an opening can be created in a blood vessel or arteriotomy to allow for the insertion of various medical devices which can be navigated through the blood vessel to the site to be treated. For example, a guidewire may first be inserted through a tissue tract created between the skin, or the epidermis, of the patient down through the subcutaneous tissue and into the opening formed in the blood vessel. The guidewire is then navigated through the blood vessel to the site of the occlusion or other treatment site. Once the guidewire is in place, an introducer sheath can be inserted over the guide wire to form a wider, more easily accessible, tract between the epidermis and the opening into the blood vessel. The appropriate medical device can then be introduced over the guidewire through the introducer sheath and then up the blood vessel to the site of the occlusion or other treatment site.
Once the procedure is completed, the medical devices or other equipment introduced into the vessel can be retracted through the blood vessel, out the opening in the blood vessel wall, and out through the tissue tract to be removed from the body. The physician or other medical technician is presented with the challenge of trying to close the opening in the blood vessel and/or the tissue tract formed in the epidermis and subcutaneous tissue. A number of different device structures, assemblies, and methods are known for closing the opening in the blood vessel and/or tissue tract, each having certain advantages and disadvantages. However, there is an ongoing need to provide new and improved device structures, assemblies, and/or methods for closing and/or sealing the opening in the blood vessel and/or tissue tract.
This disclosure pertains to a vascular or tissue tract closure plug having a reinforced proximal cap which minimizes distortions during vascular closure plug deployment by providing a more uniform distribution of axial forces across the top of the plug during positioning and compression/expansion to a desired shape.
In one aspect, this disclosure relates to a device for sealing an opening in a vessel wall and/or tissue tract, the device comprising an expandable plug having a proximal end, a distal end, a central axis joining the proximal end and distal end, and at least one sidewall therebetween, said expandable plug being adapted to expand generally perpendicular to the central axis in response to axial compression and/or exposure to a liquid; a proximal force distributing member generally coextensive with the proximal end of the expandable plug prior to expansion; and a plurality of plug restraining members each having a proximal end attached directly or indirectly to the proximal force distributing member, distal ends, and lateral extents, wherein the plurality of plug restraining members extend generally parallel to the central axis prior to expansion of the expandable plug and the distal ends of the plurality of plug restraining members are displaced radially outward when the expandable plug is expanded.
In another aspect, this disclosure relates to a method of sealing an opening in a vessel wall and/or tissue tract comprising positioning an expandable plug within a tissue tract, said expandable plug being adapted to expand generally perpendicular to the central axis in response to axial compression and/or exposure to a liquid, a proximal force distributing member generally coextensive with the proximal end of the expandable plug, and a plurality of plug restraining members each having a proximal end attached directly or indirectly to the proximal force distributing member, a distal end, and a lateral extent, wherein the plurality of plug restraining members extend generally parallel to the central axis prior to expansion of the expandable plug and the distal ends of the plurality of plug restraining members are displaced radially outward from the respective proximal ends of said plug restraining members when the expandable plug is expanded; compressing said expandable plug axially within the tissue tract thereby expanding at least a portion of the expandable plug radially; and exposing the expandable plug to a liquid, whereupon the expandable plug is substantially prevented from expanding axially in the proximal direction by the force distributing member and the plurality of plug restraining members.
The following description should be read with reference to the drawings wherein like reference numerals indicate like elements throughout the several views. The drawings, which are not necessarily to scale, are not intended to limit the scope of the claimed invention. The detailed description and drawings illustrate example embodiments of the claimed invention.
All numbers are herein assumed to be modified by the term “about.” The recitation of numerical ranges by endpoints includes all numbers subsumed within that range (e.g., 1 to 5 includes 1, 1.5, 2, 2.75, 3, 3.80, 4, and 5). As used in this specification and the appended claims, the singular forms “a”, “an”, and “the” include the plural referents unless the content clearly dictates otherwise. As used in this specification and the appended claims, the term “or” is generally employed in its sense including “and/or” unless the content clearly dictates otherwise.
