US20110077683A1 - Puncture closure apparatuses, sealing plugs, and related methods - Google Patents

Abstract

A puncture closure device is disclosed. Particularly, a puncture closure device may include an anchor support including a coupling feature and an anchor connected to the anchor support. Further, the puncture closure device may include a movable compression element configured to compress a sealing plug generally between the compression element and the anchor. Such a puncture closure device may be positioned at least partially within an insertion sheath to form a puncture closure assembly. A method of compressing a sealing plug and a method of sealing a puncture are disclosed. In addition, in one embodiment, a sealing plug may comprise a first, a second, and an intermediate end region, wherein the intermediate region has a density less than the first and second end regions. In another embodiment, a sealing plug may include a bore formed therethrough and a plurality of slits formed into an exterior surface of the sealing plug.

Description

RELATED APPLICATION
• This is a divisional of U.S. patent application Ser. No. 11/419,941 filed on 23 May 2006, now pending, the disclosure of which is incorporated, in its entirety, by this reference.
TECHNICAL FIELD
• This relates generally to medical devices and more particularly to methods and devices for sealing punctures or incisions in a tissue wall
BACKGROUND
• Various surgical procedures are routinely carried out intravascularly or intraluminally. For example, in the treatment of vascular disease, such as arteriosclerosis, it is a common practice to invade the artery and insert an instrument (e.g., a balloon or other type of catheter) to carry out a procedure within the artery. Such procedures usually involve the percutaneous puncture of the artery so that an insertion sheath can be placed in the artery and thereafter instruments (e.g., a catheter) can pass through the sheath and to an operative position within the artery. Intravascular and intraluminal procedures unavoidably present the problem of stopping the bleeding at the percutaneous puncture after the procedure has been completed and after the instruments (and any insertion sheaths used therewith) have been removed. Bleeding from puncture sites, particularly in the case of femoral arterial punctures, is typically stopped by utilizing vascular closure devices, such as those described in U.S. Pat. Nos. 6,179,963; 6,090,130; and 6,045,569 and related patents, which are hereby incorporated by this reference.
• Typical closure devices such as the ones described in the above-mentioned patents place a sealing plug at the tissue puncture site. Nevertheless, the incision track leading to the invaded artery often continues to ooze blood from side vessels at the puncture site. Manual compression is typically applied at the puncture site to stop the track bleeding. Manual compression can lead to patient soreness and requires additional time from medical personnel. The time spent by medical personnel compressing the puncture site to stop the bleeding from the incision track can be expensive to the patient, and tiring to the medical personnel. Accordingly, there is a need for improving the sealing methods and apparatus at the site of subcutaneous tissue punctures.
SUMMARY OF THE INVENTION
• One aspect of the present invention relates to a puncture closure device. Particularly, a puncture closure device may include an anchor support including a coupling feature and an anchor connected to the anchor support, wherein the anchor is configured for insertion through a puncture. Further, the puncture closure device may include a movable compression element configured to be movable between a first position and a second position, wherein movement of the compression element to the second position causes coupling of the compression element to the coupling feature of the anchor support and a sealing plug positioned generally between the compression element and the anchor. The compression element may be configured to cause compression of the sealing plug generally between the compression element and the anchor upon movement of the compression element from the first position to the second position. A puncture closure assembly may comprise a puncture closure device and an insertion sheath configured to receive at least a portion of the puncture closure device.
• Another aspect of the present invention relates to a method of compressing a sealing plug. Particularly, a bore of a sealing plug may be positioned generally about a portion of an anchor support, wherein the anchor support is connected to an anchor and the sealing plug may be longitudinally compressed. A further aspect of the present invention relates to a method of sealing a puncture. More specifically, an anchor may be positioned generally within a puncture, the anchor connected to an anchor support. Further, a bore of a sealing plug may be positioned generally about a portion of an anchor support. In addition, the sealing plug may be longitudinally compressed generally between the anchor and a compression element.
• An additional aspect of the present invention relates to a sealing plug for use in a puncture closure apparatus. In one embodiment, a sealing plug may comprise a first end region, a second end region, and an intermediate region positioned between the first end region and the second end region, wherein the intermediate region comprises a material with a density less than a density of the first end region and a density of the second end region. In another embodiment a sealing plug may comprise a generally cylindrical body including a bore formed therethrough and a plurality of slits formed into an exterior surface of the sealing plug, the plurality of slits configured to facilitate radial expansion of the sealing plug in response to longitudinal compression of the sealing plug.
• Features from any of the above mentioned embodiments may be used in combination with one another, without limitation. In addition, other features and advantages of the instant disclosure will become apparent to those of ordinary skill in the art through consideration of the ensuing description, the accompanying drawings, and the appended claims.
BRIEF DESCRIPTION OF THE DRAWINGS
• Further features of the subject matter of the present invention, its nature, and various advantages will be more apparent from the following detailed description and the accompanying drawings, which illustrate various exemplary embodiments, are representations, and are not necessarily drawn to scale, wherein:
• FIG. 1 shows a side view, partly in section, of a conventional puncture closure device;
• FIG. 2 shows a schematic side view of the puncture closure device shown inFIG. 1 inserted through an insertion sheath and engaged with a blood vessel;
• FIG. 3 shows a schematic side view of the conventional puncture closure device as shown inFIG. 2, wherein the conventional puncture closure device and insertion sheath are being withdrawn from the artery to deploy a sealing plug;
• FIG. 4 shows a side view of the conventional puncture closure device, as shown inFIG. 3, illustrating use of a tamping tube to tamp the sealing plug;
• FIG. 5 shows a schematic perspective view of a puncture closure device according to the present invention;
• FIG. 6 shows a perspective view of one embodiment of an assembly of an anchor and an anchor support;
• FIG. 7 shows a side cross-sectional view of one embodiment of an anchor and a anchor support, wherein the anchor is pinned to the anchor support;
• FIG. 8 shows a side cross-sectional view of another embodiment of an anchor and an anchor support, wherein the anchor is pivotably coupled to the anchor support by a suture;
• FIG. 9 shows a perspective view of one embodiment of a sealing plug for use with a tissue puncture closure device according to the present invention;
• FIG. 10 shows a perspective view of another embodiment of a sealing plug for use with a tissue puncture closure device according to the present invention;
• FIG. 11 shows a perspective view of a further embodiment of a sealing plug for use with a tissue puncture closure device according to the present invention;
• FIG. 12 shows a perspective view of an additional embodiment of a sealing plug for use with a tissue puncture closure device according to the present invention;
• FIG. 13 shows a partial side view, partly in section, of an internal tissue puncture closure device prior to deployment of a plug assembly;
• FIG. 14 shows a partial side view, partly in section, of the internal tissue puncture closure device shown inFIG. 13 following deployment of the plug assembly;
• FIG. 15 shows a perspective view of a plug assembly prior to deployment according to the invention;
• FIG. 16 shows a perspective view of the plug assembly shown inFIG. 15 after deployment;
• FIG. 17 shows a partial side cross-sectional view of a puncture closure device during use;
• FIG. 18 shows a partial side cross-sectional view of a puncture closure device shown inFIG. 17, wherein the sealing plug has been longitudinally compressed and radially expanded; and
• FIG. 19 shows perspective view of a plug assembly deployed partially within a tissue tract and partially within a blood vessel to effectively close a puncture formed in the blood vessel.
• FIG. 20 is a perspective view of another embodiment of a puncture closure device prior to deployment.
• FIG. 21A is a partial cross-sectional view of the puncture closure device shown inFIG. 20.
• FIGS. 21B-21D illustrate stages of deployment of the puncture closure device shown inFIG. 21A.
• FIG. 22 is perspective view of another embodiment of a puncture closure device prior to deployment.
• FIGS. 23A and 23B illustrate stages of deployment of the puncture closure device shown inFIG. 22.
• Throughout the drawings, identical reference numbers designate similar, but not necessarily identical, elements.
DETAILED DESCRIPTION
• As mentioned above, vascular procedures are conducted throughout the world and require access to an artery through a puncture. Most often, the artery is a femoral artery. To close the puncture following completion of the procedure, many times a closure device is used to sandwich the puncture between an anchor and a sealing plug. However, sometimes the sealing plug is difficult to eject from the sealing device and may not properly seat against an exterior situs of the arteriotomy. If the plug does not seat properly against the arteriotomy, there is a potential for elongated bleeding. The present disclosure describes methods and apparatus that facilitate placement and sealing of tissue punctures. While the vascular instruments shown and described below include procedure sheaths and puncture sealing devices, the application of principles described herein are not limited to the specific devices shown. The principles described herein may be used with any medical device. Therefore, while the description below is directed primarily to arterial procedures and certain embodiments of a puncture closure device, the methods and apparatus are only limited by the appended claims.
• The term “tissue,” as used herein, means an aggregation of morphologically similar cells and associated intercellular matter acting together to perform one or more specific functions in a body. The term “lumen,” as used herein, means any open space or cavity in a bodily organ, especially in a blood vessel. The terms “tamp” or “tamping,” as used herein, mean pushing or packing by one or a succession of pushes, blows, or taps. The term “biologically resorbable material,” as used herein, means a material capable of degradation by biological processes such as collagen, synthetic collagen, polymerized polylactic acid, polyglycolic acid matrix, or any other bioabsorbable material. The words “including” and “having,” as used in the specification, including the claims, have the same meaning as the word “comprising.”