It is noted that references in the specification to “an embodiment”, “some embodiments”, “other embodiments”, etc., indicate that the embodiment described may include a particular feature, structure, or characteristic, but every embodiment may not necessarily include the particular feature, structure, or characteristic. Moreover, such phrases are not necessarily referring to the same embodiment. Further, when a particular feature, structure, or characteristic is described in connection with an embodiment, it would be within the knowledge of one skilled in the art to select and effect such feature, structure, or characteristic in connection with other embodiments whether or not explicitly described in combination.
The proximal force distributing member 212 and plug restraining members 218 may be fabricated from commonly employed bioabsorbable materials including, but not limited to polylactic acid, polylactic-co-glycolic acid, polyglycolic acid, polycaprolactone, and the like. In some embodiments, in which only brief containment is required, faster degrading/dissolving/absorbing materials may be used or may be included in the formulation. Such materials may include, for example a biodegradable polymer blended with sugar esters such as sucrose octaacetate, sucrose acetate isobuterate, β-D-galactose pentaacetate, β-D-glucose pentaacetate, α-D(+)-glucose pentaacetate, and the like. Some formulations may beneficially include plasticizers such as acetyl tributyl citrate, glycerol and its esters, sorbitol, triacetin, and the like. Other embodiments may beneficially include soluble fillers. In some embodiments, the materials may be somewhat tacky to better remain in position relative to the expandable plug 200 during deployment. In other embodiments, the materials may be selected to be somewhat lubricious to facilitate transport within an introducer sheath and/or a tissue tract.
The proximal force distributing member 212 and plug restraining members 218 may be fabricated by molding, extrusion, solvent casting, and the like. In some embodiments, the proximal force distributing member 212 and plug restraining members 218 may be formed separately and then joined. The proximal force distributing member 212 and plug restraining members 218 are not necessarily formed of the same materials. In other embodiments, the proximal force distributing member 212 and plug restraining members 218 may be integrally formed. In some embodiments, the proximal force distributing member 212 and the plug restraining members 218 are joined along a weakened line which facilitates a hinge-like fold at the transition therebetween.
The expandable plug 200 may be any of those employed in the art. For example, expandable plug 200 may comprise a sponge-like material (e.g., naturally occurring collagens, synthetic collagens, or other biologically resorbable sponge-like material), a foam, or a fibrous woven or nonwoven material, and may be configured in any shape to facilitate sealing the puncture in vessel wall 220 and tissue tract 224. The expandable plug 200 may initially be flexible or somewhat rigid. In some embodiments the expandable plug 200 may comprise a hemostatic foam. Plug 200 may be a material of uniform composition or may include layers and/or regions of different composition. The expandable plug 200 may also include a hemostatic agent, such as a tissue thromboplastin, to accelerate local hemostasis. In some embodiments, the expandable plug 200 may comprise a hemostatic foam. In other embodiments, the expandable plug may comprise a substantially axial central bore connecting the proximal end of the expandable plug to the distal end of the expandable plug.
As illustrated, proximal force distributing member 212 is generally coextensive with the proximal end of the expandable plug 200; however it will be appreciated that the proximal force distributing member 212 may be larger than or smaller than the proximal end of the expandable plug 200 and may optionally include holes or other apertures. Such holes may provide access to an interior bore 210 and/or may provide fluid access to the expandable plug.
As illustrated in
In some embodiments, the plug restraining members 218 may be perforated along adjacent edges 214 to an extent which will allow the plug restraining members 218 to separate as the expandable plug 200 begins to expand upon compression and/or exposure to liquid. Such perforations may provide a degree of integrity to the unified proximal force distributing member 212 and plug restraining members 218 to facilitate assembly of the device prior to insertion into the tissue tract 224 or within the tissue tract 224.
In other embodiments, the proximal force distributing member 212, plug restraining members 218, and expandable plug 200 may be integrally formed. In yet other embodiments, the proximal force distributing member 212 and plug restraining members 218 may be formed as a coating on the expandable plug 200 and optionally may be slit or perforated after formation.
As illustrated in
In the embodiment of
The embodiment of
The proximal force distributing member of the embodiment of
In use, a device of the present disclosure may be inserted into a tissue tract adjacent to a vessel puncture or into a suitable lumen. The insertion may be accomplished with the assistance of any of the devices commonly employed for that purpose, such as guidewires, introducer sheaths, hydration chambers, and the like or may be directly inserted into the tissue tract or lumen. In some instances, the device will be used in conjunction with an anchor, such as anchor 120 of
An optional bore (110, 210, 310) passing axially through the device may accommodate a guidewire, one or more sutures, a placement shaft or tube, or the like. A tube or shaft, such as element 140 of
As initially inserted, plug restraining members (218, 218a-d, 318, 418a-b, 518) will extend generally parallel to the surface(s) of the expandable plug (200, 300, 400, 500). In some embodiments, the components will be preassembled and inserted simultaneously; however portions of the device may be inserted sequentially. For example, a distal force distribution member 212d or 412b, with or without associated plug restraining members, may precede the plug into a tissue tract 210. Similarly, a supplemental force distribution member 230 or 512 may follow the expandable plug 200, 500 into a tissue tract 210. Upon mechanical compression or exposure to a liquid, the plug restraining members (218, 218a-d, 318, 418a-b, 518) will expand radially at their free ends to accommodate radial expansion of the expandable plug (200, 300, 400, 500). Within a tissue tract 210, the device is allowed to expand in response to exposure to liquid and/or upon being subjected to axial compression. In some embodiments, axial compression may be created by an externally supplied compressive force such as might be produced by advancing a pusher (not shown) against the proximal end of a device while holding the distal end stationary.
In other embodiments a component at the distal end of the device may be withdrawn relative to the proximal end of the device by withdrawing a suture, shaft, or tube similar to those represented by element 140 of
During expansion of the device, the expanding expandable plug is substantially prevented from expanding axially by the force distributing member(s) and/or any force directing and plug restraining members (218, 218a-d, 318, 418a-b, 518). As discussed above, the device may include a distal force distributing member (212d, 412b) and a plurality of distal plug restraining members (218d, 418b) which may be inserted before, or concurrently with, the expandable plug (200, 400).
The nonlimiting examples provided herein are intended to be generally indicative of the materials and associated properties which are believed to be desirable for the formation of the force distribution members, plug restraining members, supplemental force distribution members, and incidental components of the devices of the present disclosure, whether they are disposed about a proximal or a distal end of an expandable plug. It will be appreciated that some of these materials may be better suited for use in various fabrication methods.
Small quantities of the ingredients indicated in Table I were combined and melted in an aluminum weighing dish and allowed to cool. Once cool, the aluminum weighing dishes were folded and the properties and response to physical distortion noted. For selected samples, a test coupon having dimensions of 2 millimeters (mm) by 3 mm by 1 mm were submerged in a solution of TWEEN 20® (Sigma-Aldrich, Inc., St. Louis, Mo.) in phosphate buffered saline to estimate the relative rates of solubility in a liquid similar to bodily fluids.
The non-limiting materials characterized above should be viewed as illustrative of the range of components which may be combined to provide suitable materials for the fabrication of devices of this disclosure and to indicate approximate suitable ranges thereof.
Although the illustrative examples described above relate to sealing a tissue tract and an adjacent vessel wall puncture, applications in which tissue wall punctures or other lumens are to be sealed are also contemplated. In such an embodiment, the anchors 120 discussed above may be omitted or otherwise replaced by suitable elements.
Various modifications and alterations of this present disclosure will become apparent to those skilled in the art without departing from the scope and principles of this present disclosure, and it should be understood that this present disclosure is not to be unduly limited to the illustrative embodiments set forth hereinabove. All publications and patents mentioned are herein incorporated by reference to the same extent as if each individual publication or patent was specifically and individually indicated to be incorporated by reference.
This application claims priority to U.S. Provisional Application No. 61/451,833, filed Mar. 11, 2011.
Number | Date | Country | |
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61451833 | Mar 2011 | US |