• Referring now to the drawings, and in particular toFIGS. 1-4, a vascularpuncture closure device100 is shown according to the prior art. The vascularpuncture closure device100 includes acarrier tube102 with a filament orsuture104 extending at least partially therethrough. Theclosure device100 also includes a first orproximal end106 and a second ordistal end107. External to a second ordistal end107 of thecarrier tube102 is ananchor108. The anchor is an elongated, stiff, low profile member including aneye109 formed at the middle. Theanchor108 is typically made of a biologically resorbable polymer.
• Thesuture104 is threaded through theanchor108 and back to acollagen pad110. Thecollagen pad110 may comprise randomly oriented fibrous material bound together by chemical means. Thecollagen pad110 is slidingly attached to thesuture104 as the suture passes distally through thecarrier tube102, but as the suture traverses theanchor108 and reenters thecarrier tube102, it is securely slip knotted proximal to thecollagen pad110 to facilitate cinching of thecollagen pad110 when theclosure device100 is properly placed and theanchor108 deployed (seeFIG. 4). Thecarrier tube102 typically includes a tampingtube112 disposed therein. The tampingtube112 is slidingly mounted on thesuture104 and may be used by an operator to tamp thecollagen pad110 toward theanchor108 at an appropriate time to seal a percutaneous tissue puncture.
• Prior to deployment of theanchor108 within an artery, theeye109 of theanchor108 rests outside thedistal end107 of thecarrier tube102. Theanchor108 may be temporarily held in place flush with thecarrier tube102 by abypass tube114 disposed over thedistal end107 of thecarrier tube102. The flush arrangement of theanchor108 andcarrier tube102 allows theanchor108 to be inserted into a procedure sheath such asinsertion sheath116 as shown inFIGS. 2-4, and eventually through anarterial puncture118. Theinsertion sheath116 is shown inFIGS. 2-4 inserted through apercutaneous incision119 and into anartery128. However, the bypass tube114 (FIG. 1) includes anoversized head120 that prevents thebypass tube114 from passing through an internal passage of theinsertion sheath116. Therefore, as thepuncture closure device100 is inserted into theinsertion sheath116, theoversized head120 bears against asurface122 ofinsertion sheath116. Further insertion of thepuncture closure device100 results in sliding movement between the carrier tube102 (FIG. 1) and thebypass tube114, releasing theanchor108 from the bypass tube114 (FIG. 1). However, theanchor108 remains in the flush arrangement shown inFIG. 1 following release from thebypass tube114, limited in movement by theinsertion sheath116.
• Theinsertion sheath116 includes amonofold124 at a second ordistal end126 thereof. Themonofold124 acts as a one-way valve to theanchor108. Themonofold124 is a plastic deformation in a portion of theinsertion sheath116 that elastically flexes as theanchor108 is pushed out through thedistal end126 of theinsertion sheath116. Typically, after theanchor108 passes through thedistal end126 of theinsertion sheath116 and enters theartery128, theanchor108 is no longer constrained to the flush arrangement with respect to thecarrier tube102 and it deploys and rotates to the position shown inFIG. 2.
• Referring next toFIGS. 3-4, with theanchor108 deployed, thepuncture closure device100 and theinsertion sheath116 are withdrawn together, ejecting thecollagen pad110 from thecarrier tube102 into theincision tract119 and exposing the tampingtube112. With the tampingtube112 fully exposed as shown inFIG. 4, thecollagen pad110 is manually tamped, and theanchor108 andcollagen pad110 are cinched together and held in place with the self-tightening slip-knot on thesuture102. Thus, the tissue puncture is sandwiched between theanchor108 and thecollagen pad110, thereby sealing thetissue puncture118. Thesuture104 is then cut and theincision tract119 may be closed. Thesuture104,anchor108, andcollagen pad110 are generally made of resorbable materials and therefore remain in place while thepuncture118 heals.
• Using the typical tissuepuncture closure device100 described above, however, it may be difficult to adequately tamp thecollagen pad110. Tamping cannot commence until thesheath116 has been removed so as to expose the tampingtube112 for manual grasping. Under certain conditions, removal of thesheath116 prior to tamping thecollagen pad110 causes thecollagen pad110 to retract or displace proximally from thetissue puncture118, creating anundesirable gap120 between thecollagen pad110 and thepuncture118. Thegap120 may remain even after tamping as shown inFIG. 4, and sometimes results in only a partial seal and bleeding from thetissue puncture118.
• Therefore, the present specification describes an methods and apparatuses including a tissue puncture closure device that may provide a stable seal at the tissue puncture site. The tissue puncture closure device may include an anchor attached to a rigid support with a sealing plug movably disposed thereover.
• Generally, one aspect of the present invention described herein relates to a puncture closure device including a movable compression element configured to compress and deform a sealing plug within a tissue tract of a patient. More particularly, in one embodiment, a puncture closure device may include an anchor, an anchor support, and a movable compression element. Further, the movable compression element may be configured to compress the sealing plug and lock, contact, or couple to the anchor support upon moving to a selected position. Such a configuration may provide repeatability in the compression of the sealing plug and may provide a relatively unobtrusive closure assembly which may be deployed within a patient.
• FIG. 5 shows one embodiment of apuncture closure device200 according to principles of the present invention. Thepuncture closure device200 may have particular utility when used in connection with intravascular procedures, such as angiographic dye injection, cardiac catheterization, balloon angioplasty and other types of vascular access of atherosclerotic arteries, etc., as may be appreciated with respect to use of thepuncture closure device200 to effectively close vascular incisions as described below. However, it will be understood that while the description of the embodiments below are directed to closure of percutaneous punctures in blood vessels, such devices have much more wide-spread applications and can be used for sealing punctures or incisions in other types of tissue walls and tissues as well. Thus, the sealing of a percutaneous puncture in a blood vessel, as shown and discussed herein, is merely illustrative of one particular application of the apparatuses and methods of the present invention.
• As shown inFIG. 5, thepuncture closure device200 includes aproximal end206 and adistal end207. Aplug assembly204 is positioned generally near thedistal end207 and includes ananchor208, ananchor support210, acoupling feature226, a sealingplug240, and acompression element280. The sealingplug240 may comprise any biologically resorbable material (e.g., collagen, polyglycolic acid, etc.), as known in the art. For example, sealingplug240 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 material, and may be configured in any shape to facilitate sealing thepuncture218. The sealing plug may also include a hemostatic agent, such as a tissue thromboplastin, to accelerate local hemostasis.Anchor support210 includes aproximal end222 anddistal end224 which, optionally, may be coincident with thedistal end207 of theclosure device200. As shown inFIG. 5, theanchor208 is positioned at least partially within arecess212 of theanchor support210 to facilitate insertion into a lumen of a blood vessel. In further detail,FIG. 6 shows a perspective view ofanchor support210 andanchor208 according to one embodiment.Anchor208 may be pivotably coupled to anchorsupport210. Put another way,anchor208 may be coupled toanchor support210 so thatanchor208 may pivot generally about an axis ofrotation209. As shown inFIG. 6,anchor208 includes a body that is elongated along an axis ofelongation211, which, optionally, may be oriented substantially perpendicularly with respect to axis ofrotation209. Of course, many different embodiments foranchor208 andanchor support210 are contemplated by the present invention. For example,FIGS. 7,8,20, and22 show different embodiments of an assembly including an anchor and an anchor support. In one embodiment,anchor208 may be coupled to theanchor support210 with apin260 shown inFIG. 7. Pin260 passes through ahole264 formed throughanchor support210 and aneyelet aperture262 formed through a portion ofanchor208. In another embodiment shown inFIG. 8,anchor208 may be coupled to theanchor support210 with asuture266 or any other relatively flexible member which can be attached or molded to theanchor support210. In the separate embodiments shown in ofFIGS. 20 and 22,anchor support210 may have thesuture266 attached or molded to adistal end224. Thesuture266 attaches theanchor support210 to theanchor208. Theanchor208 may be initially arranged in anest267 formed in theanchor support210 at thedistal end224.
• In the embodiments ofFIGS. 7,8,20, and22, theanchor208 may be configured to be positioned inside a blood vessel and against a wall of the blood vessel. Further, theanchor208 may be configured to be generally centered with respect to a puncture formed through a wall of a blood vessel. Theanchor208 may comprise an elongated, low-profile member (i.e., with respect to a distance inwardly from the wall of a blood vessel) and may comprise a relatively stiff (e.g., exhibiting a relatively high modulus of elasticity) material. In addition, theanchor208 may comprise a biologically resorbable material such as, for example, a mixture of approximately 50% lactide and 50% glycolide material. Theanchor support210 may also comprise a biologically resorbable material such as, for example, collagen or polyglycolic acid (PGA).
• As shown the embodiments ofFIGS. 7,8,20, and22anchor support210 includes first orproximal end222 and second ordistal end224. Coupling feature226 (shown inFIGS. 7,8,20 and22 as an annular groove) may be located nearfirst end222 ofanchor support210.Anchor support210 tends to hold its shape and may be substantially rigid.Anchor support210 defines a rigid support to which theanchor208 is mounted.Anchor support210 may be referred to as a rigid support member and have a rigid portion.Anchor support210 is shown in at leastFIG. 7 having a generally elongate construction and may be referred to as a generally rigid elongated member.Anchor support210 comprises a bioabsorbable material and may include a hemostasis promoting material. Generally,coupling feature226 may be configured for selectively engaging an associated coupling feature of a movable compression element, as described in greater detail below. As shown inFIGS. 7,8,20 and22, thecoupling feature226 may be a groove indented intoanchor support210 that is substantially concentric with respect to the body ofanchor support210 and may be positioned anywhere along the outside surface of the anchor support. In the embodiments ofFIGS. 7,8,20 and22 thecoupling feature226 is arranged proximate to thefirst end222 of theanchor support210. Thus, it may be appreciated that in some embodiments, a mating device such as suitably sized retaining ring or disc-shaped member may be moved along thefirst end222 ofanchor support210 and positioned at least partially withincoupling feature226. It should be noted that the retaining ring or disc-shaped member is not necessarily closed, it may comprise a partial ring or disc. Such a configuration may effectively couple the suitably sized ring or disc to thecoupling feature226. Of course, many different interlocking, coupling, contacting, and engaging structures (e.g., tabs, slots, threads, protrusions, recesses, snap-fittings, etc.) may be employed as acoupling feature226 in cooperation with an associated coupling feature of a mating device such as a movable compression element (discussed below).
• As further shown inFIGS. 7 and 8,anchor support210 may optionally include acavity214 defining an opening at thefirst end222 ofanchor support210 that extends towardsecond end224. In one embodiment,cavity214 may include one or more substantiallycylindrical regions270 and one or morenon-cylindrical regions272.Non-cylindrical regions272 may be substantially conical or substantially spherical in shape. Thenon-cylindrical regions272 may form diverging/converging cones as shown inFIGS. 7 and 8.
• Referring again toFIG. 5, prior to deployment of theplug assembly204 within a tissue tract, theanchor support210 may be positioned adjacent to aplacement rod202 at thefirst end222 of theanchor support210.Sealing plug240 may be initially substantially concentrically positioned with respect toplacement rod202 as shown inFIG. 5, and may also be slidably connected or radially adjacent to anchorsupport210 as shown inFIGS. 20 and 22. Put another way, a bore may be formed through sealingplug240 andplacement rod202 oranchor support210 may be positioned within the bore of the sealingplug240. Optionally, sealingplug240 may at least partially interfere (i.e., an interference fit) with the exterior ofplacement rod202 oranchor support210 to provide a snug fit such that the sealingplug240 tends to remain in place until acted upon by a force exceeding the frictional force between the sealingplug240 and theplacement rod202 or theanchor support210. However, a compression element such as aslideable collar280 may be arranged around theplacement rod202 or theanchor support210 proximal of the sealing plug. Theslideable collar280 can be moved to cause movement and/or compression of the sealingplug240 as discussed in more detail below.
• Further,placement rod202 may extend from thefirst end206 of thepuncture closure device200 to theanchor support210 through atamper217 and through asheath216.Tamper217 is also positioned withinsheath216 and abutsslideable collar280.Tamper217 has an outer diameter that is larger than an inner diameter of the slideable collar280 (or an inner diameter that is smaller than an outer diameter of the slideable collar280) so that an operator may apply a force to thetamper217 and advance thecompression element280 along theplacement rod202 and/or theanchor support210 in the direction of thesecond end224 of theplug assembly204. In one embodiment depicted inFIG. 5,slideable collar280 may be substantially concentrically disposed about (e.g., about a circumference of)placement rod202 and adjacent to sealingplug240. In embodiments depicted inFIGS. 20 and 22, however, the sealingplug240 is radially adjacent to or substantially concentrically disposed about theanchor support210. Theslideable collar280 may be substantially concentrically arranged about the anchor support or theplacement rod202.Slideable collar280 is moveably arranged with respect toplacement rod202 oranchor support210. During deployment of theplug assembly204,slideable collar280 may be moved along theplacement rod202 and/or theanchor support210 until entering, contacting, locking with, or engagingcoupling feature226. As theslideable collar280 advances distally, it contacts, moves, compresses, and/or deforms the sealingplug240. If the sealing plug is not already arranged adjacent to theanchor208, theslideable collar280 moves the sealing plug toward the anchor and may cause the sealingplug240 to buckle or expand radially as it is compressed. Radial expansion of the sealingplug240 may promote sealing of a puncture between theanchor element208 and the sealingplug240.
• It will be appreciated by one of ordinary skill in the art having the benefit of this disclosure that prior to a successful deployment of the sealing plug, an insertion sheath may be properly positioned within a blood vessel (or another selected lumen). Proper placement of an insertion sheath may be accomplished with the aid of a puncture locator. Explaining further, according to one aspect, a puncture locator and insertion sheath are inserted through the hole in the vessel wall. The puncture locator may provide fluid communication path from a distal tip (where the insertion sheath enters the vessel) to a proximal end, where blood flow can be observed by an operator or the puncture locator may otherwise indicate proper placement of the distal tip within a blood vessel. Proper placement of the insertion sheath enables proper placement of the sealing plug or insertion of a vascular tool for another purpose. Any locating device and method may be used in conjunction with a puncture closure device according to principles described herein.
• Turning toFIGS. 9-11, various embodiments of the sealingplug240 are shown in respective perspective views. The sealingplug240 may encompass any number of configurations, including the ones shown inFIGS. 9-11 that promote compression of the sealingplug240 generally alonglongitudinal axis201. Compression of the sealingplug240 as shown inFIGS. 9-11 tends to cause the radial outward expansion with respect tolongitudinal axis201. When used in a puncture tract, such compression may cause sealingplug240 to expand radially outwardly and sealingly engage or contact tissue surrounding the sealingplug240. As shown inFIGS. 9-11, anend region242 of the sealingplug240 may comprise a relatively dense matrix of bioabsorbable material and may be positioned longitudinally adjacent to (along interfacial surface254) anintermediate region246 comprising a less dense bioabsorbable material than theend region242.Intermediate region246 is adjacent (along interfacial surface256) anend region244 comprising another relatively dense matrix of bioabsorbable material.Bore248 may be formed through each ofend regions242,244, andintermediate region246. Further, bore248 may be substantially centered aboutlongitudinal axis201.Regions242 and244, respectively, may be configured to facilitate compaction oflayer246 and corresponding radial expansion ofregion246 by application of a compressive force betweenend regions242 and244 (i.e., toward intermediate region246). Furthermore, as shown inFIG. 9, a plurality of slits such as substantiallylinear slits250 may be formed at least partially intoregion246 and may extend at least partially betweeninterfacial surfaces254 and256. Optionally,linear slits250 may be substantially parallel. Suchlinear slits250 may promote radial expansion ofregion246 in response to compression. Particularly,linear slits250 may substantially inhibit or reduce development of hoop stress withinregion246 that may resist radial expansion ofregion246. In one embodiment shown inFIG. 10, a plurality of arcuate (e.g., helical) slits252 may be formed at least partially intoregion246 betweeninterfacial surfaces254 and256. Also, as shown inFIG. 10, the plurality ofarcuate slits252 may extend substantially parallel to one another. In one embodiment, the plurality ofarcuate slits252 may extend in an intersecting (e.g., a so-called crisscross) fashion, may be unevenly spaced, or may be of unequal length. In one embodiment depicted inFIG. 11, sealingplug240 may compriseend region242,intermediate region246, and endregion244 with no slits. In yet another embodiment depicted inFIG. 12, the sealingplug240 may compriseuniform material247. Of course, optionally, the sealingplug240 may include linear slits, arcuate slits, or combinations of linear and arcuate slits as may be desired. Also, as shown inFIGS. 9-11, sealingplug240 may be substantially cylindrical and a bore formed through the sealingplug240 may also be substantially cylindrical. As mentioned above, sealingplug240 can be made of animal derived collagens or synthetic type materials. Bore248 of sealingplug240 may be either molded, punched, machined, or otherwise formed. Although the sealingplug240 is shown inFIGS. 9-12 as substantially cylindrical, any other shape may be used.
• The bore formed through a bioabsorbable sealing plug may provide a structure that facilitates positioning of the sealing plug with respect to an anchor. Such a configuration may reduce the tamping distance applied to compress a sealing plug. Such a configuration may also reduce or eliminate tearing of a sealing pad during tamping and may promote more reproducible and reliable tamping and compression of a sealing plug.
• More particularly, turning toFIG. 13, a portion of thepuncture closure device200 is shown in an initial or “ready to deploy” configuration, wherein each of theanchor support210, sealingplug240,tamper217, andplacement rod202 are generally aligned alonglongitudinal axis201. Following insertion ofanchor208 through a percutaneous tissue incision and into an arterial puncture or other lumen, theanchor208 may be caused to rotate to the position shown inFIG. 14, such that itswings238,239 are arranged adjacent to an internal wall of the lumen to anchorpuncture closure device200 to the tissue breach (similar to the position ofanchor108 as shown inFIG. 2). Thepuncture closure device200 may be twisted and/or pulled in a proximal direction to facilitate rotation of theanchor208 to engage the lumen. Similar to the above-described operation of a conventionalpuncture closure device100, thesheath216 houses atamper217 for advancing theslideable collar280 along theplacement rod202 toward thecoupling feature226 and toward theanchor208. Tamper217 may be driven manually (i.e., by hand) or with an automatic driving system to forceslideable collar280 toward theanchor208. Accordingly,slideable collar280 may engage orabut sealing plug240 at a first orproximal end281 of the sealingplug240 to move the sealingplug240 generally alonglongitudinal axis201. Such movement of sealingplug240 may be substantially concentric with respect to the placement rod202 (and/or the support anchor210). Further, such movement of sealingplug240 may cause the bore of sealingplug240 to become positioned about (e.g., substantially concentrically) at least a portion of theanchor support210. Force applied toslideable collar280 may compress sealingplug240, as shown inFIG. 14. As the sealingplug240 is compressed longitudinally generally betweenanchor208 andslideable collar280, it correspondingly expands radially against the surrounding tissue to secure theanchor208 and seal a puncture. In two embodiments shown inFIGS. 20 and 22, a protrudinglip213 arranged on theanchor support210 may limit the travel of the sealingplug210 toward theanchor208. In other embodiments, sealingplug210 travel is only limited by theanchor208.
• In addition, theslideable collar280 may be configured to couple to thecoupling feature226 formed inanchor support210. More specifically, in one embodiment, the inner circumference ofslideable collar280, as shown inFIGS. 15-16 may include a plurality of inwardradial protrusions284. Asslideable collar280 moves toward and passes ontoanchor support210, sealingplug240 is longitudinally compressed and radially expands in proximity to anchor208. Whenslideable collar280reaches coupling feature226, the plurality ofprotrusions284 expand into and are captured (e.g., within a groove as shown inFIG. 15) or otherwise coupled to or locked in position with respect to thecoupling feature226.Slideable collar280 may comprise a biologically resorbable material made of the materials mentioned above or others. In one embodiment shown inFIG. 20, theslideable collar280 does not include inward radial protrusions285. Theslideable collar280 is elastically expanded from a normal diameter to fit around theanchor support210. When theslideable collar280 reaches thecoupling feature226, it springs closer to or back to its normal diameter and resists removal from thecoupling feature226. In one embodiment shown inFIGS. 22-23B, theslideable collar280 includes a pair ofleg members283 which are biased to press against theanchor support210 as theslideable collar280 is moved distally therealong. As shown inFIGS. 23A-23B, theleg members283 abut the sealingplug240 as theslideable collar280 is advanced by thetamper217 and assist in expanding the sealing plug.
• Embodiments disclosed above may provide substantial centering of a sealing plug with respect to an anchor. Such configurations may facilitate proper positioning of theplug assembly204 with respect to an arteriotomy. In addition, the embodiments described above may provide more reproducible and reliable tamping and less tearing of the sealing plug. Also, some of the disclosed embodiments which deposit a sealing plug assembly may eliminate the need to cut a suture near the surface of the patient's skin. Eliminating the need cut a suture may also reduce the risk of tissue tract infections by reducing or eliminating foreign material near the tissue tract opening.
• Once the sealingplug240 has been compressed, in some embodiments everything but theplug assembly204 is removed from the tissue tract. Therefore,anchor support210 may be operably and releasably connected toplacement rod202. A fastener, including, but not limited to: a threaded screw, a hook, an elastomeric stopper, an inflatable stopper, or the like, may be employed to selectively couple (and decouple)anchor support210 toplacement rod202. In one embodiment depicted inFIG. 17,placement rod202 may operably connect to anchorsupport210 with aplug276 positioned generally withincavity214 and affixed to filament274 (e.g., a suture, cord, hose, or other slender member). Plug276 may be pliant and, therefore, may be forced intocavity214 or removed therefrom. As shown inFIG. 17,filament274 may extend throughbore278 ofplacement rod202 and may be accessible to a user of thepuncture closure device200. Thus,placement rod202 may be coupled toanchor support210 iffilament274 is coupled toplacement rod202 and plug276 is arranged insidecavity214. The coupling ofplacement rod202 to anchorsupport210 may inhibit retracted longitudinal (i.e., away fromanchor208, along longitudinal axis201) movement of theplacement rod202 with respect to anchorsupport210. Plug276 may be elastomeric and shaped to resist removal fromcavity214 under normal conditions of placing theplug assembly204. Moreover, in one embodiment,filament274 may comprise a fluid conducting tube which may be pressurized to inflateplug276 into an expanded shape andcouple placement rod202 to anchorsupport210.
• Likewise,anchor support210 may be selectively released fromplacement rod202. In one embodiment, following deployment of theplug assembly204 and coupling ofslideable collar280 to coupling feature226 (as depicted inFIG. 18),placement rod202 can be disconnected from theanchor support210. As described above, plug276 may be pliant, compressible, or otherwise configured so that when a force exceeding a selected minimum force is applied tofilament274 in a retraction direction (i.e., away from anchor208), theplug276 deforms to pass through theupper cylinder segment270 ofcavity214. In embodiments whereinfilament274 comprises a fluid conducting tube, plug276 may be deflated to be removed fromcavity214. Thus,placement rod202 andanchor support210 may be selectively connected and disconnect as desired.
• In one embodiment, after theslideable collar280 is coupled tocoupling feature226 and theplacement rod202 is disconnected from theanchor support210, each of theplacement rod202, thetamper217, thefilament274, theplug276 and thesheath216 may be withdrawn from percutaneous tissue defining an incision. More particularly, from the foregoing discussion, it may be appreciated that theplug assembly204 may remain within a patient to close a vascular puncture. For example,FIG. 19 shows plug assembly204 anchored proximate to wall234 ofblood vessel290 and positioned at least partially within percutaneous incision219 (i.e., surrounded by percutaneous tissue220) to effectivelyclose puncture218. As shown inFIG. 19, sealingplug240 may be expanded against the surroundingpercutaneous tissue220 and substantially centered with respect to theoriginal lumen puncture218.
• The embodiments shown inFIGS. 20-21D and22-23B illustrate similar deployment of the sealingplug240 by actuating the slidingcollar280 with thetamper217. In each of these two embodiments, when theanchor208 is deployed in a lumen or vessel, the sealingplug240, which is arranged about theanchor support210, is compressed by the slidingcollar280. The slidingcollar280 may likewise be arranged around theanchor support210. Thetamper217 is forced distally, which advances the slidingcollar280 and compresses and causes radial expansion of the sealingplug240. The sealingplug240 may only advance to thelip213, and further advancement of the slidingcollar280 may tend to cause only radial expansion of the sealingplug240. The slidingcollar280 may be advanced until it reaches the radial groove orcoupling feature226 of theanchor support210. The slidingcollar280 then contacts and locks in thecoupling feature226 and prevents retraction of the sealingplug240. Theanchor support210, sealingplug208, slidingcollar280, and theanchor208 remain at the puncture side and seal the puncture.
• While certain embodiments and details have been included herein for purposes of illustrating aspects of the invention, it will be apparent to those skilled in the art that various changes in the systems, apparatuses, and methods disclosed herein may be made without departing from the scope of the invention, which is defined by the appended claims. Moreover, features shown in certain embodiments are not exclusive to the embodiment shown. Any feature shown in any embodiment may be used in any combination with other features described herein.

Claims (28)

1. A puncture closure device, comprising:

an anchor support;

an anchor connected to the anchor support, wherein the anchor is configured for insertion through a puncture;

a movable compression element configured to be movable between a first position and a second position, wherein movement of the compression element to the second position causes coupling of the compression element to the anchor support;

a removable placement rod connected to the anchor support;

a sealing plug positioned between the compression element and the anchor, at least a portion of each of the anchor support and removable placement rod extending through the sealing plug;

wherein the compression element is configured to cause compression of the sealing plug between the compression element and the anchor upon movement of the compression element from the first position to the second position.

2. The puncture closure device ofclaim 1, wherein the anchor support with the compressed sealing plug being releaseable from the removable placement rod.

3. The puncture closure device ofclaim 1, wherein the compression element is movable towards the anchor along a portion of the anchor support and along a portion of the removable placement rod.

4. The puncture closure device ofclaim 1, wherein the anchor support further comprises a first recess and a second recess, the first recess being located near the first end of the anchor support and the second recess being located at the second end of the anchor support.

5. The puncture closure device ofclaim 4, wherein the anchor is pivotably connected to the anchor support and at least a portion of the anchor is positionable within the second recess by pivoting of the anchor.

6. The puncture closure device ofclaim 1, wherein the anchor is pivotably connected to the anchor support with a pin.

7. The puncture closure device ofclaim 1, wherein the anchor is pivotably connected to the anchor support with a suture.

8. The puncture closure device ofclaim 1, wherein the removable placement rod is coupled to the anchor support by a plug affixed to a filament, wherein the plug is removably positioned within the first recess of the anchor support.

9. The puncture closure device ofclaim 8, wherein sealing plug is cylindrical shaped with a circular cross-section.

10. The puncture closure device ofclaim 9, wherein the compression element is a ring-shaped element positioned about a portion of the circumference of the removable placement rod.

11. The puncture closure device ofclaim 1, wherein the sealing plug has a bore positioned generally about a portion of the circumference of the removable placement rod.

12. The puncture closure device ofclaim 1, wherein the sealing plug comprises collagen.

13. The puncture closure device ofclaim 1, wherein the sealing plug comprises a first end region, a second end region, and an intermediate region positioned between the first end region and the second end region, wherein the intermediate region comprises a material with a density less than a density of the first end region and a density of the second end region.

14. The puncture closure device ofclaim 1, wherein the sealing plug comprises a plurality of slits formed into an exterior surface of the sealing plug.

15. The puncture closure device ofclaim 14, wherein the plurality of slits comprise a plurality of linear slits.

16. The puncture closure device ofclaim 14, wherein the plurality of slits comprise a plurality of helical slits.

17. The puncture closure device ofclaim 1, wherein the sealing plug has a bore positionable generally about a portion of the circumference of the anchor support.

18. The puncture closure device ofclaim 17, wherein movement of the compression element from the first position to the second position is intended to cause the bore of the sealing plug to be positioned generally about a portion of the circumference of the anchor support.

19. The puncture closure device ofclaim 1, wherein each of the anchor support, the anchor, the sealing plug, and the compression element comprises a biologically resorbable material.

20. The puncture closure device ofclaim 14, wherein the plurality of slits formed into an exterior surface of the sealing plug are configured to facilitate radial expansion of the sealing plug in response to longitudinal compression of the sealing plug.

21. A sealing plug for use in a puncture closure apparatus, comprising:

a first end region, a second end region, and an intermediate region positioned between the first end region and the second end region, wherein the intermediate region comprises a material with a density less than a density of the first end region and a density of the second end region.

22. The sealing plug ofclaim 21, wherein the sealing plug further comprises a plurality of slits formed into an exterior surface of the sealing plug.

23. The sealing plug ofclaim 22, wherein the plurality of slits formed into an exterior surface of the sealing plug are configured to facilitate radial expansion of the sealing plug in response to longitudinal compression of the sealing plug.

24. The sealing plug ofclaim 22, wherein the plurality of slits comprise a plurality of linear slits.

25. The sealing plug ofclaim 22, wherein the plurality of slits comprise a plurality of helical slits.

26. A sealing plug for use in a puncture closure apparatus, comprising:

a generally cylindrical body of bioabsorbable material including a bore formed therethrough and a plurality of slits formed into an exterior surface of the sealing plug, the plurality of slits configured to facilitate radial expansion of the sealing plug in response to longitudinal compression of the sealing plug.

27. The sealing plug ofclaim 26, wherein the plurality of slits comprise a plurality of linear slits.

28. The sealing plug ofclaim 26, wherein the plurality of slits comprise a plurality of helical slits.

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